000			03128nam a2200289 4500
001			ESSALUD
005			20260804235550.0
007			ta
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040			_aBMG
041			_aeng
100			_aWazni, Oussama M. _eAutor _953862
245			_aPulsed field ablation as initial therapy for persistent atrial fibrillation
300			_apáginas: 2407-2418
520			_aBackground: Guidelines recommend a trial of antiarrhythmic drugs before catheter ablation for persistent atrial fibrillation. Whether pulsed field ablation (PFA) may be a preferred initial treatment is unclear. Methods: We conducted an international, randomized trial involving patients with previously untreated persistent atrial fibrillation. The patients were randomly assigned in a 2:1 ratio to receive PFA performed with a pentaspline catheter or to receive antiarrhythmic-drug therapy. An additional group of patients (PFA-assigned) underwent PFA for the analysis of the primary safety end point alone. All the patients received an insertable cardiac monitor. The primary effectiveness end point was the short-term and long-term success of treatment through 12 months. Short-term success was defined as procedural success in the PFA group and the absence of ablation during the blanking period (90 days after treatment initiation) in the antiarrhythmic-drug group. Long-term success was defined as freedom from recurrence of atrial arrhythmias, repeat ablation, or need for antiarrhythmic drugs from 90 days through 12 months (in the PFA group) and freedom from amiodarone use at any time. The primary safety end point was device- and procedure-related serious adverse events. Results: At 12 months, treatment success was observed in 128 of 207 patients (Kaplan–Meier estimate, 56%; 95% confidence interval [CI], 48 to 63) in the PFA group and in 40 of 103 patients (Kaplan–Meier estimate, 30%; 95% CI, 21 to 40) in the antiarrhythmic-drug group (hazard ratio for composite treatment failure [a lack of short- and long-term success], 0.46; 95% CI, 0.33 to 0.65; P<0.001). A primary safety end-point event occurred in 13 of 257 patients (5.1%) in the combined PFA group (both randomized and PFA-assigned groups). At 12 months, serious adverse events had occurred in 45 patients (25%) in the PFA group and in 20 patients (21%) in the antiarrhythmic-drug group. Conclusions: Among patients with persistent atrial fibrillation, the risk of recurrence of atrial arrhythmia was significantly lower among those who received PFA as first-line treatment than among those who received antiarrhythmic-drug therapy.
650			_aARRITMIAS _953863
650			_aMARCAPASOS _953864
650			_aDESFIBRILADORES _953865
650			_aCARDIOLOGÍA _911301
700			_aChun, Julian _953866
700			_aNair, Devi G. _953867
700			_aAnic, Ante _953868
700			_aDuytschaever, Mattias _953869
700			_aChrispin, Jonathan _953870
773	0		_022717 _922639 _dMassachusetts NEJM Group _oNEJM006 _tThe New England Journal of Medicine _wESSALUD _x0028-4793
942			_cARTICULOS _e2026-07-31 _zSQB
999			_c22760 _d22760