Progression of Atrial Fibrillation after Cryoablation or Drug Therapy
Abstract
BACKGROUND: Atrial fibrillation is a chronic, progressive disorder, and persistent forms of atrial fibrillation are associated with increased risks of thromboembolism and heart failure. Catheter ablation as initial therapy may modify the pathogenic mechanism of atrial fibrillation and alter progression to persistent atrial fibrillation. METHODS: We report the 3-year follow-up of patients with paroxysmal, untreated atrial fibrillation who were enrolled in a trial in which they had been randomly assigned to undergo initial rhythm-control therapy with cryoballoon ablation or to receive antiarrhythmic drug therapy. All the patients had implantable loop recorders placed at the time of trial entry, and evaluation was conducted by means of downloaded daily recordings and in-person visits every 6 months. Data regarding the first episode of persistent atrial fibrillation (lasting ≥7 days or lasting 48 hours to 7 days but requiring cardioversion for termination), recurrent atrial tachyarrhythmia (defined as atrial fibrillation, flutter, or tachycardia lasting ≥30 seconds), the burden of atrial fibrillation (percentage of time in atrial fibrillation), quality-of-life metrics, health care utilization, and safety were collected. RESULTS: A total of 303 patients were enrolled, with 154 patients assigned to undergo initial rhythm-control therapy with cryoballoon ablation and 149 assigned to receive antiarrhythmic drug therapy. Over 36 months of follow-up, 3 patients (1.9%) in the ablation group had an episode of persistent atrial fibrillation, as compared with 11 patients (7.4%) in the antiarrhythmic drug group (hazard ratio, 0.25; 95% confidence interval [CI], 0.09 to 0.70). Recurrent atrial tachyarrhythmia occurred in 87 patients in the ablation group (56.5%) and in 115 in the antiarrhythmic drug group (77.2%) (hazard ratio, 0.51; 95% CI, 0.38 to 0.67). The median percentage of time in atrial fibrillation was 0.00% (interquartile range, 0.00 to 0.12) in the ablation group and 0.24% (interquartile range, 0.01 to 0.94) in the antiarrhythmic drug group. At 3 years, 8 patients (5.2%) in the ablation group and 25 (16.8%) in the antiarrhythmic drug group had been hospitalized (relative risk, 0.31; 95% CI, 0.14 to 0.66). Serious adverse events occurred in 7 patients (4.5%) in the ablation group and in 15 (10.1%) in the antiarrhythmic drug group. CONCLUSIONS: Initial treatment of paroxysmal atrial fibrillation with catheter cryoballoon ablation was associated with a lower incidence of persistent atrial fibrillation or recurrent atrial tachyarrhythmia over 3 years of follow-up than initial use of antiarrhythmic drugs. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979.).
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Patients with AF may be especially vulnerable to excessive cardiac monitoring with a wearable device given the high likelihood of experiencing potentially severe and disabling symptoms that have an abrupt and unexpected onset despite optimal medical or procedural therapy.
“Patients with AF may be especially vulnerable to excessive cardiac monitoring with a wearable device given the high likelihood of experiencing potentially severe and disabling symptoms (ie, fatigue, palpitations, chest pain) that have an abrupt and unexpected onset despite optimal medical or procedural therapy.”
From Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation (2024) · cites this paper as [10]
Cites
Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., Garrigue, S., Mouroux, A. L., Métayer, P. L., & Clémenty, J. (1998) · New England Journal of Medicine · doi:10.1056/nejm199809033391003 · Cited by 8,040 · see citing works
A comparison of rate control and rhythm control in patients with atrial fibrillation
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa021328 · Cited by 4,405 · see citing works
Early Rhythm-Control Therapy in Patients with Atrial Fibrillation
Kirchhof, P. F., Camm, A. J., Goette, A., Brandes, A., Eckardt, L., Elvan, A., Fetsch, T., Gelder, I. C. V., Haase, D., Haegeli, L., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2019422 · Cited by 2,227 · see citing works
The Clinical Profile and Pathophysiology of Atrial Fibrillation
Andrade, J. G., Khairy, P., Dobrev, D., & Nattel, S. (2014) · Circulation Research · doi:10.1161/circresaha.114.303211 · Cited by 1,206 · see citing works
Self-citationCryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation
Andrade, J. G., Wells, G. A., Deyell, M. W., Bennett, M. T., Essebag, V., Champagne, J., Roux, J.-F., Yung, D., Skanes, A. C., Khaykin, Y., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2029980 · Cited by 841 · see citing works
Self-citationProgression From Paroxysmal to Persistent Atrial Fibrillation
de Vos, C. B., Pisters, R., Nieuwlaat, R., Prins, M. H., Tieleman, R. G., Coelen, R. J. S., Heijkant, A. C. V. D., Allessie, M. A., & Crijns, H. J. G. M. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.11.040 · Cited by 720 · see citing works
Andrade, J. G., Aguilar, M., Atzema, C. L., Bell, A., Cairns, J. A., Cheung, C. C., Cox, J. L., Dorian, P., Gladstone, D. J., Healey, J. S., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.09.001 · Cited by 568 · see citing works
Self-citationWattigney, W. A., Mensah, G. A., & Croft, J. B. (2003) · Circulation · doi:10.1161/01.cir.0000083722.42033.0a · Cited by 505 · see citing works
Ganesan, A. N., Chew, D. P., Hartshorne, T., Selvanayagam, J. B., Aylward, P. E., Sanders, P., & McGavigan, A. D. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw007 · Cited by 394 · see citing works
Early management of atrial fibrillation to prevent cardiovascular complications
Nattel, S., Guasch, E., Savelieva, I., Cosío, F. G., Valverde, I., Halperin, J. L., Conroy, J. M., Al‐Khatib, S. M., Hess, P. L., Kirchhof, P. F., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu028 · Cited by 274 · see citing works
Burdett, P., & Lip, G. Y. H. (2020) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcaa093 · Cited by 252 · see citing works
Kück, K., Lebedev, D. S., Mikhaylov, E. N., Romanov, A. B., Gellér, L., Kalējs, O., Neumann, T., Davtyan, K. V., On, Y. K., Popov, S. V., et al. (2020) · EP Europace · doi:10.1093/europace/euaa298 · Cited by 236 · see citing works
Catheter Ablation Versus Medical Therapy for Atrial Fibrillation
Asad, Z. U. A., Yousif, A., Khan, M. S., Al‐Khatib, S. M., & Stavrakis, S. (2019) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.119.007414 · Cited by 226 · see citing works
Padfield, G. J., Steinberg, C., Swampillai, J., Qian, H., Connolly, S. J., Dorian, P., Green, M. S., Humphries, K. H., Klein, G. J., Sheldon, R. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.01.038 · Cited by 193 · see citing works
Electrical and Contractile Remodeling During the First Days of Atrial Fibrillation Go Hand in Hand
Schotten, U., Duytschaever, M. F., Ausma, J., Eijsbouts, S. C. M., Neuberger, H., & Allessie, M. A. (2003) · Circulation · doi:10.1161/01.cir.0000055314.10801.4f · Cited by 179 · see citing works
Sanders, P., Pürerfellner, H., Pokushalov, E., Sarkar, S., Di Bacco, M., Maus, B., & Dekker, L. R. C. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.03.005 · Cited by 162 · see citing works
Cryoballoon Ablation as Initial Treatment for Atrial Fibrillation
Andrade, J. G., Wazni, O. M., Kuniss, M., Hawkins, N. M., Deyell, M. W., Chierchia, G., Nissen, S. E., Verma, A., Wells, G. A., & Turgeon, R. D. (2021) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.06.038 · Cited by 127 · see citing works
Self-citationWalters, T. E., Nisbet, A. M., Morris, G. M., Tan, G., Mearns, M., Teo, E. P., Lewis, N. T., Ng, A., Gould, P. A., Lee, G., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.10.028 · Cited by 123 · see citing works
Defining Clinically Important Difference in the Atrial Fibrillation Effect on Quality-of-Life Score
