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Pulsed area ablation didn’t have superior efficacy to radiofrequency ablation in sufferers with drug-resistant paroxysmal (intermittent) atrial fibrillation, in keeping with outcomes from a late-breaking trial introduced in a Scorching Line session on the ESC Congress 2025.
Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia. Sufferers whose AF is just not managed by antiarrhythmic medicine could bear catheter ablation to disrupt the irregular electrical pathways that trigger the arrhythmia.
Principal investigator, Professor Pierre Jaïs from the IHU LIRYC (L’Institut de Rythmologie et Modélisation Cardiaque), Bordeaux, France, defined why the trial was carried out: “Pulmonary vein isolation utilizing thermal radiofrequency-based ablation (RFA) is a broadly accepted and established therapy for antiarrhythmic drug-resistant AF.
“Nonetheless, pulmonary vein isolation has advanced with the introduction of pulsed area ablation (PFA), which is a sooner, extra simple nonthermal process that doubtlessly gives extra selective tissue focusing on than thermal power sources. Different trials have in contrast PFA with thermal power sources with inconclusive outcomes.
“We conducted the BEAT-PAROX-AF trial to directly compare PFA with advanced RFA in patients with antiarrhythmic drug-resistant symptomatic paroxysmal AF.”
BEAT-PAROX-AF was an open-label, randomized managed superiority trial performed at 9 high-volume facilities throughout France, Czechia, Germany, Austria and Belgium. Eligible sufferers had been aged 18–80 years with symptomatic paroxysmal AF that was proof against no less than one antiarrhythmic drug, with a Class I or IIa indication for AF ablation in keeping with ESC Pointers and efficient oral anticoagulation for >3 weeks previous to the deliberate process.
Sufferers had been randomized 1:1 to pulmonary vein isolation utilizing both single-shot PFA or point-by-point RFA following the CLOSE protocol. The first endpoint was the single-procedure success charge after 12 months, outlined because the absence of ≥30-second atrial arrhythmia recurrence, cardioversion, Class I/III antiarrhythmic drug resumption after a 2-month blanking interval or any repeat ablation.
For follow-up, members had been instructed to carry out weekly self-recorded single-lead ECGs and to seize recordings throughout symptomatic episodes utilizing a cellular ECG system.
A complete of 289 sufferers had been analyzed who had a imply age of 63.5 years and 42% had been feminine. The imply length of drug-resistant AF was 39 months.
The first endpoint, single-procedure success at 12 months, was excessive and related between the process sorts: 77.2% within the PFA group and 77.6% within the RFA group, with an adjusted distinction of 0.9% (95% confidence interval [CI] –8.2 to 10.1; p=0.84).
The imply complete process length was considerably shorter for PFA (56 vs. 95 minutes), with an adjusted distinction of −39 minutes (95% CI −44 to −34).
Total, the security profile was glorious in each teams. Process-related critical adversarial occasions, together with unplanned or extended hospitalizations, occurred in 5 sufferers (3.4%) within the PFA group and 11 sufferers (7.6%) within the RFA group. Problems appeared extra frequent with RFA.
One transient ischemic assault was noticed with PFA, whereas two tamponade percutaneously drained and two circumstances of pulmonary vein stenosis >70% had been noticed with RFA. Pulmonary vein stenosis >50% occurred in 12 sufferers and 15 sufferers, respectively. No deaths, persistent phrenic palsy or stroke occurred.
Professor Jaïs concluded, “Both PFA and RFA using the CLOSE protocol showed excellent and similar efficacy. Single-procedure success rates were comparable, although there appeared to be fewer complications and a shorter procedure time with PFA.”
Extra info:
Summary: BEAT PAROX AF: A randomised comparability of PFA vs. RFA
Offered by
European Society of Cardiology
Quotation:
Scientific trial finds pulsed area ablation was not superior to radiofrequency ablation in paroxysmal atrial fibrillation (2025, September 1)
retrieved 1 September 2025
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