The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX (IH)-The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX (IH) (Speaker Information)

The Lead Episode 124: A Discussion of Catheter Ablation vs Lifestyle Modification With Antiarrhythmic Drugs to Treat Atrial Fibrillation: PRAGUE 25 Trial, LIVE at HRX (IH) (Speaker Information)

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The discussion, hosted by Dr. Danesh Kella at the HRX conference, centered on the PRAGUE 25 trial comparing catheter ablation versus lifestyle modification combined with antiarrhythmic drugs for treating atrial fibrillation (AF). The session included contributors Dr. Prashanthan Sanders and Dr. Ratika Parkash. A key article examined was "High Incidence of Phrenic Nerve Injury in Patients Undergoing Pulsed Field Ablation for Atrial Fibrillation," authored by Chéhirlian et al. and published in Heart Rhythm Journal. This article highlighted safety concerns regarding phrenic nerve injury associated with pulsed field ablation, a newer AF treatment technique. <br /><br />The discussion reviewed the benefits and risks of catheter ablation—a minimally invasive procedure aiming to eliminate AF sources—versus lifestyle changes and antiarrhythmic drugs, which aim to control symptoms and reduce AF burden. The PRAGUE 25 trial provided comparative data to evaluate outcomes such as AF recurrence and complications from both strategies. Pulsed field ablation was noted for its novel tissue-selective effects but with an unexpectedly high incidence of phrenic nerve injury, raising questions about procedural safety.<br /><br />The experts exchanged insights on patient selection criteria, the evolving technology of ablation modalities, and optimal treatment pathways balancing efficacy, safety, and quality of life. Disclosures revealed consulting and research ties to multiple cardiac device and pharmaceutical companies among the participants, emphasizing the importance of transparency. Overall, the session offered a comprehensive update on AF management using the latest clinical trial data and emerging ablation techniques, highlighting the need to weigh procedural risks against benefits and considering individualized therapeutic strategies for AF patients.

Keywords

PRAGUE 25 trial

catheter ablation

lifestyle modification

antiarrhythmic drugs

atrial fibrillation

pulsed field ablation

phrenic nerve injury

AF recurrence

treatment efficacy

patient selection