Pulsed field ablation demonstrated preserved effectiveness compared to thermal ablation for four-year treatment success (72.8% vs 64.1%; P=0.12) in paroxysmal atrial fibrillation.
RCT (n=364)
Does pulsed field ablation improve four-year treatment success compared to conventional thermal ablation in patients with paroxysmal atrial fibrillation?
Pulsed field ablation maintains its effectiveness and safety over four years for paroxysmal atrial fibrillation, with a trend toward fewer hospital-based arrhythmia interventions compared to thermal ablation.
Absolute Event Rate: 72.8% vs 64.1%
p-value: p=0.12
Pulsed field ablation (PFA) has proven to be a safe and effective non-thermal ablation modality for the treatment of atrial fibrillation (AF), but little outcome data beyond 1 year has been reported. Here, we present results from the ADVENT-LTO study, which provides extended follow-up of the ADVENT trial, the first randomized trial comparing PFA with conventional thermal ablation. In ADVENT-LTO, 364 paroxysmal AF patients (183 PFA, 181 thermal; 237 men, 127 women) participated, and were followed for 1,332±147 days. For the primary endpoint of four-year treatment success, PFA demonstrated preserved effectiveness compared to thermal ablation (72.8% PFA, 64.1% thermal; P=0.12). Moreover, there was a trend favoring PFA as compared to thermal ablation for the pre-specified outcome of freedom from hospital-based arrhythmia intervention (85.6% PFA, 78.6% thermal; HR 0.64, 95%CI 0.38, 1.05), including fewer repeat ablations (10.4% PFA, 17.7% thermal; P=0.04), as well as a trend favoring PFA as compared to thermal ablation for the pre-specified outcome of progression to persistent AF (2.6% PFA, 4.6% thermal; HR 0.55, 95%CI 0.16, 1.88). Taken together, these data demonstrate that the favorable outcomes of PFA are maintained over the course of four years. Coupled with the safety advantages of PFA over thermal ablation, these long-term data support widespread adoption of PFA for the treatment of AF. Clinical Trial Registration: NCT06526546.
“Thrilled to be part of this important milestone: The ADVENT long-term outcomes study results demonstrated that patients treated with FARAPULSE had greater long-term effectiveness, fewer hospital-based interventions and reduced AAD use. • Long-term treatment effectiveness at 4 years: FARAPULSE PFA 72.8% vs thermal ablation 64.3% • Hospital-based arrythmia interventions at 4 years: FARAPULSE PFA 85.6% vs thermal ablation 78.6% • Patients who used AADs out to 4 years: FARAPULSE PFA 11.5% vs thermal ablation 20.4% Nature Medicine.”
Featured in This Week in Cardiology podcast and multiple expert discussions; long-term data from ADVENT trial generating sustained buzz.
Reddy et al. (Fri,) conducted a rct in Paroxysmal Atrial Fibrillation (n=364). Pulsed field ablation vs. Conventional thermal ablation was evaluated on four-year treatment success (p=0.12). Pulsed field ablation demonstrated preserved effectiveness compared to thermal ablation for four-year treatment success (72.8% vs 64.1%; P=0.12) in paroxysmal atrial fibrillation.
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