# ADVENT: pulsed field ablatie non-inferieur aan thermale ablatie bij AF — NEJM

*geplaatst 2023-11-02 · Atriumfibrilleren · The New England journal of medicine · doi 10.1056/NEJMoa2307291 · https://hartvaat.nl/2023/11/02/advent-pulsed-field-ablatie-non-inferieur-aan-thermale-ablatie-bij-af-nejm/*

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.

## English: Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation.

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.

## Abstract (original, from the publication)

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.).

Auteurs: 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

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Bron: The New England journal of medicine, https://doi.org/10.1056/NEJMoa2307291. Bijgewerkt 2026-07-03T13:29:43Z. 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.