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Journal of Interventional Cardiac Electrophysiology
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Open Access 19-10-2023 | Atrial Fibrillation

Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy

Authors: Omar Mahmoud Aldaas, Chaitanya Malladi, Frederick T. Han, Kurt S. Hoffmayer, David Krummen, Gordon Ho, Farshad Raissi, Ulrika Birgersdotter-Green, Gregory K. Feld, Jonathan C. Hsu

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2024

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Abstract

Background

Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation.

Methods

We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group.

Results

We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD − 21.95, 95% CI − 33.77, − 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59–2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts.

Conclusions

Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.
Literature
1.
Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S adult population. Am J Cardiol. 2013;112:1142–7.CrossRefPubMed
2.
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Jr., Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM and Yancy CW. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation. 2019:CIR0000000000000665.
3.
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Wyn Davies D, Day JD, d’Avila A, de Groot N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol. 2017;50:1–55.CrossRefPubMedPubMedCentral
4.
Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33:223–31.CrossRefPubMed
5.
Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality–clinical implications. Technol Cancer Res Treat. 2007;6:37–48.CrossRefPubMed
6.
du Pre BC, van Driel VJ, van Wessel H, Loh P, Doevendans PA, Goldschmeding R, Wittkampf FH, Vink A. Minimal coronary artery damage by myocardial electroporation ablation. Europace. 2013;15:144–9.CrossRefPubMed
7.
Neven K, van Es R, van Driel V, van Wessel H, Fidder H, Vink A, Doevendans P, Wittkampf F. Acute and long-term effects of full-power electroporation ablation directly on the porcine esophagus. Circ Arrhythm Electrophysiol. 2017;10(5):e004672.
8.
van Driel VJ, Neven K, van Wessel H, Vink A, Doevendans PA, Wittkampf FH. Low vulnerability of the right phrenic nerve to electroporation ablation. Heart Rhythm. 2015;12:1838–44.CrossRefPubMed
9.
van Driel VJ, Neven KG, van Wessel H, du Pre BC, Vink A, Doevendans PA, Wittkampf FH. Pulmonary vein stenosis after catheter ablation: electroporation versus radiofrequency. Circ Arrhythm Electrophysiol. 2014;7:734–8.CrossRefPubMed
10.
Schaack D, Schmidt B, Tohoku S, Bordignon S, Urbanek L, Ebrahimi R, Hirokami J, Efe TH, Chen S, Chun KJ. Pulsed field ablation for atrial fibrillation. Arrhythm Electrophysiol Rev. 2023;12:e11.CrossRefPubMedPubMedCentral
11.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65-94.CrossRefPubMed
12.
Reddy VY, Gerstenfeld EP, Natale A, Whang W, Cuoco FA, Patel C, Mountantonakis SE, Gibson DN, Harding JD, Ellis CR, Ellenbogen KA, DeLurgio DB, Osorio J, Achyutha AB, Schneider CW, Mugglin AS, Albrecht EM, Stein KM, Lehmann JW, Mansour M and Investigators A. Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation. N Engl J Med. 2023.
13.
Cochet H, Nakatani Y, Sridi-Cheniti S, Cheniti G, Ramirez FD, Nakashima T, Eggert C, Schneider C, Viswanathan R, Derval N, Duchateau J, Pambrun T, Chauvel R, Reddy VY, Montaudon M, Laurent F, Sacher F, Hocini M, Haissaguerre M, Jais P. Pulsed field ablation selectively spares the oesophagus during pulmonary vein isolation for atrial fibrillation. Europace. 2021;23:1391–9.CrossRefPubMedPubMedCentral
