National study suggests it’s time to rethink how we treat

National study suggests it’s time to rethink how we treat

Montreal, Nov. 7, 2022 (GLOBE NEWSWIRE) — Medical researchers from the Montreal Heart Institute (MHI) presented new data today at the American Heart Association’s breaking scientific sessions. Simultaneously published in the New England Journal of Medicine, the data show that catheter ablation may be better than antiarrhythmic drugs in stopping the progression of the disease.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately 1-2% of the general population. Treatment guidelines recommend a trial of drug therapy to maintain a normal atrial heart rhythm before catheter ablation is considered. However, these medications have only a limited ability to maintain a normal heart rhythm and have significant side effects. Catheter ablation is considered superior to antiarrhythmic drugs for maintaining normal (sinus) rhythm and improving quality of life for patients in whom drugs have already failed, but it was previously unknown whether earlier ablation could prevent progression of the illness.

“By treating patients with catheter ablation early on, we see fewer people progressing to more persistent and life-threatening forms of atrial fibrillation,” said MHI-affiliated electrophysiologist Dr. Jason Andrade, Assistant Professor of Medicine at the University of Montreal and lead author of the EARLY-AF study.

“These data provide clear evidence that early invasive therapy may be a more effective method of improving the lives of our patients with atrial fibrillation. In addition, this study further supports the recommendation to pursue catheter ablation as an initial treatment strategy in appropriate patients,” added Laurent Macle, MD, chief of the electrophysiology service at MHI and co-chair of the MHI atrial fibrillation guidelines. Canadian Cardiovascular Society.

The findings, published today in the New England Journal of Medicinecome from a multisite clinical trial known as Early Aggressive Intervention for Atrial Fibrillation (EARLY-AF).

For the EARLY-AF trial, the pan-Canadian research team enrolled 303 AF patients at 18 sites across Canada. Half of the patients were randomized to receive antiarrhythmic drugs, while the other half were treated with first-line catheter ablation by cryoablation. All patients received an implantable monitoring device that recorded their heart activity over a three-year period.

At the end of the three-year study, the researchers found that patients in the cryoablation group were 75% less likely to progress to persistent AF compared with patients treated with antiarrhythmic drugs. Catheter ablation during follow-up was associated with a 69% reduction in hospitalization and fewer serious adverse health events.

in a previous paper, the same team showed that first-line catheter ablation was more effective than antiarrhythmic drugs in reducing short-term recurrence of atrial fibrillation. The current study demonstrates that the intervention prevents the disease from progressing.

Although the condition begins as an isolated electrical disorder, each recurring incident can cause electrical and structural changes in the heart that can lead to longer-lasting events known as persistent AF. These longer duration events have been associated with an increased risk of serious health conditions, including stroke and heart failure, as well as higher rates of hospitalization.

“Atrial fibrillation is like a snowball rolling downhill. With each episode of atrial fibrillation there are gradual changes in the heart, causing the heart rhythm problem to become more and more severe,” explains Dr. Andrade. “Effective early intervention can help prevent the progression of this potentially life-altering disease for our patients.”

The researchers say the most effective early interventions would benefit both patients and the health care system. Currently, the costs associated with providing atrial fibrillation-related services are estimated to be two and a half percent of overall annual health care expenses, and those costs are expected to increase as much as four percent in the next two decades.

“The evidence increasingly shows that it is time to rethink how we approach the treatment of atrial fibrillation. With effective early intervention, we can keep people healthy, happy and out of the hospital, which would be a tremendous benefit to patients and their families, as well as our entire health system.”

About the Montreal Heart Institute

Founded in 1954, the Montreal Heart Institute constantly pursues the highest standards of excellence in the cardiovascular field through its leadership in basic and clinical research, ultra-specialized care, professional training and prevention. It houses the largest research center in Canada, the largest cardiovascular prevention center in the country and the largest cardiovascular genetics center in Canada. The Institute is affiliated with the Université de Montréal and has more than 2,000 employees, including 245 physicians and more than 85 researchers.


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