A Head-to-Head Contest: Pulsed Field Ablation vs. Thermal Ablation in Patients with Atrial Fibrillation

Pulsed field ablation (PFA) has been seen as one of the most exciting new technologies in electrophysiology. The technique aims to irreversibly kill cardiac cells while sparing noncardiac cells, thus being safer and potentially more effective than radiofrequency ablation and cryoablation for patients with atrial fibrillation (AF).

In this single-blind, randomized study, the first to compare these techniques directly, 607 patients with drug-refractory, paroxysmal AF received PFA or thermal ablation (either radiofrequency ablation or cryoablation). The study was funded by the maker of the PFA system.

The primary efficacy composite endpoint was freedom from failure to attain pulmonary-vein isolation; documented atrial arrhythmia >30 seconds, use…