Time to Rethink AF Treatment: Prolonged Benefits of Cryoballoon Ablation

Clinical question: Does initial therapy with catheter cryoballoon ablation reduce progression to persistent atrial fibrillation (AF) in patients with symptomatic, paroxysmal AF when compared to antiarrhythmic therapy? Background: Atrial fibrillation can progress from a paroxysmal to a persistent form due to electrical and structural remodeling of the heart. The Early Aggressive Invasive Intervention for Atrial Fibrillation (Early-AF) trial concluded that initial treatment of symptomatic, paroxysmal AF with cryoballoon ablation resulted in lower recurrence of arrhythmias compared to antiarrhythmic drug therapy alone during one year of follow-up. However, it was unclear if catheter cryoballoon ablation reduced progression to persistent AF compared to antiarrhythmic therapy. Study design: Multicenter, open-label, randomized trial with blinded end-point adjudication Setting: 18 centers in Canada Synopsis: Patients with symptomatic, paroxysmal AF were randomly assigned to rhythm control with either cryoballoon ablation (n=154) or antiarrhythmic drug therapy (n=149). All 303 patients had an implantable loop recorder placed. Crossover between groups was restricted and all patients received their assigned strategy before the primary endpoint event. Patients were followed for 36 months with the primary endpoint being the first occurrence of persistent AF. Secondary outcomes included arrhythmia burden, quality of life, health care utilization (defined as emergency department visits), h...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: Cardiology In the Literature Source Type: research