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March 8, 2023Heart Rhythm O2Open Access

A randomized controlled trial of pulsed field ablation versus standard-of-care ablation for paroxysmal atrial fibrillation: The ADVENT trial rationale and design

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Why the study?

Thermal PVI carries risk of collateral tissue injury, whereas PFA may ablate myocardium preferentially; randomized comparative data against conventional ablation were needed.

Does pulsed field ablation using a pentaspline catheter improve outcomes compared to conventional thermal ablation in patients with drug-resistant paroxysmal atrial fibrillation?

Population

Patients with drug-resistant PAF (adaptively determined sample size)

Comparison

PVI using PFA vs conventional thermal ablation (cryoballoon or radiofrequency)

Design

Multicenter, prospective, single-blind, randomized controlled noninferiority trial

Follow-up

12 months

Authors

VRVivek Y. ReddyJLJohn W. LehmannEGEdward P. Gerstenfeld

Discussion

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Overview

ADVENT RCT will deliver first randomized data on pulsed field versus thermal ablation in paroxysmal AF; extends evidence beyond observational reports.

Structured PICO

Does pulsed field ablation using a pentaspline catheter improve outcomes compared to conventional thermal ablation in patients with drug-resistant paroxysmal atrial fibrillation?

P
Population
Patients with drug-resistant paroxysmal atrial fibrillation (PAF)
I
Intervention
Pulmonary vein isolation (PVI) using pulsed field ablation (PFA) with a multielectrode pentaspline catheter
C
Comparator
Conventional thermal ablation (either cryoballoon or radiofrequency ablation)
O
Outcome
Composite of acute procedural success and freedom from any documented atrial arrhythmia recurrence, repeat ablation, or use of antiarrhythmic drugs after a 3-month postablation blanking periodcomposite

The ADVENT trial is designed to evaluate the safety and efficacy of a novel pulsed field ablation system compared to standard-of-care thermal ablation for drug-resistant paroxysmal atrial fibrillation.

Cite This Study

Reddy et al. (2023) studied this question.

synapsesocial.com/papers/6a1be1a801af05bf0da8facdhttps://doi.org/10.1016/j.hroo.2023.03.001
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