The New England journal of Medicine in its January 28th 2021 edition has published an excellent paper on Cryoablation or drug therapy for initial treatment of atrial fibrillation.The conclusions are that “Among patients receiving treatment for symptomatic paroxysmal atrial fibrillation.there was a significantly lower rate of atrial fibrillation with catheter cryroballon ablation than with anti arrhythmic drug therapy as assessed by continuous rhythm monitoring “.
N.B. This is a landmark study,and the New England Journal of Medicine generally only publishes really interesting and well controlled studies.Perhaps,if you were not sure of,or on the fence of whether to have Cryoablation or drug therapy,this excellent study will help.
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Elephantlydia
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What many of us believe and have done for years but sadly there are too few EPs to deal with every case of AF even if patients could be persuaded to go through the procedures. From evidence here it if obvious that most people are terrified of having "somebody burning bits of my heart" until they feel it is the last resort.
There is also a question of suitability of patient as many would be excluded due to other consideratiaons such as obesity which has been shown to make ablation unlikely to succeed and where careful dieting may well remove the need for ablation anyway. (LEGACY trials).
Sadly it is a far more complex problem than simple statistics can show.
Having struggled for 7 months with the medication I asked the arrhythmia nurse if I would be a candidate for ablation, having previously been completely against it for cowardess reasons, and optimism that I could diet and exercise the condition away. My condition has deteriorated a lot in 7 months since my diagnosis despite my best efforts, and I'm convinced it's the Diltiazem doing me harm. The nurse said they would only consider an ablation on the NHS if they considered that my condition was risking my life, which they don't. She basically said that regardless of how unwell I am with my heart in and out of rhythm daily, and how much I'm struggling with side effects of medication, they are not going to change my treatment. I'm now waiting for a response to an enquiry to a private EP as to whether he thinks an ablation is an option for me. 6 months ago one of the nurses said I should continue with my weight loss as ablation was something to aim for and wouldn't be possible on the NHS if I was outside of healthy BMI. I don't know if the change of message is due to COVID or guideline change.
Please see my answer to your other original post on this matter but I do know that obesity does in many cases exclude a person from ablation as it is unlikely to work.
I appreciate this input about obesity! I asked my EP point blank about ablation & obesity (my BMI is considered obese) & he said he has done ablations on many "older" people (senior citizens) who are obese. My secret thought is that this EP wants to do ablations, that's why he studied extra stuff--he didn't necessarily study for extra abilities so he could give prescriptions, but to ablate as he would consider that would be helping people. It's of concern to me, of course, as ablations are seldom one and done, through no fault of anyone and being overweight is something I'm addressing with a more strict diet.
Perhaps not 'terrified' but also very wary of the complications that have been mentioned from time to time on this Forum. If these alone can be reduced through better equipment/procedures whilst I postpone an ablation that would be a result in itself.
Hello Bob, I am curious about success rates and serious complication rates when comparing the US to UK as well as other Countries. Do you have any information on this? I am in the US and still on the fence about pursuing a cryoblation for proximal Afib. I have months long periods of near normalcy. I also entirely stopped Pvc’s with magnesium and Vitamin D3 so I’m not in a rush and I’m willing to travel.
I have only the off the record comment of a leading UK EP who felt that the money driven system in US had the risk of attracting doctors to electrophysiology who might less skilled with predictable results. Apparently complications were higher in some centres but I have no data on this. Here in UK doctors are paid a salary regardless of how many ablations they do so tend to only take patients for whom the procedure may be beneficial.
Thank you, unfortunately I tend to agree. There are some very good doctors here and there are some that put money ahead of the best decision. Trying to find the good ones can be a bit of a chore. I’ve been told the best outcomes are from high volume doctors/hospitals, that I can verify. Appreciate your answer!
Yes you really would not be advised to go to somebody who maybe does only two or three a month. Look for high volume centres where they do five or six a week at least. Teaching hospitals can be a mixed blessing unless you have a guarantee the Professor will perform your ablation. Look up the EP and his history, where he trained, who under and check out their performances. You also need to ask for sucess/complication records. I am lucky enough to have met several top EPs here in UK through my work with AF Association but have little knowledge of US doctors. You could contact AF Association USA aand see if they have any recommendations.
Thank you. In the US there is really no way to confirm how many ablations a Doctor does in a month., it’s difficult to get information here.I thought this site was for both US and UK 😊 So there is a different website for US?
The forum is for all, but there is a dedicated AF Association USA. The main AF Association website does contain under patient resources is list of EPs by area but I don't think there are recommendations
That's all very well but access to ablation is limited. If your cardiologist could say that he knows that catheter ablation is the best treatment for you and you can be booked in next month that would be fine. Unfortunately, that is not the case for the vast majority of patients.
Guidelines recommend a trial of one or more antiarrhythmic drugs before catheter ablation is considered in patients with atrial fibrillation. However, first-line ablation may be more effective in maintaining sinus rhythm.
METHODS
We randomly assigned 303 patients with symptomatic, paroxysmal, untreated atrial fibrillation to undergo catheter ablation with a cryothermy balloon or to receive antiarrhythmic drug therapy for initial rhythm control. All the patients received an implantable cardiac monitoring device to detect atrial tachyarrhythmia. The follow-up period was 12 months. The primary end point was the first documented recurrence of any atrial tachyarrhythmia (atrial fibrillation, atrial flutter, or atrial tachycardia) between 91 and 365 days after catheter ablation or the initiation of an antiarrhythmic drug. The secondary end points included freedom from symptomatic arrhythmia, the atrial fibrillation burden, and quality of life.
RESULTS
At 1 year, a recurrence of atrial tachyarrhythmia had occurred in 66 of 154 patients (42.9%) assigned to undergo ablation and in 101 of 149 patients (67.8%) assigned to receive antiarrhythmic drugs (hazard ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66; P<0.001). Symptomatic atrial tachyarrhythmia had recurred in 11.0% of the patients who underwent ablation and in 26.2% of those who received antiarrhythmic drugs (hazard ratio, 0.39; 95% CI, 0.22 to 0.68). The median percentage of time in atrial fibrillation was 0% (interquartile range, 0 to 0.08) with ablation and 0.13% (interquartile range, 0 to 1.60) with antiarrhythmic drugs. Serious adverse events occurred in 5 patients (3.2%) who underwent ablation and in 6 patients (4.0%) who received antiarrhythmic drugs.
CONCLUSIONS
Among patients receiving initial treatment for symptomatic, paroxysmal atrial fibrillation, there was a significantly lower rate of atrial fibrillation recurrence with catheter cryoballoon ablation than with antiarrhythmic drug therapy, as assessed by continuous cardiac rhythm monitoring. (Funded by the Cardiac Arrhythmia Network of Canada and others; EARLY-AF ClinicalTrials.gov number, NCT02825979. opens in new tab.)
Hi everyone. I am 68, with AF symtomatic for the last 15 years. I am in amidorone and aspixaban daily. My cardiologist thinks that due my heart condition, is convenient to go into cryoablation right now due the illness is going to become permanent in the long time. As cryoablation is relativy new in my residence country Argentina (3 to 5 years) I can not find local statistics about the succesful of this procedure. For that reason I will appreciate if anybody can send me a link to read the The New England journal of Medicine , January 28th 2021 edition. But at last but no least, also the personal experiences with cryoablation surely will help to make my mind. Please keep safe and thanks everyone.
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