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Meta-Analysis
. 2025 Sep;36(9):2165-2178.
doi: 10.1111/jce.16776. Epub 2025 Jul 9.

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

Marco Valerio Mariani  1 , Andrea Matteucci  2 , Nicola Pierucci  1 , Marta Palombi  1 , Paolo Compagnucci  3 , Raffaele Bruti  1 , Pietro Cipollone  1 , Sara Vinciullo  1 , Sara Trivigno  1 , Agostino Piro  1 , Vincenzo Mirco La Fazia  4 , Wael Saade  5 , Cristina Chimenti  5 , Giovanni Battista Forleo  6 , Antonio Dello Russo  3 , Claudio Pandozi  2 , Andrea Natale  4 , Carmine Dario Vizza  5 , Carlo Lavalle  5
Affiliations
Meta-Analysis

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

Marco Valerio Mariani et al. J Cardiovasc Electrophysiol. 2025 Sep.

Abstract

Background: Pulsed field energy has been proposed as alternative to radiofrequency energy in atrial fibrillation (AF) ablation.

Objective: To compare data from studies assessing AF ablation with pulsed field ablation (PFA) versus high-power short-duration (HPSD) or very HPSD (vHPSD) radiofrequency ablation (RFA) in terms of AF recurrence, procedure-related complications, fluoroscopy and procedure times.

Methods: A search of online scientific libraries (from inception to October 1, 2024) was performed. Six studies were considered eligible for the meta-analysis totaling 1190 patients of whom 568 receiving PFA and 622 receiving HPHD/vHPSD RFA.

Results: In patients with paroxysmal AF (PAF), a nonsignificant reduction of AF recurrence was related to PFA as compared to HPSD/vHPSD RFA (OR 0.74 [0.50; 1.11], p = 0.14, I2 10%). In patients with persistent AF (PeAF) a nonsignificant reduction of AF recurrence was related to PFA as compared to HPSD/vHPSD RFA (OR of 0.68 [95%CI 0.35; 1.34], p-value 0.27, I2 10%). In the overall population PFA was associated with a significant reduction of AF recurrence at follow-up (OR 0.65 [0.47; 0.90], p = 0.009, I2 11%). No statistical differences were found among the groups in terms of total complications (OR 0.92, [0.45; 1.86], p = 0.81, I2 = 27%), stroke (p = 0.78), and cardiac tamponade (p = 0.80). PFA was associated with significantly longer fluoroscopy time (WMD 8.69 [5.64; 11.75], p < 0.001, I2 = 95%), but shorter procedure time (WMD -35.16 [ - 46.03; -24.28], p < 0.001, I2 = 89%) compared to HPSD/vHPSD RFA.

Conclusion: PFA in AF patients is associated with similar efficacy and safety profiles as compared to HPSD/vHPSD RFA.

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

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of AF recurrence between PFA and HPSD/vHPSD RFA in PAF patients. CI, confidence interval; HPSD, high‐power short‐duration; PFA, pulsed field ablation; vHPSD, very high‐power short‐duration.
Figure 2
Figure 2
Comparison of AF recurrence between PFA and HPSD/vHPSD RFA in PeAF patients. CI, confidence interval; HPSD, high‐power short‐duration; PFA, pulsed field ablation; vHPSD, very high‐power short‐duration.
Figure 3
Figure 3
Comparison of AF recurrence between PFA and HPSD/vHPSD RFA in overall population. CI, confidence interval; HPSD, high‐power short‐duration; PFA, pulsed field ablation; vHPSD, very high‐power short‐duration.
Figure 4
Figure 4
Comparison of procedure time (superior panel) and fluoroscopy time (inferior panel) between PFA and HPSD/vHPSD RFA. CI, confidence interval; HPSD, high‐power short‐duration; PFA, pulsed field ablation; vHPSD, very high‐power short‐duration.
Figure 5
Figure 5
Comparison of overall complication, tamponade, stroke and vascular complications between PFA and HPSD/vHPSD RFA (from the top to the bottom). CI, confidence interval; HPSD, high‐power short‐duration; PFA, pulsed field ablation; vHPSD, very high‐power short‐duration.
See this image and copyright information in PMC

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