Ablation Methods Equally Effective For Drug-resistant Paroxysmal Atrial Fibrillation

Pulsed section ablation did not person superior efficacy to radiofrequency ablation successful patients pinch drug-resistant paroxysmal (intermittent) atrial fibrillation, according to results from a late-breaking proceedings presented successful a Hot Line convention coming astatine ESC Congress 2025.

Atrial fibrillation (AF) is nan astir communal sustained cardiac arrhythmia. Patients whose AF is not controlled by antiarrhythmic narcotics whitethorn acquisition catheter ablation to disrupt nan abnormal electrical pathways that origin nan arrhythmia.

Principal Investigator, Professor Pierre Jaïs from nan IHU LIRYC (L'Institut de Rythmologie et Modélisation Cardiaque), Bordeaux, France, explained why nan proceedings was carried out: "Pulmonary vein isolation utilizing thermal radiofrequency-based ablation (RFA) is simply a wide accepted and established curen for antiarrhythmic drug-resistant AF. However, pulmonary vein isolation has evolved pinch nan preamble of pulsed section ablation (PFA), which is simply a faster, much straightforward nonthermal process that perchance offers much selective insubstantial targeting than thermal power sources. Other tests person compared PFA pinch thermal power sources pinch inconclusive results. We conducted nan BEAT-PAROX-AF proceedings to straight comparison PFA pinch precocious RFA successful patients pinch antiarrhythmic drug-resistant symptomatic paroxysmal AF."

BEAT-PAROX-AF was an open-label, randomized controlled superiority proceedings conducted astatine 9 high-volume centres crossed France, Czechia, Germany, Austria and Belgium. Eligible patients were aged 18-80 years pinch symptomatic paroxysmal AF that was resistant to astatine slightest 1 antiarrhythmic drug, pinch a Class I aliases IIa denotation for AF ablation according to ESC Guidelines and effective oral anticoagulation for >3 weeks anterior to nan planned procedure. Patients were randomised 1:1 to pulmonary vein isolation utilizing either single-shot PFA aliases point-by-point RFA pursuing nan CLOSE protocol. The superior endpoint was nan single-procedure occurrence complaint aft 12 months, defined arsenic nan absence of ≥30-second atrial arrhythmia recurrence, cardioversion, Class I/III antiarrhythmic supplier resumption aft a 2-month blanking play aliases immoderate repetition ablation. For follow-up, participants were instructed to execute play self-recorded single-lead ECGs and to seizure recordings during symptomatic episodes utilizing a mobile ECG system.

A full of 289 patients were analysed who had a mean property of 63.5 years and 42% were female. The mean long of drug-resistant AF was 39 months.

The superior endpoint, single-procedure occurrence astatine 12 months, was precocious and akin betwixt nan process types: 77.2% successful nan PFA group and 77.6% successful nan RFA group, pinch an adjusted quality of 0.9% (95% assurance interval [CI] -8.2 to 10.1; p=0.84).

The mean full process long was importantly shorter for PFA (56 vs. 95 minutes), pinch an adjusted quality of −39 minutes (95% CI −44 to −34).

Overall, nan information floor plan was fantabulous successful some groups. Procedure-related superior adverse events Including unplanned aliases prolonged hospitalisations occurred successful 5 patients (3.4%) successful nan PFA group and 11 patients (7.6%) successful nan RFA group. Complications appeared much predominant pinch RFA. One transient ischaemic onslaught was observed pinch PFA, while 2 tamponade percutaneously drained and 2 cases of pulmonary vein stenosis >70% were observed pinch RFA. Pulmonary vein stenosis >50% occurred successful 12 patients and 15 patients, respectively. No deaths, persistent phrenic palsy aliases changeable occurred.

Professor Jaïs concluded: "Both PFA and RFA utilizing nan CLOSE protocol showed fantabulous and akin efficacy. Single-procedure occurrence rates were comparable, though location appeared to beryllium less complications and a shorter process clip pinch PFA."