Cryoballoon Ablation

Cyoablation involves guiding a small tube into the heart and blowing a small balloon with cold heat to kill the problem tissue. Credit: Medtronic

Early treatment with catheter cryoablation can stop the progression of the disease and reduce the risk of serious health risks.

A national study led by researchers at the University of British Columbia’s Center for Cardiovascular Innovation sheds light on how to treat atrial fibrillation (AF), a common heart condition that increases the risk of stroke and heart attack.

Recently published research New England Journal of MedicineEarly intervention using cryoballoon catheter removal (cryoablation), as opposed to standard primary treatment with antiarrhythmic drugs, has been shown to be more effective in reducing the risk of long-term health complications.

Dr. Jason Andrade, associate professor of medicine at UBC and director of the Heart Rhythm Service in Vancouver, said: “We see very few people who go on to permanent, life-threatening atrial fibrillation after treating patients with atrial fibrillation from the beginning. General Hospital. “In the short term, this means reduced recurrence of arthritis, improved quality of life and reduced hospital visits. In the long term, this reduces the risk of stroke and other serious heart problems.”

Cryoablation is a minimally invasive procedure that involves inserting a small tube into the heart to kill the affected tissue with cold temperatures. Historically, the procedure was used only as a second-line treatment for individuals who did not respond to antiarrhythmic drugs.

“This study adds to the growing body of evidence that early intervention for cryoablation may be a more effective first-line treatment in appropriate patients,” Dr. Andrade said.

Early intervention stops the progression of the disease

More than one million Canadians, or about 3% of the population, are affected by AF.

The condition begins as an isolated electrical disorder, each subsequent event can cause electrical and structural changes in the heart, which can lead to long-lasting events called persistent AF (a series lasting more than seven consecutive days).

“Atrial fibrillation is like a snowball rolling down a hill. With each episode of atrial fibrillation, there are gradual changes in the heart, and the heart rhythm problem gets worse,” explains Dr. Andrade.

New findings from a multi-site clinical trial show that noise can stop this snowball effect.

For the trial, the pan-Canadian research team enrolled 303 patients with AF at 18 sites across Canada. Half of the patients were randomly assigned to receive antiarrhythmic drugs, while the rest were treated with noise. All patients received an implantable monitoring device that recorded their heart activity during the study period.

After three years, the researchers found that compared to patients treated with antiarrhythmic drugs, patients in the cryoablation group were less likely to develop persistent AF. During the follow-up period, noise patients had lower rates of hospitalization and less serious health problems leading to death, disability, or prolonged hospitalization.

Solve the root cause

Because cryoablation targets and destroys the cells that initiate and promote AF, the researchers say it has long-lasting benefits.

Dr. Andrade said, “Instead of using drugs to cover up the symptoms, we are treating the cause of the disease.” “If we start with noise, we may be able to correct atrial fibrillation early in the course.”

The new study builds on Dr. Andrade and his team’s finding that cryoablation is more effective than antiarrhythmic drugs in reducing the short-term recurrence of atrial fibrillation.

The researchers said more effective early intervention would benefit patients and the health care system. Currently, the costs associated with providing care associated with atrial fibrillation are estimated at 2.5 percent of total annual health care expenditures. These costs are expected to rise to four percent over the next two decades.

“The evidence is mounting that it’s time to rethink how we treat atrial fibrillation. With early intervention, we can keep people healthy, happy and out of the hospital, which benefits patients and their families, as well as our entire health system.

Reference: “Development of Atrial Fibrillation After Cryoablation or Drug Therapy” by Jason G. Andrade, MD, Mark W. Dale, MD, Laurent McCall, MD, George A. Wells, PhD, Matthew Bennett, MD, Vidal Acebag, MD, PhD, Jean Champagne, MD, Jean-Francis Roux, MD, Derek Yung, MD, Alan Skanes, MD, Yariv Kakin, MD, Carlos Morillo, MD, Umjeet Jolly, MD, Paul Novak, MD, Evan Lockwood, MD, Guy Amit, MD, Paul Angaran, MD, John Sapp, MD, Stefan Wardell, MD, Sandra Lauck, PhD, Julia Cadrin-Tourigny, MD, Simon Kochhauser, MD, and Atal Verma. , MD to EARLY-AF Investigators, 7 Nov 2022; New England Journal of Medicine.
DOI: 10.1056/NEJMoa2212540

The study was funded by the Canadian Cardiac Arrhythmia Network, Medtronic and Bayliss Medical.

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