High-Power Short Duration or Pulsed Field Ablation: What is the Best Choice for AF Ablation?

Conclusion

Both methods highlight the advancements in AF ablation techniques, focusing on improving procedural efficiency and safety. The HPSD meta-analysis demonstrates that high-power, short-duration radiofrequency ablation reduces AF recurrence and procedural times while minimizing complications like esophageal injury. On the other hand, the PFA meta-analysis shows that pulsed field ablation offers shorter procedural times compared to traditional thermal ablation, with no significant difference in complications or AF recurrence. Finally, a highly relevant issue that has not been adequately considered in these studies is the extent of vagal denervation resulting from these techniques. It is well established that a greater degree of vagal denervation, including the potential incorporation of cardioneuroablation^, is strongly associated with a significant reduction in long-term recurrence rates.

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