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Aldaas OM, Malladi C, Han FT, Hoffmayer KS, Krummen D, Ho G, Raissi F, Birgersdotter-Green U, Feld GK, Hsu JC. Pulsed field ablation versus thermal energy ablation for atrial fibrillation: a systematic review and meta-analysis of procedural efficiency, safety, and efficacy. J Interv Card Electrophysiol 2024; 67:639-648. [PMID: 37855992 PMCID: PMC11016003 DOI: 10.1007/s10840-023-01660-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) induces cell death through electroporation using ultrarapid electrical pulses. We sought to compare the procedural efficiency characteristics, safety, and efficacy of ablation of atrial fibrillation (AF) using PFA compared with thermal energy ablation. METHODS We performed an extensive literature search and systematic review of studies that compared ablation of AF with PFA versus thermal energy sources. Risk ratio (RR) 95% confidence intervals (CI) were measured for dichotomous variables and mean difference (MD) 95% CI were measured for continuous variables, where RR < 1 and MD < 0 favor the PFA group. RESULTS We included 6 comparative studies for a total of 1012 patients who underwent ablation of AF: 43.6% with PFA (n = 441) and 56.4% (n = 571) with thermal energy sources. There were significantly shorter procedures times with PFA despite a protocolized 20-min dwell time (MD - 21.95, 95% CI - 33.77, - 10.14, p = 0.0003), but with significantly longer fluroscopy time (MD 5.71, 95% CI 1.13, 10.30, p = 0.01). There were no statistically significant differences in periprocedural complications (RR 1.20, 95% CI 0.59-2.44) or recurrence of atrial tachyarrhythmias (RR 0.64, 95% CI 0.31, 1.34) between the PFA and thermal ablation cohorts. CONCLUSIONS Based on the results of this meta-analysis, PFA was associated with shorter procedural times and longer fluoroscopy times, but no difference in periprocedural complications or rates of recurrent AF when compared to ablation with thermal energy sources. However, larger randomized control trials are needed.
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Affiliation(s)
- Omar Mahmoud Aldaas
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Chaitanya Malladi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Ulrika Birgersdotter-Green
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology at the University of California San Diego Health System, 9452 Medical Center Drive, La Jolla, CA, 92037, USA.
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of CA - San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
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Aksu T, Skeete JR, Huang HH. Ganglionic Plexus Ablation: A Step-by-step Guide for Electrophysiologists and Review of Modalities for Neuromodulation for the Management of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2023; 12:e02. [PMID: 36845167 PMCID: PMC9945432 DOI: 10.15420/aer.2022.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023] Open
Abstract
As the most common sustained arrhythmia, AF is a complex clinical entity which remains a difficult condition to durably treat in the majority of patients. Over the past few decades, the management of AF has focused mainly on pulmonary vein triggers for its initiation and perpetuation. It is well known that the autonomic nervous system (ANS) has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for AF. Neuromodulation of ANS - ganglionated plexus ablation, vein of Marshall ethanol infusion, transcutaneous tragal stimulation, renal nerve denervation, stellate ganglion block and baroreceptor stimulation - constitute an emerging therapeutic approach for AF. The purpose of this review is to summarise and critically appraise the currently available evidence for neuromodulation modalities in AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | | | - Henry H Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, US
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