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Andrade JG, et al. LBS. 06: To check or not, and then what? Studies of detection and treatment of atrial fibrillation. Presented in: The American Heart Association’s Scientific Sessions. Nov. 13-17, 2020 (virtual meeting).

Andrade JG, et al. LBS. 06: To check or not, and then what? Studies of detection and treatment of atrial fibrillation. Presented in: The American Heart Association’s Scientific Sessions. Nov. 13-17, 2020 (virtual meeting).

Balloon resection of the balloon was associated with a significant improvement over antiarrhythmic drugs as a first-class intervention in preventing atrial fibrillation events, according to results from the EARLY-AF trial.

“At the present time, contemporary guidelines recommend trying antiarrhythmic drugs before considering catheter ablation,” Jason J.. Andrade, MD, director of the Atrial Fibrillation, Electrodiagnostic and Cardiac Electrophysiology Clinic at Vancouver Coastal Health Research Institute, during his presentation at the American Heart Association’s virtual science sessions. “However, we are aware that antiarrhythmic drugs have limited benefit in addition to potential toxicity. Ablation is most effective when performed early.

The first recurrence time for symptomatic or asymptomatic atrial arrhythmias – defined as atrial fibrillation, atrial flutter, or atrial tachycardia – that lasted 30 seconds or more between days 91 and 360 after the start of treatment was the primary endpoint. Result was assessed with a continuous implantable pacemaker (CareLink, Medtronic)..

Secondary endpoints included the time of first recurrence of symptomatic atrial arrhythmia during the same duration and the overall burden of arrhythmias as assessed by the time ratio in atrial fibrillation as detected by continuous monitoring. Standards of quality of life, emergency or hospitalization visits, frequent excision procedures and adverse events were also evaluated.

The analysis included 303 patients with symptomatic atrial fibrillation with naive therapy who were randomly assigned to a first-line ablation or antiarrhythmic drug. The results were published simultaneously in the New England Journal of Medicine.

At around the age of 58, Andrade described the study population as “relatively young and healthy.”. Men make up more than two-thirds of the group. “The most common comorbidities are high blood pressure, sleep apnea and obesity,” Andrade said.. The patients had severe symptoms.

Primary endpoint results showed freedom from any event rates of atrial fibrillation were 57. 1% in the ablation arm and 32. 2% in the antiarrhythmic drug arm, an absolute difference of 24. 9 percentage points (heart rate = 0. 48; 95% CI, 0. 35-0. 66; P < . 001).

“The incidence of ablation group was significantly lower than that of antiarrhythmic drugs,” Andrade said. He added that the 24. 9 per cent difference corresponds to the number to be processed 4.

Ablation (89%) outperformed drug therapy (73%) at secondary endpoint for freedom from symptomatic atrial arrhythmias (heart rate = 0. 39; 95% CI, 0. 0-22. 68; P < . 001). "From a patient perspective, freedom from symptomatic arrhythmias is perhaps the most important outcome," Andrade said.

The mean percentage time in atrial fibrillation was 0% in the ablation group (quadrant range [IQR], 0-0. 08) and 0. 13% in the pharmacotherapy group (IQR 0-1. 6).

Likewise, ablation was superior to antiarrhythmic drug therapy in terms of freedom from symptomatic atrial fibrillation, freedom from any atrial arrhythmias after multiple resection procedures, and freedom from symptomatic arrhythmias after multiple resection procedures (P < . 001 for everyone). "When you look at the remaining arrhythmia endpoints, you see a very consistent effect," Andrade said..

In terms of quality of life criteria, although both interventions provided a benefit as assessed by the effect of atrial fibrillation on quality of life score (AFEQT) and EQ-5D, “we see again a significant benefit towards ablation,” he said..

The serious adverse events “did not differ between groups,” according to Andrade, who reported these events in 3. 2% of patients in the ablation group and 4% of patients in the antiarrhythmic group (heart rate = 0. 81; 95% CI, 0. 25-2. 59).

There were three phrenic nerve injuries and two defibrillators for bradycardia in the ablation group, while the drug treatment group had two each of tachycardia and broad-complex bradycardia and one each for HF and syncope.

No security endpoint occurred in 9. 1% of patients were treated with excision and 16. 1% of those treated with antiarrhythmics (heart rate = 0. 59; 95% CI, 0. 29-1. 21).

Discussion Christine M.. Albert, MD, MPH, chair of cardiology at the Smidt Heart Institute at Cedars-Sinai Medical Center and president of the Heart Rhythm Association, said EARLY-AF is adding “in big ways” to the body of knowledge about using ablation as a first line for preventing atrial fibrillation events.

She said, “First, it’s the biggest trial.”. Second, and most importantly, they used an implantable loop recorder to record their AF events. This is a novel.

The study also allowed an assessment of the burden of atrial fibrillation, which showed that this outcome could be significantly reduced with antiarrhythmic drugs and ablation, according to Albert. She said, “But much more with the ablation.”.

A key component of the study was that an independent panel evaluated AF events, according to Albert. It was the last independent commission to approve the relocations. “All of our ablation trials always had crossovers,” she said, “and they didn’t actually have patients who crossed over from the designated group before the primary endpoint.”. “Once again, an excellent experience.

The most important message from EARLY-AF is that early excision really matters. The other thing we find is that although the ring recorders recorded more frequency, the symptomatic atrial fibrillation was significantly less with ablation.. The results are very encouraging. Of course, there was a significant difference between ablation and antiarrhythmic drugs.

Once diagnosed atrial fibrillation, if it is not caused by hyperthyroidism or some other severe disease, we should treat it aggressively and early. The sooner we intervene, the better the results. Now is the time for all societies to consider studies showing the benefit of early ablation, including EARLY-AF, STOP AF First, and EAST-AFNET 4, as they may change our guidelines and practice.. Medicines do have side effects, and frankly, they’re ineffective. The issue of cost-effectiveness could arise, but I believe that ablation, if studied, would also prove to be cost-effective in these patients..

Atrial Fibrillation, Heart Disease, and Catheter Ablation

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