Pulsed Field Ablation Versus Cryoballoon Ablation for Pulmonary Vein Isolation in Atrial Fibrillation: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background and Aims: Atrial fibrillation (AF) is the most common sustained arrhythmia, with pulmonary vein isolation (PVI) via catheter ablation serving as a key rhythm control strategy. Cryoballoon ablation (CBA) is established, but pulsed field ablation (PFA), a non-thermal technique, promises enhanced safety and efficiency. This meta-analysis aims to compare PFA and CBA in adults undergoing first-time PVI for paroxysmal or persistent AF, evaluating acute procedural success, safety (e.g., phrenic nerve palsy, tamponade), and 1-year arrhythmia-free survival, with subgroup analyses by AF type. Methods : Conducted per PRISMA guidelines and registered on PROSPERO (ID: CRD420251139409), we searched PubMed, Embase, Web of Science, and others from inception to August 2025. Included were RCTs and observational studies comparing PFA and CBA with extractable data on key outcomes. Quality was assessed via Newcastle-Ottawa Scale and GRADE. Random-effects models in RevMan 5.4 pooled mean differences (MD) for continuous outcomes and odds/risk ratios (OR/RR) for dichotomous ones, with heterogeneity via I 2 . Results: Seven studies were included. PFA showed shorter procedure time (MD -15.24 min, 95% CI -16.63 to -13.85; P<0.00001; I 2 =89%) and no difference in fluoroscopy time (MD -0.06 min, 95% CI -0.45 to 0.33; P=0.77; I 2 =94%). Freedom from arrhythmia was higher with PFA (OR 1.27, 95% CI 1.04-1.55; P=0.02; I 2 =45%), and phrenic nerve palsy lower (RR 0.17, 95% CI 0.04-0.63; P=0.008; I 2 =0%). No differences in cardiac tamponade (OR 2.11, 95% CI 0.80-5.57; P=0.13; I 2 =0%), repeat ablation (OR 0.84, 95% CI 0.65-1.09; P=0.18; I 2 =75%), or vascular complications (OR 0.96, 95% CI 0.32-2.94; P=0.96; I 2 =0%). Subgroups by AF type were consistent. GRADE certainty was low to very low. Conclusion: PFA offers procedural advantages and reduced phrenic injury over CBA, with superior arrhythmia control, though evidence quality is limited. Large RCTs are needed for confirmation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.023 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.034 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".