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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...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
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
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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.
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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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