To compare the efficacy, safety, and procedural characteristics of
pulsed field ablation (PFA) versus high-power short-duration (HPSD)
radiofrequency ablation in patients with atrial fibrillation (AF). We conducted a
systematic review and meta-analysis of randomized controlled trials and
observational studies comparing PFA and HPSD in AF ablation. A
comprehensive search was performed in PubMed and relevant databases
through July 2025. A total of 12 studies were included, with data extracted on
baseline characteristics, procedural details, clinical outcomes, and
complications. Risk of bias was assessed using appropriate tools for
randomized and nonrandomized studies. Statistical pooling was conducted
using random-effects models where feasible. Across 12 studies including over
2000 patients, freedom from AF at 12 months was similar between PFA
(mean 85.3%) and HPSD (mean 83.2%). PFA demonstrated a lower
incidence of complications such as cardiac tamponade, phrenic nerve injury,
and esophageal damage. Procedural parameters such as fluoroscopy time,
energy delivery, and touch-up requirement favored PFA in multiple studies.
Kaplan–Meier curves confirmed equivalent arrhythmia-free survival.
Heterogeneity in protocols was noted but generally low across major
outcomes. PFA offers comparable efficacy to HPSD while demonstrating a
superior safety profile and procedural efficiency, supporting its role as a
favorable ablation modality for AF.