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Background <p>Atrial fibrillation (AF) is the most common cardiac arrhythmia and a leading cause of stroke. Pulsed field ablation (PFA) emerges as a novel, non-thermal energy source offering myocardial-selective ablation with a potentially improved safety and efficacy profile.</p> Objectives <p>To compare the safety and efficacy of PFA versus RFA/CBA ablation in patients with AF.</p> Methods <p>Multiple databases were systematically searched from inception to May 2025. Randomized Controlled Trials (RCTs) comparing PFA versus thermal ablation (TA) were analyzed using risk ratio (RR) and mean difference (MD) with 95% Confidence Intervals (CI). Random-effects model was employed to account for heterogeneity, as measured by I<sup>2</sup> and quantified using leave-one-out analysis.</p> Results <p>We included 1,294 patients, of whom 653 (50.4%) underwent PFA from four RCTs. Among the included patients, 62.4% have hypertension and a CHA<sub>2</sub>DS<sub>2</sub>-VASc mean score of 2.0 ± 1.4. In the pooled analysis, no significant differences were found between PFA group when compared to TA regarding treatment success (RR = 1.11; 95% CI 0.87–1.42; ρ = 0.20), serious adverse events (RR = 1.24; 95% CI 0.38–4.09; ρ = 0.51), recurrent atrial arrhythmias (RR = 0.86; 95% CI 0.54–1.38; ρ = 0.31), and repeat ablation (RR = 0.89; 95% CI 0.18–4.38; ρ = 0.78). However, the procedural time (MD = -38.80&#xa0;min; 95% CI -75.52–2.08; ρ = 0.04) was significantly reduced in patients who underwent PFA.</p> Conclusion <p>PFA appears comparable to radiofrequency and cryoballoon ablation for atrial fibrillation, with shorter procedure times but similar efficacy and complication rates. Given that most outcomes were graded as low or very low certainty, further large, long-term randomized trials are needed to confirm these findings.</p> Graphical Abstract <p></p>

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Efficacy and safety of pulsed field ablation versus conventional thermal techniques for patients with atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月19日

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  • John Cedric Mojica,
  • Mrunalini Dandamudi,
  • Jasmine Interior,
  • Tooba Rehman,
  • Muhammad Aqib Faizan,
  • Salomon Chamay,
  • Navya Mandalapu,
  • Omar Kasimieh,
  • Juliana Giorgi

摘要

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and a leading cause of stroke. Pulsed field ablation (PFA) emerges as a novel, non-thermal energy source offering myocardial-selective ablation with a potentially improved safety and efficacy profile.

Objectives

To compare the safety and efficacy of PFA versus RFA/CBA ablation in patients with AF.

Methods

Multiple databases were systematically searched from inception to May 2025. Randomized Controlled Trials (RCTs) comparing PFA versus thermal ablation (TA) were analyzed using risk ratio (RR) and mean difference (MD) with 95% Confidence Intervals (CI). Random-effects model was employed to account for heterogeneity, as measured by I2 and quantified using leave-one-out analysis.

Results

We included 1,294 patients, of whom 653 (50.4%) underwent PFA from four RCTs. Among the included patients, 62.4% have hypertension and a CHA2DS2-VASc mean score of 2.0 ± 1.4. In the pooled analysis, no significant differences were found between PFA group when compared to TA regarding treatment success (RR = 1.11; 95% CI 0.87–1.42; ρ = 0.20), serious adverse events (RR = 1.24; 95% CI 0.38–4.09; ρ = 0.51), recurrent atrial arrhythmias (RR = 0.86; 95% CI 0.54–1.38; ρ = 0.31), and repeat ablation (RR = 0.89; 95% CI 0.18–4.38; ρ = 0.78). However, the procedural time (MD = -38.80 min; 95% CI -75.52–2.08; ρ = 0.04) was significantly reduced in patients who underwent PFA.

Conclusion

PFA appears comparable to radiofrequency and cryoballoon ablation for atrial fibrillation, with shorter procedure times but similar efficacy and complication rates. Given that most outcomes were graded as low or very low certainty, further large, long-term randomized trials are needed to confirm these findings.

Graphical Abstract