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

In the treatment of atrial fibrillation (AF), cryoballoon ablation (CBA) is associated with a high incidence of pulmonary vein reconnection, potentially limiting long-term efficacy. Pulsed field ablation (PFA) has emerged as a promising alternative with the potential for improved safety. Hence, this study was conducted to compare the safety and efficacy of PFA with CBA in patients with AF. Several databases were searched for studies that compared PFA with CBA in AF patients and reported safety and efficacy outcomes. A random-effects meta-analysis was performed using RStudios. Binary and continuous outcomes were pooled using odds ratios (ORs) and mean difference, respectively, along with 95% confidence intervals. Statistical significance was set at P < 0.05. A total of 26 studies involving 6673 patients were included. PFA showed a reduced incidence of recurrence of any atrial tachyarrhythmia (OR: 0.78; [0.65-0.93]; P value = 0.007), recurrence of AF (OR: 0.64; [0.54-0.77]; P value <0.001), phrenic nerve palsy (OR: 0.16; [0.09-0.28]; P value <0.01), and esophageal injury (OR: 0.41; [0.17-0.99]; P value = 0.047) as compared with CBA. No significant differences were observed between the groups for the incidence of recurrence of early ATA, atrial flutter, atrial tachycardia, redo procedure, all-cause mortality, access complications, cardiac tamponade, stroke, or transient ischemic attack. These findings support the potential of PFA as a safer and more effective alternative to CBA in the management of AF. Further randomized trials are needed to validate these findings, which should be interpreted cautiously given the limited long-term comparative evidence.