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September 10, 2025
2 min read
Key takeaways:
- AF recurrence after pulsed field ablation was comparable vs. after radiofrequency ablation.
- There were fewer procedure-related adverse events with pulsed field ablation, and procedure time was shorter.
Pulsed field ablation demonstrated similarly durable atrial fibrillation ablation as radiofrequency ablation, with fewer procedure-related adverse events and shorter procedure time, researchers reported.
The results of the BEAT PAROX-AF trial were presented at the European Society of Cardiology Congress.
AF recurrence after pulsed field ablation was comparable vs. after radiofrequency ablation. Image: Adobe Stock
“[Atrial fibrillation] is the most common [arrhythmia] in patients, in over 40 million people worldwide. … The socioeconomic burden is huge, either directly or indirectly, and the impact on quality of life is viable. It’s as significant as coronary artery disease,” Pierre Jais, MD, professor of cardiology at the University of Bordeaux, France, and co-manager of the LIRYC Institute, said during a press conference. “We conducted this trial to compare a new energy source for catheter ablation in the heart for cardiac arrhythmias, which is pulsed field ablation, to the very old and refined radiofrequency ablation that we’ve been using for over 30 years now.”
Jais and colleagues randomly assigned 292 patients with drug-resistant paroxysmal AF to undergo pulmonary vein isolation with either high-voltage pulsed field ablation (Farapulse, Boston Scientific) or CLOSE protocol radiofrequency ablation with a contact for catheter (CARTO SmartTouch, Biosense Weber). The trial was conducted across nine centers in France, Czech Republic, Germany, Austria and Belgium.
The primary endpoint was 1-year, single-procedure, off-drug absence of atrial arrhythmia recurrence.
“We chose the most advanced form of treatment using radiofrequency ablation, which is using the best navigation system and using the best protocol, which is the CLOSE protocol,” Jais said. “Under this protocol, we have specific attempts to reach enough depth in tissue, and also to ensure the contiguity between adjacent points, to make sure that the encirclement around the veins is really successful.”
The mean duration of the pulsed field ablation procedure was 56 minutes compared with 95 minutes with radiofrequency ablation.
The primary endpoint occurred in 77.2% of the pulsed field ablation group and 77.6% of the radiofrequency ablation group (adjusted risk difference = 0.9%; 95% CI, –8.2% to 10.1%; P = .84).
“This is very interesting because when we wrote this protocol in 2020 we’d been looking at previous randomized control trials … where the success rate for both radiofrequency and cryoablation was 65%. We made the assumption that we would compare [pulsed field ablation] to the 65% success rate, which is no longer the case because in the meantime the CLOSE protocol was there,” Jais said during the press conference. “The ‘young’ pulsed field ablation is already as effective as radiofrequency ablation, that we have been refining for over 30 years. It makes me hopeful that in the future, we will see better results with refined forms of pulsed field ablation.”
The researchers reported more procedure-related adverse events among those who underwent radiofrequency ablation vs. pulsed field ablation, such as cardiac tamponade/perforation (0% vs. 1.4%), vascular access complications (0.7% vs. 2.8%) and pulmonary vein stenosis of 70% or more (0% vs. 1.4%). Excluding unrelated hospitalizations, 3.4% of participants who underwent pulsed field ablation experienced at least one procedure-related serious adverse event compared with 7.6% in the radiofrequency ablation group.
Moreover, 12 patients assigned to radiofrequency ablation experienced pulmonary vein stenosis of 50% or more vs. none in the pulsed field ablation arm.
“Safety is an important aspect of our procedures. It matters a lot for patients and for our health care system,” Jais said during the press conference. “The most devastating complications were not observed in our patients. So no myocardial infarction, no stroke and just one transient ischemic attack in the pulsed field ablation group. All together, we had fewer complications in the pulsed field ablation as compared to radiofrequency ablation.”
Sources/Disclosures
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Jais P, et al. Hot line 8. Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 1, 2025; Madrid (hybrid meeting).
Disclosures:
BEAT PAROX-AF was partially funded by the LIRYC Institute. Jais reports receiving a research grant from Boston Scientific.
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