Jason Andrade, MD, FRCPC, FHRS, director of electrophysiology, Vancouver General Hospital, clinical associate professor, University of British Columbia, and principal investigator for the PROGRESSIVE AF trial, explains how cryoablation can be used as a frontline treatment for atrial fibrillation (AFib). He presented this late-breaking trial at the American Heart Association (AHA) 2022 meeting, which showed the therapy can be used instead of trying drug therapy first.
This trial included young, healthy patients with highly symptomatic AFib. They were randomized between cryoablation or anti-arrhythmic drugs and followed out to three years. The study looked to answer the question if younger patients should be treated with catheter ablation as a frontline therapy, or if drug therapy was a better option. The study looked at patient reported outcomes such as quality of life, symptom status, healthcare utilization and outcomes like hospitalization and overall safety.
"We saw for each of those outcomes, catheter ablation performed much better than anti-arrhythmic drugs," Andrade said.
He said there was a clear separation between the therapies in the line graphs that persisted early on and widened over time.
The Medtronic cryoballoon catheter used in the study was chosen because of the reproducible results across users, which the trial investigators felt would perform better than previous studies.
"There had been a few studies performed about 10 years ago using point-by-point radio-frequency catheters, and the results were not particularly compelling in terms of arrhythmia freedom," Andrade explained. "We thought as cry matured as a technology it gives much more reproducible results, so we knew across the 18 participating centers, our ablation results would be fairly standard, and that was the idea behind designing the study. And that infect was what we saw. We saw a significant improvement in preventing arrhythmia recurrence, with significant improvement in quality of life and healthcare utilization."
One of the biggest take aways from the trial is the cryoablation appears to be disease modifying. Andrade said there was a 75% reduction in the progression of paroxysmal AFib to persistent AFib.
Read more details on this trial
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com