Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis

This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.