Comparative Efficacy and Safety of Catheter Ablation Energy Modalities for Atrial Fibrillation: A Network Meta-Analysis of Randomized Trials
Abstract
BACKGROUND
Pulsed field ablation (PFA) has reshaped atrial fibrillation (AF) ablation landscape, yet the relative advantages and limitations of currently available catheter ablation energy modalities-radiofrequency ablation (RFA), cryoballoon ablation (CBA), laserballoon ablation (LBA), PFA, and lattice-tip dual-energy (LTD) ablation-remain incompletely understood.
OBJECTIVE
To compare the efficacy, procedural efficiency, and safety of catheter ablation modalities for AF.
METHODS
MEDLINE, Scopus, and the Cochrane Library were searched through March 15, 2026. Comparative effects across 5 ablation energy modalities were synthesized using random-effects network meta-analysis.
RESULTS
Thirty-two randomized controlled trials (7,226 patients) were analyzed. No significant differences were observed among modalities for atrial tachyarrhythmia recurrence, repeat ablation, cardioversion, or patient-reported outcomes. PFA showed greater AF burden reduction compared to RFA (mean difference [MD] -0.78%, 95% confidence interval [CI] -0.91% to -0.65%) and CBA (MD -0.90%, 95% CI -1.01% to -0.79%). PFA was associated with lower hospitalization risk than RFA in the primary frequentist analysis (RR 0.34, 95% CI 0.12-0.95), whereas Bayesian sensitivity analysis showed no significant differences across modalities. Both PFA and CBA were associated with shorter total procedure duration and left atrial dwell time than RFA, whereas fluoroscopy time was shortest with RFA. Safety profiles were broadly…
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: 7,226 participants or records.
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