Abstract 14193: Safety and Efficacy of Catheter Ablation of Atrial Fibrillation With Pulsed Field Ablation versus Thermal Energy Ablation: A Systematic Review and Meta-Analysis

Introduction: Pulsed field ablation (PFA) has emerged as a novel energy source for the ablation of atrial fibrillation (AF) using ultrarapid electrical pulses to induce cell death via electroporation.

Hypothesis: Ablation of AF with PFA will be more safe and as effective as thermal energy sources.

Methods: We performed an extensive literature search and systematic review of studies that evaluated the safety and efficacy of ablation of AF with PFA and compared these to landmark clinical trials of ablation of AF with thermal energy sources. Freeman-Tukey double arcsine transformation was used to establish variance of raw proportions followed by the inverse with the random effects model to combine the transformed proportions and generate the pooled prevalence and 95% confidence intervals (CI).

Results: We included 24 studies for a total of 5,203 patients who underwent ablation of AF. Among these patients, 54.6% (n=2,842) underwent PFA and 45.4% (n=2,361) underwent thermal ablation. There were significantly fewer periprocedural complications in the PFA group (2.05%; CI 0.94-3.46) compared to the thermal ablation group (7.75%; CI 5.40-10.47) (p=0.001). When comparing AF recurrence up to one year, there was a statistically insignificant trend towards a lower prevalence of recurrence in the PFA group (14.24%, CI 6.97-23.35) compared to the thermal ablation group (25.98%, CI 15.75-37.68) (p=0.132) as shown in Figure 1.

Conclusion: Based on the results of this meta-analysis, PFA was associated with lower rates of periprocedural complications and similar rates of recurrent AF with up to one year of follow-up when compared to ablation with thermal energy sources.