https://doi.org/10.55788/7d766704
“AF is a chronic and progressive condition and persistent AF is linked to adverse clinical events, such as stroke, heart failure, and death” explained Dr Jason Andrade (University of Montreal, Canada). “Since catheter ablation modifies the pathogenic mechanism of AF, early initiation of this procedure may lead to improved clinical outcomes.”
The PROGRESSIVE-AF trial (NCT05514860) randomised 303 patients with AF (mean age 58 years) 1:1 to first-line catheter ablation or first-line antiarrhythmic drugs. The primary endpoint was the time-to-first occurrence of an episode of persistent atrial tachyarrhythmia [1].
At 3 years, the incidence of persistent AF was reduced by 75% in the ablation compared with the antiarrhythmic drug group (HR 0.25, 95% CI 0.09–0.70). The observed effect was consistent across subcomponents of the primary outcome, namely atrial tachyarrhythmias lasting more than 7 days (HR 0.30; 95% CI 0.10–0.93) and cardioversion for atrial tachyarrhythmia lasting between 2 and 7 days (HR 0.14; 95% CI 0.02–0.85). Furthermore, 42.7% of the patients in the ablation arm were free of any recurrence of atrial tachyarrhythmia after 3 years compared with 9.3% in the antiarrhythmic drug arm (HR 0.49; 95% CI 0.37–0.65). Quality of life after 3 years of follow-up was also significantly better in patients randomised to the ablation arm. The Atrial Fibrillation Effect on Quality-of-Life (AFEQT) revealed mean differences from baseline of 28.1 versus 24.8 respectively, while the mean difference from baseline of EQ-5D-assessed quality of life was 0.06 versus 0.01 and the relative risk for symptoms of AF was 4.8% versus 17.1% respectively (all comparisons ablation vs antiarrhythmic drug). At 3 years, fewer adverse events were reported in the ablation group (11.0%) than in the antiarrhythmic drug group (23.5%; RR 0.47; 95% CI 0.28–0.79). Also, serious AEs were numerically less frequently observed in the ablation arm (4.5% vs 10.1%; RR 0.45; 95% CI 0.19–1.05).
Dr Andrade concluded that first-line treatment with ablation led to a lower risk of progression to persistent AF than first-line treatment with antiarrhythmic drug therapy. Dr Carina Blomström Lundqvist agreed that first-line ablation reduces AF progression compared with initial antiarrhythmic drug therapy, but that the optimal patient and timing remain unclear: “The CLOSE-to-CURE study (NCT02925624) demonstrated that patients respond very well to ablation, even if they are in a progressed stage of the condition and have a high AF burden” [2].
- Andrade JG, et al. The impact of “first-line” rhythm therapy on atrial fibrillation progression: the PROGRESSIVE-AF trial. LBS.08, AHA Scientific Sessions 2022, 05–07 November, Chicago, USA.
- Strisciuglio T, et al. EP Europace. 2020;22(8):1189–1196.
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Table of Contents: AHA 2022
Featured articles
What Is New in Heart Failure
Torsemide not superior to furosemide after hospitalisation for heart failure
IRONMAN failed primary endpoint but shows potential long-term benefits of iron repletion in HF patients
Up-titration of HF therapies following HF discharge saves lives
Hypertension: Novel Developments
The endothelin system: a new target for resistant high blood pressure
Can renal denervation lower BP on top of antihypertensive drugs?
Quadruple, ultra-low-dose treatment did not meet primary endpoint in hypertension
Mindfulness programme contributes to office blood pressure lowering
Interventional Cardiology in 2022
Grafting with the radial vein: an underrated option in CABG surgery?
Extracorporeal membrane oxygenation not superior to conservative therapy in cardiogenic shock
Surgery with adequate saphenous vein partly better than endovascular treatment in CLTI
Arrhythmia – State of the Art
First-line ablation limits progression to persistent AF
Doubling the dose of self-administered etripamil terminates PSVT
Novel Developments in Primary and Secondary Prevention
Grafting with the radial vein: an underrated option in CABG surgery?
Digitally delivered cognitive behavioural therapy successful in type 2 diabetes
Empagliflozin reduces risk of kidney disease progression and CV events in patients with CKD
RESPECT-EPA misses primary endpoint but hints towards improvements in CV outcomes by EPA
Pemafibrate fails to reduce cardiovascular events in diabetes but may benefit the liver
Dietary supplements not effective in lowering LDL-C, use of low-dose statins encouraged
No sex differences in lipid-lowering effect and treatment benefit of PCSK9 inhibitors
COVID-19 and the Heart
‘No’ to routine use of rivaroxaban in outpatients with COVID-19
COVID-19 pandemic: Older adults and those affected by the delta variant experienced increased cardiovascular morbidity and mortality
COVID-19 mRNA vaccination does not amplify risk of cardiovascular hospitalisation
Best of the Posters
Higher LDL-cholesterol levels linked to higher CVD mortality risk in the elderly
AF: Moderate alcohol intake possibly associated with a reduced mortality risk
Periodontitis: An independent risk factor for AF
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