Vol. 29 No. 4 (2025): Patologiya krovoobrashcheniya i kardiokhirurgiya
HEART RHYTHM DISORDERS

Pulsed-field ablation versus thermal ablation for persistent atrial fibrillation: a systematic review and meta-analysis

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  • Robert I. Kashapov,
  • Anastasia V. Guseva,
  • Sergey E. Khrushchev,
  • Pavel S. Ruzankin,
  • Alexander B. Romanov
Robert I. Kashapov
ФГБУ «Национальный медицинский исследовательский центр имени Е.Н. Мешалкина» Минздрава России
Anastasia V. Guseva
E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
Sergey E. Khrushchev
Sobolev Institute of Mathematics, Novosibirsk, Russian Federation
Pavel S. Ruzankin
Sobolev Institute of Mathematics, Novosibirsk, Russian Federation
Alexander B. Romanov
E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2025-4-54-66

Published 2026-01-21

Keywords

  • atrial fibrillation; catheter ablation; electroporation; persistent atrial fibrillation; pulsed field ablation; thermal ablation

How to Cite

Kashapov, R. I. K., Guseva, A. V. G., Khrushchev, S. E. K., Ruzankin, P. S. R., & Romanov, A. B. R. (2026). Pulsed-field ablation versus thermal ablation for persistent atrial fibrillation: a systematic review and meta-analysis. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 29(4), 54–66. https://doi.org/10.21688/1681-3472-2025-4-54-66

Copyright (c) 2026 Robert I. Kashapov, Anastasia V. Guseva, Sergey E. Khrushchev, Pavel S. Ruzankin, Alexander B. Romanov

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: Pulsed field ablation (PFA) is a widespread safe and effective approach to treat paroxysmal atrial fibrillation (AF). However, data regarding its use in persistent AF are limited, especially in comparison with thermal energy sources.

Objective: The study aimed to assess the efficacy and safety of PFA for persistent AF treatment in comparison with radiofrequency (RFA) and cryoballoon ablations (CBA). The primary concern was to evaluate 1 year freedom from any atrial arrhythmias (AA) recurrence, including AF, atrial flutter or atrial tachycardia lasting 30 seconds or longer after the blanking period.

Methods: We performed an extensive search using MEDLINE, EMBASE, and PubMed databases for studies providing outcome data on PFA in patient with persistent AF. Additionally, several studies on RFA and CBA involvement for persistent AF treatment were selected for comparative analysis.

Results: Freedom from AA at 1 year after PFA, RFA and CBA was 68.95% [95 % CI 62.72%, 74.57%], 61.72% [95 % CI 51.74%, 70.79%], 68.23% [95 % CI

63.76%, 72.39%] respectively, with no significant differences between types of energy used. No significant differences were revealed in periprocedural and postprocedural complications between compared ablation types, as well.

Conclusion: In patients with persistent AF, PFA required a shorter total procedural time than RFA but a longer one than CBA. Fluoroscopy time for PFA was significantly shorter than for thermal energy sources. No significant differences were found in safety or freedom from atrial arrhythmias at the 1-year follow-up between the compared ablation methods. Large randomized multicenter trials are needed to further assess the benefits of PFA compared to thermal energy sources in persistent AF treatment.

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