Incidence of Silent Cerebral Events Detected by MRI in Patients with Atrial Fibrillation Undergoing Pulsed Field Ablation versus Thermal Ablation: A Systematic Review and Network Meta-Analysis
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and catheter ablation has been demonstrated to achieve superior success rates compared to antiarrhythmic drugs. However, this procedure entails certain risks, including silent cerebral events (SCEs), which may impact cognitive function. This network meta-analysis (NMA) aimed to determine the global incidence of SCEs in patients with AF undergoing catheter ablation and to compare the incidence across energy sources and catheter types. Our analysis included 86 trials involving 10,456 patients with AF, with a pooled SCE incidence of 19.1%. For pulsed field ablation, the incidence of SCEs was 14.4%, while thermal ablation techniques showed rates of 17.7% for radiofrequency ablation, 20.8% for cryoballoon ablation, and 32.7% for laser ablation. No significant differences were found between pulsed field ablation and thermal ablation in SCE incidence. The comparison of SCE incidence among different catheter types revealed variations. The HD Mesh Ablator demonstrated the lowest incidence rate (15.1%), whereas the PVAC catheter had the highest (36.2%). The Farawave catheter had an incidence rate of 18.5% and showed no significant differences compared to most thermal catheters, except the HD Mesh Ablator (RR: 0.15; 95% CrIs: 0.03, 0.89). Our findings indicate that a substantial proportion of patients experience SCEs following catheter ablation for AF, with an overall incidence of approximately 19.1% occuring…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 10,456 participants or records.
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