Meta‐analysis of pulsed‐field ablation versus cryoablation for atrial fibrillation

Abstract

PurposeThe available data on the treatment strategy of pulsed field ablation (PFA) for patients with atrial fibrillation (AF) is limited. This study aims to provide a comparative analysis of the efficacy, safety, and procedural efficiency between PFA and cryoballoon ablation (CBA) for AF.MethodsWe conducted a comprehensive search of the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases to identify trials comparing PFA with CBA for AF from their inception until December 2023. The odds ratio (OR) and mean difference (MD), along with a 95% confidence interval (CI), were utilized as measures of treatment effect.ResultsThe analysis included 15 eligible trials with a total enrollment of 1880 patients. No significant differences were found in recurrent atrial arrhythmia (OR 0.83, 95% CI 0.64, 1.07) or periprocedural complications (OR 0.78, 95% CI 0.46, 1.30) between the two ablation techniques examined in this study. However, the PFA technique demonstrated a significantly shorter procedure time (MD ‐7.17, 95% CI ‐13.60, ‐0.73), but a longer fluoroscopy time (MD 2.53, 95% CI 0.87, 4.19). Similarly, PFA was found to be significantly associated with a decreased incidence of phrenic nerve palsy (OR 0.20, 95% CI 0.07, 0.59), but an increased incidence of cardiac tamponade (OR 4.07, 95% CI 1.15, 14.39). Moreover, there was a significantly higher release of troponin with PFA compared to CBA (MD 470.28, 95% CI 18.89, 921.67), while the increase in S100 protein and heart rate was significantly lower with PFA than with CBA (MD ‐64.41, 95% CI ‐105.46, ‐17.36), (MD ‐8.76, 95% CI ‐15.12, ‐2.40).ConclusionThe utilization of PFA provides a safer, time‐saving, and tissue‐specific procedure compared to CBA, while maintaining comparable success rates. This has the potential to enhance procedural efficiency and optimize resource utilization in clinical practice. These findings underscore the feasibility and promise of PFA as an alternative technique for PVI in patients with AF.

Radiofrequency Ablation, Cryotherapy Ablation, or Pulsed-Field Ablation to Treat Paroxysmal Atrial Fibrillation Unresponsive to Pharmacological Treatments: Interpreting Efficacy Through Reconstruction of Individual Patient Data From Randomized Trials

“…From the analysis of six comparative studies involving a total of 1,012 patients, the main conclusion of Aldaas et al was that pulse-field ablation is associated with shorter procedural times and longer fluoroscopy times, but there is no difference in periprocedural complications or rates of recurrent atrial fibrillation compared with thermal ablation. These results of Aldaas et al are consistent with those recently published by Zhang et al [ 18 ], whose meta-analysis based on 15 studies compared pulse-field ablation and cryoablation for safety and procedural efficiency; the main safety endpoints included periprocedural complications, procedure time, and fluoroscopy time. The conclusions of Zhang et al [ 18 ] are in favor of pulse-field ablation, as it was shown to be a safer, time-saving, and tissue-specific procedure compared to cryoablation, with comparable success rates; this has the potential to improve procedural efficiency and optimize resource utilization in clinical practice.…”

“…These results of Aldaas et al are consistent with those recently published by Zhang et al [ 18 ], whose meta-analysis based on 15 studies compared pulse-field ablation and cryoablation for safety and procedural efficiency; the main safety endpoints included periprocedural complications, procedure time, and fluoroscopy time. The conclusions of Zhang et al [ 18 ] are in favor of pulse-field ablation, as it was shown to be a safer, time-saving, and tissue-specific procedure compared to cryoablation, with comparable success rates; this has the potential to improve procedural efficiency and optimize resource utilization in clinical practice.…”

“…In this framework, the present study was undertaken with two main objectives: (i) to provide a systematic overview of the overall evidence of efficacy deriving from these randomized trials; and (ii) to improve the methodological value of this overall analysis by applying an artificial intelligence technique (the IPDfromKM method [ 13 - 16 ]) that reconstructs individual patient data from the published graphs of Kaplan-Meier curves. Although our study is similar to the two meta-analyses recently published by Aldaas et al [ 17 ] and Zhang et al [ 18 ], the use of the IPDfromKM method represents an interesting methodological advantage that characterizes our analysis.…”