{"id":"90fb4a05ae58","type":"article","url":"https://hartvaat.nl/2024/07/02/pfa-versus-thermale-ablatie-bij-paroxysmaal-af-aritmielastanalyse/","title":"PFA versus thermale ablatie bij paroxysmaal AF: aritmielastanalyse","title_en":"Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["pulsed-field-ablatie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2024.05.001","source_url":"https://doi.org/10.1016/j.jacc.2024.05.001","authors":["Vivek Y Reddy","Moussa Mansour","Hugh Calkins","Andre d'Avila","Larry Chinitz","Christopher Woods","Sanjaya K Gupta","Jamie Kim","Zayd A Eldadah","Robert A Pickett","Jeffrey Winterfield","Wilber W Su","Jonathan W Waks","Christopher W Schneider","Elizabeth Richards","Elizabeth M Albrecht","Brad S Sutton","Edward P Gerstenfeld"],"significance":6,"published":"2024-07-02","source_date":"2024-07-02","image":"","kennis":[],"congress":"","summary_en":"This ADVENT analysis showed that the arrhythmia burden after pulsed field ablation is comparable to thermal ablation for paroxysmal AF, confirming equivalent rhythm control with the newer tissue-selective technology.","created":"2026-07-03T10:31:01Z","updated":"2026-07-03T13:30:04Z","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":"Analyse van ADVENT vergeleek de recurrente aritmielast na PFA versus thermale ablatie bij paroxysmaal AF. De AF-last was vergelijkbaar na beide technieken, wat de therapeutische equivalentie van PFA bevestigt.","abstract_original":"BACKGROUND: The ADVENT randomized trial revealed no significant difference in 1-year freedom from atrial arrhythmias (AA) between thermal (radiofrequency/cryoballoon) and pulsed field ablation (PFA). However, recent studies indicate that the postablation AA burden is a better predictor of clinical outcomes than the dichotomous endpoint of 30-second AA recurrence. OBJECTIVES: The goal of this study was to determine: 1) the impact of postablation AA burden on outcomes; and 2) the effect of ablation modality on AA burden. METHODS: In ADVENT, symptomatic drug-refractory patients with paroxysmal atrial fibrillation underwent PFA or thermal ablation. Postablation transtelephonic electrocardiogram monitor recordings were collected weekly or for symptoms, and 72-hour Holters were at 6 and 12 months. AA burden was calculated from percentage AA on Holters and transtelephonic electrocardiogram monitors. Quality-of-life assessments were at baseline and 12 months. RESULTS: From 593 randomized patients (299 PFA, 294 thermal), using aggregate PFA/thermal data, an AA burden exceeding 0.1% was associated with a significantly reduced quality of life and an increase in clinical interventions: redo ablation, cardioversion, and hospitalization. There were more patients with residual AA burden <0.1% with PFA than thermal ablation (OR: 1.5; 95% CI: 1.0-2.3; P = 0.04). Evaluation of outcomes by baseline demographics revealed that patients with prior failed class I/III antiarrhythmic drugs had less residual AA burden after PFA compared to thermal ablation (OR: 2.5; 95% CI: 1.4-4.3; P = 0.002); patients receiving only class II/IV antiarrhythmic drugs pre-ablation had no difference in AA burden between ablation groups. CONCLUSIONS: Compared with thermal ablation, PFA more often resulted in an AA burden less than the clinically significant threshold of 0.1% burden. (The FARAPULSE ADVENT PIVOTAL Trial PFA System vs SOC Ablation for Paroxysmal Atrial Fibrillation [ADVENT]; NCT04612244)."}