Meta‐Analysis of Thermal Versus Pulse Field Ablation for Pulmonary Vein Isolation Durability in Atrial Fibrillation: Insights From Repeat Ablation

ABSTRACT Purpose Pulsed field ablation (PFA) represents an innovative technique for pulmonary vein isolation (PVI), exhibiting promising efficacy and safety in initial clinical studies. However, the long‐term durability of PVI and reconnection patterns following PFA are not as well‐characterized compared to those associated with thermal energy sources such as cryoballoon ablation (CBA) or radiofrequency ablation (RFA). The objective of this study is to compare the durability of lesions resulting from repeat ablation after index PVI using PFA versus thermal ablation (TA). Methods We conducted a comprehensive search of multiple databases to identify relevant studies published before January 2025. PVI durability was assessed on a per patient and per vein level. Results This study included 14 trials involving a total of 7,367 patients. PFA demonstrated a trend toward reduced rates of repeat ablation in comparison to TA (OR 0.77; 95% CI, 0.59–1.00). Durability of PVI per patient (OR 1.42; 95% CI, 0.92–2.19) or per vein (OR 1.42; 95% CI, 0.92–2.19) were similar after PFA and TA. The most common site of reconnection was the right inferior PV for both PFA and TA (39.7% and 38.1%, respectively). Subgroup analyses demonstrated that PVI durability per vein was significantly higher with PFA compared to RFA (OR 1.32; 95% CI, 1.03–1.70). Conclusion At the time of repeat ablation, PFA exhibited a trend toward a reduced incidence of repeat procedures compared to CBA or RFA. PFA is comparable to CBA in achieving durable isolation of all veins but demonstrates superiority over RFA.