WHY AND WHEN TO REFER PATIENTS FOR CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION

2020 ESC Guidelines for atrial fibrillation Management

The 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation recommend catheter ablation for AF symptom improvement (class I, level A), targeting pulmonary vein isolation (class I, level A)6.

AF Catheter Ablation as a First-line Therapy:

  • Should be considered as first-line rhythm control therapy to improve symptoms in selected patients with symptomatic paroxysmal AF episodes (class IIa, level B)
  • May be considered for persistent AF without major risk factors for AF recurrence (level IIb, level C)
  • Is recommended to reverse LV dysfunction in AF patients when tachycardia-induced cardiomyopathy is highly probable, independent of their symptom status (class I, level A)
  • Should be considered in selected AF patients with HF with reduced LVEF to improve survival and reduce HF hospitalization (class IIa, level B)6

2020 ESC Guidelines Highlights
Watch Prof. G. Hindricks explain key updates made to the ESC Guidelines for AF Management.
Please refer to the following link for additional guidance on which patients to refer for catheter ablation: 2020 ESC Guidelines on AF Management

ATRIAL FIBRILLATION PROGRESSION

AF is progressive is nature, with longer diagnosis-to-ablation times associated with markers of atrial remodelling2.

For patients with symptomatic paroxysmal AF, antiarrhythmic drugs (AAD) are often prescribed as the first-line therapy. However, these drugs fail to prevent AF recurrence in up to 50% of patients3. Some of these patients go on to receive catheter ablation.

Importantly, prior studies suggest that a shorter diagnosis to ablation time is associated with lower rates of atrial arrythmia recurrence, repeat procedures, and cardiovascular hospitalisation4-7. These observations paired with evidence that catheter ablation can halt AF progression more effectively than AAD therapy7 has sparked debate around the optimal first line therapy for symptomatic AF patients.

The positive results from the Cryo-FIRST study demonstrate Cryoballoon ablation is safe and superior to AAD therapy in reducing AF recurrence in this first line patient population1.

AF DETECTION AND TREATMENT

  • AF detection tools that are best suited for different patients and how they can impact clinical practice
  • AF detection and treatment guidelines
  • Who should be referred for an AF ablation and what outcomes can be expected
  • An overview of AF progression and the benefits of early treatment
  • AF patient expectations for treatment
  • Risks and benefits associated with AF ablation compared to AAD therapy
  • The role of AF management guidelines in improving the standard of care delivered to patients

TREATING PERSISTENT ATRIAL FIBRILLATION

Find out more
Atric Front Advance Pro Cryoballoon

PATIENT VIDEOS FOR YOUR WAITING ROOM​

Part 1 - What is Atrial Fibrillation - (04:00)

Atrial Fibrillation Disease And Symptoms
More information (see more) Less information (see less)

Part 2 - Atrial Fibrillation Treatments - (03:14)

Part 3 – Benefits of early atrial fibrillation treatment - (01:46)

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References

1

Hermida et al., Cryoballoon catheter ablation versus antiarrhythmic drugs as a first-line therapy for patients with paroxysmal atrial fibrillation: Rationale and design of the international Cryo-FIRST study. Am Heart J. 2020 Apr;222:64-72    

2

Kuniss et al. Presented at the German Cardiac Society conference DGK 2020.

3

Chierchia, GB., et al. Quality of Life Measured in First-Line Therapy During the Cryo-FIRST Study: A Comparison Between Cryoballoon Catheter Ablation Versus Antiarrhythmic Drug Therapy. Poster presented at the 2020 ESC Congress – The Digital Experience.

4

Wazni et al. Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation. New England Journal of Medecine. 2020. 

5

Andrade, J. et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. New England Journal of Medecine. 2020.    

6

Hindricks, G., et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2020. 00, 1-126.