While several medical practices are considering catheter ablation as the initial treatment for atrial fibrillation (AF), guidelines suggest that a trial of one or more antiarrhythmic drugs should be conducted. This study aims to compare the effectiveness of cryoablation and drug therapy in maintaining sinus rhythm after AF.
This randomized trial included a total of 303 patients with symptomatic, paroxysmal, untreated AF. The patients were randomly assigned to receive a cryothermy balloon or antiarrhythmic drug therapy for rhythm control. The primary outcome of the study was the first recurrence of any atrial tachyarrhythmia after catheter ablation or the initiation of drug therapy.
At a follow-up of 1 year, a recurrence of atrial tachyarrhythmia was reported in 42.9% of patients assigned to cryoablation and 67.8% assigned to antiarrhythmic drugs. The recurrence of symptomatic atrial tachyarrhythmia occurred in 11.0% of patients in the cryoablation group and 26.2% of those in the antiarrhythmic group. The incidence of serious adverse events was 3.2% in the ablation group and 4.0% in the antiarrhythmic drugs group.
The research concluded that patients with symptomatic, paroxysmal atrial fibrillation who received catheter cryoballoon ablation experienced a lower rate of AF recurrence when compared with those who received antiarrhythmic drug therapy.
Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa2029980
