{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T16:00:28Z","timestamp":1784995228152,"version":"3.55.0"},"reference-count":57,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"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":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pulsed\u2010field ablation (PFA) is a novel, nonthermal modality for the treatment of atrial fibrillation (AF) that may reduce procedural complications compared with conventional thermal ablation methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p>\n                      A systematic literature review was conducted to identify studies comparing PFA with second\u2010generation cryoballoon ablation (2G\u2010CBA) and contact force\u2010sensing radiofrequency ablation (CF\u2010RFA) for paroxysmal AF (pAF) from the inception of PFA to January 2026. A single\u2010arm meta\u2010analysis was performed using random\u2010effects models, reporting the arcsine of the square root transformation (PAS) or mean (95% CI) for each intervention. Overall, 29 studies (9 randomized controlled trials and 20 observational studies) were included. Arrhythmia recurrence rates were comparable across all three interventions [PFA: 23.90% (PAS 0.24, 95% CI 0.19\u20130.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001); CF\u2010RFA: 23.72% (PAS 0.24, 95% CI 0.19\u20130.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001); 2G\u2010CBA: 25.56% (PAS 0.26, 95% CI 0.20\u20130.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001)]. Overall procedure time was significantly shorter with PFA than with CF\u2010RFA and comparable to 2G\u2010CBA [PFA: mean 87.66\u00a0min (95% CI 74.29\u2013101.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001); CF\u2010RFA: mean 137.54\u00a0min (95% CI 123.65\u2013151.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001); 2G\u2010CBA: mean 105.56\u00a0min (95% CI 89.93\u2013121.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001)]. Fluoroscopy time was shorter with PFA than with 2G\u2010CBA but comparable to CF\u2010RFA [PFA: mean 16.12\u00a0min (95% CI 12.36\u201319.88); CF\u2010RFA: mean 17.28\u00a0min (95% CI 13.59\u201320.98); 2G\u2010CBA: mean 22.08\u00a0min (95% CI 18.23\u201325.94)]. Overall complication rates did not differ significantly among the three interventions [PFA: 2.93% (95% CI 1.87\u20134.22%); CF\u2010RFA: 3.66% (95% CI 1.84\u20136.07%); 2G\u2010CBA: 6.52% (95% CI 4.41\u20139.00%)]. The incidence of phrenic nerve palsy was significantly higher with 2G\u2010CBA than with PFA or CF\u2010RFA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PFA demonstrated comparable efficacy and safety to CF\u2010RFA and 2G\u2010CBA, with a numerically shorter procedure time than CF\u2010RFA and a lower incidence of phrenic nerve palsy than 2G\u2010CBA, supporting PFA as a viable alternative to established ablation techniques for pAF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70375","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T15:00:37Z","timestamp":1784991637000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy, Safety, and Procedural Outcomes of Pulsed\u2010Field Ablation for Paroxysmal Atrial Fibrillation: A Meta\u2010Analysis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2276-0476","authenticated-orcid":false,"given":"Mohamad Anas","family":"Oudih","sequence":"first","affiliation":[{"name":"Division of Internal Medicine Ball Memorial Hospital Indiana University  Muncie Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0720-3380","authenticated-orcid":false,"given":"Marco","family":"Schiavone","sequence":"additional","affiliation":[{"name":"Department of Clinical Electrophysiology and Cardiac Pacing Centro Cardiologico Monzino IRCCS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1809-2367","authenticated-orcid":false,"given":"Mouaz","family":"Oudih","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine Ascension Health\/Saint Joseph Hospital  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4586-8607","authenticated-orcid":false,"given":"Muhammad Khuzzaim","family":"Khan","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2016-1496","authenticated-orcid":false,"given":"Majd Al Deen","family":"Alhuarrat","sequence":"additional","affiliation":[{"name":"Division of Cardiology UMass Chan School of Medicine  Worcester Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1968-4962","authenticated-orcid":false,"given":"Hussam Al","family":"Hennawi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Geisinger Wyoming Valley Medical Center  Wilkes\u2010Barre Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8967-7995","authenticated-orcid":false,"given":"Nils","family":"Guttenplan","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Montefiore Medical Center Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengwei","family":"Zou","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Montefiore Medical Center Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Montefiore Medical Center Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Di","family":"Biase","sequence":"additional","affiliation":[{"name":"Division of Cardiac Electrophysiology, Montefiore Medical Center Albert Einstein College of Medicine  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"other members of the PFA Meta\u2010Analysis Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"issue":"5","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1136\/hrt.2006.110791","article-title":"Atrial Fibrillation\u2014The Growing Epidemic","volume":"93","author":"Lip G. 