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PFA vs. Cryoballoon, CONFIRM2, and Marathon CV Mortality
April 7, 2025
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Together with
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“Often, you have no choice but to kill the parts of your heart that go out of control.”
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Obaid Imtiyaz, MD on pulsed field ablation for treating AFib.
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Expanding the potential patient population for pulsed field ablation, results from the SINGLE SHOT CHAMPION study suggest PFA might be just as good as cryoballoon ablation for patients with paroxysmal AFib.
- Paroxysmal atrial fibrillation is a type of AFib that causes short, intermittent episodes of irregular and rapid heartbeats originating in the atria.
- Cryoballoon ablation is typically used to treat PAF and involves using a balloon catheter to freeze heart tissue and isolate the pulmonary veins that can cause irregular heartbeats.
- PFA has shown advantages in procedure time and safety, but its effectiveness is unproven compared to cryoballoon ablation.
In one of the first PFA versus cryoballoon head-to-heads, researchers randomized 210 patients with symptomatic paroxysmal AFib to undergo PFA with Boston Scientific’s Farapulse or cryoablation.
- Atrial tachyarrhythmia recurred in 37.1% of the PFA group compared to 50.7% of the cryoballoon group between day 91 and day 365 after the procedure.
- Both procedures were safe and had similar complications rates (1% for PFA vs. 2% for cryoballoon).
- Delivering on its efficiency reputation, PFA procedures were shorter on average than cryoablation (55 vs. 73 minutes).
Although those stats seem to favor PFA, it’s important to note that the trial was strictly designed to determine non-inferiority, so these results can only suggest PFA is as good as cryoballoon ablation for paroxysmal AFib.
- Future studies with larger enrollment, a longer follow-up, and measured AFib burden before and after ablation would be needed to truly say if one is better than the other.
The Takeaway
While this study has several limitations, it adds to the body of evidence for considering PFA as a first-line treatment for AFib rather than as an unproven newcomer. We’ll still have to wait for future studies to see whether PFA’s outcomes will match its safety and efficiency benefits.
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