Efficacy and safety of pulsed field ablation for atrial fibrillation: A systematic review and meta-analysis

Pulsed-field ablation versus radiofrequency or cryoballoon thermal ablation in atrial fibrillation: a systematic review and meta-analysis

This review investigated efficacy and safety of pulsed-field ablation (PFA) in comparison with radiofrequency ablation (RFA), cryoballoon ablation (CBA), or both combined. The Odds ratio (OR) and mean difference (MD) with 95% confidence interval (95% CI) were computed. PFA allowed shorter procedure (MD -44.27 minutes, 95% CI: -63.61; -24.93) and left atrium (LA) dwell (MD -32.71 minutes (95% CI: -58.64; -6.78) times, but with longer fluoroscopy time than RFA (MD 8.54 minutes, 95% CI: 4.03; 13.04). Post-procedural complications rate was lower with PFA than CBA (OR 0.53, 95% CI: 0.35, 0.80). Atrial arrhythmias recurrence rate within one year of follow-up was lower with PFA than RFA (OR 0.68, 95% CI; 0.53; 0.87) and CBA (OR 0.69, 95% CI: 0.48; 0.97). PFA allowed shorter procedure and LA dwell times, as well as lower atrial arrhythmia recurrence than RFA and lower post-procedural complications and atrial arrhythmias recurrence rates than CBA.

Transient conduction disturbance during pulsed-field ablation for atrial fibrillation in a patient with pre-existing conduction disease

Pulsed-field ablation (PFA) is a novel, non-thermal technique for atrial fibrillation (AF) ablation, known for its tissue specificity and reduced risk of collateral damage. However, its impact on cardiac conduction pathways in patients with pre-existing conduction abnormalities is not well understood. We present the first documented case of transient conduction block observed during PFA for AF. A late 60s male with paroxysmal AF and a dual chamber pacemaker for sinus node disease underwent successful PFA using a 31 mm pentaspline FARAPULSE catheter. During pulmonary vein isolations, transient prolongation of atrioventricular conduction time and a temporary shift from right bundle branch block to left bundle branch block lasting up to four beats were observed. This novel observation underscores the need for careful monitoring of conduction during PFA, particularly in patients with underlying conduction disorders, and highlights the importance of further research into PFA's mechanism of action and its long-term impact.

Pulsed-field ablation for paroxysmal atrial fibrillation: An indirect comparison of effectiveness among three proprietary devices conducted in the absence of randomized trials

INTRODUCTION

In patients with paroxysmal atrial fibrillation, pulsed-field ablation has been developed as an alternative to thermal ablation. Three devices are currently available: Farawave by Boston, PulseSelect by Medtronic, and Varipulse by Johnson. In the present report, we studied the outcomes at 12 months of these three devices using indirect comparisons.

METHODS

A standard PubMed search was conducted that identified all studies evaluating these devices in patients with paroxysmal atrial fibrillation. The endpoint was freedom from arrhythmia recurrence. Kaplan-Meier curves were subjected to the IPDfromKM method that generated reconstructed patients. Standard time-to-event statistical testss (including heterogeneity assessment) were performed.

RESULTS

Our analysis included 9 studies (8 single-arm and 1 randomized trial based on Farawave for a total of 1916 patients). A significant heterogeneity was found across the trials using Farawave because the outcomes found in the single-arm trials were better than those found in the randomized trial. Farawave (according exclusively to the results of the randomized trial), PulseSelect, and Varipulse showed a similar time-course of their respective outcomes with no significant difference. The single-arm trials using Farawave showed better outcomes than the randomized trial using Farawave and the pivotal trials using PulseSelect and Varipulse.

DISCUSSION

Our study provided an updated overview of all the studies that have so far used pulsed-fileld ablation in patients with paroxysmal atrial fibrillation.