AVANT-GUARD: Pulsed Field Ablation as First-Line Therapy For Patients With Persistent AFib

The likelihood of recurrence of atrial arrhythmia in patients with persistent atrial fibrillation (AFib) was lower for those who received pulsed field ablation (PFA) as first-line therapy when compared to those who first tried antiarrhythmic drug (AAD) therapy, according to results from the AVANT-GUARD trial published April 25 in NEJM. Oussama M. Wazni, MD, et al., randomized 310 patients with persistent AFib 2:1 to receive either PFA or AAD. An additional group of 100 patients were enrolled to undergo PFA for the primary safety endpoint alone. All patients received an insertable cardiac monitor. The primary effectiveness endpoint was short-term success – defined as procedural success in the PFA group and the absence of ablation 90 days after treatment initiation in the AAD group – and long-term success – defined as no recurrence of atrial arrhythmias, repeat ablation, or need for AAD from 90 days to 12 months and freedom from amiodarone use at any time. The authors found that 128 out of 207 patients in the PFA group (Kaplan-Meier estimate, 56%; 95% CI, 48-63) and 40 out of 103 patients in the AAD group (Kaplan-Meier estimate, 30%; 95% CI, 21-40) saw treatment success. The hazard ratio for composite treatment failure
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