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E.","year":"2020","journal-title":"Journal of the American College of Cardiology"},{"issue":"6","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1016\/j.tcm.2021.07.006","article-title":"Pulsed Field Catheter Ablation in Atrial Fibrillation","volume":"32","author":"Di Biase L.","year":"2022","journal-title":"Trends in Cardiovascular Medicine"},{"issue":"5","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.hrthm.2018.10.030","article-title":"Intracardiac Pulsed Field Ablation: Proof of Feasibility in a Chronic Porcine Model","volume":"16","author":"Stewart M. T.","year":"2019","journal-title":"Heart Rhythm"},{"issue":"8","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1111\/jce.14414","article-title":"Pulsed Field Ablation for Pulmonary Vein Isolation in the Treatment of Atrial Fibrillation","volume":"31","author":"Bradley C. 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A.","year":"2013"},{"issue":"5","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v049.i05","article-title":"Closing the Gap Between Methodologists and End\u2010Users: R as a Computational Back\u2010End","volume":"49","author":"Wallace B. C.","year":"2012","journal-title":"Journal of Statistical Software"},{"issue":"6","key":"e_1_2_11_12_1","article-title":"Lattice\u2010Tip Focal Ablation Catheter That Toggles Between Radiofrequency and Pulsed Field Energy to Treat Atrial Fibrillation: A First\u2010in\u2010Human Trial","volume":"13","author":"Reddy V. Y.","year":"2020","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"issue":"5","key":"e_1_2_11_13_1","first-page":"614","article-title":"Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1\u2010Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II","volume":"7","author":"Reddy V. Y.","year":"2021","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"6","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1007\/s00392-022-02091-2","article-title":"Pulsed\u2010Field Ablation\u2010Based Pulmonary Vein Isolation: Acute Safety, Efficacy and Short\u2010Term Follow\u2010Up in a Multi\u2010Center Real World Scenario","volume":"112","author":"Lemoine M. D.","year":"2023","journal-title":"Clinical Research in Cardiology"},{"issue":"3","key":"e_1_2_11_15_1","article-title":"Paroxysmal Atrial Fibrillation Ablation Using a Novel Variable\u2010Loop Biphasic Pulsed Field Ablation Catheter Integrated With a 3\u2010Dimensional Mapping System: 1\u2010Year Outcomes of the Multicenter inspIRE Study","volume":"16","author":"Duytschaever M.","year":"2023","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"issue":"19","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1161\/CIRCULATIONAHA.123.063988","article-title":"Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial","volume":"147","author":"Verma A.","year":"2023","journal-title":"Circulation"},{"issue":"3","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.hrthm.2022.11.013","article-title":"Effects of Pulsed Field Ablation on Autonomic Nervous System in Paroxysmal Atrial Fibrillation: A Pilot Study","volume":"20","author":"Guo F. B.","year":"2023","journal-title":"Heart Rhythm"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae053"},{"issue":"8","key":"e_1_2_11_19_1","first-page":"1401","article-title":"Pulsed\u2010Field Ablation for Paroxysmal Atrial Fibrillation: Results From the Prospective, Multicenter, Single\u2010Arm PLEASE\u2010AF Study","volume":"21","author":"Wang X.","year":"2024","journal-title":"Heart Rhythm"},{"issue":"9","key":"e_1_2_11_20_1","first-page":"1975","article-title":"Pulsed Field Ablation for Paroxysmal Atrial Fibrillation: 1\u2010Year Outcomes of the AdmIRE Trial","volume":"10","author":"Reddy V. Y.","year":"2024","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"2","key":"e_1_2_11_21_1","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/europace\/euu215","article-title":"Contact\u2010Force Guided Radiofrequency vs. Second\u2010Generation Balloon Cryotherapy for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation\u2014A Prospective Evaluation","volume":"17","author":"Jourda F.","year":"2015","journal-title":"EP Europace"},{"issue":"23","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation","volume":"374","author":"Kuck K. H.","year":"2016","journal-title":"New England Journal of Medicine"},{"issue":"1","key":"e_1_2_11_23_1","first-page":"43","article-title":"Influence