Pulsed field ablation helps prevent atrial tachyarrhythmia recurrence

Pulsed field ablation (PFA) appears to reduce atrial tachyarrhythmia recurrence, and its use tends to lead to fewer redo ablations, a study in the Philippines has shown.

PFA also delivered superior overall procedural efficiency and reduced left atrial dwell time compared with very/high-power short duration radiofrequency ablation (v/HPSD RFA).

A team of investigators performed a systematic review and meta-analysis according to PRISMA 2020 guidelines. They identified 10 studies directly comparing PFA with v/HPSD RFA: nine reporting atrial tachyarrhythmia recurrence, five reporting redo ablation rates, four reporting left atrial dwell time, and all reporting procedural and fluoroscopy times.

Recurrence of atrial tachyarrhythmia was defined as any documented episode of atrial fibrillation (AF), atrial flutter, or tachycardia lasting >30 sec after a 3-month blanking period. Pooled outcomes were synthesized using fixed- or random-effects models based on heterogeneity.

PFA significantly correlated with lower atrial tachyarrhythmia recurrence than v/HPSD RFA across nine studies (risk ratio [RR], 0.81, 95 percent confidence interval [CI], 0.69–0.69; p=0.01; I2=0 percent). Across five studies assessing redo ablation, statistically comparable rates were observed, albeit nonsignificant, with trends appearing to be in favour of PFA (RR, 0.93, 95 percent CI, 0.83–1.03; p=1.03).

In terms of procedural efficiency, PFA had shorter duration (mean difference [MD], –35.97 min; p<0.00001) but longer fluoroscopy time (MD, 7.78 mins; p=0.001), possibly due to fluoroscopic guidance in device positioning and confirmation of antral contact. Moreover, PFA showed significant reductions in left atrial dwell time (MD, –33.25 min; p<0.0001).

Both procedures had similar safety outcomes, including overall and individual complications, with uniformly low event rates. In funnel plot analysis, no evidence of publication bias was noted.

"These findings position PFA as a highly effective and durable ablation modality, with the potential to further refine first-line strategies as long-term randomized evidence continues to evolve,” the investigators said.