- Researchers say a surgery known as cryoablation appears to be more effective than drugs in treating atrial fibrillation (AFib).
- They say the results include both short-term and long-term benefits.
- Experts say this latest research is in line with medical professionals moving away from medications to treat AFib.
A new study suggests ablation surgery may be more effective as a first-step strategy for atrial fibrillation (AFib) than using medication.
AFib is a type of arrhythmia or abnormal heartbeat. It’s caused by fast and irregular beats from the upper chambers of the heart.
It’s a condition frequently associated with an increased risk of stroke and heart failure. It’s usually treated with antiarrhythmic drugs.
Symptoms of AFib include angina (chest pain caused by a reduced blood supply to the heart muscle), dizziness, fainting, fatigue, palpitations (feeling like the heart is fluttering or racing), weakness, and shortness of breath.
Risk factors include being older than 50, alcohol use, heart failure, high-stress levels, high blood pressure, obesity, sleep apnea or poor sleep, and thyroid disease.
In their study, researchers from the University of British Columbia Centre for Cardiovascular Innovation say early intervention with cryoballoon catheter ablation (cryoablation) better reduces the risk of serious long-term health impacts from AFib than drugs.
Cryoablation uses extremely cold gas to freeze and destroy abnormal cells or diseased tissue. The procedure has usually been used when people with abnormal heartbeats don’t respond to antiarrhythmic medications.
Scientists looked at 303 people at 18 sites across Canada, with 154 patients undergoing cryoballoon ablation and 149 assigned antiarrhythmic drug therapy.
Over the next three years, three people (2%) in the ablation group had an episode of persistent atrial fibrillation, compared with 11 people (7%) in the antiarrhythmic drug group.
Over a follow-up period, researchers reported that people who received cryoablation had lower hospitalization rates and fewer serious adverse health events resulting in death, disability, or prolonged hospitalization.
“The new trial results will change the conversation between patient and doctor,” Dr. Marcin Kowalski, the director of electrophysiology of cardiology at Staten Island University Hospital in New York, told Healthline.
“The new evidence shows… that ablation as the first-line therapy is more effective than anti-arrhythmic drugs. Doctors now are more likely to offer the ablation earlier, which can significantly lower [AFib] burden and progression of atrial fibrillation,” he added.
“Patients with atrial fibrillation should be treated earlier and treated with ablation rather than anti-arrhythmic medication,” Kowalski noted. “The early intervention with ablation will prevent atrial fibrillation recurrence and improvement in quality of life and symptoms.”
Dr. Shephal Doshi, a cardiac electrophysiologist and director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in California, told Healthline multiple studies in recent years show a minimally invasive procedure is better at fixing atrial fibrillation compared to medications.
“Ablation fixes electrical short circuits that are in the heart and the short circuits while they can respond to medication,” Doshi said. “Medications can have many side effects and are not as effective as the procedure, and this study validates that.”
Doshi added that the effectiveness of drugs for AFib “has never been great,” despite their use as a first-line option.
“But now in 2022, these procedures called ablation are safer – and with continuous improvement and technology – are also more successful,” Doshi said. “It’s not just that the drugs are covering up symptoms, but the drugs just aren’t as effective at fixing these short circuits and a definitive approach is this non-surgical procedure.”
Dr. Nikhil Warrier, medical director of electrophysiology at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in California, told Healthline the study is “a great addition to the ablation literature” showing ablation gives better results compared to antiarrhythmic drugs.
“This is an extremely well-utilized option for most patients as an effective treatment strategy for [AFib] management,” he said. “This speaks to the advances in ablation therapy over the past decade along with relatively unchanged options from a medical standpoint for management of this disease process.”
“Our tools have gotten more effective and safer in treating AF,” Warrier added. “In fact, there are new modalities such as PFA, which is still in clinical trials in the U.S., which is showing improved safety and efficacy outcomes – this should lead to more effective management of AF and increase adoption of ablation therapy.
Warrier said drugs and ablation are just tools for AFib management.
“While the improved outcomes with ablation vs [medications] are exciting, the high recurrence rates shown in this trial as well as prior studies show there is still work to be done in ‘curing’ [AFib],” Warrier said.