Arq. Bras. Cardiol. 2022; 119(1): 95-96
Catheter Ablation as First-Line Therapy in the Treatment of Atrial Fibrillation – Should We Always Indicate it?
Luiz Eduardo Montenegro Camanho
, Gustavo Vignoli dos Santos
This Short Editorial is referred by the Research article "Catheter Ablation is Superior to Antiarrhythmic Drugs as First-Line Treatment for Atrial Fibrillation: a Systematic Review and Meta-Analysis".
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, affecting approximately 1 to 2% of the general population and is associated with an increased risk of cardioembolic events and a negative impact on quality of life. The cardiovascular mortality rate described is approximately 5% per year, and it is estimated that the risk of cardiovascular complications is higher in the first year after the diagnosis of arrhythmia. The recurrence rate of AF without adequate preventive treatment is around 90%, which expresses the magnitude of the problem.
Thus, it seems quite reasonable to postulate the concept that an early approach to AF brings relevant clinical benefits to these patients. Recent data obtained from the EAST-AFNET4 study clearly demonstrated that this approach is a valid and effective strategy. The study involved 2789 patients diagnosed with AF for at least 12 months who were randomized to early treatment of AF (ablation: 8% and AAD: 87%) or conservative treatment. At a median follow-up period of 5.1 years, the early treatment group demonstrated a significant reduction in the primary endpoint of cardiovascular death compared to the conservative group. The risk of stroke, hospitalization for HF or acute coronary syndrome was also lower in the early approach group. The study design was not primarily intended to assess the safety and effectiveness of early treatment components (ablation vs. antiarrhythmic drugs – AAD). Therefore, the authors concluded that an early heart rhythm control strategy was associated with a lower risk of unfavorable outcomes than usual care in patients with AF and associated cardiovascular conditions.
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