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

Jean Sylvain Hermida, Jian Chen, Christian Meyer, Saverio Iacopino, Giuseppe Arena, Nikola Pavlovic, Vedran Velagic, Stewart Healey, Douglas L. Packer, Heinz Friedrich Pitschner, Carlo de Asmundis, Malte Kuniss, Gian Battista Chierchia

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Radiofrequency current (RFC) catheter ablation for patients with paroxysmal atrial fibrillation (AF) has been shown to be safe and effective in first-line therapy. Recent data demonstrates that RFC ablation provides better clinical outcomes compared to antiarrhythmic drug (AAD) in the treatment of early AF disease. Furthermore, studies comparing RFC and cryoballoon have established comparable efficacy and safety of pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF. OBJECTIVES: The Cryo-FIRST trial was designed to compare AAD treatment against cryoballoon PVI as a first-line therapy in treatment naïve patients with AF. Efficacy and safety will be compared between the two cohorts and amongst subgroups. METHODS: The primary hypothesis is that cryoablation is superior to AAD therapy. To test this hypothesis, patients will be randomized in a 1:1 design. Using a 90-day blanking period, primary efficacy endpoint failure is defined as (at least) one episode of atrial arrhythmia with a duration >30 sec (documented by 7-day Holter or 12-lead ECG). Secondary endpoints (Quality-of-Life, rehospitalization, arrhythmia recurrence rate, healthcare utilization, and left atrial function) and adverse events will also be evaluated. Study enrollment will include 218 patients in up to 16 centers. CONCLUSIONS: This study will be a multi-national randomized controlled trial comparing cryoablation against AAD as a first-line treatment in patients with paroxysmal AF. The results may help guide the selection of patients for early AF disease therapy via cryoballoon ablation.

Original languageEnglish (US)
Pages (from-to)64-72
Number of pages9
JournalAmerican heart journal
Volume222
DOIs
StatePublished - Apr 1 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Hermida, J. S., Chen, J., Meyer, C., Iacopino, S., Arena, G., Pavlovic, N., Velagic, V., Healey, S., Packer, D. L., Pitschner, H. F., de Asmundis, C., Kuniss, M., & Chierchia, G. B. (2020). 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. American heart journal, 222, 64-72. https://doi.org/10.1016/j.ahj.2019.12.006