Pulsed field ablation for paroxysmal supraventricular tachycardia: a systematic review and single-arm meta-analysis

Background: Pulsed field ablation (PFA) is a novel, non-thermal technique for atrial fibrillation ablation that is currently under early investigation for paroxysmal supraventricular tachycardia (PSVT). We conducted a meta-analysis to evaluate the efficacy and safety of PFA in this setting. Methods: We systematically searched PubMed, Embase, Cochrane Central, and Web of Science for studies on PFA in PSVT, including atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) with concealed or manifest accessory pathways. Outcomes included acute ablation success, success at 1, 3, and 6 months, and procedural/postoperative adverse events (AEs). Proportions were pooled using a random-effects model with arcsine transformation to account for extreme values. Analyses were conducted using R (v4.3.2). Results: Five prospective single-arm studies involving 202 patients were included. The pooled acute success rate was 99.98% (95% CI: 99.29–100), with sustained success at 1, 3, and 6 months. Procedural and postoperative AE rates were low: 0.92% (95% CI: 0.00–4.88) and 0.06% (95% CI: 0.00–0.87), respectively. Subgroup analysis showed 100% acute success in AVNRT and in AVRT with concealed pathways, with high sustained success at 6 months. In AVRT with manifest pathways, acute success was 97.5% (95% CI: 84.74–100), maintained through follow-up. Conclusion: In this systematic review and meta-analysis, PFA demonstrated excellent safety and efficacy for the treatment of PSVT. Randomized controlled trials are warranted to establish the outcomes of PFA in this setting relative to thermal ablation.