Abstract 320 Effect of Early Treatment of Atrial Fibrillation on Atrial Arrhythmia Recurrence in the Cryo-FIRST Study: A Comparison between Cryoballoon Ablation Versus Antiarrhythmic Drug Therapy

BACKGROUND

Following clinical guidelines, catheter ablation is a recommended treatment for patients with symptomatic drug-refractory paroxysmal atrial fibrillation (PAF). Also, ablation as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence. However, the impact of early versus late therapy has not been well characterized in either treatment (cryoballoon ablation (CBA) or AAD) with regards to longer-term atrial arrhythmia recurrence.

PURPOSE

Cryo-FIRST trial evaluated AAD treatment against pulmonary vein isolation (PVI) via CBA (Arctic Front Advance) as a first-line rhythm control therapy in patients with symptomatic PAF. This current analysis examines the impact of early versus late treatment after the initial AF diagnosis.

METHODS

Patients with PAF who had not been administered a class I or III AAD therapy for >48 hours were enrolled at 18 sites in 9 countries. Patients were randomized (1:1) to CBA or AAD therapy (Class IC or III). Subjects were followed at 1, 3, 6, 9, and 12 months using 7-day Holter recordings. Four total groups of patients were evaluated based on modality of randomization and duration since first-AF diagnosis, including: 1) CBA within 6 months; 2) CBA after 6 months; 3) AAD within 6 months; and 4) AAD after 6 months.

RESULTS

After a median duration of 0.4 (0-2) years after PAF diagnosis, 218 patients were randomized (age 52±13 years, 68% male), and 86% completed the 12-month follow-up. Crossovers occurred in 9% of subjects (N=20), including: 1 subject in the CBA and 19 subjects in the AAD arm. Subgroup analysis comparing CBA with AAD treatment on the primary endpoint (freedom from atrial arrhythmia recurrence) in 116 subjects treated early (< 6month) after PAF diagnosis resulted in a similar improvement by CBA compared to AAD treatment (HR: 0.47 (0.18-1.23)) as in 98 patients treated later (≥ 6 months; HR: 0.43 (0.19-0.95)). Evaluation of the effect of early treatment (< 6month) on atrial arrhythmia recurrence resulted in a 40% risk reduction of atrial arrhythmia recurrence in both study arms together (HR= 0.60 (0.34-1.07); p=0.084) and a 36% risk reduction in the CBA arm alone (HR: 0.64 (0.23-1.80); p=0.396).

CONCLUSIONS

Early treatment of PAF resulted in a trend towards less atrial arrhythmia recurrence, and the improvement by CBA compared to AAD treatment seemed similar for early and late treatment after the diagnosis of PAF.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Effect of Early Treatment of Atrial Fibrillation on Atrial Arrhythmia Recurrence in the Cryo-FIRST Study: A Comparison between Cryoballoon Ablation Versus Antiarrhythmic Drug Therapy
E. Waezsada¹, N. Pavlovic², V. Velagic³, J. S. Hermida⁴, S. Healey⁵, G. Arena⁶, N. Badenco⁷, C. Meyer⁸, J. Chen⁹, S. Iacopino¹⁰, F. Anselme¹¹, F. Di Piazza¹², D. Becker¹³, G.-B. Chierchia¹⁴, M. Kuniss¹, für die Studiengruppe: Cryo-FIRST
¹Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; ²Cardiology, Sestre Milosrdnice University Hospital Centre, Zagreb, HR; ³Cardiovascular Medicine, University Hospital Centre Zagreb, Zagreb, HR; ⁴Service de Cardiologie Rythmologie et Stimulation Cardiaque, Centre Hospitalier Universitaire d'Amiens-Picardie, Amiens, FR; ⁵MonashHeart, Monash Health, Clayton, AU; ⁶Cardiology, Ospedale Apuane, Massa Carrara, IT; ⁷Cardiologie, AP-HP Sorbonne Université, ICAN Institute, Hopital Pitié-Salpétrière, Paris, FR; ⁸Klinik für Kardiologie, Angiologie, Intensivmedizin, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf; ⁹Department of Heart Disease, Haukeland University Hospital, Bergen, NO; ¹⁰GVM Care&Research, Maria Cecilia Hospital, Cotignola,, IT; ¹¹Cardiologie, CHU de Rouen, Rouen, FR; ¹²Core Clinical Solutions, Study and Scientific Solutions, Medtronic, Rome, IT; ¹³Cardiac Ablation Solutions, Medtronic GmbH, Meerbusch; ¹⁴Heart Rhythm Management Center, Universiteit Brussel, Postgraduate Course in Clinical ElectroPhysiology and Pacing, Brussels, BE;
BACKGROUND Following clinical guidelines, catheter ablation is a recommended treatment for patients with symptomatic drug-refractory paroxysmal atrial fibrillation (PAF). Also, ablation as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence. However, the impact of early versus late therapy has not been well characterized in either treatment (cryoballoon ablation (CBA) or AAD) with regards to longer-term atrial arrhythmia recurrence. PURPOSE Cryo-FIRST trial evaluated AAD treatment against pulmonary vein isolation (PVI) via CBA (Arctic Front Advance) as a first-line rhythm control therapy in patients with symptomatic PAF. This current analysis examines the impact of early versus late treatment after the initial AF diagnosis. METHODS Patients with PAF who had not been administered a class I or III AAD therapy for >48 hours were enrolled at 18 sites in 9 countries. Patients were randomized (1:1) to CBA or AAD therapy (Class IC or III). Subjects were followed at 1, 3, 6, 9, and 12 months using 7-day Holter recordings. Four total groups of patients were evaluated based on modality of randomization and duration since first-AF diagnosis, including: 1) CBA within 6 months; 2) CBA after 6 months; 3) AAD within 6 months; and 4) AAD after 6 months. RESULTS After a median duration of 0.4 (0-2) years after PAF diagnosis, 218 patients were randomized (age 52±13 years, 68% male), and 86% completed the 12-month follow-up. Crossovers occurred in 9% of subjects (N=20), including: 1 subject in the CBA and 19 subjects in the AAD arm. Subgroup analysis comparing CBA with AAD treatment on the primary endpoint (freedom from atrial arrhythmia recurrence) in 116 subjects treated early (< 6month) after PAF diagnosis resulted in a similar improvement by CBA compared to AAD treatment (HR: 0.47 (0.18-1.23)) as in 98 patients treated later (≥ 6 months; HR: 0.43 (0.19-0.95)). Evaluation of the effect of early treatment (< 6month) on atrial arrhythmia recurrence resulted in a 40% risk reduction of atrial arrhythmia recurrence in both study arms together (HR= 0.60 (0.34-1.07); p=0.084) and a 36% risk reduction in the CBA arm alone (HR: 0.64 (0.23-1.80); p=0.396). CONCLUSIONS Early treatment of PAF resulted in a trend towards less atrial arrhythmia recurrence, and the improvement by CBA compared to AAD treatment seemed similar for early and late treatment after the diagnosis of PAF.
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