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Pulsed field ablation (PFA), the newest energy source for ablation of atrial fibrillation (AF), involves rapidly repetitive high-voltage shocks and appears to be relatively selective for myocardial cells. PFA and thermal energy (radiofrequency and cryoablation) did not differ in efficacy in the ADVENT trial (NEJM JW Cardiol Aug 28 2023 and N Engl J Med 2023; 389:1660). Now, in a noninferiority trial from Switzerland (NCT05534581), investigators randomized 210 patients (mean age, 64 years; 72% men) with symptomatic paroxysmal AF to undergo PFA or cryoablation. All participants had continuous rhythm monitoring with an implantable recorder.
Incidence of the primary endpoint — first occurrence of an atrial tachyarrhythmia lasting ≥30 sec from da…