Pulsed field ablation ranked highest for rhythm outcomes and procedure duration among evaluated atrial fibrillation (AF) ablation strategies. Findings from a network meta-analysis published in Frontiers in Cardiovascular Medicine compared commonly used interventional approaches for AF ablation.

Randomized controlled trials (RCTs) and propensity-score matched (PSM) studies were identified through searches of PubMed, Embase, and the Cochrane Library through December 2024. Eligible studies included cryoballoon ablation (CBA), conventional radiofrequency ablation (RFA), remote magnetic navigation ablation (RMN), or pulsed field ablation (PFA). A frequentist network meta-analysis was performed.

The analysis included 14 studies comprising 10 RCTs and 4 PSM studies. For freedom from AF and atrial tachyarrhythmias (AT), PFA ranked highest with a surface under the cumulative ranking curve (SUCRA) of 88.4% and relative risk (RR) of 1.11 (95% confidence interval [CI] 1.03-1.21).

For procedure duration, PFA also ranked highest (SUCRA 91.2%; standardized mean difference [SMD] -1.43; 95% CI -2.47 to -0.39). The analysis suggested RMN may be preferable when minimizing complications or fluoroscopy time is prioritized.

Choice of ablation strategy may depend on clinical priorities, including rhythm control, procedure efficiency, safety considerations, and patient-specific factors.