JACC This Week Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden
Jun 24, 2024
Dr. Valentin Fuster dives into the intriguing comparison between pulsed field and thermal ablation for atrial fibrillation. He discusses the risks of conventional methods and highlights the advantages of the non-thermal pulsed field technique. The latest ADVENT trial results reveal pulsed field's efficacy while maintaining safety. Fuster argues that measuring arrhythmia burden provides a clearer view of patient outcomes compared to traditional metrics. Continuous monitoring and a focus on managing AF burden are framed as essential for improving quality of life.
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PFA Preferentially Ablates Myocardium
- Pulse field ablation (PFA) uses microsecond high-voltage fields to preferentially electroporate myocardium with limited collateral injury.
- PFA was superior for efficacy and noninferior for safety compared with thermal ablation in the ADVENT trial.
Burden Beats Binary Recurrence
- Measuring any single 30-second AF recurrence is a limited endpoint for ablation success.
- Post-ablation atrial arrhythmia burden better correlates with quality of life and clinical outcomes than a dichotomous 30-second metric.
Monitor Frequently And Use The Higher Estimate
- Use frequent transtelephonic monitoring plus 72-hour Holters to estimate post-ablation arrhythmia burden.
- Define burden using the higher estimate from weekly strips or Holter data for a conservative assessment.