Indirect treatment comparison of two pulsed field ablation systems for the treatment of persistent atrial fibrillation

Kazuo Matsumoto; Kelly A. van Bragt; Fred Kueffer; Waruiru Mburu; Khaldoun G. Tarakji

doi:10.1007/s10840-025-02124-6

September 10, 2025Journal of Interventional Cardiac ElectrophysiologyOpen Access

Indirect treatment comparison of two pulsed field ablation systems for the treatment of persistent atrial fibrillation

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Why the study?

Does the wide-focal lattice-tip PFA catheter improve 12-month treatment success compared to the pentaspline PFA catheter in patients with persistent atrial fibrillation?

Structured PICO

Does the wide-focal lattice-tip PFA catheter improve 12-month treatment success compared to the pentaspline PFA catheter in patients with persistent atrial fibrillation?

P

Population

472 patients with symptomatic persistent atrial fibrillation (PerAF). Cohorts included n=212 from the SPHERE Per-AF trial (Sphere-9 arm) and n=260 from the ADVANTAGE AF trial (pentaspline cohort). Predominantly USA enrollment. SPHERE Per-AF mean age 67.8, 34.4% female. ADVANTAGE AF mean age 66.2, 30.8% female.

I

Intervention

Pulsed field ablation (PFA) using the dual-energy (RF/PF), wide-focal (9 mm) lattice-tip ablation catheter (Sphere-9) for pulmonary vein isolation (PVI) and adjunctive linear lesions at investigator discretion.

C

Comparator

Pulsed field ablation (PFA) using the pentaspline catheter (Farawave) for protocol-mandated PVI and posterior wall isolation.

O

Outcome

12-month treatment success (freedom from atrial arrhythmias/primary effectiveness) and primary safety (composite of predefined serious procedure or device related adverse events).composite

Limitations

Unanchored indirect comparison prone to residual bias due to unobserved prognostic variables
Differences in remote trans telephonic monitoring (TTM) frequency between trials
Different definitions for primary efficacy endpoint failure between trials
Differences in applied adjunctive linear lesions beyond PVI
Comparative safety analysis was underpowered due to low number of adverse events

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Implication

An indirect treatment comparison suggests that using a wide-focal lattice-tip PFA catheter may yield higher 12-month arrhythmia-free success rates than a pentaspline PFA catheter in patients with persistent atrial fibrillation.

Abstract

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Cite This Study

Matsumoto et al. (2025) studied this question.

synapsesocial.com/papers/69db1a1e498b35d3e6a3c3ae https://doi.org/10.1007/s10840-025-02124-6

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Indirect treatment comparison of two pulsed field ablation systems for the treatment of persistent atrial fibrillation

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Indirect treatment comparison of two pulsed field ablation systems for the treatment of persistent atrial fibrillation

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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