In cryoablation, a small tube is led into the heart and a small balloon is inflated to kill the problem tissue with low temperatures.Credit: Medtronic
Early treatment with catheter cryoablation can halt disease progression and reduce the potential for serious health risks.
A national study led by researchers at the University of British Columbia in the Center for Cardiovascular Innovation has revealed a cure for atrial fibrillation (AF).
A recently published study New England Journal of Medicineearly intervention using cryoballoon catheter ablation (cryoablation), as opposed to antiarrhythmic drugs, which are the first step in standard treatment, may reduce the risk of serious long-term health consequences. It shows that it is effective.
“By treating patients with cryoablation right from the start, fewer people progress to the persistent, life-threatening form of atrial fibrillation,” said associate professor of medicine at UBC and director of Heart Rhythm Services in Vancouver. said Dr. Jason Andrade, general Hospital. “In the short term, this means fewer arrhythmia recurrences, improved quality of life, and fewer hospital visits. can lead to a decline in
Cryoablation is a minimally invasive procedure that involves guiding a small tube into the heart and killing the problem tissue at low temperatures. Historically, this procedure has been used only as a second-line treatment for individuals who do not respond after taking antiarrhythmic drugs.
“This study adds to growing evidence that early intervention with cryoablation may be a more effective initial treatment in suitable patients,” said Dr. Andrade.
Stopping disease progression with early intervention
Over one million Canadians, or about 3% of the population, are affected by atrial fibrillation.
The condition begins as an isolated electrical disturbance, but each subsequent occurrence triggers electrical and structural changes in the heart, leading to long-term events known as persistent atrial fibrillation (episodes lasting more than 7 consecutive days). may lead to
“Atrial fibrillation is like a snowball rolling down a hill. With each episode of atrial fibrillation, there are progressive changes in the heart that worsen heart rhythm problems,” Andrade explains Dr.
A new finding, derived from a multi-site clinical trial, shows that cryoablation can stop this snowball effect.
In this trial, a nationwide research team enrolled 303 patients with atrial fibrillation at 18 sites across Canada. Half of the patients were randomly selected to receive antiarrhythmic drugs and the other half were treated with cryoablation. All patients received an implantable monitoring device that recorded cardiac activity throughout the study period.
Three years later, the researchers found that patients in the cryoablation group were less likely to progress to persistent AF compared with those treated with antiarrhythmic drugs. Cryoablation patients also had lower hospitalization rates and experienced fewer serious adverse events leading to death, disability, or prolonged hospital stay.
Addressing root causes
Because cryoablation targets and destroys the cells that initiate and sustain atrial fibrillation, researchers say it may lead to longer-term benefits.
“Cryoablation treats the cause of symptoms rather than masking them with drugs,” says Dr. Andrade. “If you start cryoablation, you may be able to cure atrial fibrillation early.”
The new study builds on previous papers in which Dr. Andrade and his team showed that cryoablation is more effective than antiarrhythmic drugs in reducing short-term recurrences of atrial fibrillation.
Researchers say more effective early intervention would benefit not only patients but also the healthcare system. Currently, costs associated with providing care related to atrial fibrillation are estimated at 2.5% of his total annual medical costs. These costs are expected to rise to 4% he within the next 20 years.
“Evidence increasingly indicates that it is time to rethink how we approach treating atrial fibrillation. Effective early interventions keep people healthy, happy and avoid hospitalization. This will have enormous benefits for patients, their families and our entire healthcare system.”
Reference: “Atrial Fibrillation Progression After Cryoablation or Drug Therapy” by Jason G. Andrade, MD, Mark W. Deyel, MD, Laurent McCle, MD, George A. Wells, MD, Matthew Bennett, MD, Vidal Essebag, MD, Ph D., Jean Champagne, MD, Jean-Francois Roux, MD, Derek Yung, MD, Allan Skanes, MD, Yaariv Khaykin, MD, Carlos Morillo, MD, Umjeet Jolly, MD, Paul Novak, MD, Evan Lockwood, MD , Guy Amit, MD, Paul Angaran, MD, John Sapp, MD, Stephan Wardell, MD, Sandra Lauck, Ph.D., Julia Cadrin-Tourigny, MD, Simon Kochhauser, MD and Atul Verma, MD EARLY-AF Investigators, 7 November 2022, New England Journal of Medicine.
DOI: 10.1056/NEJMoa2212540
This study was funded by the Cardiac Arrhythmia Network of Canada, Medtronic, and Bayliss Medical.
