{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:02:16Z","timestamp":1785423736005,"version":"3.56.0"},"reference-count":52,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"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":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Pulsed field ablation (PFA) has emerged as a non\u2010thermal alternative for pulmonary vein isolation (PVI), offering shorter procedural times and a favorable safety profile for atrial fibrillation (AF) ablation. However, large\u2010scale data evaluating its efficacy in patients with persistent AF remain limited. Our objective was to perform a systematic review and meta\u2010analysis evaluating 12\u2010month atrial arrhythmia recurrence following PFA in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of MEDLINE, Embase, Scopus, LILACS, and Cochrane databases was performed. Studies including patients with persistent AF undergoing first\u2010time PVI with PFA and reporting 12\u2010month arrhythmia\u2010free survival were included. When available, outcomes were compared with thermal ablation using time\u2010to\u2010event analyses. Random\u2010effects models were used. Exploratory meta\u2010regression analyses were conducted to assess potential sources of heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1699 screened studies, 26 met the inclusion criteria, comprising 3744 patients with persistent AF treated with PFA. The pooled 12\u2010month freedom from atrial arrhythmia recurrence was 72.3% (95% CI, 69.0\u201375.5), with substantial heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      \u00b2\u2009=\u200974.4%). Eight studies (31%) included a thermal comparator; pooled time\u2010to\u2010event analysis demonstrated no significant difference between PFA and thermal ablation (HR, 0.91 [95% CI, 0.78\u20131.07]). Exploratory meta\u2010regression did not identify significant effect modification by baseline characteristics, lesion\u2010set strategy, rhythm monitoring intensity, or year of publication. Ablation\u2010related adverse events occurred in &lt;\u20091% of cases for both energy sources.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with persistent AF, PFA is associated with a high arrhythmia\u2010free survival at 12 months and low rates of ablation\u2010related adverse events. Comparative findings versus thermal ablation should be considered exploratory and interpreted cautiously, given the limited and heterogeneous comparator data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70384","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:02:02Z","timestamp":1780398122000},"page":"1541-1553","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulsed\u2010Field Ablation for Persistent Atrial Fibrillation: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9719-4870","authenticated-orcid":false,"given":"Daniel","family":"Villarreal","sequence":"first","affiliation":[{"name":"Harvard\u2010Thorndike Electrophysiology Institute Beth Israel Deaconess Medical Center Boston Massachusetts 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