Pulsed Field Ablation Versus Radiofrequency Ablation for Persistent Atrial Fibrillation

Traditional treatment options for persistent atrial fibrillation (PeAF) include pharmacological management, electrical cardioversion, and catheter ablation. Pulmonary vein isolation (PVI) has become the cornerstone of ablation therapy and has been shown to be effective in clinical practice. However, its efficacy is relatively limited in patients with persistent AF compared with those with paroxysmal AF, and many patients still experience recurrence after treatment.

In recent years, linear ablation strategies based on alcohol ablation have been shown to improve the one-year maintenance of sinus rhythm in patients with PeAF. Traditional radiofrequency ablation (RF) has demonstrated good outcomes but still has certain limitations when dealing with PeAF. In several clinical studies, pulsed field ablation (PFA), an emerging and innovative technique, has shown non-inferiority in treating paroxysmal AF. Furthermore, PFA has also demonstrated significant efficacy in linear ablation sites such as the mitral isthmus line, posterior left atrial wall, and tricuspid isthmus line, highlighting its potential in treating PeAF. This study aims to compare the safety and efficacy of PFA and radiofrequency ablation (RF) in the treatment of PeAF through a multi-center, prospective, randomized, open-label, non-inferiority clinical trial, to provide a safer and more effective treatment option for clinical practice.

Inclusion criteria

• 18-80 years
• Patients with non-valvular persistent atrial fibrillation undergoing their first catheter ablation (AF duration: 3 months to 3 years)
• Left atrial diameter on parasternal long-axis view of echocardiogram < 50 mm
• Agree to be randomly assigned to the ablation strategy and able to follow up

Exclusion criteria

• Atrial fibrillation due to reversible causes
• LVEF < 30%
• Severe congenital heart disease
• Severe liver or kidney dysfunction (eGFR < 15, Child-Pugh grade 3), or history of dialysis
• History of cardiac surgery, such as coronary artery bypass grafting, mechanical valve or prosthetic valve replacement
• History of pacemaker implantation, left atrial appendage closure, or patent foramen ovale closure
• Contraindications to oral anticoagulation
• Contraindications to right or left heart catheterization
• Pregnancy
• Life expectancy < 1 year (e.g., advanced malignancy, end-stage renal disease)
• Currently enrolled in another trial evaluating medical devices or drugs
• Other situations where the investigator determines the subject is unsuitable for the study