Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions
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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Heart Rhythm O2 |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501823002222 |
| _version_ | 1797653911166779392 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Omar M. Aldaas, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T16:51:41Z |
| format | Article |
| id | doaj.art-b83e30c7635e4ea08445025260ecdd85 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-03-11T16:51:41Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-b83e30c7635e4ea08445025260ecdd852023-10-21T04:23:17ZengElsevierHeart Rhythm O22666-50182023-10-01410599608Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportionsOmar M. Aldaas, MD0Chaitanya Malladi, MD1Amer M. Aldaas, BS2Frederick T. Han, MD, FHRS3Kurt S. Hoffmayer, MD, PharmD, FHRS4David Krummen, MD, FHRS5Gordon Ho, MD, FHRS6Farshad Raissi, MD, FHRS7Ulrika Birgersdotter-Green, MD, FHRS8Gregory K. Feld, MD, FHRS9Jonathan C. Hsu, MD, MAS, FHRS10Section of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaT. Still University School of Osteopathic Medicine, Mesa, ArizonaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection of Cardiac Electrophysiology, Division of Cardiology at the University of California San Diego Health System, La Jolla, CaliforniaSection 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.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.http://www.sciencedirect.com/science/article/pii/S2666501823002222Atrial fibrillationPulsed field ablationThermal ablationMeta-analysisSafety |
| spellingShingle | 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 Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions Heart Rhythm O2 Atrial fibrillation Pulsed field ablation Thermal ablation Meta-analysis Safety |
| title | Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions |
| title_full | Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions |
| title_fullStr | Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions |
| title_full_unstemmed | Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions |
| title_short | Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions |
| title_sort | safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation a meta analysis of single proportions |
| topic | Atrial fibrillation Pulsed field ablation Thermal ablation Meta-analysis Safety |
| url | http://www.sciencedirect.com/science/article/pii/S2666501823002222 |
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