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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626185/ https://www.ncbi.nlm.nih.gov/pubmed/37936671 http://dx.doi.org/10.1016/j.hroo.2023.09.003 |
_version_ | 1785131291009613824 |
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author | Aldaas, Omar M. Malladi, Chaitanya Aldaas, Amer M. Han, Frederick T. Hoffmayer, Kurt S. Krummen, David Ho, Gordon Raissi, Farshad Birgersdotter-Green, Ulrika Feld, Gregory K. Hsu, Jonathan C. |
author_facet | Aldaas, Omar M. Malladi, Chaitanya Aldaas, Amer M. Han, Frederick T. Hoffmayer, Kurt S. Krummen, David Ho, Gordon Raissi, Farshad Birgersdotter-Green, Ulrika Feld, Gregory K. Hsu, Jonathan C. |
author_sort | Aldaas, Omar M. |
collection | PubMed |
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. |
format | Online Article Text |
id | pubmed-10626185 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-106261852023-11-07 Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation vs thermal energy ablation: A meta-analysis of single proportions Aldaas, Omar M. Malladi, Chaitanya Aldaas, Amer M. Han, Frederick T. Hoffmayer, Kurt S. Krummen, David Ho, Gordon Raissi, Farshad Birgersdotter-Green, Ulrika Feld, Gregory K. Hsu, Jonathan C. Heart Rhythm O2 Clinical 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. Elsevier 2023-09-12 /pmc/articles/PMC10626185/ /pubmed/37936671 http://dx.doi.org/10.1016/j.hroo.2023.09.003 Text en © 2023 Heart Rhythm Society. Published by Elsevier Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Clinical Aldaas, Omar M. Malladi, Chaitanya Aldaas, Amer M. Han, Frederick T. Hoffmayer, Kurt S. Krummen, David Ho, Gordon Raissi, Farshad Birgersdotter-Green, Ulrika Feld, Gregory K. Hsu, Jonathan C. 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 | 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 | Clinical |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626185/ https://www.ncbi.nlm.nih.gov/pubmed/37936671 http://dx.doi.org/10.1016/j.hroo.2023.09.003 |
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