TY - JOUR
T1 - Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation
T2 - Recurrent Atrial Arrhythmia Burden
AU - ADVENT Investigators
AU - Reddy, Vivek Y.
AU - Mansour, Moussa
AU - Calkins, Hugh
AU - d'Avila, Andre
AU - Chinitz, Larry
AU - Woods, Christopher
AU - Gupta, Sanjaya K.
AU - Kim, Jamie
AU - Eldadah, Zayd A.
AU - Pickett, Robert A.
AU - Winterfield, Jeffrey
AU - Su, Wilber W.
AU - Waks, Jonathan W.
AU - Schneider, Christopher W.
AU - Richards, Elizabeth
AU - Albrecht, Elizabeth M.
AU - Sutton, Brad S.
AU - Gerstenfeld, Edward P.
AU - Whang, William
AU - Reddy, Vivek
AU - Koruth, Jacob
AU - Dukkipati, Srinivas
AU - DeLurgio, David
AU - Patel, Anshul
AU - Osorio, Jose
AU - Rajendra, Anil
AU - Morales, Gustavo
AU - D'Souza, Benjamin
AU - Bullinga, John
AU - Cuoco, Frank
AU - Sidney, Darren
AU - Daccarett, Marcos
AU - Harding, John
AU - Sangrigoli, Robert
AU - Pickett, Robert
AU - Kaiser, Daniel
AU - Natale, Andrea
AU - Gallinghouse, Joseph
AU - Gupta, Sanjaya
AU - Steinhaus, Daniel
AU - Heist, Kevin
AU - Van Houzen, Nathan
AU - Field, Michael
AU - McElderry, Tom
AU - Maddox, William
AU - Holmes, Douglas
AU - Spragg, David
AU - Eldadah, Zayd
AU - Lee, Sung
AU - Thomaides, Athanasios
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/7/2
Y1 - 2024/7/2
N2 - 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 = 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 = 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.
AB - 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 = 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 = 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.
KW - arrhythmia burden
KW - atrial fibrillation
KW - pulsed field ablation
UR - http://www.scopus.com/inward/record.url?scp=85196166418&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2024.05.001
DO - 10.1016/j.jacc.2024.05.001
M3 - Article
C2 - 38864538
AN - SCOPUS:85196166418
SN - 0735-1097
VL - 84
SP - 61
EP - 74
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -