Pulsed field ablation shows similar efficacy to radiofrequency ablation for paroxysmal AF

This multicenter randomized controlled trial compared pulsed field ablation (PFA) using a pentaspline catheter against radiofrequency ablation (RFA) following the CLOSE protocol in 289 patients aged 18-80 years with symptomatic, drug-resistant paroxysmal atrial fibrillation. The primary outcome was single-procedure success at 12 months, defined as absence of ≥30-second atrial arrhythmia recurrence, cardioversion, class I/III antiarrhythmic drug resumption after a 2-month blanking period, or any repeat ablation.

For efficacy, there was no significant difference between groups: PFA achieved 77.2% success (112/145) compared to 77.6% (111/143) with RFA. The adjusted difference was 0.9% with a 95% confidence interval of -8.2% to 10.1% (P=0.84), indicating PFA was not superior to RFA. Regarding safety, procedure-related serious adverse events occurred in 3.4% of PFA patients (5 events) versus 7.6% of RFA patients (11 events), representing a difference of -3.3% (95% CI -8.4% to 1.8%).

Key limitations include the study being reported only as an abstract, which typically provides limited methodological details. Adverse event reporting beyond procedure-related serious events was not reported, and discontinuation rates and tolerability data were unavailable. The confidence intervals for both efficacy and safety outcomes include no difference, meaning the observed numerical advantages for PFA in safety could be due to chance.

For practice, this trial suggests PFA may achieve similar 12-month efficacy outcomes as established RFA techniques in patients with drug-resistant paroxysmal AF. The numerically lower serious adverse event rate with PFA warrants attention but requires confirmation in larger studies with comprehensive safety reporting. Clinicians should interpret these findings cautiously given the abstract-only publication and need for longer-term data.