Study Shows Pulmonary Vein Isolation with Pulsed Field Ablation Similar in Effectiveness to Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

A recent late-breaking clinical trial presented at the ESC Congress 2025 reveals that pulsed field ablation (PFA) does not outperform traditional radiofrequency ablation (RFA) in treating patients with drug-resistant paroxysmal atrial fibrillation (AF). The study underscores that both techniques achieve comparable success rates in initiating and maintaining sinus rhythm, with additional benefits favoring PFA in terms of safety and procedure duration.

Atrial fibrillation, the most common sustained cardiac arrhythmia, often requires catheter ablation when medication fails to control symptoms. While thermal RFA has been the standard approach, PFA emerges as a promising nonthermal alternative designed for faster and more selective tissue targeting.

This multicenter trial involved 289 patients across Europe, all of whom had symptomatic paroxysmal AF resistant to at least one antiarrhythmic drug. Participants were randomly assigned to undergo either PFA or RFA, following the same procedural protocol. The primary goal was to achieve a single-procedure success rate after 12 months—meaning no significant arrhythmia recurrence, no need for cardioversion, resumption of antiarrhythmic drugs, or repeat ablation.

Results showed that success rates were nearly identical: 77.2% for the PFA group and 77.6% for the RFA group. Notably, procedures utilizing PFA had a significantly shorter duration—averaging around 56 minutes compared to 95 minutes for RFA. Safety profiles were excellent across both groups, but fewer complications were observed with PFA, including a lower incidence of serious adverse events.

Specific complications with RFA included instances of pulmonary vein stenosis and tamponade, whereas PFA’s safety profile was slightly better without any occurrences of stroke or persistent phrenic nerve palsy. A transient ischemic attack was reported in the PFA group but was isolated and resolved.

Lead researcher Professor Pierre Jaïs highlighted that both approaches are effective, with PFA showing potential advantages in reducing procedure time and complications. These findings support the continued integration of pulsed field technology into clinical practice for AF management.

For more details, visit the source.