14.
Kuroki K, Whang W, Eggert C, Lam J, Leavitt J, Kawamura I, Reddy A, Morrow B, Schneider C, Petru J, Turagam MK, Koruth JS, Miller MA, Choudry S, Ellsworth B, Dukkipati SR, Neuzil P, Reddy VY. Ostial dimensional changes after pulmonary vein isolation: pulsed field ablation vs radiofrequency ablation. Heart Rhythm. 2020;17:1528–35.CrossRefPubMed
15.
Nakatani Y, Sridi-Cheniti S, Cheniti G, Ramirez FD, Goujeau C, Andre C, Nakashima T, Eggert C, Schneider C, Viswanathan R, Krisai P, Takagi T, Kamakura T, Vlachos K, Derval N, Duchateau J, Pambrun T, Chauvel R, Reddy VY, Montaudon M, Laurent F, Sacher F, Hocini M, Haissaguerre M, Jais P, Cochet H. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation. Europace. 2021;23:1767–76.CrossRefPubMedPubMedCentral
16.
Maurhofer J, Kueffer T, Madaffari A et al. Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2023.
17.
Blockhaus C, Guelker JE, Feyen L, Bufe A, Seyfarth M, Shin DI. Pulsed field ablation for pulmonary vein isolation: real-world experience and characterization of the antral lesion size compared with cryoballoon ablation. J Interv Card Electrophysiol. 2022;66(3):567–75
18.
19.
Reddy VY, Anic A, Koruth J, Petru J, Funasako M, Minami K, Breskovic T, Sikiric I, Dukkipati SR, Kawamura I, Neuzil P. Pulsed field ablation in patients with persistent atrial fibrillation. J Am Coll Cardiol. 2020;76:1068–80.CrossRefPubMed
20.
Duytschaever M, De Potter T, Grimaldi M, Anic A, Vijgen J, Neuzil P, Van Herendael H, Verma A, Skanes A, Scherr D, Purerfellner H, Rackauskas G, Jais P, Reddy VY. Paroxysmal atrial fibrillation ablation using a novel variable-loop biphasic pulsed field ablation catheter integrated with a 3-dimensional mapping system: 1-year outcomes of the multicenter inspIRE study. Circ Arrhythm Electrophysiol. 2023;16:e011780.CrossRefPubMedPubMedCentral
21.
Ekanem E, Reddy VY, Schmidt B, Reichlin T, Neven K, Metzner A, Hansen J, Blaauw Y, Maury P, Arentz T, Sommer P, Anic A, Anselme F, Boveda S, Deneke T, Willems S, van der Voort P, Tilz R, Funasako M, Scherr D, Wakili R, Steven D, Kautzner J, Vijgen J, Jais P, Petru J, Chun J, Roten L, Futing A, Rillig A, Mulder BA, Johannessen A, Rollin A, Lehrmann H, Sohns C, Jurisic Z, Savoure A, Combes S, Nentwich K, Gunawardene M, Ouss A, Kirstein B, Manninger M, Bohnen JE, Sultan A, Peichl P, Koopman P, Derval N, Turagam MK, Neuzil P, Cooperative M-P. Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace. 2022;24:1256–66.CrossRefPubMedPubMedCentral
22.
Reddy VY, Peichl P, Anter E, Rackauskas G, Petru J, Funasako M, Minami K, Koruth JS, Natale A, Jais P, Marinskis G, Aidietis A, Kautzner J, Neuzil P. A focal ablation catheter toggling between radiofrequency and pulsed field energy to treat atrial fibrillation. JACC Clin Electrophysiol. 2023;9:1786–801.CrossRefPubMed
23.
Ruwald MH, Johannessen A, Hansen ML, Haugdal M, Worck R and Hansen J. Pulsed field ablation in real-world atrial fibrillation patients: clinical recurrence, operator learning curve and re-do procedural findings. J Interv Card Electrophysiol. 2023.
24.
Turagam MK, Neuzil P, Petru J, Funasako M, Koruth JS, Reinders D, Skoda J, Kralovec S, Reddy VY. PV isolation using a spherical array PFA catheter: application repetition and lesion durability (PULSE-EU study). JACC Clin Electrophysiol. 2023;9:638–48.CrossRefPubMed
25.
