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LISBON, PORTUGAL – MARCH 17, 2019: A catheter ablation procedure involving only the basics and producing the same results could reduce waiting lists for patients with atrial fibrillation, according to the latest results. AVATAR-AF trial minute presented today at the EHRA 2019, a congress of the European Society of Cardiology (ESC).1 With the simplified protocol, 30% more patients could benefit from catheter ablation for the same cost.
Atrial fibrillation is the most common heart rhythm disorder (arrhythmia). It causes 20-30% of all strokes and increases the risk of premature death.2 Symptoms include palpitations, shortness of breath, fatigue, and difficulty in exercising. Catheter ablation, which aims to burn or freeze heart tissue, causing atrial fibrillation, is recommended to restore normal rhythm after failure or intolerance to drug therapy.
Principal Professor Prapa Kanagaratnam, of Imperial College London, said: "Catheter ablation began in 1998. Clinical results have been slow over the past decade, despite more expensive technologies As a more complex procedure requiring highly qualified personnel, we have reduced the procedure to the essentials to see if the same results were obtained.
The AVATAR protocol eliminates electrical mapping of pulmonary veins, eliminating the need for pulmonary venous catheters, electrical recording equipment and trained personnel to use equipment.
The trial included 321 patients with atrial fibrillation requiring symptom control. Patients were randomly badigned to one of three treatments: 1) AVATAR protocol with cryoballoon ablation and return home on the same day; 2) anti-arrhythmic drugs; 3) conventional cryoballoon ablation with mapping of the pulmonary veins and hospitalization during the night.
For all patients, there was a 12-week treatment period during which procedures were performed and medications optimized. The main evaluation criterion was whether patients should return to the hospital after this period.
At one year, 21% of patients in the AVATAR group needed hospital treatment to relieve their symptoms. This was significantly lower than in the drug therapy group, 76% of whom needed treatment (p
"Some of the more technical parts of the procedure can be omitted, which makes the procedure easier, cheaper and faster, without sacrificing results." said Professor Kanagaratnam. "In the UK, patients with atrial fibrillation have to wait months for catheter ablation.The simpler protocol could shorten the waiting lists with the same budget."
"Eight out of ten patients no longer need to see their specialist," he continued. "Currently, we are medicalizing patients with regular monitoring, but the study shows that a long-term follow-up is not necessary." Patients can contact the hospital if they have symptoms. "
The study provides the first direct evidence that ablation is better than drugs to control symptoms and avoid hospital treatments. "It is possible that more patients are now opting for catheter ablation, rather than trying drugs first," said Professor Kanagaratnam. "The findings also question the value of drug therapy and the question of whether catheter ablation should be the first-line treatment for atrial fibrillation patients with symptoms."
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Authors: ESC Press Office
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Notes to the editor
The hashtag of the meeting is # ehra2019.
Funding sources: British Heart Foundation, Medtronic, National Institute of Health Research.
Disclosures: No.
References and notes
1L "Abbreviation versus antiarrhythmic treatment to reduce all hospital episodes of recurrent atrial fibrillation" will be presented during the session. Last-minute essays on Sunday 17 March from 2.00 pm to 3.30 pm (reading room) in the Sokolov conference room.
2Kirchhof P, Benussi S, Kotecha D, et al. The 2016 ESC guidelines for the management of atrial fibrillation have been developed in collaboration with EACTS. Eur Heart J. 2016 37: 2893-2962.
About the European Heart Rhythm Association
The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its goal is to improve the quality of life and reduce sudden cardiac death by limiting the impact of cardiac arrhythmias. EHRA disseminates knowledge and sets standards; offers continuing education, training and certification to physicians and related professionals involved in the field of cardiac arrhythmias, with a focus on atrial fibrillation (AF) and electrophysiology (EP). EHRA publishes consensus documents and international positions. It is a source of high quality, unbiased, evidence-based scientific information that promotes the quality of care for AF patients, and has also dedicated a website. for the benefit of patients "afibmatters.org". .
About the EHRA congress
EHRA 2019 is the annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).
About the European Society of Cardiology
The European Society of Cardiology brings together health professionals from more than 150 countries who are working to advance cardiovascular medicine and help people live longer and healthier lives.
Information for journalists present at EHRA 2019
EHRA 2019 will be held from 17 to 19 March at the Lisbon Congress Center (CCL) in Lisbon, Portugal. Explore the scientific program.
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