Study Title: BEAT PAROX AF: A Randomized Comparison of PFA vs. RFA

Published in Congress: ESC Congress 2025

Link: https://esc365.escardio.org/presentation/312224

Prepared by: Dr. Abdalrahman Shawky A. Mostafa, Dr. Mustafa Yenerçağ

Introduction:
Paroxysmal atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. When symptoms are not controlled with medications, catheter ablation is frequently performed to achieve pulmonary vein isolation (PVI) and interrupt abnormal electrical activity. Radiofrequency ablation (RFA) is a well-established and evidence-based treatment for drug-resistant AF. However, thermal energy-based ablation carries a risk of injury to surrounding tissues. Pulsed field ablation (PFA) has been developed as a non-thermal alternative with more selective tissue targeting, and its efficacy and safety compared to RFA are of clinical interest.

Objective:
The aim of this study was to compare the efficacy and safety of PFA versus advanced RFA in patients with drug-resistant paroxysmal AF, with particular attention to procedure duration and complication rates.

Methods:
The BEAT-PAROX-AF trial was a multicenter, randomized, open-label clinical study conducted across nine centers in France, Czechia, Germany, Austria, and Belgium. A total of 289 symptomatic patients with paroxysmal AF, resistant to at least one antiarrhythmic drug and with an ESC Class I/IIa indication for ablation, were enrolled. Participants were randomized 1:1 to undergo PVI using either PFA (FARAPULSE) or RFA (CLOSE protocol with SmartTouch catheter). The primary endpoint was single-procedure success at 12 months, defined as freedom from ≥30-second atrial arrhythmia recurrence, cardioversion, resumption of antiarrhythmic drugs, or repeat ablation.

Results:
Single-procedure success rates were similar between the two groups: 77.2% for PFA and 77.6% for RFA. Procedure duration was significantly shorter with PFA (56 minutes vs. 95 minutes). Serious procedure-related events occurred in 3.4% of PFA patients and 7.6% of RFA patients. In the RFA group, two tamponades and pulmonary vein stenosis >70% were reported, whereas one transient ischemic attack occurred in the PFA group. No deaths, strokes, or persistent phrenic nerve palsy were reported.

Conclusions:
Both PFA and RFA demonstrated high efficacy, with comparable single-procedure success rates. PFA was associated with shorter procedure times and a trend toward fewer complications.

Comment:
PFA may be considered a safe and effective alternative to RFA. Shorter procedure duration and lower complication rates may support its clinical use, although further studies with longer follow-up and larger patient populations are warranted.