Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation

This randomized trial (EARLY-AF) compared cryoballoon catheter ablation with antiarrhythmic drug therapy as first-line treatment for symptomatic, paroxysmal atrial fibrillation. A total of 303 patients were randomly assigned to either ablation or drug therapy, with continuous rhythm monitoring via implantable devices over 12 months. The primary outcome first recurrence of any atrial tachyarrhythmia (AF, flutter, or atrial tachycardia) post–90-day blanking period, occurred in 42.9% of the ablation group versus 67.8% of the drug group (HR 0.48; P<0.001). Symptomatic recurrences were also significantly lower (11.0% vs. 26.2%), and median AF burden was reduced to 0% in the ablation group versus 0.13% with drugs. Quality-of-life scores improved more with ablation. Serious adverse events occurred in 3.2% (ablation) vs. 4.0% (drug therapy). The study concludes that first-line cryoablation yields superior arrhythmia control compared to drug therapy, with acceptable safety and better patient-reported outcomes.

This randomized trial (EARLY-AF) compared cryoballoon catheter ablation with antiarrhythmic drug therapy as first-line treatment for symptomatic, paroxysmal atrial fibrillation. A total of 303 patients were randomly assigned to either ablation or drug therapy, with continuous rhythm monitoring via implantable devices over 12 months. The primary outcome first recurrence of any atrial tachyarrhythmia (AF, flutter, or atrial tachycardia) post–90-day blanking period, occurred in 42.9% of the ablation group versus 67.8% of the drug group (HR 0.48; P<0.001). Symptomatic recurrences were also significantly lower (11.0% vs. 26.2%), and median AF burden was reduced to 0% in the ablation group versus 0.13% with drugs. Quality-of-life scores improved more with ablation. Serious adverse events occurred in 3.2% (ablation) vs. 4.0% (drug therapy). The study concludes that first-line cryoablation yields superior arrhythmia control compared to drug therapy, with acceptable safety and better patient-reported outcomes.