Arrhythmias & electrophysiologyMeta-analysis
Comparative efficacy and safety of catheter ablation energy modalities for atrial fibrillation: A network meta-analysis of randomized trials
- network meta-analysis of randomized trials
- random-effects
Authors' conclusion
Contemporary catheter ablation modalities demonstrated broadly comparable efficacy and safety for AF. PFA was associated with greater AF burden reduction and superior procedural efficiency, whereas the observed hospitalization benefit was not confirmed in Bayesian sensitivity analysis and warrants cautious interpretation.
Study context
- Population
- Patients undergoing catheter ablation for atrial fibrillation (AF)
- Participants
- 7,226 patients · 32 randomized controlled trials
- Comparison
- Comparative effects across 5 ablation energy modalities
Pooled result
As reported in the abstract
Atrial tachyarrhythmia recurrence, repeat ablation, cardioversion, patient-reported outcomes
- No significant differences were observed among modalities
Further pooled results
| Outcome | mean difference (95% CI) | |
|---|---|---|
| AF burden reduction — PFA vs RFA · greater AF burden reduction with PFA | −0.78% (−0.91 to −0.65) | |
| AF burden reduction — PFA vs CBA · greater AF burden reduction with PFA | −0.90% (−1.01 to −0.79) | |
| −1.5−1−0.500.5Difference (linear scale) |
| Outcome | risk ratio (95% CI) | |
|---|---|---|
| Hospitalization · lower with PFA; primary frequentist analysis · primary frequentist analysis | 0.34 (0.12–0.95) | |
| 0.10.31310Risk ratio (log scale) |
Hospitalization
- Bayesian sensitivity analysis showed no significant differences across modalities
Procedural efficiency
- Both pulsed field ablation (PFA) and cryoballoon ablation (CBA) were associated with shorter total procedure duration and left atrial dwell time than RFA
- fluoroscopy time was shortest with RFA
Original publication
Comparative efficacy and safety of catheter ablation energy modalities for atrial fibrillation: A network meta-analysis of randomized trials. Heart Rhythm. Published 26 May 2026. doi:10.1016/j.hrthm.2026.05.038
Summarised from the published abstract; every number is checked against it