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The Lead Episode 155: A Discussion of A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD)

June 11, 2026·21 min
Episode Description from the Publisher

In this episode of The Lead, host Christopher C. Cheung, MD, MPH, FHRS, is joined by Edward P. Gerstenfeld, MD, MS, FHRS, and Paul C. Zei, MD, PhD, FHRS, to discuss the journal article, A Prospective Randomized Multicenter Global Study Comparing Pulsed Field Ablation versus Anti-Arrhythmic Drug Therapy as a First Line Treatment for Persistent Atrial Fibrillation (AVANT GUARD). Together, they review the study design and findings, examining pulsed field ablation and anti-arrhythmic drug therapy as first-line treatment approaches for patients with persistent atrial fibrillation. Learning Objectives Review the design and key findings of the AVANT GUARD study comparing pulsed field ablation with anti-arrhythmic drug therapy as first-line treatment for persistent atrial fibrillation. Discuss the potential role of pulsed field ablation as an initial treatment strategy for patients with persistent atrial fibrillation. Examine the comparative considerations of ablation-based and pharmacologic approaches in the management of persistent atrial fibrillation.   Podcast Contributors: Host: Christopher C Cheung, MD, MPH, FHRS       Guests: Edward P. Gerstenfeld, MD, MS, FHRS and Paul C Zei, MD, PhD, FHRS   Disclosures: Christopher C Cheung, MD, MPH, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biotronik, Biosense Webster, Inc., Abbott Edward P. Gerstenfeld, MD, MS, FHRS Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Abbott, Boston Scientific, Varian Medical Systems Other Non-Financial Relationships: Adagio Medical, Boston Scientific, Abbott Medical Research: Abbott Medical Officer, Trustee, Director, Committee Chair, or Other Fiduciary Role: American College of Cardiology Paul C Zei, MD, PhD, FHRS Honoraria/Speaking/Consulting Fee/Speaker's Bureau: Varian Medical Systems, Biosense Webster, Inc., Abbott, Boston Scientific, APT Medical Research: Biosense Webster, Inc.

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