Farapulse, a nonthermal treatment, uses electric fields to selectively ablate heart tissue. It’s one of the leading PFA systems in a market that includes Medtronic, Johnson & Johnson MedTech, Abbott and Kardium.
Investigators shared findings from the ADVENT LTO study at the 2026 AF Symposium in Boston. Outcomes included greater long-term treatment success compared to thermal ablation. Additional outcomes included fewer hospital-based arrhythmia interventions and repeat ablations, reduced anti-arrhythmic drug (AAD) use and no long-term safety concerns.
The findings, simultaneously published in Nature Medicine, came from an observational extension of the pivotal ADVENT trial. ADVENT LTO assessed Farapulse’s effectiveness out to four years in paroxysmal AFib patients, comparing the therapy to thermal (radiofrequency or cryo) ablation.
Boston Scientific said it marks the first clinical study to report results out to four years in a randomized cohort of patients comparing PFA to thermal ablation.
A look at the findings from Boston Scientific
The study evaluated 364 patients, with 183 receiving PFA and 181 receiving thermal ablation. Farapulse demonstrated greater long-term effectiveness at four years (72.8%) compared with thermal ablation (64.3%). It also delivered fewer hospital-based arrhythmia interventions at four years. Freedom from intervention came in at 85.6% for Farapulse, compared to 78.6% with thermal ablation.
Boston Scientific said patients treated with Farapulse proved more likely to stay off antiarrhythmic drugs (AADs), as 11.5% of Farapulse patients used AADs out to four years, compared to 20.4% with thermal ablation.
More than 90% of Farapulse patients who registered as event-free at one year remained event-free long-term. Patients treated with thermal ablation had a higher probability of needing repeat ablation, as 17.7% of them had repeat ablations. Just 10.4% of Farapulse patients received repeat ablations.
Long-term safety outcomes proved similar for both treatments with no long-term safety concerns.
“This is the first long-term study comparing outcomes of PFA versus thermal ablation for the treatment of atrial fibrillation in a randomized cohort of patients,” said Dr. Vivek Reddydirector, Cardiac Arrhythmia Services, Mount Sinai Health System and Leona M. and Harry B. Helmsley Charitable Trust professor of medicine, Cardiac Electrophysiology, Icahn School of Medicine at Mount Sinai and study principal investigator. “The data reinforce the safety and lasting efficacy of therapy provided by the Farapulse PFA platform for its use treating patients living with paroxysmal AF, and also demonstrate they are more likely to stay off anti-arrhythmic drugs long-term.”
