Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr;48(4):402-413.
doi: 10.1111/pace.15166. Epub 2025 Feb 24.

Pulsed Field Versus High-Power Short-Duration Radiofrequency Ablation in Atrial Fibrillation: A Meta-Analysis

Muhammad Hassan Waseem  1 , Zain Ul Abideen  2 , Ayesha Ahmed  2 , Barka Sajid  3 , Ameer Haider Cheema  4 , Noor Ul Huda Ramzan  5 , Amina Tahir  2 , Sania Aimen  6
Affiliations
Meta-Analysis

Pulsed Field Versus High-Power Short-Duration Radiofrequency Ablation in Atrial Fibrillation: A Meta-Analysis

Muhammad Hassan Waseem et al. Pacing Clin Electrophysiol. 2025 Apr.

Abstract

Background: Atrial fibrillation, which has increased in prevalence by 33% over the past two decades, affects 59 million people worldwide. It is treated using thermal and nonthermal techniques like radiofrequency, cryoballoon, laser, and pulsed-field ablation (PFA). This meta-analysis is the first to compare PFA with high-power short-duration radiofrequency ablation (HPSD-RFA).

Methods: We comprehensively searched PubMed, Cochrane Central, and ScienceDirect from inception to August 2024. In Review Manager 5.4.1, we pooled risk ratios (RRs) and weighted mean difference (WMD) along with 95% confidence intervals for dichotomous and continuous outcomes, respectively, and employed a random effects model. Study quality was assessed via the Newcastle-Ottawa Scale, and funnel plots were used to evaluate the risk of publication bias.

Results: Seven studies with a total of 1538 patients were analyzed in this meta-analysis. PFA was associated with a shorter total procedural time (MD = -36.39 min; 95% CI: [-46.23, -26.55]; p < 0.00001; I2 = 90%), left atrial dwell time (MD = -33.22 min; 95% CI: [-53.21, -13.23]; p = 0.001; I2 = 93%), and a longer fluoroscopy time compared to the HPSD-RFA (MD = 9.06 min; 95% CI: [6.13, 11.99]; p < 0.00001; I2 = 96%). Other outcomes were comparable between the two arms.

Conclusion: PFA outperforms HPSD ablation in terms of procedural efficiency outcomes except for the total fluoroscopy time. Still, both techniques are comparable regarding safety and arrhythmia control outcomes.

Keywords: atrial fibrillation; catheter ablation; high‐power short‐duration ablation; pulmonary vein isolation; pulsed‐field ablation; single shot.

PubMed Disclaimer

References

    1. D. Linz, M. Gawalko, K. Betz, et al., “Atrial Fibrillation: Epidemiology, Screening and Digital Health,” Lancet Regional Health Europe 37 (2024): 100786, https://doi.org/10.1016/J.LANEPE.2023.100786.
    1. G. Lippi, F. Sanchis‐Gomar, and G. Cervellin, “Global Epidemiology of Atrial Fibrillation: An Increasing Epidemic and Public Health Challenge,” International Journal of Stroke 16, no. 2 (2021): 217–221, https://doi.org/10.1177/1747493019897870.
    1. G. Hindricks, T. Potpara, P. Kirchhof, et al., “2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio‐Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed With the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC,” European Heart Journal 42, no. 5 (2021): 373–498, https://doi.org/10.1093/EURHEARTJ/EHAA612.
    1. N. Soubh, J. Gronwald, H. Haarmann, et al., “Next‐Generation Atrial Fibrillation Ablation: Clinical Performance of Pulsed‐Field Ablation and Very High‐Power Short‐Duration Radiofrequency,” Journal of Interventional Cardiac Electrophysiology 67 (2024): 2067–2075. Published online, https://doi.org/10.1007/S10840‐024‐01853‐4.
    1. J. Wörmann, J. H. Schipper, J. Lüker, et al., “Comparison of Pulsed‐Field Ablation Versus Very High Power Short Duration‐Ablation for Pulmonary Vein Isolation,” Journal of Cardiovascular Electrophysiology 34, no. 12 (2023): 2417–2424, https://doi.org/10.1111/JCE.16101.

LinkOut - more resources