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Pulsed Field vs Conventional Thermal Ablation for ...
Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden (JACC July 2024-1)
Description
BACKGROUND:
The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence.
OBJECTIVES:
The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden.
METHODS:
In ADVENT, symptomatic drug-refractory patients with paroxysmal atrial fibrillation underwent PFA or thermal ablation. Postablation transtelephonic electrocardiogram monitor recordings were collected weekly or for symptoms, and 72-hour Holters were at 6 and 12 months. AA burden was calculated from percentage AA on Holters and transtelephonic electrocardiogram monitors. Quality-of-life assessments were at baseline and 12 months.
RESULTS:
From 593 randomized patients (299 PFA, 294 thermal), using aggregate PFA/thermal data, an AA burden exceeding 0.1% was associated with a significantly reduced quality of life and an increase in clinical interventions: redo ablation, cardioversion, and hospitalization. There were more patients with residual AA burden <0.1% with PFA than thermal ablation (OR: 1.5; 95% CI: 1.0-2.3; P ¼ 0.04). Evaluation of outcomes by baseline demographics revealed that patients with prior failed class I/III antiarrhythmic drugs had less residual AA burden after PFA compared to thermal ablation (OR: 2.5; 95% CI: 1.4-4.3; P ¼ 0.002); patients receiving only class II/IV antiarrhythmic drugs pre-ablation had no difference in AA burden between ablation groups.
CONCLUSIONS:
Compared with thermal ablation, PFA more often resulted in an AA burden less than the clinically significant threshold of 0.1% burden.
Editors
Editor-in-Chief
Valentin Fuster, MD, PhD, MACC
CME Editor
Ragavendra R. Baliga, MD
Author
Mahmoud Houmsse, MD, FACC
Important Dates
Date of Release:
June 24, 2024
Term of Approval/Date of CME/MOC Expiration:
June 23, 2025
Summary
Availability:
On-Demand
Expires on Jun 23, 2025
Cost:
FREE
Credit Offered:
1 CME Credit
1 ABIM-MOC Point
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Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden (JACC July 2024-1) Course List
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