{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:18:16Z","timestamp":1790875096977,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>There are several interventional approaches to atrial fibrillation (AF) ablation; however, it is not yet known which procedure is most effective. Our aim was to compare the efficacy and safety of different interventional approaches for the treatment of AF through network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched randomized controlled trial (RCT) and propensity-score matched (PSM) studies in PubMed, Embase, and Cochrane Library databases from the initial period to December 2024, and studies were selected which had cryoballoon ablation (CBA), conventional radiofrequency ablation (RFA), remote magnetic navigation ablation (RMN), and pulsed field ablation (PFA) as an arm in the study. Network meta-analysis (NMA) was performed using a frequentist approach with STATA (version 14.0) software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 10 RCT studies and 4 PSM studies. For freedom from AF and other atrial tachyarrhythmias (AT) indicators, PFA may become the most effective ablation procedure (SUCRA\u2009=\u200988.4%, RR\u2009=\u20091.11, 95% CI: 1.03\u20131.21). For procedure duration, PFA may also be the ablation procedure with the best results (SUCRA\u2009=\u200991.2%, SMD\u2009=\u2009\u22121.43, 95% CI: \u22122.47 to \u22120.39).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The choice of ablation technique needs to be weighed against the specific clinical needs and the patient's situation. PFA may be the best choice if success rate and procedure time are prioritized, while RMN is more appropriate if complication rates and fluoroscopy time are more important.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42025631158<\/jats:ext-link>\n                      , identifier: CRD42025631158.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1667194","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T04:20:38Z","timestamp":1776140438000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative efficacy and safety of catheter ablation technologies for atrial fibrillation: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruiting","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]},{"name":"The First Clinical Medical College, Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yajie","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]},{"name":"The First Clinical Medical College, Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuli","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]},{"name":"The First Clinical Medical College, Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Hospital of Shanxi Medical University","place":["Taiyuan, Shanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1161\/01.CIR.0000140263.20897.42","article-title":"Lifetime risk for development of atrial fibrillation: the Framingham Heart Study","volume":"110","author":"Lloyd-Jones","year":"2004","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.1016\/j.jacc.2010.09.013","article-title":"2011 ACCF\/AHA\/HRS focused updates incorporated into the ACC\/AHA\/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society","volume":"57","author":"Fuster","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/j.tcm.2018.11.009","article-title":"Towards a tailored cryo-pulmonary vein isolation. Lessons learned from second-generation cryoballoon ablation","volume":"29","author":"Ciconte","year":"2019","journal-title":"Trends Cardiovasc Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1056\/NEJMoa1602014","article-title":"Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation","volume":"374","author":"Kuck","year":"2016","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1111\/j.1540-8159.2012.03382.x","article-title":"Catheter ablation utilizing remote magnetic navigation: a review of applications and outcomes","volume":"35","author":"Bradfield","year":"2012","journal-title":"Pacing Clin Electrophysiol"},{"key":"B6","doi-asserted-by":"publisher","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","year":"2022","journal-title":"Trends Cardiovasc Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/sim.5984","article-title":"The use of propensity score methods with survival or time-to-event outcomes: reporting measures of effect similar to those used in randomized experiments","volume":"33","author":"Austin","year":"2014","journal-title":"Stat Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"B9","first-page":"1","article-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses","volume":"2","author":"Peterson","year":"2011","journal-title":"Ottawa"},{"key":"B10","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"B11","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ (Clin Res Ed)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.medcli.2016.02.025","article-title":"The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA","volume":"147","author":"Hutton","year":"2016","journal-title":"Med Clin (Barc)"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e76654","DOI":"10.1371\/journal.pone.0076654","article-title":"Graphical tools for network meta-analysis in STATA","volume":"8","author":"Chaimani","year":"2013","journal-title":"PLoS One"},{"key":"B15","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1002\/sim.3767","article-title":"Checking consistency in mixed treatment comparison meta-analysis","volume":"29","author":"Dias","year":"2010","journal-title":"Stat Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e2017047","DOI":"10.4178\/epih.e2017047","article-title":"Network meta-analysis: application and practice using stata","volume":"39","author":"Shim","year":"2017","journal-title":"Epidemiol Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"154","DOI":"10.4103\/2229-3485.140550","article-title":"Multiple treatment and indirect treatment comparisons: an overview of network meta-analysis","volume":"5","author":"Bhatnagar","year":"2014","journal-title":"Perspect Clin Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s13643-017-0473-z","article-title":"Approaches to interpreting