{"id":"ef3147a9082a","type":"article","url":"https://hartvaat.nl/2024/02/01/pulmonaalvenenstenose-na-pfa-versus-thermale-ablatie-vergelijking/","title":"Pulmonaalvenenstenose na PFA versus thermale ablatie: vergelijking","title_en":"Pulmonary vein narrowing after pulsed field versus thermal ablation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","katheterablatie","pulsed-field-ablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euae038","source_url":"https://doi.org/10.1093/europace/euae038","authors":["Moussa Mansour","Edward P Gerstenfeld","Chinmay Patel","Andrea Natale","William Whang","Frank A Cuoco","Stavros E Mountantonakis","Douglas N Gibson","John D Harding","Scott K Holland","Anitha B Achyutha","Christopher W Schneider","Andrew S Mugglin","Elizabeth M Albrecht","Kenneth M Stein","John W Lehmann","Vivek Y Reddy"],"significance":6,"published":"2024-02-01","source_date":"2024-02-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"This study showed that pulsed field ablation causes significantly less pulmonary vein narrowing than thermal ablation for AF, demonstrating a key safety advantage of the tissue-selective PFA technology.","created":"2026-07-03T10:30:46Z","updated":"2026-07-03T13:29:49Z","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":"Studie vergeleek het risico op pulmonaalvenenstenose na pulsed field ablatie versus thermale ablatie bij AF. PFA toonde significant minder PV-vernauwing, wat de weefselspecifieke eigenschappen van PFA bevestigt.","abstract_original":"AIMS: When it occurs, pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is associated with significant morbidity. Even mild-to-moderate PV narrowing may have long-term implications. Unlike thermal ablation energies, such as radiofrequency (RF) or cryothermy, pulsed field ablation (PFA) is a non-thermal modality associated with less fibrotic proliferation. Herein, we compared the effects of PFA vs. thermal ablation on PV narrowing after AF ablation. METHODS AND RESULTS: ADVENT was a multi-centre, randomized, single-blind study comparing PFA (pentaspline catheter) with thermal ablation-force-sensing RF or cryoballoon (CB)-to treat drug-refractory paroxysmal AF. Pulmonary vein diameter and aggregate cross-sectional area were obtained by baseline and 3-month imaging. The pre-specified, formally tested, secondary safety endpoint compared a measure of PV narrowing between PFA vs. thermal groups, with superiority defined by posterior probability > 0.975. Among subjects randomized to PFA (n = 305) or thermal ablation (n = 302), 259 PFA and 255 thermal ablation (137 RF and 118 CB) subjects had complete baseline and 3-month PV imaging. No subject had significant (≥70%) PV stenosis. Change in aggregate PV cross-sectional area was less with PFA (-0.9%) than thermal ablation (-12%, posterior probability > 0.999)-primarily driven by the RF sub-cohort (-19.5%) vs. CB sub-cohort (-3.3%). Almost half of all PFA PV diameters did not decrease, but the majority (80%) of RF PVs decreased, regardless of PV anatomic location. CONCLUSION: In this first randomized comparison of PFA vs. thermal ablation, PFA resulted in less PV narrowing-thereby underscoring the qualitatively differential and favourable impact of PFA on PV tissue."}