Objective:

To compare the efficacy and safety of pulsed field ablation (PFA) and very high power short duration ablation (vHPSD) in the treatment of atrial fibrillation.

Approach:

• Literature Search: Relevant studies on PFA vs. vHPSD published up to May 11, 2026, were collected from multiple databases.
• Quality Assessment: Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale (NOS) and ROBINS-I tool.
• Data Analysis: Pooled effect sizes were calculated using random-effects models, with meta-regression and sensitivity analyses to explore heterogeneity and publication bias.

Key Findings:

• No significant difference in the recurrence rate of atrial fibrillation between PFA and vHPSD (RR = 0.99, 95% CI: 0.91 to 1.07, P = 0.722).
• No significant difference in the rate of pulmonary vein isolation between the two groups (RR = 1.00, 95% CI: 1.00 to 1.00, P = 1.000).
• No significant difference in total incidence of surgery-related complications (RR = 0.89, 95% CI: 0.58 to 1.35, P = 0.5353).
• PFA group had a shorter procedure time (MD = −31.64, 95% CI: −40.22 to −23.06, P < 0.0001) and longer fluoroscopy time (MD = 6.93, 95% CI: 4.32 to 9.55, P < 0.0001) compared to vHPSD.

Interpretation:

The study indicates no significant difference in efficacy and safety between PFA and vHPSD for atrial fibrillation treatment.

Limitations:

• Small sample size and short follow-up time.
• Lack of high-quality randomized controlled trials directly comparing the two techniques.

Conclusion:

Further randomized controlled trials with larger sample sizes and longer follow-up are needed.

Sources:

• Systematic Review Registration