Meta-Analysis of Thermal Versus Pulse Field Ablation for Pulmonary Vein Isolation Durability in Atrial Fibrillation: Insights From Repeat Ablation

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-05-28 DOI:10.1002/clc.70151

Jin-Cheng Chen, Yin-Jun Mao, Qun-Ying Huang, Zhen-Dong Cheng, Shao-Bin He, Qiu-Xia Xu, Yin Zhang

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引用次数: 0

Abstract

Purpose

Pulsed field ablation (PFA) represents an innovative technique for pulmonary vein isolation (PVI), exhibiting promising efficacy and safety in initial clinical studies. However, the long-term durability of PVI and reconnection patterns following PFA are not as well-characterized compared to those associated with thermal energy sources such as cryoballoon ablation (CBA) or radiofrequency ablation (RFA). The objective of this study is to compare the durability of lesions resulting from repeat ablation after index PVI using PFA versus thermal ablation (TA).

Methods

We conducted a comprehensive search of multiple databases to identify relevant studies published before January 2025. PVI durability was assessed on a per patient and per vein level.

Results

This study included 14 trials involving a total of 7,367 patients. PFA demonstrated a trend toward reduced rates of repeat ablation in comparison to TA (OR 0.77; 95% CI, 0.59–1.00). Durability of PVI per patient (OR 1.42; 95% CI, 0.92–2.19) or per vein (OR 1.42; 95% CI, 0.92–2.19) were similar after PFA and TA. The most common site of reconnection was the right inferior PV for both PFA and TA (39.7% and 38.1%, respectively). Subgroup analyses demonstrated that PVI durability per vein was significantly higher with PFA compared to RFA (OR 1.32; 95% CI, 1.03–1.70).

Conclusion

At the time of repeat ablation, PFA exhibited a trend toward a reduced incidence of repeat procedures compared to CBA or RFA. PFA is comparable to CBA in achieving durable isolation of all veins but demonstrates superiority over RFA.

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热与脉冲场消融对房颤肺静脉隔离持久性的meta分析：来自重复消融的见解

目的脉冲场消融（PFA）是肺静脉隔离（PVI）的一项创新技术，在初步临床研究中显示出良好的疗效和安全性。然而，与低温球囊消融（CBA）或射频消融（RFA）等热能源相比，PVI的长期耐久性和PFA后的重连模式并没有得到很好的表征。本研究的目的是比较PFA和热消融（TA）在指数PVI后重复消融造成的病变的持久性。方法对多个数据库进行综合检索，找出2025年1月前发表的相关研究。PVI耐久性在每个患者和每个静脉水平上进行评估。结果本研究纳入14项试验，共7367例患者。与TA相比，PFA有降低重复消融率的趋势(OR 0.77；95% ci, 0.59-1.00)。每位患者PVI的持久性(OR 1.42；95% CI, 0.92-2.19)或每根静脉(or 1.42；95% CI, 0.92-2.19)， PFA和TA后相似。PFA和TA最常见的重连部位是右下PV（分别为39.7%和38.1%）。亚组分析表明，与RFA相比，PFA组每条静脉的PVI持久性显著提高(OR 1.32；95% ci, 1.03-1.70)。结论在重复消融时，与CBA或RFA相比，PFA显示出重复手术发生率降低的趋势。PFA在实现所有静脉的持久隔离方面与CBA相当，但表现出优于RFA的优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.