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Background <p>Cryoballoon ablation (CBA) is a widely used method for pulmonary vein isolation (PVI), while Pulsed-Field ablation (PFA) is a newer, non-thermal technique that shows promise for improved safety and efficacy.</p> Methods <p>PubMed and Cochrane Library were searched until June 2025 for studies comparing PFA and CBA techniques for atrial fibrillation (AF<b>).</b> We included randomized controlled trials and observational studies that directly compared PFA and CBA in patients with AF, including both paroxysmal and persistent AF. The primary outcome was arrhythmia recurrence. The secondary outcomes included phrenic nerve palsy, cardiac tamponade, and vascular access complications, total ablation time, total procedure duration, fluoroscopy time, and high-sensitivity cardiac troponin T (hs-cTnT) measured one day after PVI. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs). A p-value of less than 0.05 was considered significant throughout the analysis.</p> Results <p>Our meta-analysis included 24 studies with 6,435 patients (2,877 PFA; 3,558 CBA). For the outcome of arrhythmia recurrence, it was significantly lower in PFA (RR: 0.76; CI [0.68, 0.86]; <i>p</i> &lt; 0.0001) compared to patients undergoing CBA. Regarding secondary outcomes, phrenic nerve palsy (RR: 0.17; CI [0.08, 0.36]; <i>P</i> &lt; 0.00001) was found to be significantly lower in the PFA arm. From the continuous outcomes, total procedure duration (MD: -11.37; CI [-15.02, -7.72]; <i>P</i> &lt; 0.00001), total ablation duration (MD: -16.48; CI [-18.03, -14.93]; <i>P</i> &lt; 0.00001) were significantly shorter in the PFA group compared to the CBA group. As for fluoroscopy time (MD: 1.42; CI [0.42, 2.41]; <i>P</i> = 0.005) and hs-cTnT 1&#xa0;day after PVI (MD: 500.56; CI [311.61, 689.50]; <i>P</i> &lt; 0.00001) were statistically higher in the PFA. All other secondary outcomes were found to be statistically insignificant.</p> Conclusion <p>PFA was associated with lower arrhythmia recurrence, fewer complications, and shorter procedure times compared to CBA, though with higher fluoroscopy time and hs-cTnT levels.</p>

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Pulsed-field ablation versus cryoballoon ablation in patients with atrial fibrillation: A systematic review, meta-analysis and meta-regression

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Muhammad Ahmed,
  • Fatima Muskan,
  • Manesh Kumar,
  • Muzainah Tabassum,
  • Muhammad Ahmed Ali Fahim,
  • Muhammad Bilal Munir

摘要

Background

Cryoballoon ablation (CBA) is a widely used method for pulmonary vein isolation (PVI), while Pulsed-Field ablation (PFA) is a newer, non-thermal technique that shows promise for improved safety and efficacy.

Methods

PubMed and Cochrane Library were searched until June 2025 for studies comparing PFA and CBA techniques for atrial fibrillation (AF). We included randomized controlled trials and observational studies that directly compared PFA and CBA in patients with AF, including both paroxysmal and persistent AF. The primary outcome was arrhythmia recurrence. The secondary outcomes included phrenic nerve palsy, cardiac tamponade, and vascular access complications, total ablation time, total procedure duration, fluoroscopy time, and high-sensitivity cardiac troponin T (hs-cTnT) measured one day after PVI. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs). A p-value of less than 0.05 was considered significant throughout the analysis.

Results

Our meta-analysis included 24 studies with 6,435 patients (2,877 PFA; 3,558 CBA). For the outcome of arrhythmia recurrence, it was significantly lower in PFA (RR: 0.76; CI [0.68, 0.86]; p < 0.0001) compared to patients undergoing CBA. Regarding secondary outcomes, phrenic nerve palsy (RR: 0.17; CI [0.08, 0.36]; P < 0.00001) was found to be significantly lower in the PFA arm. From the continuous outcomes, total procedure duration (MD: -11.37; CI [-15.02, -7.72]; P < 0.00001), total ablation duration (MD: -16.48; CI [-18.03, -14.93]; P < 0.00001) were significantly shorter in the PFA group compared to the CBA group. As for fluoroscopy time (MD: 1.42; CI [0.42, 2.41]; P = 0.005) and hs-cTnT 1 day after PVI (MD: 500.56; CI [311.61, 689.50]; P < 0.00001) were statistically higher in the PFA. All other secondary outcomes were found to be statistically insignificant.

Conclusion

PFA was associated with lower arrhythmia recurrence, fewer complications, and shorter procedure times compared to CBA, though with higher fluoroscopy time and hs-cTnT levels.