Pentaspline Pulsed Field Ablation Versus High-Power Short-Duration/Very High-Power Short-Duration Radiofrequency...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Pulsed field ablation (PFA) is an emerging alternative to radiofrequency ablation (RFA) for treating atrial fibrillation (AF).
• Understanding the comparative efficacy and safety of PFA versus contemporary RFA techniques is crucial for clinical decision-making.

Purpose of the Study:

• To compare pulsed field ablation (PFA) with high-power short-duration (HPSD) or very HPSD (vHPSD) radiofrequency ablation (RFA) in atrial fibrillation (AF) treatment.
• Key outcomes assessed include AF recurrence, procedural complications, and procedure/fluoroscopy times.

Main Methods:

• A systematic literature search was conducted up to October 1, 2024.
• A meta-analysis included six studies with a total of 1190 patients (568 PFA, 622 RFA).

Main Results:

• Overall, PFA demonstrated a significant reduction in AF recurrence compared to HPSD/vHPSD RFA (OR 0.65 [0.47; 0.90], p=0.009).
• No significant differences were observed in total complications, stroke, or cardiac tamponade between PFA and RFA groups.
• PFA was associated with significantly longer fluoroscopy times (p<0.001) but shorter procedure times (p<0.001) than RFA.

Conclusions:

• Pulsed field ablation (PFA) exhibits comparable efficacy and safety profiles to HPSD/vHPSD radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).
• The findings support PFA as a viable alternative, with specific trade-offs in procedural and imaging times.