2026 AF Symposium

Late Breaking Clinical Science: ADVENT-LTO Study

Dr. Vivek Reddy

In the Late Breaking Clinical Science, Session 2, Dr. Vivek Reddy (Mount Sinai Medical Center, New York, NY) gave a presentation on “Long Term Outcomes of Pulsed Field Ablation (PFA) versus Standard of Care Thermal Ablation for Paroxysmal Atrial Fibrillation: Primary Results of the ADVENT-LTO Study.”

ADVENT-LTO Follow-up to ADVENT

The original ADVENT study found that Pulsed Field Ablation (PFA) was “not inferior” [no better or worse] than Thermal Ablation.

The ADVENT-LTO was a follow-up study to the original study. (They were able to re-enroll 60% of the original ADVENT study PFA patients.)

The ADVENT-LTO study followed PFA and thermal ablation patients for nearly 4 years (3.6 years). Basically, they performed an observational extension of the original ADVENT trial.

PFA Versus Thermal Ablation

Researchers used Holter monitors, patients’ clinical records, and quality of life surveys to conduct the study.

The primary end point was freedom from recurrence beyond the 3-month blanking period, cardioversions, or repeat ablations.

The PFA group included 183 patients, the thermal ablation group included 181 (81 RF ablation patients and 100 Cryo ablation patients). There was a 3.6-year follow-up.

ADVENT-LTO Study Findings

Recurrence: Both groups had similar recurrence rates. Overall, 9% of ablation patients will experience recurrence. There was a trend for PFA to be more successful, but it didn’t achieve statistical superiority (an 8-point improvement). The PFA recurrence rate was 9.3%.

Hospital Intervention/Repeat Ablations: PFA patients had fewer hospital-based arrhythmia interventions and repeat ablations. Freedom from intervention in the PFA group was 85.6%, compared to 78.6% for thermal ablation.

Repeat ablation occurred in 10.4.% of PFA patients, compared to 17.7% for thermal ablation.

Drug/Safety Issues: There was reduced anti-arrhythmic drug use in the PFA group, and no long-term safety concerns.

AF Progression: There was less progression from Paroxysmal to Persistent A-Fib in the PFA patients.

Conclusion: PFA Superior to and Preferred Over Thermal Ablation

PFA was found to be superior to thermal ablation, though not statistically significant, the data and trends were meaningful and consequential.

Researchers concluded that coupled with the safety advantages of PFA over thermal ablation, the long-term data supports widespread adoption of PFA for the treatment of Atrial Fibrillation.

Editor’s Comments

Though the findings did not prove statistically significant, the trends are quite revealing. More research is needed with larger numbers of patients.

PFA Superior to Thermal Ablation: The first ADVENT study showed only that PFA was “non-inferior”(not better or worse) to thermal ablation. Not so with the ADVENT-LTO study findings.

Though the ADVENT-LTO study findings did not achieve statistical significance, the trends and data indicate that PFA is superior to thermal ablation.

Kudos to Dr. Reddy: We are very grateful to Dr. Reddy and his colleagues for this important study.

What This Means to Patients: From the follow-up ADVENT-LTO study findings, we patients should prefer PFA over thermal ablation. If you have a choice, select PFA ablation. According to the researchers in ADVENT-LTO, long-term data supports the choice of PFA to treat your Atrial Fibrillation.

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