Holmes, D. N., Piccini, J. P., Allen, L. A., Fonarow, G. C., Gersh, B. J., Kowey, P. R., O'Brien, E. C., Reiffel, J. A., Naccarelli, G. V., Ezekowitz, M. D., et al. (2019) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.118.005358 · Cited by 111 · see citing works
Incidence and predictors of atrial fibrillation progression: A systematic review and meta-analysis
Blum, S., Meyre, P. B., Aeschbacher, S., Berger, S., Auberson, C., Briel, M., Osswald, S., & Conen, D. (2018) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.022 · Cited by 94 · see citing works
Nishida, K., Datino, T., Macle, L., & Nattel, S. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.06.1172 · Cited by 92 · see citing works
Self-citationDorian, P., Cvitkovic, S., Kerr, C. R., Crystal, E., Gillis, A. M., Guerra, P. G., Mitchell, L. B., Roy, D., Skanes, A. C., & Wyse, D. G. (2006) · Canadian Journal of Cardiology · doi:10.1016/s0828-282x(06)70922-9 · Cited by 87 · see citing works
Self-citationTemporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V
With, R. R. D., Erküner, Ö., Rienstra, M., Nguyen, B., Körver, F. W. J., Linz, D., Cate, H. T., Spronk, H. M. H., Kroon, A. A., Maass, A. H., et al. (2020) · EP Europace · doi:10.1093/europace/euaa123 · Cited by 83 · see citing works
Pokushalov, E. A., Romanov, A. B., Melis, M. D., Николаевич, А. С., Викторовна, Б. В., Losik, D., Байрамова, С. А., Karaskov, A. M., Mittal, S., & Steinberg, J. S. (2013) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000495 · Cited by 55 · see citing works
Andrade, J. G., Champagne, J., Deyell, M. W., Essebag, V., Lauck, S., Morillo, C. A., Sapp, J. L., Skanes, A. C., Theoret-Patrick, P., Wells, G. A., et al. (2018) · American Heart Journal · doi:10.1016/j.ahj.2018.05.020 · Cited by 34 · see citing works
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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
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Rosman, L., Lampert, R., Zhuo, S., Li, Q., Varma, N., Burg, M., Gaffey, A. E., Armbruster, T., & Gehi, A. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.033750 · Cited by 65 · see citing works
- Authors
- Andrade, J. G., Deyell, M. W., Macle, L., Wells, G. A., Bennett, M., Essebag, V., Champagne, J., Roux, J.-F., Yung, D., Skanes, A., Khaykin, Y., Morillo, C., Jolly, U., Novak, P., Lockwood, E., Amit, G., Angaran, P., Sapp, J., Wardell, S., Lauck, S., Cadrin-Tourigny, J., Kochhäuser, S., & Verma, A.
- Affiliations
- Western University (CA)
- From the University of British Columbia (J.G.A., M.W.D., M.B., S.L.) and the Centre for Cardiovascular Innovation (J.G.A., M.W.D.), Vancouver, Montreal Heart Institute, Université de Montréal, Montreal (J.G.A., L.M., J.C.-T.), the University of Ottawa Heart Institute, Ottawa (G.A.W.), McGill University Health Centre, Montreal (V.E., A.V.), Université Laval, Quebec (J.C.), Université de Sherbrooke, Sherbrooke, QC (J.-F.R.), Rouge Valley Centenary Hospital, Scarborough, ON (D.Y.), University of Western Ontario, London (A.S.), Southlake Regional Health Centre, University of Toronto, Newmarket, ON (Y.K.), Libin Cardiovascular Institute, University of Calgary, Calgary, AB (C.M.), St. Mary’s Hospital, Kitchener, ON (U.J.), Royal Jubilee Hospital, Victoria, BC (P.N.), Royal Alexandra Hospital, Edmonton, AB (E.L.), McMaster University, Hamilton, ON (G.A.), St. Michael’s Hospital, University of Toronto, Toronto (P.A.), Dalhousie University, Halifax, NS (J.S.), and the University of Saskatchewan, Saskatoon (S.W.) — ...
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2023-01-12
- Volume
- 388
- Issue
- 2
- Pages
- 105-116
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W4308372963
- Cited by
- 385
- References
- 25
- Citations by year
- 2026: 63 · 2025: 102 · 2024: 132 · 2023: 81 · 2022: 6
- FWCI
- 55.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- CANet (SRG-15-P15-001)
- Baylis Medical
- Medtronic
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, cryoballoon ablation, antiarrhythmic drugs, persistent atrial fibrillation, atrial tachyarrhythmia recurrence, atrial fibrillation burden, paroxysmal atrial fibrillation, rhythm control, implantable loop recorder, quality of life, health care utilization, atrial flutter, atrial tachycardia, cardioversion
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Cryosurgery, Follow-Up Studies, Humans, Recurrence, Tachycardia, Treatment Outcome, Catheter Ablation, Disease Progression
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