Arrhythmias & electrophysiologyMeta-analysis
Ventricular pulsed field ablation from bench to bedside: preclinical and clinical evidence from a systematic review and meta-analysis
- Systematic review and meta-analysis of preclinical and clinical studies
- random-effects models
Authors' conclusion
Ventricular PFA demonstrates high acute efficacy and encouraging mid-term outcomes, supported by preclinical evidence of favourable lesion penetration within scarred myocardium.
Study context
- Population
- Preclinical models and patients undergoing ventricular pulsed field ablation (PFA) for ventricular arrhythmia75 studies (33 preclinical, 43 clinical)
- Participants
- 355 participants
Pooled result
As reported in the abstract
Pooled preclinical lesion depth/transmurality and clinical acute success, recurrence of ventricular PFA
Within-study mean depth difference
2.09 mm
95% CI 0.84–3.34
PFA vs RF
within-study mean depth difference 2.09 mm (95% CI 0.84–3.34)
- Mean lesion depth, healthy endocardium (preclinical)
- 5.96 mm (95% CI 5.07-6.84)
- Mean lesion depth, healthy epicardium (preclinical)
- 5.19 mm (95% CI 2.58-7.79)
- Mean lesion depth, scarred myocardium (preclinical)
- 5.96 mm (95% CI 5.39-6.53)
- Lesion transmurality, healthy tissues
- 32% (95% CI 15-52%)
- Lesion transmurality, within scar
- 53% (95% CI 36-70%)
- Acute success, PVCs (studies with ≥3 patients)
- 90% (95% CI 83-96%)
- Acute success, VT (studies with ≥3 patients)
- 92% (95% CI 87-96%)
- Recurrence, PVCs (mean follow-up ≈5 months)
- 19% (95% CI 12-28%)
- Recurrence, VT (mean follow-up ≈5 months)
- 21% (95% CI 10-35%)
Further pooled results
Recurrence · mean follow-up approximately 5 months
- PVCs
- 19% (95% CI 12-28%)
- VT
- 21% (95% CI 10-35%)
Determinants of lesion depth
- Greater contact force, repeated applications and higher energy/duration associated with increased lesion depth
Safety
Overall complication rate (studies with ≥3 patients)
- Overall complications (95% CI 5-17%); most frequent: coronary artery spasm and conduction disturbances
- 10%
Original publication
Ventricular pulsed field ablation from bench to bedside: preclinical and clinical evidence from a systematic review and meta-analysis. Europace. Published 19 August 2026. doi:10.1093/europace/euag221
Summarised from the published abstract; every number is checked against it