Pulsed field ablation (PFA) is the technique drawing the most attention in catheter ablation for atrial fibrillation. Instead of heat, it uses very short high-voltage electrical pulses, so many expected it to be quicker and gentler on surrounding tissue. But does it actually outperform radiofrequency ablation (RFA), the long-standing standard? A randomised head-to-head trial, BEAT-PAROX-AF, addressed exactly that question in a Hot Line session at ESC Congress 2025 in Madrid on 31 August 2025.
A note on terms first. The RFA discussed here is a heart-rhythm procedure for atrial fibrillation. It shares the same type of energy with the radiofrequency treatment of liver or lung tumours that this blog usually covers, but the target and purpose are entirely different.
Nine experienced centres in France, Czechia, Germany, Austria and Belgium took part. Patients aged 18 to 80 had symptomatic paroxysmal AF that had not responded to at least one antiarrhythmic drug. They were split 1:1: one group had pulmonary vein isolation with single-shot PFA, the other with point-by-point RFA guided by the CLOSE protocol. Both patients and doctors knew which procedure was used, and the trial was designed to show that PFA was superior.
The main measure was freedom from failure after a single procedure at 12 months. After a two-month blanking period, any atrial arrhythmia lasting 30 seconds or more, a cardioversion, restarting a class I or III antiarrhythmic drug, or a repeat ablation counted as failure. Participants recorded a single-lead ECG at home every week and also whenever they had symptoms, so recurrences would not be missed.
In total, 289 patients were analysed (average age 63.5, 42% women), who had lived with drug-resistant AF for 39 months on average. Single-procedure success at 12 months was 77.2% with PFA and 77.6% with RFA (adjusted difference 0.9%, 95% CI -8.2 to 10.1, p=0.84). The idea that PFA works better was not confirmed; both approaches achieved high success rates.
The clear difference was time. Total procedure time averaged 56 minutes with PFA and 95 minutes with RFA, about 39 minutes shorter for PFA (95% CI -44 to -34).
Safety was good in both groups, but serious procedure-related events, including unplanned or longer hospital stays, occurred in 5 PFA patients (3.4%) and 11 RFA patients (7.6%). There was one transient ischaemic attack after PFA; after RFA there were two cases of cardiac tamponade drained through the skin and two pulmonary vein narrowings above 70%. Narrowing above 50% was seen in 12 and 15 patients respectively. No deaths, lasting phrenic nerve palsy or strokes occurred.
Some context helps. These results were first released as a congress presentation and press release, so details are worth checking again in the full paper. The comparison was against modern RFA performed in experienced centres, and the design was open-label. Funding came from the EU Horizon 2020 programme and IHU LIRYC, with part of the system and catheter costs covered by Boston Scientific; the principal investigator disclosed ties with several device companies.
Principal investigator Professor Pierre Jaïs of IHU LIRYC in Bordeaux summed up that both methods worked very well and similarly, with PFA seeming to cause fewer complications and take less time. The fair reading is not that PFA works better, but that results were similar and PFA showed advantages in time and some safety measures. Which procedure suits a given patient is for the treating doctors to decide.
Source: European Society of Cardiology press release, "Pulsed field ablation was not superior to radiofrequency ablation in paroxysmal atrial fibrillation" (31 August 2025), presentation 'BEAT PAROX AF: A randomised comparison of PFA vs. RFA', ESC Congress 2025 Hot Line 8.
About this medical information · This website is operated to support a general understanding of overseas cancer-related medical information and medical technologies. FTH is not a medical institution and does not provide diagnosis, prescriptions, treatment, or medical judgment. The information published here cannot replace professional care from a medical practitioner. The choice of treatment and whether it is suitable must be decided in consultation with your own medical team.
Want to read overseas medical information accurately?
FTH translates overseas medical papers and materials together with their study stage and limitations, and provides interpreting for medical consultations abroad.