Arrhythmias & electrophysiologyMeta-analysis
Pulsed field vs thermal ablation for atrial fibrillation: A Bayesian meta-analysis
- Bayesian meta-analysis
- individual patient data reconstructed from Kaplan-Meier curves
- Cox frailty regression model
- Bayesian random-effects model
Authors' conclusion
In patients with AF undergoing catheter ablation, PFA was associated with reduced arrhythmia recurrence compared with thermal ablation, with larger effects in observational studies and more modest effects in RCTs, and no signal of increased harm.
Study context
- Population
- Patients with atrial fibrillation (AF) undergoing catheter ablation12 studies (4 RCTs, 8 observational), 46.6% pulsed field ablation (PFA) · randomized controlled trials [RCTs] 4 · observational 8
- Participants
- 3,120 patients
- Comparison
- PFA vs thermal ablation
Pooled result
As reported in the abstract
Freedom from atrial tachyarrhythmia recurrence (time-to-event analysis, 1 RCT, 6 observational)
Hazard ratio
0.68
95% credible interval CI 0.55–0.84
PFA vs thermal ablation
hazard ratio 0.68 (95% credible interval CI 0.55–0.84)
Further pooled results
Time to benefit
- Time to benefit to prevent 5 atrial arrhythmia recurrences per 100 PFA-treated patients
- 12 months
Probability of a clinically meaningful reduction (odds ratio <0.8) in arrhythmia recurrence (study-level)
- RCTs
- 34.1%
- observational studies
- 96.5%
Procedural and left atrial dwell times
- PFA had a high likelihood of shorter procedural and left atrial dwell times
Original publication
Pulsed field vs thermal ablation for atrial fibrillation: A Bayesian meta-analysis. Heart Rhythm. Published 25 February 2026. doi:10.1016/j.hrthm.2026.02.028
Summarised from the published abstract; every number is checked against it