Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis
ABSTRACT Background Pulsed‐field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear. Objective To compare the efficacy and safety of PFA...
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| Format: | Article |
| Language: | English |
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Wiley
2025-08-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.70158 |
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| author | Inês Martins Esteves Vinicius Bittar de Pontes Thierry Trevisan Sebastian Jaramillo Wilton F. Gomes |
| author_facet | Inês Martins Esteves Vinicius Bittar de Pontes Thierry Trevisan Sebastian Jaramillo Wilton F. Gomes |
| author_sort | Inês Martins Esteves |
| collection | DOAJ |
| description | ABSTRACT Background Pulsed‐field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear. Objective To compare the efficacy and safety of PFA and RFA in adult patients with PAF. Methods A systematic review and meta‐analysis were conducted following the Cochrane methodology and reported in accordance with PRISMA guidelines. The PubMed, Embase, and Cochrane databases were searched through February 2025 for studies comparing PFA and RFA in adults with PAF. The outcomes of interest included procedure time, 1‐year success rate, and major complications. All the statistical analyses were performed via R version 4.5 with a random effects model. Results One randomized controlled trial (RCT) and five observational studies comprising 3163 patients with PAF were included, of whom 972 (30.7%) underwent PFA. The follow‐up time ranged from 12 to 30 months. PFA was associated with a significantly shorter procedure time (MD –39.15 min; 95% CI –58.19 to −20.11, p < 0.01), but a significantly longer fluoroscopy time (MD 10.75 min; 95% CI 5.58–15.92, p < 0.01) as compared with RFA. There were no statistically significant differences in terms of the 1‐year success rate (RR 1.04; 95% CI 0.77–1.41, p = 0.79) and major complications (RR 0.95; 95% CI 0.60–1.52, p = 0.83) between PFA and RFA. Conclusion In this meta‐analysis, PFA was associated with a reduced operative time and an increased fluoroscopy time, with comparable 1‐year efficacy and overall safety profiles. Trial Registration PROSPERO number: CRD420251000165 |
| format | Article |
| id | doaj-art-684d1edcb98f49e2b31b033b429615ee |
| institution | Kabale University |
| issn | 1880-4276 1883-2148 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj-art-684d1edcb98f49e2b31b033b429615ee2025-08-26T10:38:54ZengWileyJournal of Arrhythmia1880-42761883-21482025-08-01414n/an/a10.1002/joa3.70158Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐AnalysisInês Martins Esteves0Vinicius Bittar de Pontes1Thierry Trevisan2Sebastian Jaramillo3Wilton F. Gomes4School of Medicine and Biomedical Sciences University of Porto Porto PortugalCentro Universitário das Faculdades Associadas de Ensino São João da Boa Vista BrazilCentro Universitário das Faculdades Associadas de Ensino São João da Boa Vista BrazilUniversidad Austral Pilar ArgentinaHospital INC Curitiba BrazilABSTRACT Background Pulsed‐field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear. Objective To compare the efficacy and safety of PFA and RFA in adult patients with PAF. Methods A systematic review and meta‐analysis were conducted following the Cochrane methodology and reported in accordance with PRISMA guidelines. The PubMed, Embase, and Cochrane databases were searched through February 2025 for studies comparing PFA and RFA in adults with PAF. The outcomes of interest included procedure time, 1‐year success rate, and major complications. All the statistical analyses were performed via R version 4.5 with a random effects model. Results One randomized controlled trial (RCT) and five observational studies comprising 3163 patients with PAF were included, of whom 972 (30.7%) underwent PFA. The follow‐up time ranged from 12 to 30 months. PFA was associated with a significantly shorter procedure time (MD –39.15 min; 95% CI –58.19 to −20.11, p < 0.01), but a significantly longer fluoroscopy time (MD 10.75 min; 95% CI 5.58–15.92, p < 0.01) as compared with RFA. There were no statistically significant differences in terms of the 1‐year success rate (RR 1.04; 95% CI 0.77–1.41, p = 0.79) and major complications (RR 0.95; 95% CI 0.60–1.52, p = 0.83) between PFA and RFA. Conclusion In this meta‐analysis, PFA was associated with a reduced operative time and an increased fluoroscopy time, with comparable 1‐year efficacy and overall safety profiles. Trial Registration PROSPERO number: CRD420251000165https://doi.org/10.1002/joa3.70158atrial fibrillationcatheter ablationparoxysmal atrial fibrillationpulsed‐field ablationradiofrequency ablation |
| spellingShingle | Inês Martins Esteves Vinicius Bittar de Pontes Thierry Trevisan Sebastian Jaramillo Wilton F. Gomes Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis Journal of Arrhythmia atrial fibrillation catheter ablation paroxysmal atrial fibrillation pulsed‐field ablation radiofrequency ablation |
| title | Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis |
| title_full | Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis |
| title_fullStr | Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis |
| title_full_unstemmed | Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis |
| title_short | Pulsed‐Field Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta‐Analysis |
| title_sort | pulsed field ablation versus radiofrequency ablation for paroxysmal atrial fibrillation a systematic review and meta analysis |
| topic | atrial fibrillation catheter ablation paroxysmal atrial fibrillation pulsed‐field ablation radiofrequency ablation |
| url | https://doi.org/10.1002/joa3.70158 |
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