Arrhythmias & electrophysiologySecondary analysis
Pulmonary vein narrowing after pulsed field versus thermal ablation
- Secondary analysis of the ADVENT randomised trial
- multicentre
- single-blind
- pre-specified secondary safety endpoint
Authors' conclusion
In this first randomized comparison of PFA vs. thermal ablation, PFA resulted in less PV narrowing-thereby underscoring the qualitatively differential and favourable impact of PFA on PV tissue.
Study context
- Population
- Drug-refractory paroxysmal atrial fibrillation (AF) undergoing ablation259 pulsed field ablation (PFA), 255 thermal with imaging
- Participants
- 305 vs 302
- Comparison
- PFA vs thermal ablation
- PFAn = 305
- Thermaln = 302reference
- Primary endpoint
- PV narrowing: change in aggregate PV cross-sectional area (pre-specified, formally tested secondary safety endpoint; superiority by posterior probability > 0.975)
- Follow-up
- 3 months
Primary result
As reported in the abstract
Change in aggregate PV cross-sectional area
PFA
−0.9%
Thermal ablation
−12%
posterior probability > 0.999
Further findings
| Outcome | RF | CB |
|---|---|---|
| Change in aggregate PV cross-sectional area, thermal sub-cohorts · 3 months | −19.5% | −3.3% |
- Change in aggregate pulmonary vein (PV) cross-sectional area, thermal sub-cohorts: 137 radiofrequency (RF) and 118 cryoballoon (CB)
PV diameters · 3 months
- RF PVs decreased, regardless of PV location
- 80%
- Almost half of PFA PV diameters did not decrease
Safety
Significant (≥70%) PV stenosis · 3 months
- No subject had significant (≥70%) PV stenosis
Original publication
Pulmonary vein narrowing after pulsed field versus thermal ablation. Europace. Published 2 February 2024. doi:10.1093/europace/euae038
Summarised from the published abstract; every number is checked against it