Pulsed field <i>vs</i> cryoballoon ablation: A meta-analysis with Hartung–Knapp, subgroup, and meta-regression analyses
Bibliographic record
Abstract
BACKGROUND Atrial fibrillation, affecting approximately 33 million people globally, is the most common sustained arrhythmia, increasing risks of stroke, heart failure, and mortality. Pulmonary vein isolation via catheter ablation is a key rhythm control strategy, with cryoballoon ablation (CBA) being a standard thermal method but associated with risks like phrenic nerve palsy (5%-10%), esophageal injury, and vein stenosis. Pulsed field ablation (PFA), a non-thermal technique using electrical pulses for selective electroporation, offers potential for shorter procedures and improved safety. Limited direct comparisons between PFA and CBA necessitate a systematic evaluation of their efficacy and safety. AIM To compare the procedural success, safety, and 1-year arrhythmia-free survival of PFA vs CBA for first-time pulmonary vein isolation in adults with paroxysmal or persistent atrial fibrillation. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis was conducted, searching PubMed, EMBASE, Web of Science, and other databases up to August 2025 for comparative studies. Pooled mean difference for continuous outcomes and odds ratio (OR) for dichotomous outcomes were calculated using random-effects models. Study quality was assessed with the Newcastle-Ottawa Scale, heterogeneity with I 2, and publication bias with funnel plots. RESULTS Seven studies (six cohorts, one randomized controlled trial) were included, with a mean age of approximately 66 years, 59%-78% male, and high prevalence of hypertension and diabetes. PFA significantly reduced procedure time (mean difference = -15.24 minutes, 95%CI: -16.63 to -13.85, P < 0.00001; I 2 = 89%), improved arrhythmia-free survival (OR = 1.27, 95%CI: 1.04-1.55, P = 0.02; I 2 = 45%), and lowered phrenic nerve palsy risk (OR = 0.17, 95%CI: 0.04-0.63, P = 0.008; I 2 = 0%). No significant differences were found in fluoroscopy time, cardiac tamponade, repeat ablation, or vascular complications. CONCLUSION PFA demonstrates shorter procedure times, reduced phrenic nerve palsy, and better arrhythmia control compared to CBA, with comparable safety profiles. However, evidence is limited by observational study designs, heterogeneity, and potential bias. Large-scale randomized controlled trials with extended follow-up are needed to confirm these findings and guide clinical practice.
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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 | 0.019 | 0.038 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.025 | 0.083 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
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".