Arrhythmias & electrophysiologyRandomised controlled trial
Pulsed field vs radiofrequency ablation for paroxysmal atrial fibrillation: the BEAT PAROX-AF trial
- Randomised controlled trial
- multicentre
- open-label
- superiority
- 9 European sites
Authors' conclusion
This randomized trial performed in patients with paroxysmal AF did not demonstrate superior efficacy of single-shot PFA vs point-by-point RFA using the CLOSE protocol regarding single-procedure freedom from atrial arrhythmias, despite fewer safety events being observed in this study with PFA.
Study context
- Population
- Patients aged 18–80 years with symptomatic, drug-resistant paroxysmal atrial fibrillation (AF)289 analysed
- Participants
- 292 patients
- Comparison
- Pulsed field ablation (PFA) vs radiofrequency ablation (RFA)
- PFAn = 145
- RFAn = 144reference
- Primary endpoint
- Single-procedure success: absence of ≥30 s atrial arrhythmia recurrence, cardioversion, class I/III antiarrhythmic drug resumption after a 2-month blanking period, or any repeat ablation
- Follow-up
- 12 months
Primary result
Single-procedure success
Adjusted difference
0.9%
95% CI −8.2% to 10.1%
P = 0.84
Events by treatment group
PFA vs RFA
adjusted difference 0.9% (95% CI −8.2% to 10.1%); P = 0.84
As reported in the abstract
Further findings
Deaths, persistent phrenic palsy, stroke
- No deaths, persistent phrenic palsy nor stroke occurred
Safety
| Outcome | PFA | RFA | difference (CI) | |
|---|---|---|---|---|
| Procedure-related serious adverse events | 3.4% | 7.6% | −3.3% (−8.4% to 1.8%) | |
| −10−505Difference (linear scale) |
- Complications in RFA
- 2 · Pulmonary vein stenosis >70% · Pulmonary vein stenosis > 50% 12 · Tamponade 2 · Oesophageal bleed 1
Original publication
Pulsed field vs radiofrequency ablation for paroxysmal atrial fibrillation: the BEAT PAROX-AF trial. Eur Heart J. Published 22 January 2026. doi:10.1093/eurheartj/ehaf1115
Summarised from the published abstract; every number is checked against it