Related Experiment Video
Updated: May 7, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Pulsed field vs thermal ablation for atrial fibrillation: A Bayesian meta-analysis
Flávia Queiroga1, André Rivera2, Leo N Consoli3
1Department of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia.
Background:
Pulsed field ablation (PFA) has emerged as a promising alternative to thermal catheter ablation for pulmonary vein isolation in atrial fibrillation (AF).
Objective:
This study aimed to estimate the efficacy and safety of PFA vs thermal ablation in AF.
Methods:
We searched PubMed, Embase, and Cochrane through July 2025 for studies comparing PFA with thermal ablation. Individual patient data were reconstructed from Kaplan-Meier curves, and hazard ratios were estimated using a Cox frailty regression model. Time to benefit was assessed to determine when the treatment effect became clinically meaningful. Study-level odds ratios and mean differences with 95% credible intervals were estimated fitting a Bayesian random-effects model and vague priors for overall effect in the primary analyses.
Results:
12 studies (4 randomized controlled trials [RCTs], 8 observational) involving 3120 patients (46.6% PFA) were included. Time-to-event analysis (1 RCT, 6 observational) showed PFA was associated with a higher freedom from atrial tachyarrhythmia recurrence (hazard ratio 0.68; 95% credible interval 0.55-0.84). A time to benefit of 12 months was needed to prevent 5 atrial arrhythmia recurrences per 100 PFA-treated patients. In study-level analyses, the probability of a clinically meaningful reduction (odds ratio <0.8) in arrhythmia recurrence was 34.1% for RCTs and 96.5% for observational studies. PFA had a high likelihood of shorter procedural and left atrial dwell times. Safety outcomes showed no consistent excess risk with PFA.
Conclusion:
In patients with AF undergoing catheter ablation, PFA was associated with reduced arrhythmia recurrence compared with thermal ablation, with larger effects in observational studies and more modest effects in RCTs, and no signal of increased harm.
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