No dia 28 de janeiro de 2021 foi publicado no The New England Journal of Medicine o estudo “Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation – EARLY AF”. O Arritmed fez um resumo desse artigo.
Os Guidelines recomendam tratamento inicial com antiarrítmicos para manutenção de ritmo sinusal em pacientes com fibrilação atrial sintomática. A ablação por cateter é superior a tratamento medicamentoso na manutenção do ritmo sinusal nos pacientes que o tratamento medicamentoso falhou. A ablação por cateter realizada como primeira linha de tratamento pode ser melhor estratégia na prevenção de recorrência de taquiarrimitas atriais e também na qualidade de vida do paciente. Muitos estudos realizados nesse contexto foram inconclusivos, apresentando alta incidência de arritmias e aconteceu também muito “crossover” entre os grupos. Diante desse cenário, foi realizado esse estudo canadense, randomizado e multicêntrico (18 centros no Canadá).
Randomização e Métodos:
- Adultos maiores que 18 anos, que tiveram fibrilação atrial sintomática registrado em ECG até 24 meses antes da randomização, sem tratamento prévio.
- 303 pacientes, randomizados 1:1 para: A) Ablação por cateter com Balão de Crioterapia; B) Drogas antiarrítmicas para controle do Ritmo.
- Realizado um seguimento de 12 meses dos grupos.
- End Point Primário: Recorrência de Taquiarritmia Atrial de pelo menos 30 segundos entre 91 a 365 dias.
- End Point Secundário: Recorrência de Taquiarritmia Atrial Sintomática de pelo menos 30 segundos entre 91 a 365 Dias, carga de Fibrilação Atrial, Qualidade de Vida e Efeitos Adversos Graves.
- Colocado Monitor de Eventos implantável (REVEAL) nos grupos para monitorização da fibrilação atrial.
Resultados:
- Recorrência de taquiarritmia atrial foi de 42,9% no grupo da Ablação e 67,8% no grupo dos Antiarrítmicos (hazard ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66; P<0,001);
- Taquiarritmia atrial Sintomática teve recorrência em 11% no grupo Ablação e 26,2% no grupo Antiarrítmico (hazard ratio, 0.39; 95% CI, 0.22 to 0.68);
- Eventos adversos sérios ocorreram em 5 pacientes (3,2%) no grupo ablação e 6 pacientes (4%) no grupo que receberam antiarrítmicos.
Conclusão:
Entre os pacientes que receberam tratamento inicial na fibrilação atrial paroxística sintomática existiu uma significante menor taxa de recorrência no grupo que foi submetido a ablação por cateter de crioterapia quando comparado a estratégia de drogas antiarrítmicas.
Referência:
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