Pulsed Field Ablation Versus High‐Power Short‐Duration Ablation for Atrial Fibrillation—A Meta-analysis of Reconstructed Time-to-event Data

Background: Pulsed field ablation (PFA) has shown promising results for atrial fibrillation (AF), with early trials reporting similar success rates to cryoablation and thermal energy ablation. High-power short duration (HPSD) ablation for the treatment of AF is emerging as an alternative to current ablation therapies with less local edema and collateral tissue damage. To date, there is no consensus regarding a possible treatment superiority between PFA and HPSD ablation. We performed a systematic review and meta-analysis to compare the AF recurrence between these two procedures.

Methods: We conducted a comprehensive search of three databases to identify relevant studies. The primary outcome was AF recurrence, while secondary outcomes included tamponade and other complications, as well as procedure and fluoroscopy durations. Time-to-event data for AF recurrence were reconstructed, and a random-effects model was employed for the analysis of secondary outcomes.

Results: A total of seven studies comprising 1,304 patients with AF (PFA: 607; HPSD: 697) were included. There were no significant differences between PFA and HPSD in terms of AF recurrence (HR = 1.26, 95% CI: 0.93–1.70, p = 0.12), fluoroscopy duration (MD = −5.8 minutes, 95% CI: −12.10 to 1.95, p = 0.16), incidence of tamponade (OR = 0.79, 95% CI: 0.20–3.01, p = 0.72), or other complications (OR = 1.05, 95% CI: 0.48–2.32, p = 0.92). However, PFA was associated with a significantly shorter procedure duration (MD = 31.98 minutes, 95% CI: 10.29–53.68, p < 0.01).

Conclusion: PFA and HPSD ablation show no significant differences in AF recurrence, fluoroscopy time, or complications. However, PFA significantly reduces procedure duration.

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Artikel online veröffentlicht:
11. Februar 2025