A significantly lower percentage of patients with symptomatic, paroxysmal atrial fibrillation (AFib) who received first-line catheter ablation with a cryothermy balloon had a recurrence of AFib at one year, compared with those receiving antiarrhythmic drug therapy, said researchers presenting findings from the EARLY-AF trial Nov. 16 during AHA 2020.

The study, which was simultaneously published in the New England Journal of Medicine, randomized 303 patients with symptomatic, paroxysmal, untreated AFib to either cryoablation or antiarrhythmic drug therapy for initial rhythm control. All patients received an implantable cardiac monitoring device to detect atrial tachyarrhythmia. The primary endpoint was the first documented recurrence of any atrial tachyarrhythmia between 91 and 365 days after the initiation of treatment. The secondary endpoints included freedom from symptomatic arrhythmia, AFib burden, and quality of life.

Overall results showed a recurrence of atrial tachyarrhythmia occurred in 42.9% of patients in the cryoablation group (66/154) compared with 67.8% of patients in the antiarrhythmic drug group (101/149). Additionally, symptomatic atrial tachyarrhythmia recurred in 11.0% of those in the cryoablation group versus 26.2% of those in the antiarrhythmic drug group. Serious adverse events occurred in five patients (3.2%) who underwent cryoablation and in six patients (4.0%) who received antiarrhythmic drugs.

Researchers, including Jason G. Andrade, MD, note that guidelines recommend a trial of one or more antiarrhythmic drugs before cryoablation is considered in AFib patients. However, these findings show first-line ablation was associated with meaningful improvements in quality of life and symptoms and suggest it "may be more effective," they conclude.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: AHA Annual Scientific Sessions, AHA20, Atrial Fibrillation, Catheter Ablation, Percutaneous Coronary Intervention, Arrhythmias, Cardiac

< Back to Listings