Xue Jun, Huang Qunying, Yu Fuling, Mao Yinjun
Department of Pharmacy, The First Hospital of Putian City, Putian, China.
Department of Cardiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Pacing Clin Electrophysiol. 2025 Feb;48(2):180-191. doi: 10.1111/pace.15141. Epub 2025 Jan 5.
To optimize the effectiveness and safety of pulmonary vein isolation, pulsed-field ablation (PFA) and high-power short-duration ablation (HPSD) have recently been incorporated into clinical practice. The objective of this study is to conduct a comparative analysis, focusing on the efficacy, safety, and procedural efficiency of PFA and HPSD in the treatment of atrial fibrillation (AF).
A thorough search was performed across multiple databases to identify trials that compared PFA with HPSD for AF from their inception until July 2024. The odds ratio (OR) and mean difference (MD), accompanied by a 95% confidence interval (CI), were employed as indicators of treatment efficacy.
The analysis included six eligible trials, encompassing a total enrollment of 1382 patients. No statistically significant disparities were observed in terms of freedom from any atrial arrhythmia (OR 1.10; 95% CI 0.75, 1.63) or periprocedural complications (OR 1.04; 95% CI 0.52, 2.09) between the two ablation techniques. The likelihood of requiring a repeat ablation procedure was significantly reduced with PFA compared to HPSD (OR 0.63; 95% CI 0.41-0.97); however, there was no significant difference in the incidence of PV reconnection between patients initially treated with HPSD and those using PFA (OR 0.83; 95% CI 0.53-1.30). The PFA technique demonstrated significantly shorter procedure time (MD -34.58; 95% CI -45.20, -23.96) and left atrium (LA) dwell time (MD -34.52; 95% CI -58.42, -10.61), but longer fluoroscopy time (MD 8.81; 95% CI 6.25, 11.37). The subgroup analyses revealed that PFA continued to exhibit superior procedure time and LA dwell time but inferior fluoroscopy time.
The efficacy and safety profiles of both PFA and HPSD are comparable in patients undergoing ablation therapy for AF; however, PFA is associated with shorter procedural time and longer fluoroscopy time.
为优化肺静脉隔离的有效性和安全性，脉冲场消融（PFA）和高功率短时程消融（HPSD）最近已应用于临床实践。本研究的目的是进行一项对比分析，重点关注PFA和HPSD治疗心房颤动（AF）的疗效、安全性和手术效率。
对多个数据库进行全面检索，以确定从开始到2024年7月比较PFA和HPSD治疗AF的试验。比值比（OR）和平均差（MD）以及95%置信区间（CI）用作治疗疗效指标。
分析纳入了6项符合条件的试验，共纳入1382例患者。两种消融技术在无任何房性心律失常（OR 1.10；95%CI 0.75，1.63）或围手术期并发症（OR 1.04；95%CI 0.52，2.09）方面未观察到统计学上的显著差异。与HPSD相比，PFA需要重复消融手术的可能性显著降低（OR 0.63；95%CI 0.41 - 0.97）；然而，最初接受HPSD治疗的患者与接受PFA治疗的患者之间肺静脉重新连接的发生率没有显著差异（OR 0.83；95%CI 0.53 - 1.30）。PFA技术显示手术时间（MD -34.58；95%CI -45.20，-23.96）和左心房（LA）停留时间（MD -34.52；95%CI -58.42，-10.61）显著缩短，但透视时间较长（MD 8.81；95%CI 6.25，11.37）。亚组分析显示，PFA的手术时间和LA停留时间仍然更优，但透视时间较差。
在接受AF消融治疗的患者中，PFA和HPSD的疗效和安全性相当；然而，PFA与较短的手术时间和较长的透视时间相关。