of Energy Source on Early Atrial Fibrillation Recurrences: A Comparison of Cryoballoon vs. radiofrequency Current Energy Ablation With the Endpoint of Unexcitability in Pulmonary Vein Isolation","volume":"20","author":"Gunawardene M. A.","year":"2018","journal-title":"EP Europace"},{"issue":"4","key":"e_1_2_11_24_1","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/pace.13293","article-title":"Head\u2010to\u2010head Comparison of Acute and Chronic Pulmonary Vein Stenosis for Cryoballoon Versus Radiofrequency Ablation","volume":"41","author":"Watanabe R.","year":"2018","journal-title":"Pacing and Clinical Electrophysiology"},{"issue":"22","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1161\/CIRCULATIONAHA.119.042622","article-title":"Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial","volume":"140","author":"Andrade J. G.","year":"2019","journal-title":"Circulation"},{"issue":"7","key":"e_1_2_11_26_1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1111\/jce.13933","article-title":"Effect of Cryoballoon and Radiofrequency Ablation for Pulmonary Vein Isolation on Left Atrial Function in Patients With Nonvalvular Paroxysmal Atrial Fibrillation: A Prospective Randomized Study (Cryo\u2010LAEF study)","volume":"30","author":"Giannopoulos G.","year":"2019","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"5","key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1111\/jce.15383","article-title":"Pulmonary Vein Isolation Using Cryoballoon Ablation Versus RF Ablation Using Ablation Index Following the CLOSE Protocol: A Prospective Randomized Trial","volume":"33","author":"Theis C.","year":"2022","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"5","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1093\/europace\/euv060","article-title":"Comparison Between Radiofrequency With Contact Force\u2010Sensing and Second\u2010Generation Cryoballoon for Paroxysmal Atrial Fibrillation Catheter Ablation: A Multicentre European Evaluation","volume":"17","author":"Squara F.","year":"2015","journal-title":"EP Europace"},{"key":"e_1_2_11_29_1","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/6495753","article-title":"Two\u2010Year Follow\u2010Up After Contact Force Sensing Radiofrequency Catheter and Second\u2010Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study","volume":"2016","author":"Kardos A.","year":"2016","journal-title":"BioMed Research International"},{"issue":"2","key":"e_1_2_11_30_1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1111\/jce.13378","article-title":"Ablation of Paroxysmal Atrial Fibrillation Using a Second\u2010Generation Cryoballoon Catheter or Contact\u2010Force Sensing Radiofrequency Ablation Catheter: A Comparison of Costs and Long\u2010Term Clinical Outcomes","volume":"29","author":"Yokokawa M.","year":"2018","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"4","key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.2459\/JCM.0000000000000633","article-title":"Cryoballoon vs. radiofrequency Contact Force Ablation for Paroxysmal Atrial Fibrillation: A Propensity Score Analysis","volume":"19","author":"Matta M.","year":"2018","journal-title":"Journal of Cardiovascular Medicine"},{"issue":"3","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00380-018-1257-7","article-title":"Endothelial Damage and Thromboembolic Risk After Pulmonary Vein Isolation Using the Latest Ablation Technologies: A Comparison of the Second\u2010generation Cryoballoon vs. contact Force\u2010sensing Radiofrequency Ablation","volume":"34","author":"Hisazaki K.","year":"2019","journal-title":"Heart and Vessels"},{"issue":"3","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1253\/circj.CJ-18-1035","article-title":"Comparison of the Safety and Efficacy of Automated Annotation\u2010Guided Radiofrequency Ablation and 2nd\u2010Generation Cryoballoon Ablation in Paroxysmal Atrial Fibrillation","volume":"83","author":"Tanaka N.","year":"2019","journal-title":"Circulation Journal"},{"key":"e_1_2_11_34_1","doi-asserted-by":"crossref","first-page":"563","DOI":"10.3889\/oamjms.2020.4447","article-title":"Smart Touch Radiofrequency Catheter Ablation Versus Cryoballoon Ablation of Pulmonary Veins in Patients With Paroxysmal Atrial Fibrillation","volume":"8","author":"Hassan W. S.","year":"2020","journal-title":"Open Access Macedonian Journal of Medical Sciences"},{"issue":"5","key":"e_1_2_11_35_1","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1111\/jce.14423","article-title":"A Comparative Study of Pericardial Effusion and Pleural Effusion After Cryoballoon Ablation or Radiofrequency Catheter Ablation of Atrial Fibrillation","volume":"31","author":"Xiao F. Y.","year":"2020","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"18","key":"e_1_2_11_36_1","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1056\/NEJMoa2307291","article-title":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation","volume":"389","author":"Reddy V. 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