Pulsed Field Versus Contact Force Radiofrequency Ablation in Persistent Atrial Fibrillation: A Meta‐Analysis
ARSH REHMAN, ZhuHua Sun, Muhammad Khalid, HaoZhe Deng, Yuanyuan Chen, Shengli An, Kun Xiang, JianQin Zhang, XinZhong Li, Fahd Mohammed Abdullah Makhsham, SenLin Huang, HaiRuo Lin, LiWei He, YanMei Chen, GuoJun Chen, YueGang WangABSTRACT
Background
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.
Methods
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.
Results
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).
Conclusion
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.