Pulsed-Field Ablation for Persistent Atrial Fibrillation: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Electrophysiology
• Medical Technology

Background:

• Pulsed field ablation (PFA) is a novel non-thermal energy source for pulmonary vein isolation (PVI).
• PFA offers potential advantages in procedural time and safety for atrial fibrillation (AF) ablation.
• Limited large-scale data exist on PFA efficacy in persistent AF patients.

Purpose of the Study:

• To systematically review and meta-analyze 12-month atrial arrhythmia recurrence after PFA in persistent AF.
• To compare PFA efficacy against thermal ablation methods.

Main Methods:

• Systematic search of major biomedical databases (MEDLINE, Embase, Scopus, LILACS, Cochrane).
• Inclusion of studies on first-time PVI with PFA in persistent AF patients reporting 12-month outcomes.
• Random-effects models and meta-regression for outcome analysis and heterogeneity assessment.

Main Results:

• 26 studies including 3744 patients met criteria; pooled 12-month freedom from recurrence was 72.3% (95% CI, 69.0-75.5).
• Substantial heterogeneity (I²=74.4%) was observed.
• No significant difference in recurrence was found compared to thermal ablation (HR, 0.91 [95% CI, 0.78-1.07]).
• Ablation-related adverse events were <1% for both PFA and thermal ablation.

Conclusions:

• PFA demonstrates high arrhythmia-free survival at 12 months in persistent AF patients.
• PFA is associated with low rates of adverse events.
• Comparative data against thermal ablation are exploratory due to limited and heterogeneous comparator studies.