In the Phase 2 results of the multicenter ADVANTAGE AF trial, researchers have demonstrated that pulsed field ablation (PFA), when used for pulmonary vein isolation (PVI) and posterior wall ablation (PWA), is safe and effective in patients with persistent atrial fibrillation (PerAF). This trial is the first to utilize insertable cardiac monitors (ICMs) for continuous rhythm surveillance in a large PerAF cohort. The results were published in the Circulation Journal.
Involving 255 patients, the study employed the pentaspline PFA catheter for PVI and PWA, and a novel focal-linear catheter for cavotricuspid isthmus ablation, with intravenous nitroglycerin used prophylactically to mitigate vascular spasm.
The primary efficacy endpoint—freedom from atrial arrhythmias (AAs) mimicking traditional intermittent monitoring—was achieved in 73.4% of patients at one year. Real-time continuous ICM data showed that 52.0% of patients were free from AA episodes ≥30 seconds, and 94.0% had no episode lasting more than 24 hours. Cavotricuspid isthmus ablation achieved a 98.6% bidirectional block rate with no complications, suggesting high procedural safety.