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

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Cryoballoon ablation (CBA) for atrial fibrillation (AF) can lead to pulmonary vein reconnection, impacting long-term success.
• Pulsed field ablation (PFA) offers a potentially safer alternative for AF treatment.

Purpose of the Study:

• To compare the safety and efficacy of PFA versus CBA in patients diagnosed with atrial fibrillation.
• To evaluate key outcomes including recurrence rates and procedure-related complications.

Main Methods:

• A systematic literature search was conducted across multiple databases.
• A random-effects meta-analysis of 26 studies involving 6673 patients was performed.
• Pooled data using odds ratios and mean differences with 95% confidence intervals.

Main Results:

• PFA demonstrated a lower incidence of AF recurrence (OR: 0.64) and any atrial tachyarrhythmia recurrence (OR: 0.78) compared to CBA.
• PFA was associated with significantly reduced rates of phrenic nerve palsy (OR: 0.16) and esophageal injury (OR: 0.41).
• No significant differences were found in early recurrence, atrial flutter, atrial tachycardia, redo procedures, mortality, or major adverse events.

Conclusions:

• PFA shows promise as a safer and more effective ablation strategy for atrial fibrillation compared to CBA.
• Further randomized trials are recommended to confirm these findings and assess long-term outcomes.
• Current evidence suggests PFA may offer an improved safety profile in AF management.