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

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.