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Pulsed Field Ablation: A Systematic Review

Authors: Poe Nu Htay; Mya Hnin Aung; Thiri May Sin; May Thet Naing Oo; Sai Say Han; Eaint Nadi Naing; Myat Soe Thet; +1 Authors

Pulsed Field Ablation: A Systematic Review

Abstract

ABSTRACT Background Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, leading to significant health and economic burdens. Pulmonary vein isolation (PVI) is a key treatment strategy, with pulsed field ablation (PFA) emerging as a promising method due to its specificity and reduced collateral damage compared to traditional thermal ablation techniques like radiofrequency ablation (RFA) and cryoablation (CB). Materials and Methods A comprehensive literature search was performed across multiple databases, including PubMed, Embase, and MEDLINE via Ovid, Scopus, Cochrane CENTRAL, and ClinicalTrials.Gov . Studies reporting on the efficacy and safety of PFA in AF treatment were selected and analyzed. Quality assessment of the studies was conducted using the Newcastle–Ottawa Scale. Result Of the 440 articles initially identified, 28 met the inclusion criteria. PVI using PFA demonstrated high success rates, with most studies reporting over 90% success. Durability stands around 65% after 1 year. Mortality was 0.06%–0.32%, while stroke rate was 0.3%–4.4%. There were no reported oesophageal injuries or pulmonary vein stenosis due to the highly selective electroporation‐induced cell death caused by PFA rather than coagulative necrosis, sparing nearby structures. There is a short learning curve for PFA. Conclusion PFA is a highly effective and safe ablation method. It offers an alternative to conventional thermal ablation strategies in the treatment of AF, showing promise to reduce the risk of collateral damage and complications associated with thermal ablation techniques. However, further research is needed to understand its long‐term efficacy and safety fully and to standardize procedural protocols for wider clinical application.

Keywords

thermal ablation, cryoablation, pulsed‐field ablation, R, Medicine, atrial fibrillation, radiofrequency ablation, Systematic Review

  • BIP!
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    These citations are derived from selected sources.
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    3
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Average
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
3
Top 10%
Average
Average
Green
gold