Pulsed Field Versus Contact Force Radiofrequency Ablation in Persistent Atrial Fibrillation: A Meta-Analysis

Atrial fibrillation (AF) remains a challenging arrhythmia to manage, and catheter ablation is a cornerstone therapy. Pulsed Field Ablation (PFA) has recently emerged as a novel non-thermal alternative to Contact Force Radiofrequency (CF-RF) ablation. This meta-analysis compares the efficacy, safety, and procedural efficiency of PFA versus CF-RF in patients with persistent atrial fibrillation.

A systematic review and meta-analysis were conducted using randomized controlled trials and cohort studies identified from MEDLINE, Embase, and Cochrane databases. Primary outcomes included 12-month freedom from atrial arrhythmia (AF, atrial flutter, or atrial tachycardia), procedure duration, fluoroscopy time, and major complications. Subgroup analyses were performed based on PFA device type (Farapulse vs. HT-9000Pro) and patient characteristics, including left atrial size and AF duration.

Seventeen studies met inclusion criteria. PFA was associated with significantly higher 12-month freedom from atrial arrhythmia compared with CF-RF (OR = 1.36, 95% CI 1.26-1.47, p < 0.001). Procedure time was markedly shorter with PFA (MD = -40.5 minutes, p < 0.001), while fluoroscopy time also showed a significant reduction (MD = -1.8 minutes, p = 0.001). Major complications were significantly lower with PFA (1.2% vs. 2.8%; OR = 0.44, 95% CI 0.35-0.57, p < 0.001).

In persistent AF, PFA, demonstrates superior efficacy, safety, and procedural efficiency compared with CF-RFA, supporting its role as a potential first-line ablation strategy. Larger multicenter trials with long-term follow-up are needed to confirm durability and device-specific outcomes.