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2021 AF Symposium

Another Study Finds Ablation Better First-Line Treatment Than Medication

To date there have been many research studies demonstrating the superiority of ablation versus drug therapy for A-Fib.

Dr. Jason Andrade

EARLY-AF is a Canadian study of CyroBalloon ablation by lead author Dr. Jason Andrade of the University of British Columbia Faculty of Medicine and colleagues. According to study researchers, CryoBalloon ablation “is a more effective first-line treatment for (A-Fib) patients than medication.” (The full name of the EARLY-AF study is “Early Aggressive Invasive Intervention for Atrial Fibrillation”.)

Cryoballoon ablation was better at preventing symptoms of A-Fib from recurring at all, and reduced the amount of time some patients experienced A-Fib.

The Study: CryoBalloon Ablation Halved Rate of Recurrence vs. Drugs

All 303 patients were treated for A-Fib for the first time in their lives. Half were randomized to receive CryoBalloon ablation (Medtronic Arctic Front Advance), while the other half were treated with antiarrhythmic drugs (AADs)(flecainide, sotalol, propafenone, or dronedarone). (Flecainide was the most frequently prescribed.) All patients received an implantable loop recorder (Medtronic Reveal LINQ) which allowed for continuous monitoring and the assessment of atrial fibrillation burden. .

Of the Cryo-Balloon group, 57.1% didn’t have a recurrence of some form of an irregular heartbeat by the one-year mark [not as high a success rate compared to other studies]. While the success rate of the AAD group was only 32.2%.

CryoBalloon ablation halved the rate of recurrence compared to usual drug therapy.

Additional Benefit: CryoBalloon Ablation Improved Quality-Of-Life

Ablation outperformed the drug group in terms of quality-of-life improvement. Eighty-nine per cent of CryoBalloon patients were free of symptomatic arrhythmia episodes.

According to Dr. Andrade, “Patients who received cryoballoon ablation were more likely to be symptom-free and not require hospitalization for their atrial fibrillation.”

Editor’s Comments

Choose Ablation Over Drugs: Dr. Andrade states explicitly that A-Fib patients should think of catheter ablation as first-line therapy, not something you do after trying multiple antiarrhythmic drugs (AADs).
This is in accordance with current best practices i.e., Guidelines for the Management of Patients with Atrial Fibrillation. AADs don’t work half as well as catheter ablation. In the real world, AADs are ineffective, cause bad side effect, or lose what effectiveness they had over time. And while you’re wasting a year or two trying various AADs, you’re usually still miserable in A-Fib and your A-Fib has gotten worse (remodeling).
Catheter Ablation Transforms Your Life: An A-Fib attack can totally incapacitate you. Even mild to moderate A-Fib can make you feel unwell, produces shortness of breath, brain fog, etc. You may be unable or reluctant to pursue normal activities like traveling and exercise. And you often live in fear of the next A-Fib attack. Or you’re angry and frustrated at your out-of-control heart.
A catheter ablation can change all that.

There are few medical procedures so transformative and life changing as a successful catheter ablation. Ask any former A-Fib patient who is now A-Fib free.

Resources for this article

• A procedure, not medication, may be a more effective first-line of treatment for common heart rhythm problem. UBC Faculty of Medicine, November 24, 2020. https://www.med.ubc.ca/news/a-procedure-not-medication-may-be-a-more-effective-first-line-of-treatment-for-common-heart-rhythm-problem/

• Minimally invasive procedure beats meds for atrial fibrillation. Bottom Line Personal, Volume 42, Number 8, April 15, 2021.

• Andrade, J. et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. The New England Journal of Medicine, January 28, 2021, https://www.nejm.org/doi/full/10.1056/NEJMoa2029980. DOI: 10.1056/NEJMoa2029980.

f you find any errors on this page, email us. Y Last updated: Monday, May 31, 2021

Return to 2021 AF Symposium Reports

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