Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions

Omar M. Aldaas, MD; Chaitanya Malladi, MD; Amer M. Aldaas, BS; Frederick T. Han, MD, FHRS; Kurt S. Hoffmayer, MD, PharmD, FHRS; David Krummen, MD, FHRS; Gordon Ho, MD, FHRS; Farshad Raissi, MD, FHRS; Ulrika Birgersdotter-Green, MD, FHRS; Gregory K. Feld, MD, FHRS; Jonathan C. Hsu, MD, MAS, FHRS

Heart Rhythm O2 (Oct 2023)

Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions

Omar M. Aldaas, MD,
Chaitanya Malladi, MD,
Amer M. Aldaas, BS,
Frederick T. Han, MD, FHRS,
Kurt S. Hoffmayer, MD, PharmD, FHRS,
David Krummen, MD, FHRS,
Gordon Ho, MD, FHRS,
Farshad Raissi, MD, FHRS,
Ulrika Birgersdotter-Green, MD, FHRS,
Gregory K. Feld, MD, FHRS,
Jonathan C. Hsu, MD, MAS, FHRS

Affiliations

Omar M. Aldaas, MD: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Chaitanya Malladi, MD: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Amer M. Aldaas, BS: T. Still University School of Osteopathic Medicine, Mesa, Arizona
Frederick T. Han, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Kurt S. Hoffmayer, MD, PharmD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
David Krummen, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Gordon Ho, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Farshad Raissi, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Ulrika Birgersdotter-Green, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Gregory K. Feld, MD, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California
Jonathan C. Hsu, MD, MAS, FHRS: Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, California; Address reprint requests and correspondence: Dr. Jonathan C. Hsu, Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California–San Diego, 9452 Medical Center Dr, 3rd Floor, Room 3E-417, La Jolla, CA 92037.

Journal volume & issue: Vol. 4, no. 10
pp. 599 – 608

Abstract

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Background: 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. Objective: The purpose of this study was to compare the safety and acute efficacy of ablation for AF with PFA vs thermal energy sources. Methods: We performed an extensive literature search and systematic review of studies that evaluated the safety and efficacy of ablation for AF with PFA and compared them to landmark clinical trials for 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 interval (CI). Results: We included 24 studies for a total of 5203 patients who underwent AF ablation. Among these patients, 54.6% (n = 2842) underwent PFA and 45.4% (n = 2361) underwent thermal ablation. There were significantly fewer periprocedural complications in the PFA group (2.05%; 95% CI 0.94–3.46) compared to the thermal ablation group (7.75%; 95% CI 5.40–10.47) (P = .001). When comparing AF recurrence up to 1 year, there was a statistically insignificant trend toward a lower prevalence of recurrence in the PFA group (14.24%; 95% CI 6.97–23.35) compared to the thermal ablation group (25.98%; 95% CI 15.75–37.68) (P = .132). Conclusion: Based on the results of this meta-analysis, PFA was associated with lower rates of periprocedural complications and similar rates of acute procedural success and recurrent AF with up to 1 year of follow-up compared to ablation with thermal energy sources.

Published in Heart Rhythm O2

ISSN: 2666-5018 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/heart-rhythm-o2

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