Early Aggressive Invasive Intervention for Atrial Fibrillation - EARLY-AF
Contribution To Literature:
The EARLY-AF trial showed that catheter ablation reduces the incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia compared with antiarrhythmic drug therapy.
The goal of the trial was to evaluate catheter cryoballoon ablation compared with antiarrhythmic drug therapy among patients with paroxysmal atrial fibrillation.
Patients with paroxysmal atrial fibrillation were randomized to cryoballoon ablation (n = 154) vs. antiarrhythmic drug therapy (n = 149). All patients had an implantable loop recorder placed.
- Total number of enrollees: 303
- Duration of follow-up: 3 years
- Mean patient age: 60 years
- Percentage female: 31%
- At least 18 years of age with symptomatic paroxysmal atrial fibrillation within the last 24 months
- Use of a class I or class III antiarrhythmic drug
The co-primary outcome of persistent atrial fibrillation occurred in 1.9% of the ablation group vs. 7.4% of the antiarrhythmic drug group (p < 0.05).
The co-primary outcome of recurrent atrial tachyarrhythmia occurred in 56.5% in the ablation group vs. 77.2% in the antiarrhythmic drug group (p < 0.05).
- Hospitalization: 5.2% in the ablation group vs. 16.8% in the antiarrhythmic drug group (p < 0.05)
- Serious adverse events: 4.5% in the ablation group vs. 10.1% in the antiarrhythmic drug group (p = not significant)
Among patients with paroxysmal atrial fibrillation, an initial strategy of catheter cryoballoon ablation was beneficial. Catheter cryoballoon ablation compared with antiarrhythmic drug therapy was associated with a lower incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia. Catheter cryoballoon ablation was also associated with a reduction in hospitalization compared with antiarrhythmic drug therapy. Serious adverse events were similar between treatment groups.
Highlighted text has been updated as of January 12, 2023.
Andrade JG, Deyell MW, Macle L, et al., on behalf of the EARLY-AF Investigators. Progression of Atrial Fibrillation After Cryoablation or Drug Therapy. N Engl J Med 2023;388:105-16.
Editorial: Sandhu RK, Albert CM. First-Line Catheter Ablation for Paroxysmal Atrial Fibrillation — Have We Reached the Tipping Point? N Engl J Med 2023;388:177-8.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias
Keywords: AHA Annual Scientific Sessions, AHA22, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Atrial Fibrillation, Cardiology Interventions, Catheter Ablation, Cryosurgery, Secondary Prevention, Tachycardia
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