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Randomized Controlled Trial
. 2025 Aug;22(8):e318-e327.
doi: 10.1016/j.hrthm.2025.03.161. Epub 2025 Mar 6.

Predictors of atrial fibrillation freedom postablation with the pentaspline pulsed field ablation catheter: Subanalysis of the ADVENT Study

Stavros E Mountantonakis  1 , Edward P Gerstenfeld  2 , Moussa Mansour  3 , Frank A Cuoco  4 , Andrea Natale  5 , Chinmay Patel  6 , Douglas N Gibson  7 , Blair D Halperin  8 , Pasquale Santangeli  9 , Benjamin D'Souza  10 , Kristie M Coleman  11 , Elizabeth Richards  12 , Elizabeth M Albrecht  12 , Christopher W Schneider  12 , Brad S Sutton  12 , Vivek Y Reddy  13
Affiliations
Randomized Controlled Trial

Predictors of atrial fibrillation freedom postablation with the pentaspline pulsed field ablation catheter: Subanalysis of the ADVENT Study

Stavros E Mountantonakis et al. Heart Rhythm. 2025 Aug.

Abstract

Background: Pulsed field ablation (PFA) has proven to be at least noninferior to thermal ablation for paroxysmal atrial fibrillation (AF). Predictors of AF freedom for PFA have not yet been described.

Objective: The purpose of this study was to identify clinical and procedural predictors of treatment success in paroxysmal AF patients treated with the pentaspline PFA catheter.

Methods: ADVENT (Randomized Controlled Trial for Pulsed Field Ablation versus Standard of Care Ablation for Paroxysmal Atrial Fibrillation) was a prospective randomized trial comparing PFA to thermal ablation with centers designated to randomize patients to either radiofrequency or cryoballoon ablation. Hazard ratios were estimated to evaluate clinical and procedural characteristics associated with ablation success. Subgroup analyses were performed by ablation modality and operator/center experience.

Results: Of the 607 randomized patients (age 62.4 years, 34.6% female), treatment failure was documented in 26.7% of PFA and 28.7% of thermal ablation patients. The most common failure was arrhythmia recurrence (73.8% vs 76.5%) with no difference in subtype (non-AF arrhythmia: 12.1% PFA vs 14.6% thermal). Patients who previously failed Class I/III antiarrhythmic drugs (AADs) were more likely to benefit from PFA (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.44-0.96). Shorter left atrial dwell time was associated with higher success (HR 0.48, 95% CI 0.30-0.76), and a trend toward better outcomes was noted for patients enrolled during the second half of the trial (75.5% vs 69.9%, P = .17). PFA patients had similar success across radiofrequency and cryoballoon centers.

Conclusion: PFA with the pentaspline catheter is not associated with a higher incidence of postablation atypical flutters/tachycardias. Patients with previous Class I/III AAD failure are more likely to benefit from PFA and greater operator experience, irrespective of previous thermal modality, may be associated with better outcomes.

Keywords: Atrial fibrillation; Catheter ablation; Learning curve; Long-term predictors; Pulsed field ablation.

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Conflict of interest statement

Disclosures Dr Mountantonakis reports being a consultant to Medtronic and Boston Scientific Inc; research support from Medtronic, Biotronik, Abbott, and CVRx; and lecture honoraria from Biosense Webster, Medtronic, Boston Scientific Inc, Zoll, and Abbott. Dr Gerstenfeld reports being a consultant to Farapulse Inc and an unpaid consultant to Boston Scientific Inc; and lecture honoraria from Boston Scientific Inc. Dr Mansour reports being a consultant for Boston Scientific. Dr Cuoco reports being a consultant to Boston Scientific and Biosense Webster. Dr Natale reports being a consultant to Abbott, Baylis, Biotronik, Biosense Webster, Boston Scientific, and Medtronic. Dr Patel reports being a consultant to Boston Scientific. Dr Gibson reports being a consultant to Abbott, Baylis, Biotronik, Biosense Webster, Boston Scientific, and Medtronic. Dr Santangeli reports being a consultant for Boston Scientific, Medtronic, Abbott, and Biosense Webster. Dr D’Souza reports being a consultant to Boston Scientific and Biosense Webster. Ms Richards, Dr Albrecht, Mr Schneider, and Dr Sutton are employees of Boston Scientific. Dr Reddy reports being a consultant to and received equity from Farapulse (now divested) and receives grant support from and serves as a consultant to Boston Scientific; and unrelated to this manuscript; has served as a consultant for and has equity in Ablacon, Acutus Medical, Affera-Medtronic, Anumana, Apama Medical-Boston Scientific, APN Health, Aquaheart, Atacor, Autonomix, Axon Therapies, Backbeat, BioSig, CardiaCare, CardioNXT/AFTx, Circa Scientific, CoRISMA, Corvia Medical, Dinova-Hangzhou DiNovA EP Technology, East End Medical, EPD-Philips, EP Frontiers, Epix Therapeutics-Medtronic, EpiEP, Eximo, Field Medical, Focused Therapeutics, HRT, Intershunt, Javelin, Kardium, Keystone Heart, LuxMed, Medlumics, Middlepeak, Neutrace, Nuvera-Biosense Webster, Oracle Health, Restore Medical, Sirona Medical, SoundCath, and Valcare; unrelated to this work; has served as a consultant for Abbott, Adagio Medical, AtriAN, Biosense Webster, BioTel Heart, Biotronik, Cairdac, Cardiofocus, Cardionomic, CoreMap, Fire1, Gore & Associates, Impulse Dynamics, Medtronic, Novartis, Philips, Pulse Biosciences; unrelated to this work; and has equity in Atraverse, Manual Surgical Sciences, Newpace, Nyra Medical, Surecor, and Vizaramed. Dr Halperin and Ms Coleman have no conflicts to disclose.

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