Introduction. Pulsed-field ablation (PFA) has emerged as a non-thermal catheter-based treatment for paroxysmal atrial fibrillation. This study aimed to compare the efficacy of PFA with various conventional thermal ablation methods that are currently available.
Method. Randomised controlled trials were retrieved to compare atrial tachyarrhythmia recurrence among any combination of ablation modalities. A Bayesian and frequentist network meta-analysis (NMA) using risk ratio (RR) was conducted with MetaInsight v5.1.1. Treatment strategies were ranked using the surface under the cumulative ranking area (SUCRA).
Results. Across 14 studies comparing five ablation therapies (3,233 patients), Bayesian NMA-derived RRs of atrial arrhythmia recurrence compared to PFA were 0.90 (95% Credible Interval [CrI]=0.57-1.45) for cryoballoon ablation (CBA), 0.99 (95% CrI=0.61-1.55) for radiofrequency ablation (RFA), 1.07 (95% CrI=0.61-1.87) for combined CBA and RFA, and 0.81 (95% CrI=0.43-1.51) for laser-balloon ablation (LBA) (Figure 1). Similarly, the frequentist-based NMAs showed no significant benefit of all ablation therapies over PFA. The direct and indirect comparison among the various ablation techniques showed similar outcomes within the different ablation modalities evaluated in this NMA. The higher SUCRA value for LBA (80%) indicated the likelihood that the treatment is the best, followed by CBA (67%), PFA (48%), and RFA (45%) (Figure 2).
Conclusions. This NMA demonstrated that among patients with paroxysmal atrial fibrillation receiving a catheter-based therapy, PFA was non-inferior to conventional thermal ablation concerning freedom from documented atrial tachyarrhythmia during follow-up.
