Pulsed field ablation versus conventional thermal ablation for paroxysmal atrial fibrillation: 4-year outcomes in the ADVENT-LTO study

Abstract Pulsed field ablation (PFA) has proven to be a safe and effective non-thermal ablation modality for the treatment of atrial fibrillation (AF), but little outcome data beyond 1 year has been reported. Here, we present results from the ADVENT-LTO study, which provides extended follow-up of the ADVENT trial, the first randomized trial comparing PFA with conventional thermal ablation. In ADVENT-LTO , 364 paroxysmal AF patients (183 PFA, 181 thermal; 237 men, 127 women) participated, and were followed for 1,332±147 days. For the primary endpoint of four-year treatment success, PFA demonstrated preserved effectiveness compared to thermal ablation (72.8% PFA, 64.1% thermal; P =0.12). Moreover, there was a trend favoring PFA as compared to thermal ablation for the pre-specified outcome of freedom from hospital-based arrhythmia intervention (85.6% PFA, 78.6% thermal; HR 0.64, 95%CI 0.38, 1.05), including fewer repeat ablations (10.4% PFA, 17.7% thermal; P =0.04), as well as a trend favoring PFA as compared to thermal ablation for the pre-specified outcome of progression to persistent AF (2.6% PFA, 4.6% thermal; HR 0.55, 95%CI 0.16, 1.88). Taken together, these data demonstrate that the favorable outcomes of PFA are maintained over the course of four years. Coupled with the safety advantages of PFA over thermal ablation, these long-term data support widespread adoption of PFA for the treatment of AF. Clinical Trial Registration: NCT06526546 .