Comparison of pulse field ablation versus cryoballoon ablation in atrial fibrillation: systematic review and meta-analysis on safety and efficacy

As the cornerstone of ablation, cryoballoon Ablation (CBA) still has certain limitations, whereas Pulse Field Ablation (PFA) offers a non-thermal and tissue specific alternative. This review aims to compare the safety and efficacy of PFA and CBA. A systematic search for eligible studies was conducted in trial registries and databases until August 31, 2024. A total of 1090 patients from eight studies were included. Most studies reported higher 1-year free recurrence rate in PFA, but did not yield statistical significance (RR 1.03, 95%CI: 0.94, 1.12, p = 0.55, I2 = 0%). PFA was associated with a significantly lower contrast volume (MD −41.63, 95% CI: −49.19 to −34.06, p < 0.00001, I2 = 0%), but showed non-significant differences in procedural time (MD −5.84, 95% CI: −12.35 to 0.66, p = 0.08, I2 = 83%) and fluoroscopy time (MD 1.43, 95% CI: −0.09 to 2.95, p = 0.07, I2 = 75%). Complications were comparable, except for phrenic nerve palsy (PNP) that occurred exclusively in CBA. PFA and CBA are comparable in the terms of acute success and 1-year free recurrence rates. Repeat procedures were more frequent after PFA. However, organized atrial tachycardia (AT) was more commonly observed in the CBA group, while recurrences in both groups were predominantly Atrial Fibrillation (AF). PFA offers advantages in procedural time and contrast medium use. Complication rate for PFA and CBA was similar except for PNP which exclusively occurred in CBA.