Surgeries & Interventions

Cryoablation as a First-Line AFib Therapy

For people with atrial fibrillation, cryoballoon catheter ablation (cryoablation) as a first-line treatment can halt disease progression and reduce long-term burden. 

Cryoablation involves using extreme cold to kill harmful tissue in the heart and is usually reserved for patients who don’t respond to antiarrhythmic drugs. 

The authors of this NEJM-published study argue that it may be better to start with cryoablation. While AFib 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. In contrast to drug therapies, cryoablation directly targets and destroys the tissue that initiates and perpetuates AFib, and thus can lead to longer lasting results. 

In the study, 303 patients with AFib were randomized to receive either cryoablation or antiarrhythmic drugs. After three years, patients in the cryoablation group had greater improvements than those who received initial antiarrhythmic drug therapy. Early cryoablation was associated with…

  • Fewer episodes of persistent AFib (1.9% vs. 7.4%)
  • Less recurrence of atrial tachyarrhythmia (56.5% vs. 77.2%)
  • Fewer hospitalization events (5.2% vs. 16.8%)
  • Fewer adverse events (4.5% vs. 10.1%)
  • Improvements in quality of life

The Takeaway 

First-line cryoablation led to fewer episodes of persistent AFib, reduced arrhythmia recurrence, lower AFib burden, meaningful improvements in quality of life, lower rates of health care utilization, and lower rates of adverse events. In other words, cryoablation outperformed antiarrhythmic drugs as a first-line defense against AFib. 

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