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. 2024 Jul 18;40(5):1059-1074.
doi: 10.1002/joa3.13118. eCollection 2024 Oct.

Efficacy and safety of pulsed-field versus conventional thermal ablation for atrial fibrillation: A systematic review and meta-analysis

Ahmed Mazen Amin  1 , Abubakar Nazir  2 , Mohamed T Abuelazm  3 , Ahmed A Ibrahim  4 , Hossam Elbenawi  5 , Aya Aboutaleb  6 , Mohamed Ellabban  7 , Moumen Arnaout  8 , Mustafa Turkmani  9   10 , Basel Abdelazeem  11 , Annabelle S Volgman  12
Affiliations

Efficacy and safety of pulsed-field versus conventional thermal ablation for atrial fibrillation: A systematic review and meta-analysis

Ahmed Mazen Amin et al. J Arrhythm. .

Abstract

Background: Pulsed-field ablation (PFA) has emerged as an innovative alternative to radiofrequency (RF) and cryoablation because it selectively targets myocardial tissue. Thus, we aim to estimate the efficacy and safety of PFA versus thermal ablation for atrial fibrillation (AF) ablation.

Methods: A systematic review and meta-analysis were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023480321.

Results: We included 17 studies with a total of 2255 patients. PFA was significantly associated with a decreased incidence of AF recurrence (RR: 0.66 with 95% CI [0.51, 0.87], p = .003). However, there was no significant difference between PFA and thermal ablation in arrhythmia recurrence (RR: 0.92 with 95% CI [0.74, 1.46], p = .42). PFA was significantly associated with decreased total procedure time (MD: -15.15 with 95% CI [-20.23, -10.07], p < .00001), decreased heart rate change (MD: -7.39 with 95% CI [-12.16, -2.62], p = .002), decreased phrenic nerve palsy (RR: 0.38 with 95% CI [0.15, 0.98], p = .05), and reduced esophageal lesions (RR: 0.09 with 95% CI [0.01, 0.69], p = .02). On the contrary, PFA was significantly associated with increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], p = .01).

Conclusion: PFA was significantly associated with decreased AF recurrence, total procedure time, heart rate change, phrenic nerve palsy, esophageal lesion, and increased incidence of pericardial tamponade compared with thermal ablation.

Keywords: ablation; atrial fibrillation; pulsed‐field.

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Conflict of interest statement

Disclosures for Dr. Annabelle S. Volgman (October 2023) Consulting—Sanofi, Pfizer, Janssen; Clinical Trials: Janssen, Novartis and NIH Clinical Trials; Stock: Apple, Inc while the other authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flowchart of the screening process.
FIGURE 2
FIGURE 2
Quality assessment of the risk of bias (ROB) for the included trials (A) ROB assessment for randomized controlled trials (ROB‐2 tool); (B) ROB assessment for nonrandomized trials (ROBINS‐1).
FIGURE 3
FIGURE 3
Forest plot of the primary outcomes A) AF recurrence and B) All atrial tachyarrhythmia recurrence. RR, risk ratio; CI, confidence interval.
FIGURE 4
FIGURE 4
Forest plots of the secondary outcomes A) total procedure time and B) fluoroscopy time. MD, mean difference; CI, confidence interval.
FIGURE 5
FIGURE 5
Forest plot of the safety outcomes. RR, risk ratio; CI, confidence interval.
See this image and copyright information in PMC

References

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