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Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation

Saturday, January 30, 2021

Submitted by

Aristotle Protopapas

Source

Source Name: The New England Journal of Medicine (NEJM)

Source URL: https://www.nejm.org/doi/full/10.1056/NEJMoa2029980?query=WB

Author(s)

Jason G. Andrade, George A. Wells, Marc W. Deyell, Matthew Bennett, Vidal Essebag, Jean Champagne, Jean-Francois Roux, Derek Yung, Allan Skanes, Yaariv Khaykin, Carlos Morillo, Umjeet Jolly, Paul Novak, Evan Lockwood, Guy Amit, Paul Angaran, John Sapp, Stephan Wardell, Sandra Lauck, Laurent Macle, Atul Verma. for the EARLY-AF Investigators

A Canadian multi-centre RCT of immediate baloon-cryoablation of the pulmonary veins: the intervention was compared to the relevant standard of pharmacological care. The target population was treatment-naive sufferers of de novo paroxysmal atrial fibrillation. The recruitment was successful, and unrestricted funding was secured from the healthcare device industry. The freedom from asymptomatic and symptomatic paroxysms of atrial fibrillation appeared improved at one-year follow-up.
It would be very interesting to additionally see the cardiovascular outcomes of the cohort, the thromboembolic events in particular, given that the subjects remained free from the atrial fibrillation for 99% of that year (having been continuously monitored).
The trial holds some interest for the cardiovascular surgeons practising ablation: The publication comes in the wake of a manuscript suggesting there is an underutilization of ablation during mitral surgery. (https://www.ctsnet.org/jans/variability-and-utilization-concomitant-atri...)