Arrhythmias & electrophysiologyMeta-analysis
Dosing of single-shot pulsed field ablation systems: A systematic review of efficacy and safety balance
- Systematic review
Authors' conclusion
Comparison is difficult owing to the heterogeneity of systems. Prospective trials are needed to optimize PFA dosing, balancing efficacy and safety.
Study context
- Population
- Patients undergoing pulmonary vein isolation for atrial fibrillation with single-shot pulsed field ablation systemsprimary pulmonary vein isolation (PVI) studies included, of 804 PubMed studies
- Participants
- 47 patients
- Comparison
- Efficacy and safety of single-shot pulsed field ablation (PFA) systems
Pooled result
As reported in the abstract
Acute PVI
All PFA systems reported almost 100% acute PVI
almost 100%
Further pooled results
| Outcome | multispline and circular | spherical |
|---|---|---|
| Arrhythmia-free survival · 6-12 months | 55%-88% | 77%-88% |
Safety
| Outcome | pentaspline | variable-loop |
|---|---|---|
| Acute kidney injury | n = 39 of 1307 | n = 4 of 122 |
- Acute kidney injury: occurred only with the pentaspline and variable-loop catheters
Hemolysis biomarkers
- Significant changes with the multispline, circular, and spherical catheters
Myocardial injury biomarkers
- Significantly increased in the multispline, circular, and spherical catheters
- Hemolysis, acute kidney injury, and myocardial injury were all linked to more applications
Original publication
Dosing of single-shot pulsed field ablation systems: A systematic review of efficacy and safety balance. Heart Rhythm. Published 25 May 2026. doi:10.1016/j.hrthm.2026.05.025
Summarised from the published abstract; every number is checked against it