{"id":"1b32c4852eeb","type":"article","url":"https://hartvaat.nl/2023/11/02/advent-pulsed-field-ablatie-non-inferieur-aan-thermale-ablatie-bij-af-nejm/","title":"ADVENT: pulsed field ablatie non-inferieur aan thermale ablatie bij AF — NEJM","title_en":"Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","pulsed-field-ablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307291","source_url":"https://doi.org/10.1056/NEJMoa2307291","authors":["Vivek Y Reddy","Edward P Gerstenfeld","Andrea Natale","William Whang","Frank A Cuoco","Chinmay Patel","Stavros E Mountantonakis","Douglas N Gibson","John D Harding","Christopher R Ellis","Kenneth A Ellenbogen","David B DeLurgio","Jose Osorio","Anitha B Achyutha","Christopher W Schneider","Andrew S Mugglin","Elizabeth M Albrecht","Kenneth M Stein","John W Lehmann","Moussa Mansour"],"significance":9,"published":"2023-11-02","source_date":"2023-11-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"The ADVENT trial demonstrated that pulsed field ablation was noninferior to conventional thermal ablation (radiofrequency or cryoablation) for the treatment of paroxysmal atrial fibrillation, with a comparable safety profile. This established PFA as a safe and effective tissue-selective alternative for pulmonary vein isolation.","created":"2026-07-03T10:30:40Z","updated":"2026-07-03T13:29:43Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De ADVENT-trial in de NEJM toonde dat pulsed field ablatie (PFA) non-inferieur was aan conventionele thermale ablatie voor paroxysmaal AF, met vergelijkbare effectiviteit en veiligheid. PFA biedt weefselspecifieke ablatie met mogelijk minder collaterale schade.","abstract_original":"BACKGROUND: Catheter-based pulmonary vein isolation is an effective treatment for paroxysmal atrial fibrillation. Pulsed field ablation, which delivers microsecond high-voltage electrical fields, may limit damage to tissues outside the myocardium. The efficacy and safety of pulsed field ablation as compared with conventional thermal ablation are not known. METHODS: In this randomized, single-blind, noninferiority trial, we assigned patients with drug-refractory paroxysmal atrial fibrillation in a 1:1 ratio to undergo pulsed field ablation or conventional radiofrequency or cryoballoon ablation. The primary efficacy end point was freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation. The primary safety end point included acute and chronic device- and procedure-related serious adverse events. RESULTS: A total of 305 patients were assigned to undergo pulsed field ablation, and 302 were assigned to undergo thermal ablation. At 1 year, the primary efficacy end point was met (i.e., no events occurred) in 204 patients (estimated probability, 73.3%) who underwent pulsed field ablation and 194 patients (estimated probability, 71.3%) who underwent thermal ablation (between-group difference, 2.0 percentage points; 95% Bayesian credible interval, -5.2 to 9.2; posterior probability of noninferiority, >0.999). Primary safety end-point events occurred in 6 patients (estimated incidence, 2.1%) who underwent pulsed field ablation and 4 patients (estimated incidence, 1.5%) who underwent thermal ablation (between-group difference, 0.6 percentage points; 95% Bayesian credible interval, -1.5 to 2.8; posterior probability of noninferiority, >0.999). CONCLUSIONS: Among patients with paroxysmal atrial fibrillation receiving a catheter-based therapy, pulsed field ablation was noninferior to conventional thermal ablation with respect to freedom from a composite of initial procedural failure, documented atrial tachyarrhythmia after a 3-month blanking period, antiarrhythmic drug use, cardioversion, or repeat ablation and with respect to device- and procedure-related serious adverse events at 1 year. (Funded by Farapulse-Boston Scientific; ADVENT ClinicalTrials.gov number, NCT04612244.)."}