Progression of Atrial Fibrillation after Cryoablation or Drug Therapy

This 3-year follow-up of the EARLY-AF randomized trial evaluated whether initial rhythm-control therapy with cryoballoon ablation reduces progression of paroxysmal atrial fibrillation (AF) compared to antiarrhythmic drugs. All 303 patients had implantable loop recorders for continuous rhythm monitoring. Persistent AF occurred in 1.9% of the ablation group vs. 7.4% of the drug group (HR 0.25; CI 0.09–0.70). Recurrent atrial tachyarrhythmia occurred in 56.5% vs. 77.2% respectively (HR 0.51), and arrhythmia burden was significantly lower with ablation (median AF time: 0.00% vs. 0.24%). Patients randomized to ablation also experienced fewer hospitalizations (5.2% vs. 16.8%), greater quality-of-life improvement (AFEQT score difference: +7.4 to +9.0 points across follow-up), and fewer serious adverse events (4.5% vs. 10.1%). The findings suggest cryoablation may be disease-modifying when used early in AF management.

This 3-year follow-up of the EARLY-AF randomized trial evaluated whether initial rhythm-control therapy with cryoballoon ablation reduces progression of paroxysmal atrial fibrillation (AF) compared to antiarrhythmic drugs. All 303 patients had implantable loop recorders for continuous rhythm monitoring. Persistent AF occurred in 1.9% of the ablation group vs. 7.4% of the drug group (HR 0.25; CI 0.09–0.70). Recurrent atrial tachyarrhythmia occurred in 56.5% vs. 77.2% respectively (HR 0.51), and arrhythmia burden was significantly lower with ablation (median AF time: 0.00% vs. 0.24%). Patients randomized to ablation also experienced fewer hospitalizations (5.2% vs. 16.8%), greater quality-of-life improvement (AFEQT score difference: +7.4 to +9.0 points across follow-up), and fewer serious adverse events (4.5% vs. 10.1%). The findings suggest cryoablation may be disease-modifying when used early in AF management.