- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Cryoablation scores over drugs as first-line therapy for AF, Cryo-FIRST study.
Treatment guidelines for patients with atrial fibrillation (AF) suggest that patients should be managed with an antiarrhythmic drug (AAD) before undergoing catheter ablation (CA). However, the results from the Cryo-FIRST study published in EUROPACE journal have now challenged this conventional recommendation by stating that Cryoballoon ablation is superior to antiarrhythmic drug (AAD) therapy and significantly reduces atrial arrhythmia (AA) recurrence in treatment-naive patients with paroxysmal atrial fibrillation (PAF) with a similar rate of adverse events.
Most comparisons between CA and AAD therapy have been completed in patients deemed as 'AAD-refractory' before study enrolment. These studies have consistently demonstrated that CA is superior to AADs for the reduction of AA recurrence and the avoidance of AF disease progression. Accordingly, the use of CA has received a Class I recommendation in patients with symptomatic, drug-refractory PAF in current guidelines.
However, the safety and efficacy of CA vs. AADs as a first-line treatment has not been as extensively investigated in large randomized trials (especially when considering cryoballoon CA), and consequently, the usage of CA as a first-line treatment has received a Class IIa recommendation.
Against this background, Kuniss et al randomised 218 treatment naive patients with symptomatic PAF to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD (Class I or III) and followed for 12 months. The primary endpoint was ≥1 episode of recurrent AA (AF, atrial flutter, or atrial tachycardia) >30 s after a prespecified 90-day blanking period. Secondary endpoints included the rate of serious adverse events (SAEs) and recurrence of symptomatic palpitations (evaluated via patient diaries).
Freedom from AA was achieved in 82.2% of subjects in the cryoballoon arm and 67.6% of subjects in the AAD arm (HR = 0.48, P = 0.01). There were no group differences in the time-to-first or overall incidence of SAEs. The incidence rate of symptomatic palpitations was lower in the cryoballoon compared with the AAD arm.
This prospective, randomized global study evaluated cryoballoon catheter ablation vs. antiarrhythmic drug therapy as an initial, first-line rhythm control strategy in patients with symptomatic paroxysmal atrial fibrillation.
Importantly, there were no occurrences of death, atrio-oesophageal fistula, stroke, pericardial tamponade, or chronic phrenic nerve injury within the CA cohort in the present trial. Overall, these findings align with those recently reported in STOP AF First and EARLY-AF; both of these studies observed SAEs in a similar proportion of patients randomized to first-line cryoballoon CA as AAD therapy. Moreover, these results support a growing body of literature demonstrating that CA can be safely performed by experienced operators.
Also Read:Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation
These findings suggest that cryoballoon ablation is an effective first-line treatment strategy in drug naive patients with symptomatic paroxysmal atrial fibrillation pursing rhythm control therapy.
Source: EP Europace, euab029, https://doi.org/10.1093/europace/euab029
MBBS, MD , DM Cardiology
Dr Abhimanyu Uppal completed his M. B. B. S and M. D. in internal medicine from the SMS Medical College in Jaipur. He got selected for D. M. Cardiology course in the prestigious G. B. Pant Institute, New Delhi in 2017. After completing his D. M. Degree he continues to work as Post DM senior resident in G. B. pant hospital. He is actively involved in various research activities of the department and has assisted and performed a multitude of cardiac procedures under the guidance of esteemed faculty of this Institute. He can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751