Updates · September 27, 2026

First-line PFA vs first-line drugs in persistent AFib

AVANT-GUARD (NEJM, 2026) randomized previously untreated persistent AFib to pulsed field ablation or antiarrhythmic drugs. Everyone received an insertable monitor.

Twelve-month treatment success: 56% with PFA vs 30% with drugs.

PFA can be first therapy in this setting. It is not automatic. Nearly half still had recorded recurrence and need a plan — stroke risk, sleep apnea, blood pressure, and follow-up stay in the same practice.

This is a rhythm-efficacy trial, not a 5-year stroke/death trial.

How we use PFA AFib plan

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