Abstract Body (Do not enter title and authors here): Introduction: Conventional thermal ablation (TA) has been used to treat paroxysmal atrial fibrillation (AF) refractory to medical therapy. Despite this, the energy used to isolate the pulmonary veins can extend through the myocardium and adjacent tissues, causing complications. Pulsed-field ablation (PFA), which delivers high-voltage electric fields in microseconds, may limit this tissue damage outside the myocardium. However, the efficacy of pulsed-field ablation compared with conventional thermal ablation in this population remains uncertain.
Research question: What are the benefits of using PFA in patients with paroxysmal atrial fibrillation compared to AT
Objective: The purpose of this study was to evaluate the efficacies and safety of PFA compared with TA in patients with paroxysmal atrial fibrillation
Methods: PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for studies that directly compared PFA and TA for the treatment of paroxysmal AF and reported safety or efficacy outcomes. We evaluated the following outcomes at ≥12 months of follow-up: (1) stroke, (2) arrhythmia recurrence and (3) redo procedures. Heterogeneity was assessed with I² statistics. Rstudio was used for statistical analysis.
Results: We included 1,677 patients (734 male – 43.76%) from three studies. PFA was used to treat AF in 519 (30.94%) patients and thermal energy was used in 1.158 (69.05%) patients. There was no significant incidence of stroke after performing PFA compared to TA in the pooled population (OR 1.31; 95%CI 0.11-15.59; P = 0.832). As compared to thermal ablation, PFA demonstrated similar freedom from recurrent atrial fibrillation (OR 0.77; 95%CI 0.51- 1.18; P = 0.237). There were no statistically significant differences in redo procedures (OR 0.61; 95%CI 0.36- 1.03; P = 0.066).
Conclusion: Compared to TA, PFA did not show significant differences in the occurrence of stroke after the procedure or in the recurrence of paroxysmal atrial fibrillation. Additionally, it was not associated with a lower rate of redo procedures.