# Pulsed field ablation vs high-power short duration/very high-power short duration pulmonary vein isolation—Systematic review and meta-analysis with Kaplan-Meier reconstructed individual patient data

## TL;DR

Pulsed field ablation may be more effective and faster than high-power ablation for treating atrial fibrillation, with similar safety.

## Contribution

This study provides a meta-analysis comparing pulsed field ablation with high-power ablation for pulmonary vein isolation.

## Key findings

- Pulsed field ablation was associated with a lower atrial tachyarrhythmia recurrence rate compared to high-power ablation.
- Pulsed field ablation significantly reduced procedural duration by nearly 30 minutes.
- Complication rates were similar between pulsed field ablation and high-power ablation.

## Abstract

High-power/very high-power short-duration (HPSD/VHPSD) pulmonary vein isolation has greater efficacy than does conventional pulmonary vein isolation, while pulsed field ablation (PFA) is associated with a significantly shorter procedural duration with comparable efficacy.

This meta-analysis compared the efficacy, procedural duration, and safety of PFA vs HPSD/VHPSD ablation.

Atrial tachyarrhythmia (ATa) recurrence was defined as any episode of atrial fibrillation, flutter, or tachycardia lasting >30 seconds, detected by Holter monitoring or electrocardiography, after a 3-month blanking period. The intervention group received PFA and the control group received HPSD/VHPSD ablation.

Eight studies (mostly retrospective observational) comprising 1411 patients were analyzed. ATa recurrence occurred less frequently in the PFA group than in the HPSD/VHPSD ablation group (15% in PFA vs 25% in HPSD/VHPSD ablation; odds ratio 0.57; 95% confidence interval [CI] 0.40–0.81; P = .002; I2 = 31.4%, P = .374). Meta-regression analysis indicated that the benefit of PFA was not significantly influenced by paroxysmal atrial fibrillation, sex, age, hypertension, or left ventricular ejection fraction. Reconstructed Kaplan-Meier curves showed greater freedom from ATa recurrence in the PFA group, and subsequent reconstructed individual patient data Cox regression analysis showed a lower hazard ratio (hazard ratio 0.68; 95% CI 0.48–0.97; P = .033). Pulmonary vein reconnection rates were comparable (32% in PFA vs 35% in HPSD/VHPSD ablation; odds ratio 0.84; 95% CI 0.53–1.34; P = .473). PFA significantly reduced total procedural duration (mean difference –29.67 minutes; 95% CI –38.31 to –21.03 minutes; P < .001). Complications rates were similar between the 2 groups.

PFA was potentially associated with a comparable or reduced ATa recurrence rate and a shorter procedural duration compared with HPSD/VHPSD ablation while maintaining similar complication rates. Further randomized controlled trials are warranted to validate these findings.

CRD420251034443.