Evidence mapPaperPMID 40433752Full record

SynthesisJournal of cardiovascular electrophysiology2025

Efficacy and Safety of Pulsed-Field Versus High-Power Short-Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.

Ahmed Mazen Amin, Mustafa Turkmani, Saman Al Barznji, Sanghamitra Mohanty, Rachel M Kaplan, Jeffrey Winterfield, Dhanunjaya Lakkireddy, Pasquale Santangeli, Luigi Di Biase, Andrea Natale

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Journal of cardiovascular electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Ahmed Mazen AminFaculty of Medicine, Mansoura University, Mansoura, Egypt.ORCID https://orcid.org/0009-0006-2687-3880
Mustafa TurkmaniFaculty of Medicine, Michigan State University, Faculty of Medicine, East Lansing, Michigan, USA.ORCID https://orcid.org/0009-0001-4261-0638
Saman Al BarznjiFaculty of Medicine, Michigan State University, Faculty of Medicine, East Lansing, Michigan, USA.
Sanghamitra MohantyTexas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
Rachel M KaplanSection of Cardiac Electrophysiology, Division of Cardiology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA.ORCID https://orcid.org/0000-0003-0038-9231
Jeffrey WinterfieldSection of Cardiac Electrophysiology, Division of Cardiology, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA.
Dhanunjaya LakkireddyKansas City Heart Rhythm Institute, Overland Park, Kansas, USA.
Pasquale SantangeliSection of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.ORCID https://orcid.org/0000-0002-0023-9666
Luigi Di BiaseDepartment of Electrophysiology, Albert Einstein College of Medicine at Montefiore Health System, New York, New York, USA.ORCID https://orcid.org/0000-0001-6508-4047
Andrea NataleTexas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.ORCID https://orcid.org/0000-0002-5487-0728

Funding

The authors received no specific funding for this work.
6 · The paper itself

Abstract

backgroundPulsed-field ablation (PFA) and high-power short-duration (HPSD) ablation (45-90 W) are emerging technologies in atrial fibrillation (AF) treatment, both achieving durable pulmonary vein isolation. We aim to investigate the efficacy and safety of PFA versus HPSD ablation.

methodsWe comprehensively searched PubMed, Web of Science (WOS), Scopus, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) through July 2024. Pairwise meta-analysis with reconstructed time-to-event analysis were performed using R version 4.3.1 (PROSPERO ID: CRD42024576031).

resultsSeven observational studies, including 1904 patients, were included. PFA was significantly associated with lower atrial tachyarrhythmia recurrence compared to HPSD ablation (45-90 W) at the longest follow-up (RR: 0.73, 95% CI [0.60, 0.88], p < 0.01). Subgroup analysis revealed a significant reduction in atrial tachyarrhythmia recurrence with PFA versus HPSD ablation (45-50 W) (RR: 0.69, 95% CI [0.54, 0.88], p < 0.01), but not compared to vHPSD ablation (70-90 W). Reconnected pulmonary vein rates were significantly lower with PFA compared to HPSD (45-50 W) (p = 0.03), while no significant difference was observed compared to vHPSD (70-90 W). PFA was significantly associated with reduced procedural duration (MD: -33.15 with 95% CI [-40.93, -25.36], p < 0.01) and left atrial dwell time (MD: -32.16 with 95% CI [-45.55, -18.77], p < 0.01), although fluoroscopy time increased (MD: 7.48 with 95% CI [4.29, 10.68], p < 0.01) compared to HPSD ablation (45-90 W). Safety profiles were comparable, but pericarditis rates were significantly lower with PFA versus HPSD (45-50 W) (p = 0.003) and vHPSD (70-90 W) (p = 0.019). Kaplan-Meier analysis showed a 28% lower risk of atrial tachyarrhythmia recurrence with PFA compared to HPSD ablation (45-90 W) (HR: 0.72, 95% CI [0.57, 0.91], p = 0.006) over an 18-month follow-up.

conclusionPFA and HPSD ablation (45-90 W) are effective and safe for AF ablation. PFA was significantly associated with lower atrial tachyarrhythmia recurrence, shorter procedural duration, reduced left atrial dwell time, increased fluoroscopy time, and comparable safety, with lower rates of pericarditis compared to HPSD ablation.

Indexed as

Atrial FibrillationCatheter AblationPulmonary VeinsAction PotentialsAgedFemaleHeart RateHumansMaleMiddle AgedObservational Studies as TopicRecurrenceRisk AssessmentRisk FactorsTime FactorsTreatment Outcomeatrial fibrillationcatheter ablationhigh‐power short‐durationpulmonary vein isolationpulsed‐field ablation

Identifiers

PMID40433752
PMCPMC12337618

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.