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Meta-Analysis
. 2024 Apr;67(3):639-648.
doi: 10.1007/s10840-023-01660-3. Epub 2023 Oct 19.

Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy

Omar Mahmoud Aldaas  1 , Chaitanya Malladi  1 , Frederick T Han  1 , Kurt S Hoffmayer  1 , David Krummen  1 , Gordon Ho  1 , Farshad Raissi  1 , Ulrika Birgersdotter-Green  1 , Gregory K Feld  1 , Jonathan C Hsu  2   3
Affiliations
Meta-Analysis

Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy

Omar Mahmoud Aldaas et al. J Interv Card Electrophysiol. 2024 Apr.

Abstract

Background: Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation.

Methods: We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group.

Results: We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD - 21.95, 95% CI - 33.77, - 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59-2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts.

Conclusions: Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.

Keywords: Atrial fibrillation; Catheter ablation; Pulsed field ablation; Thermal ablation.

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Conflict of interest statement

Dr. Hsu reports receiving honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, Sanofi, Zoll Medical, Hillrom, iRhythm, Acutus Medical, and Biosense-Webster; equity interest in Vektor Medical; and research grants from Biotronik and Biosense-Webster. Dr. Ho reports receiving a research grant from Abbott, equity in Vektor Medical, and fellowship support from Medtronic, Abbott, Boston Scientific, and Biotronik. Dr. Feld reports receiving fellowship training program stipends (as CCEP fellowship training program director) from Medtronic, Biotronik, Biosense Webster, and Abbott Medical; has equity interest in Vektor Medical; is co-founder and co-owner of Perminova; and is a consultant to Acutus Medical. Dr Han receives research support from Abbott and honoraria from Abbott.

Figures

Fig. 1
Fig. 1
Selection of studies
Fig. 2
Fig. 2
Procedural efficiency and safety outcomes in pulsed field ablation versus thermal ablation of atrial fibirllation
Fig. 3
Fig. 3
Recurrence of atrial arrhythmias at final follow-up with pulsed field ablation versus thermal ablation of atrial fibrillation
See this image and copyright information in PMC

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