Verma A, Haines DE, Boersma LV, Sood N, Natale A, Marchlinski FE, Calkins H, Sanders P, Packer DL, Kuck KH, Hindricks G, Onal B, Cerkvenik J, Tada H, DeLurgio DB, Investigators PA. Pulsed field ablation for the treatment of atrial fibrillation: PULSED AF pivotal trial. Circulation. 2023;147(19):1422–32.
26.
Yarmush ML, Golberg A, Sersa G, Kotnik T, Miklavcic D. Electroporation-based technologies for medicine: principles, applications, and challenges. Annu Rev Biomed Eng. 2014;16:295–320.CrossRefPubMed
27.
Sugrue A, Vaidya V, Witt C, DeSimone CV, Yasin O, Maor E, Killu AM, Kapa S, McLeod CJ, Miklavcic D, Asirvatham SJ. Irreversible electroporation for catheter-based cardiac ablation: a systematic review of the preclinical experience. J Interv Card Electrophysiol. 2019;55:251–65.CrossRefPubMed
28.
Koruth JS, Kuroki K, Iwasawa J, Viswanathan R, Brose R, Buck ED, Donskoy E, Dukkipati SR, Reddy VY. Endocardial ventricular pulsed field ablation: a proof-of-concept preclinical evaluation. Europace. 2020;22:434–9.CrossRefPubMed
29.
Koruth J, Kuroki K, Iwasawa J, Enomoto Y, Viswanathan R, Brose R, Buck ED, Speltz M, Dukkipati SR, Reddy VY. Preclinical evaluation of pulsed field ablation: electrophysiological and histological assessment of thoracic vein isolation. Circ Arrhythm Electrophysiol. 2019;12:e007781.CrossRefPubMedPubMedCentral
30.
Musikantow DR, Neuzil P, Anic A, Balin P, Petru J, Funasako M, Lisica L, Jurisic Z, Jais P, Reddy VY. Long-term clinical outcomes of pulsed field ablation in the treatment of paroxysmal atrial fibrillation. JACC Clin Electrophysiol. 2023; 9(9):2001–3.
31.
Reddy VY, Petru J, Funasako M, Kopriva K, Hala P, Chovanec M, Janotka M, Kralovec S, Neuzil P. Coronary arterial spasm during pulsed field ablation to treat atrial fibrillation. Circulation. 2022;146:1808–19.CrossRefPubMed
32.
Calkins H, Natale A, Gomez T, Etlin A, Bishara M. Comparing rates of atrioesophageal fistula with contact force-sensing and non-contact force-sensing catheters: analysis of post-market safety surveillance data. J Interv Card Electrophysiol. 2020;59:49–55.CrossRefPubMed
33.
Fender EA, Widmer RJ, Hodge DO, Cooper GM, Monahan KH, Peterson LA, Holmes DR Jr, Packer DL. Severe pulmonary vein stenosis resulting from ablation for atrial fibrillation: presentation, management, and clinical outcomes. Circulation. 2016;134:1812–21.CrossRefPubMed
34.
Andrade JG, Khairy P, Guerra PG, Deyell MW, Rivard L, Macle L, Thibault B, Talajic M, Roy D, Dubuc M. Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm. 2011;8:1444–51.CrossRefPubMed
35.
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Packer D, Skanes A. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–5.CrossRefPubMed
36.
Aldaas OM, Malladi CL, Aldaas AM, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK and Hsu JC. Safety and acute efficacy of catheter ablation for atrial fibrillation with pulsed field ablation versus thermal energy ablation: a systematic review and meta-analysis. Heart Rhythm O2. In Press.
37.
Khan AA, Lip GYH, Shantsila A. Heart rate variability in atrial fibrillation: the balance between sympathetic and parasympathetic nervous system. Eur J Clin Invest. 2019;49:e13174.CrossRefPubMed
Metadata
Title
Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy
Authors
Omar Mahmoud Aldaas
Chaitanya Malladi
Frederick T. Han
Kurt S. Hoffmayer
David Krummen
Gordon Ho
Farshad Raissi
Ulrika Birgersdotter-Green
Gregory K. Feld
Jonathan C. Hsu
Publication date
19-10-2023
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 3/2024
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-023-01660-3

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