Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation

Abstract

AF is a common chronic and progressive disorder. Without treatment, AF will recur in up to 75% of patients within a year of their index diagnosis. Antiarrhythmic drugs (AADs) have been proven to be more effective than placebo at maintaining sinus rhythm and remain the recommended initial therapeutic option for AF. However, the emergence of 'single-shot' AF ablation toolsets, which have enabled enhanced procedural standardisation and consistent outcomes with low rates of complications, has led to renewed interest in determining whether first-line catheter ablation may improve outcomes. The recently published EARLY-AF trial evaluated the role of initial cryoballoon ablation versus guideline-directed AAD therapy. Compared to AADs, an initial treatment cryoballoon ablation strategy resulted in greater freedom from atrial tachyarrhythmia, superior reduction in AF burden, greater improvement in quality of life and lower healthcare resource utilisation. These findings are relevant to patients, providers and healthcare systems when considering the initial treatment choice for rhythm-control therapy.

Keywords: AF; Guidelines; antiarrhythmic drug therapy; arrhythmias; cryoballoon ablation.

Figure 1:. Recurrence of Any Atrial Tachyarrhythmia, Stratified by Ablation Energy

Figure 2:. Recurrence of Symptomatic Atrial Tachyarrhythmia, Stratified by Ablation Energy

Figure 3:. Freedom from Atrial Tachyarrhythmia in the EARLY-AF Trial

Figure 4:. AF Burden in Patients Treated with Firstline Ablation Versus First-line AAD Therapy