Background: Pulsed‐field ablation (PFA) is a nonthermal alternative to radiofrequency ablation (RFA) for patients with atrial fibrillation (AF). However, the role of PFA compared to RFA in patients with paroxysmal AF (PAF) remains unclear. Objective: To compare the efficacy and safety of PFA and RFA in adult patients with PAF. Methods: A systematic review and meta‐analysis were conducted following the Cochrane methodology and reported in accordance with PRISMA guidelines. The PubMed, Embase, and Cochrane databases were searched through February 2025 for studies comparing PFA and RFA in adults with PAF. The outcomes of interest included procedure time, 1‐year success rate, and major complications. All the statistical analyses were performed via R version 4.5 with a random effects model. Results: One randomized controlled trial (RCT) and five observational studies comprising 3163 patients with PAF were included, of whom 972 (30.7%) underwent PFA. The follow‐up time ranged from 12 to 30 months. PFA was associated with a significantly shorter procedure time (MD –39.15 min; 95% CI –58.19 to −20.11, p < 0.01), but a significantly longer fluoroscopy time (MD 10.75 min; 95% CI 5.58–15.92, p < 0.01) as compared with RFA. There were no statistically significant differences in terms of the 1‐year success rate (RR 1.04; 95% CI 0.77–1.41, p = 0.79) and major complications (RR 0.95; 95% CI 0.60–1.52, p = 0.83) between PFA and RFA. Conclusion: In this meta‐analysis, PFA was associated with a reduced operative time and an increased fluoroscopy time, with comparable 1‐year efficacy and overall safety profiles. Trial Registration: PROSPERO number: CRD420251000165

Background: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF) and a wide QRS complex. However, up to 30–50% of patients fail to respond. The QRS Index, which quantifies QRS shortening after CRT, has emerged as a potential predictor of response. We aimed to perform a systematic review and meta-analysis to evaluate the association between QRS Index and CRT response. Methods: We searched PubMed, Scopus and Cochrane for studies reporting QRS Index values in CRT responders and non-responders. Studies defining response based on clinical, echocardiographic, or combined criteria were included. Heterogeneity was assessed using the I² statistic, and a random-effects model was applied. A meta-regression analysis explored the relationship between baseline echocardiographic parameters and QRS Index. Results: Nine studies with 1274 patients met the inclusion criteria, with 760 (59%) classified as responders and 514 (41%) as non-responders. The weighted mean ± standard deviation was 16.14 ± 13.19 in responders and 7.22 ± 14.96 in non-responders. The QRS Index was significantly higher in the responder group compared to non-responders (mean difference: 8.76; 95% CI: 6.45–11.06; I² = 45%; p < 0.00001). Meta-regression revealed that lower left ventricular end-systolic volume (LVESV) values were associated with even higher QRS Index in responders compared to non-responders (β = −0.0483; 95% CI: −0.0938; −0.0029, p = 0.0372). Conclusions: QRS Index is significantly higher in CRT responders, supporting its role as a predictor of response. Further studies are needed to standardize its clinical use and assess its prognostic impact.