Pulsed field ablation (PFA) is as effective and safe as conventional thermal ablation for the treatment of paroxysmal atrial fibrillation (AFib), based on findings from the ADVENT trial presented at ESC Congress 2023.

The study included 687 patients with drug-resistant, symptomatic paroxysmal AFib who were underwent ablation at 30 centers in the U.S. With the exception of 80 patients involved in the initial roll-in phase to ensure experience using the PFA catheter, participants were randomized to either PFA (n=305) or conventional thermal ablation using radiofrequency or cryoablation (n=302). The average age of participants was 62 years and roughly 35% were female.

The primary efficacy endpoint, defined as one-year free from recurrent atrial arrhythmias, antiarrhythmic drug use, and cardioversion or repeat ablation, was 73.3% and 71.3% in the PFA and thermal groups, respectively – meeting the prespecified criteria for noninferiority. The criteria for meeting the secondary efficacy endpoint, which was the same as the primary efficacy endpoint but testing for superiority, was not met.

In terms of safety, PFA was non-inferior to thermal ablation in terms of serious adverse events related to use of an ablation catheter or the procedure itself within seven days, as well as pulmonary vein stenosis or oesophageal fistula occurring at any time during the 12-month follow up (2.1% vs. 1.5%). Researchers noted that PFA was superior to thermal ablation in terms of reducing pulmonary vein dimension (3.3% vs. 19.5%).

"The ADVENT trial showed that PFA is as effective and safe as conventional thermal ablation to treat paroxysmal AFib," said Vivek Reddy, MD, FACC, of the Icahn School of Medicine at Mount Sinai, New York. "Procedure times were faster for PFA than thermal ablation, but there was more X-ray exposure with PFA."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: ESC Congress, ESC23, ACC International, Arrhythmias, Cardiac

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