Cryoablation Bests Antiarrhythmic Drugs for Quality of Life in AFib Patients

Patrick Campbell

An analysis of STOP AF First presented at ACC.21 details the quality of life improvements observed with cryoablation versus antiarrhythmic drugs as initial treatment for atrial fibrillation.

A new analysis of the STOP AF First study suggests patients undergoing cryoballon ablation reported a better quality of life than their counterparts who underwent treatment with antiarrhythmic drugs as an initial treatment for atrial fibrillation (AF)).

Presented less than 4 months after results of STOP AF First were published in the New England Journal of Medicine at the American College of Cardiology’s 70th Annual Scientific Session (ACC.21), results demonstrate undergoing cryoablation was associated with greater improvements in multiple quality of life domains as well as increased levels of treatment satisfaction.

A 203-patient trial randomizing treatment-naive adults with paroxysmal AF and to cryoablation or antiarrhythmic drugs, the STOP AF First trial concluded cryoablation was superior to drug therapy for preventing recurrence of atrial arrhythmia. Specifically, the study found cryoablation was associated with a treatment success rate of 74.6% (95% CI, 65.0-82.0) compared to 45.0% (95% CI, 34.6-54.7) with drug therapy.

As part of the trial, patients were asked to complete the AF Effect on QualiTy of life (AFEQT) survey and the EuroQol (EQ)-5D-5L questionnaire at baseline and 12 months. A team of investigators led by Oussama Wazni, MD, Section Head of Cardiac Electrophysiology and Pacing at the Cleveland Clinic, designed the current study to assess and compare absolute change in each score from baseline to 12 months using a two-sample t-test. Investigators pointed out results from both questionnaires at baseline and 12 months were available for 99 of the 104 patients randomized to cryoablation and 90 of the 99 patients randomized to drug therapy.

Upon analysis, improvements from baseline to 12 months in AFEQT summary and domain scores were significantly higher in the cryoablation arm versus the drug therapy arm. However, investigators pointed out not significant differences were observed when comparing change in EQ-5D index and EQ-VAS scores between the study arms.

As part of ACC.21, Practical Cardiology reached out Steve Nissen, MD, Chief Academic Officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic and an investigator of the current study, for his insight into the results and how they help inform clinical practice.

This study, “Cryoablation versus Antiarrhythmic Drug Therapy as Initial Treatment for Atrial Fibrillation: Impact on Quality of Life,” was presented at ACC.21.