Impact of Ablation on AF Progression: Implications for Timing and Type of Ablation

Dr. Jason Andrade

Dr. Jason Andrade asked “How to stop A-Fib patients from getting worse is one of the major concerns of Electrophysiologists (EPs)?”

We know that AF is a chronic, progressive disease. If patients at first are asymptomatic, within a year 8% will develop clinically apparent AF. 7% of those patients will develop more intense forms of AF.

“If you look at the lectures [in this session], every one of them is Guideline changing This is the most important session of the whole [Symposium] meeting.”—Dr. Nassir Marrouche

Left alone, they will progress to persistent and then permanent AF. Going into persistent AF, “they have a 20% risk of death and a 40% risk of stroke.” Even if they don’t progress to persistent AF, they still have a five-fold higher rate of developing heart failure.

A-Fib Progression Worst Outcome for Patients

More bad things will happen to patients as A-Fib progresses. It produces the worst outcome for patients. 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.

“More bad things will happen to patients” as A-Fib progresses.—Dr. J. Andrade

How to Stop A-Fib Progression

Dr. Andrade explained that rhythm control (drugs to stop A-Fib) is more effective than rate control (drugs to prevent A-Fib from causing the heart to beat too fast while staying in A-Fib).

Catheter Ablation Best Option

But the most effective option is catheter ablation (CA). He discussed he and his colleagues own study (EARLY-AF) where patients received CryoBalloon ablation while other patients were on rhythm control drugs (AADs-Antiarrhythmic Drugs). Ablation reduced progression by 75%.

Intervening early is the best opportunity for patients

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 success rate of AADs was only 32.2%. And ablation outperformed the drug group in terms of quality-of-life improvement. CryoBalloon ablation “is a more effective first-line treatment for (A-Fib) than medication.”

He also discussed the ATTEST study which used RF instead of cryo with similar results. In fact, In three years of follow-up, there was no A-Fib progression.

Early Intervention Best Option

“Intervening early is the best opportunity for patients.” (FYI: In the Canadian health care system, there is currently a long waiting time to get an ablation which complicates A-Fib treatment.)

To read other presentations in this series, go to My Summary Reports Written for Atrial Fibrillation Patients.

Editor’s Comments

A-Fib Progression is Dangerous: We’ve known that A-Fib is a progressive disease which usually gets worse over time. We’re all too familiar with the phrase “A-Fib begets A-Fib.” But Dr. Andrade’s work showed how dangerous A-Fib progression can be. 8% of asymptomatic patients will develop symptomatic A-Fib within a year. And if patients have to stay in A-Fib over time, many bad things will happen. If a patient progresses to persistent A-Fib, there is a 20% risk of death and a 40% risk of stroke.

Early Catheter Ablation Best Option: Ablation reduced progression by 75% and produced better quality-of-life improvement in asymptomatic patients.

There are few procedures that can transform one’s life like catheter ablation. Ask anyone who’s gone from A-Fib into sinus. Speaking from personal experience, it’s life changing!

Change the Guidelines! Dr. Andrade’s work is a powerful argument to change current guidelines so that asymptomatic patients would be given catheter ablation as a first-choice early intervention. “Intervening early is the best opportunity for patients.”

Research

Andrade, JG, et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. November 16, 2020. N Engl J Med 2021;384:305-315.DOI: 10.1056/NEJMoa2029980 VOL 384 NO.4. https://www.nejm.org/doi/full/10.1056/NEJMoa2029980

Front-End Snidget Title

Benefits of Ablation Across the AF Spectrum: From Early Intervention to Late-Stage Heart Failure: Part II

This important Friday session had five speakers: Dr. Stephen Willems, Dr. Jason Andrade, Dr. Philipp Sommer, Dr. Douglas Packer and Dr. Francis Marchlinski.

Dr. Jason Andrade of the University of Montreal, Montreal, Canada gave the second talk in what was described as the “most important session of the whole meeting.”

Impact of Ablation on AF Progression: Implications for Timing and Type of Ablation

“If you look at the lectures [in this session], every one of them is Guideline changing This is the most important session of the whole [Symposium] meeting.”—Dr. Nassir Marrouche