{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:02:44Z","timestamp":1791295364007,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Pulsed field ablation (PFA) is a non\u2010thermal alternative to conventional thermal ablation for paroxysmal atrial fibrillation (AF). We conducted an updated systematic review and meta\u2010analysis of randomized evidence comparing efficacy, safety, and procedural outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed\/MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception through March 2026 for randomized controlled trials (RCTs) comparing PFA with thermal ablation in adults undergoing first catheter ablation for paroxysmal AF. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random\u2010effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four RCTs enrolling 1 393 patients were included. PFA showed no statistically detectable difference in 12\u2010month treatment success (RR, 1.04; 95% CI, 0.97 to 1.12;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20097%), recurrent atrial arrhythmias (RR, 1.00; 95% CI, 0.77 to 1.29;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200942%), or composite serious adverse events (RR, 0.71; 95% CI, 0.32 to 1.57; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20097%). PFA shortened procedure time (MD, \u221222.42\u2009min; 95% CI, \u221233.44 to \u221211.39; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200991%) and LA dwell time (MD, \u221225.73\u2009min; 95% CI, \u221234.66 to \u221216.79;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200992%), but increased fluoroscopy time (MD, 7.34\u2009min; 95% CI, 0.39 to 14.30;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200998%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across the included trial configurations, 12\u2010month efficacy estimates did not differ detectably. Sparse safety events and wide confidence intervals precluded equivalence claims. Pooled procedure and LA dwell times favored PFA, but platform, comparator, and workflow heterogeneity limit generalizability. Procedural findings are exploratory and should not be interpreted as direct energy\u2010specific effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.70446","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:15:35Z","timestamp":1787213735000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes of Pulsed Field Vs. Thermal Ablation for Paroxysmal Atrial Fibrillation: Systematic Review and Meta\u2010Analysis of Randomized Evidence"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4664-591X","authenticated-orcid":false,"given":"Asad Ali Ahmed","family":"Cheema","sequence":"first","affiliation":[{"name":"International School of Medicine International University of Kyrgyzstan  Bishkek Kyrgyzstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3865-2619","authenticated-orcid":false,"given":"Reshail","family":"Asif","sequence":"additional","affiliation":[{"name":"Dow Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7550-0628","authenticated-orcid":false,"given":"Unsa","family":"Arif","sequence":"additional","affiliation":[{"name":"Continental Medical College  Lahore Punjab Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9087-2183","authenticated-orcid":false,"given":"Manahil","family":"Malik","sequence":"additional","affiliation":[{"name":"Women Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9585-1615","authenticated-orcid":false,"given":"Sarah","family":"Misbah","sequence":"additional","affiliation":[{"name":"Texas Health Resources HEB\/Denton  Denton Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2102-8277","authenticated-orcid":false,"given":"Eraj","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Liaquat National Medical College  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0624-7104","authenticated-orcid":false,"given":"Muhammad Iftikhar","family":"Alam","sequence":"additional","affiliation":[{"name":"Ministry of Health  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5302-7521","authenticated-orcid":false,"given":"Deep","family":"Birjani","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6671-1390","authenticated-orcid":false,"given":"Syed Umair","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Bolan Medical College  Quetta Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8797-3716","authenticated-orcid":false,"given":"FNU","family":"Hamna","sequence":"additional","affiliation":[{"name":"Fatima Jinnah Medical University  Lahore 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