and choosing the best treatments in network meta-analyses","volume":"6","author":"Mbuagbaw","year":"2017","journal-title":"Syst Rev"},{"key":"B19","doi-asserted-by":"publisher","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","year":"2019","journal-title":"Circulation"},{"key":"B20","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1093\/eurheartj\/ehad572","article-title":"Atrial fibrillation progression after cryoablation vs. Radiofrequency ablation: the CIRCA-DOSE trial","volume":"45","author":"Andrade","year":"2024","journal-title":"Eur Heart J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.amjcard.2022.08.031","article-title":"Comparative effectiveness and safety of cryoablation versus radiofrequency ablation treatments for persistent atrial fibrillation","volume":"184","author":"Baimbetov","year":"2022","journal-title":"Am J Cardiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3629384","DOI":"10.1155\/2018\/3629384","article-title":"Radiofrequency versus cryoballoon ablation of atrial fibrillation: an evaluation using ECG, holter monitoring, and implantable loop recorders to monitor absolute and clinical effectiveness","volume":"2018","author":"Davtyan","year":"2018","journal-title":"BioMed Res Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.1111\/jce.12846","article-title":"Point-by-Point radiofrequency ablation versus the cryoballoon or a novel combined approach: a randomized trial comparing 3 methods of pulmonary vein isolation for paroxysmal atrial fibrillation (The Cryo Versus RF Trial)","volume":"26","author":"Hunter","year":"2015","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1161\/CIRCULATIONAHA.115.016871","article-title":"Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: the prospective, randomized, controlled, noninferiority FreezeAF study","volume":"132","author":"Luik","year":"2015","journal-title":"Circulation"},{"key":"B25","doi-asserted-by":"publisher","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","year":"2018","journal-title":"J Cardiovas Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1111\/jce.15965","article-title":"Radiofrequency versus cryoballoon catheter ablation in patients with persistent atrial fibrillation: a randomized trial","volume":"34","author":"Mililis","year":"2023","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1093\/europace\/euab281","article-title":"Cryoballoon vs. Radiofrequency catheter ablation: insights from Norwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study)","volume":"24","author":"Shi","year":"2022","journal-title":"Europace"},{"key":"B28","doi-asserted-by":"publisher","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","year":"2022","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1111\/jce.12900","article-title":"Safety and long-term outcomes of catheter ablation of atrial fibrillation using magnetic navigation versus manual conventional ablation: a propensity-score analysis","volume":"27","author":"Adrag\u00e3o","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"euae016","DOI":"10.1093\/europace\/euae016","article-title":"Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison","volume":"26","author":"Della Rocca","year":"2023","journal-title":"Europace"},{"key":"B31","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/s10840-023-01651-4","article-title":"Pulsed-field vs. cryoballoon vs. Radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation","volume":"67","author":"Maurhofer","year":"2024","journal-title":"J Interv Cardiac Electrophysiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1056\/NEJM199809033391003","article-title":"Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins","volume":"339","author":"Ha\u00efssaguerre","year":"1998","journal-title":"N Engl J Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1161\/CIRCEP.109.859116","article-title":"Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation","volume":"3","author":"Cappato","year":"2010","journal-title":"Circ Arrhyth Electrophysiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.ijcard.2013.08.086","article-title":"Robotically assisted ablation of atrial fibrillation: a systematic review and meta-analysis","volume":"169","author":"Shurrab","year":"2013","journal-title":"Int J Cardiol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/jce.13047","article-title":"Cryoballoon versus radiofrequency catheter ablation in atrial fibrillation: a meta-analysis","volume":"27","author":"Cardoso","year":"2016","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1016\/j.jacc.2019.04.021","article-title":"Pulsed field ablation for pulmonary vein isolation in atrial fibrillation","volume":"74","author":"Reddy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1093\/europace\/eut058","article-title":"Remote magnetic with open-irrigated catheter vs. Manual navigation for ablation of atrial fibrillation: a systematic review and meta-analysis","volume":"15","author":"Proietti","year":"2013","journal-title":"Europace"},{"key":"B38","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1093\/europace\/euw330","article-title":"Cryoablation vs. radiofrequency ablation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis","volume":"19","author":"Chen","year":"2017","journal-title":"Europace"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.jacc.2020.07.007","article-title":"Pulsed field ablation in patients with persistent atrial fibrillation","volume":"76","author":"Reddy","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1016\/j.jacc.2005.11.058","article-title":"Robotic magnetic navigation for atrial fibrillation ablation","volume":"47","author":"Pappone","year":"2006","journal-title":"J Am Coll Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1667194\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T04:20:39Z","timestamp":1776140439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1667194\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":40,"alternative-id":["10.3389\/fcvm.2026.1667194"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1667194","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"article-number":"1667194"}}