PurposeThe available data on the treatment strategy of pulsed field ablation (PFA) for patients with atrial fibrillation (AF) is limited. This study aims to provide a comparative analysis of the efficacy, safety, and procedural efficiency between PFA and cryoballoon ablation (CBA) for AF.MethodsWe conducted a comprehensive search of the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases to identify trials comparing PFA with CBA for AF from their inception until December 2023. The odds ratio (OR) and mean difference (MD), along with a 95% confidence interval (CI), were utilized as measures of treatment effect.ResultsThe analysis included 15 eligible trials with a total enrollment of 1880 patients. No significant differences were found in recurrent atrial arrhythmia (OR 0.83, 95% CI 0.64, 1.07) or periprocedural complications (OR 0.78, 95% CI 0.46, 1.30) between the two ablation techniques examined in this study. However, the PFA technique demonstrated a significantly shorter procedure time (MD ‐7.17, 95% CI ‐13.60, ‐0.73), but a longer fluoroscopy time (MD 2.53, 95% CI 0.87, 4.19). Similarly, PFA was found to be significantly associated with a decreased incidence of phrenic nerve palsy (OR 0.20, 95% CI 0.07, 0.59), but an increased incidence of cardiac tamponade (OR 4.07, 95% CI 1.15, 14.39). Moreover, there was a significantly higher release of troponin with PFA compared to CBA (MD 470.28, 95% CI 18.89, 921.67), while the increase in S100 protein and heart rate was significantly lower with PFA than with CBA (MD ‐64.41, 95% CI ‐105.46, ‐17.36), (MD ‐8.76, 95% CI ‐15.12, ‐2.40).ConclusionThe utilization of PFA provides a safer, time‐saving, and tissue‐specific procedure compared to CBA, while maintaining comparable success rates. This has the potential to enhance procedural efficiency and optimize resource utilization in clinical practice. These findings underscore the feasibility and promise of PFA as an alternative technique for PVI in patients with AF.

中文翻译：

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脉冲场消融与冷冻消融治疗房颤的荟萃分析

目的关于房颤（AF）患者脉冲场消融（PFA）治疗策略的现有数据有限。本研究旨在对 PFA 和冷冻球囊消融 (CBA) 治疗 AF 的疗效、安全性和手术效率进行比较分析。方法我们对 EMBASE、PubMed、Cochrane 图书馆和 ClinicalTrials.gov 数据库进行了全面检索，以确定试验从开始到 2023 年 12 月，对 AF 的 PFA 与 CBA 进行比较。优势比 (OR) 和平均差 (MD) 以及 95% 置信区间 (CI) 被用作治疗效果的衡量标准。结果分析包括 15 名合格患者试验共入组 1880 名患者。本研究检查的两种消融技术在复发性房性心律失常（OR 0.83，95% CI 0.64，1.07）或围手术期并发症（OR 0.78，95% CI 0.46，1.30）方面没有发现显着差异。然而，PFA 技术显示出明显更短的手术时间（MD ‐7.17，95% CI ‐13.60，‐0.73），但透视时间更长（MD 2.53，95% CI 0.87，4.19）。同样，PFA 被发现与膈神经麻痹发生率降低显着相关（OR 0.20，95% CI 0.07，0.59），但与心包填塞发生率增加显着相关（OR 4.07，95% CI 1.15，14.39）。此外，与 CBA 相比，PFA 的肌钙蛋白释放量显着更高（MD 470.28，95% CI 18.89, 921.67），而 PFA 的 S100 蛋白和心率的增加显着低于 CBA（MD ‐64.41, 95）。 % CI ‐105.46, ‐17.36), (MD ‐8.76, 95% CI ‐15.12, ‐2.40)。 结论 与 CBA 相比，PFA 的使用提供了更安全、省时和组织特异性的手术，同时保持了相当的成功率。这有可能提高临床实践中的程序效率并优化资源利用。这些发现强调了 PFA 作为 AF 患者 PVI 替代技术的可行性和前景。