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Pulsed Field Ablation for Atrial Fibrillation: Impact of Adjunctive Ablation Beyond Pulmonary Vein Isolation—A Systematic Review and Meta-analysis
Session:
Sessão de Posters 05 - Ablação por campo pulsado: da viabilidade à fisiologia
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Tatiana Pereira dos Santos; Manuela Lopes; Ana L. Silva; Carolina Saleiro; Patrícia Alves; João André Ferreira; Pedro Sousa; Natália António; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Background:</span></strong><span style="font-family:"Arial",sans-serif"> Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation; however, its efficacy as a standalone strategy remains limited. Adjunctive ablation approaches, including left atrial posterior wall and mitral isthmus ablation, have gained interest, particularly with the emergence of pulsed field ablation (PFA). Evidence comparing PFA-guided PVI alone versus PVI plus adjunctive strategies remains inconsistent.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Methods:</span></strong><span style="font-family:"Arial",sans-serif"> We conducted a systematic review and meta-analysis of studies evaluating the impact of PVI plus adjunctive ablation versus PVI alone on atrial arrhythmia recurrence at one year. A systematic search identified studies involving PFA for paroxysmal or persistent AF. Random-effects models were used to pool outcomes.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Results:</span></strong><span style="font-family:"Arial",sans-serif"> From a total of 485 references, 5 observational studies comprising 1,382 patients were included (PVI plus: n=438; PVI-only: n=944). Recurrence of any atrial tachyarrhythmia at one year was similar between groups (pooled OR 1.02; 95% CI 0.72–1.46; I²=25%; P=0.89). Subgroup analyses—including PVI plus posterior wall ablation versus PVI-only (pooled OR 1.08; 95% CI 0.67–1.74; I²=32%; P=0.76) and persistent AF only (pooled OR 0.97; 95% CI 0.66–1.41; I²=32%; P=0.87)—also showed no significant differences. Overall complication rates were comparable (pooled OR 1.19; 95% CI 0.67–2.11; I²=0%; P=0.83), with no differences in major or minor complications: major complications (pooled OR 1,52; 95% CI 0.63-3,65; I2 =0%; P=0.35) and minor (pooled OR 1,30; 95% CI 0.70-2,42; I2 =0%; P=0.42).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Arial",sans-serif">Conclusion:</span></strong><span style="font-family:"Arial",sans-serif"> In AF ablation using PFA, adjunctive strategies added to PVI—predominantly posterior wall ablation—do not reduce arrhythmia recurrence and demonstrate similar safety profiles compared with PVI alone. These findings support the safety of PVI plus approaches; however, further high-quality studies are needed to clarify their clinical utility and identify optimal ablation strategies.</span></span></span></p>
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