{"id":286,"date":"2021-02-06T19:48:09","date_gmt":"2021-02-06T22:48:09","guid":{"rendered":"http:\/\/arritmed.com.br\/?p=286"},"modified":"2021-02-06T19:48:12","modified_gmt":"2021-02-06T22:48:12","slug":"early-af-crioablacao-ou-terapia-medicamentosa-para-tratamento-inicial-da-fibrilacao-atrial","status":"publish","type":"post","link":"https:\/\/arritmed.com.br\/?p=286","title":{"rendered":"EARLY &#8211; AF : Crioabla\u00e7\u00e3o ou Terapia Medicamentosa para Tratamento Inicial da Fibrila\u00e7\u00e3o Atrial?"},"content":{"rendered":"\n<p><\/p>\n\n\n\n<p>No dia 28 de janeiro de 2021 foi publicado no <em>The New England Journal of Medicine<\/em> o estudo &#8220;Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation \u2013 EARLY AF&#8221;. O Arritmed fez um resumo desse artigo.<\/p>\n\n\n\n<!--more-->\n\n\n\n<p>Os Guidelines recomendam tratamento inicial com antiarr\u00edtmicos para manuten\u00e7\u00e3o de ritmo sinusal em pacientes com fibrila\u00e7\u00e3o atrial sintom\u00e1tica. A abla\u00e7\u00e3o por cateter \u00e9 superior a tratamento medicamentoso na manuten\u00e7\u00e3o do ritmo sinusal nos pacientes que o tratamento medicamentoso falhou. A abla\u00e7\u00e3o por cateter realizada como primeira linha de tratamento pode ser melhor estrat\u00e9gia na preven\u00e7\u00e3o de recorr\u00eancia de taquiarrimitas atriais e tamb\u00e9m na qualidade de vida do paciente. Muitos estudos realizados nesse contexto foram inconclusivos, apresentando alta incid\u00eancia de arritmias e aconteceu tamb\u00e9m muito \u201ccrossover\u201d entre os grupos.  Diante desse cen\u00e1rio, foi realizado esse estudo canadense, randomizado e multic\u00eantrico (18 centros no Canad\u00e1). <\/p>\n\n\n\n<p><strong>Randomiza\u00e7\u00e3o e M\u00e9todos:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Adultos maiores que 18 anos, que tiveram fibrila\u00e7\u00e3o atrial sintom\u00e1tica registrado em ECG at\u00e9 24 meses antes da randomiza\u00e7\u00e3o, sem tratamento pr\u00e9vio.\u00a0 <\/li><li>\u00a0303 pacientes, randomizados 1:1 para: <strong>A) Abla\u00e7\u00e3o por cateter com Bal\u00e3o de Crioterapia; B) Drogas antiarr\u00edtmicas para controle do Ritmo<\/strong>.<\/li><li>Realizado um seguimento de 12 meses dos grupos. <\/li><li><strong>End Point Prim\u00e1rio: <\/strong>Recorr\u00eancia de Taquiarritmia Atrial de pelo menos 30 segundos entre 91 a 365 dias.<\/li><li><strong>End Point Secund\u00e1rio: <\/strong>Recorr\u00eancia de Taquiarritmia Atrial Sintom\u00e1tica de pelo menos 30 segundos entre 91 a 365 Dias, carga de Fibrila\u00e7\u00e3o Atrial, Qualidade de Vida e Efeitos Adversos Graves.<\/li><li>\u00a0Colocado Monitor de Eventos implant\u00e1vel  (REVEAL) nos grupos  para monitoriza\u00e7\u00e3o da fibrila\u00e7\u00e3o atrial.  <\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND-1024x1024.jpg\" alt=\"\" class=\"wp-image-284\" srcset=\"https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND-1024x1024.jpg 1024w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND-150x150.jpg 150w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND-300x300.jpg 300w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND-768x768.jpg 768w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2021\/02\/ARTIGO-FA-NEW-ENGLAND.jpg 1080w\" sizes=\"(max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Resultados:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Recorr\u00eancia de taquiarritmia atrial<\/strong> foi de 42,9% no grupo da Abla\u00e7\u00e3o e 67,8% no grupo dos Antiarr\u00edtmicos (hazard ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66; P&lt;0,001);<\/li><li><strong>Taquiarritmia atrial Sintom\u00e1tica<\/strong> teve recorr\u00eancia em 11% no grupo Abla\u00e7\u00e3o e 26,2% no grupo Antiarr\u00edtmico (hazard ratio, 0.39; 95% CI, 0.22 to 0.68);<\/li><li> <strong>Eventos adversos s\u00e9rios<\/strong> ocorreram em 5 pacientes (3,2%) no grupo abla\u00e7\u00e3o e 6 pacientes (4%) no grupo que receberam antiarr\u00edtmicos.<\/li><\/ul>\n\n\n\n<p><strong>Conclus\u00e3o:<\/strong><\/p>\n\n\n\n<p>Entre os pacientes que receberam tratamento inicial na fibrila\u00e7\u00e3o atrial parox\u00edstica sintom\u00e1tica\u00a0 <strong>existiu uma significante menor taxa de recorr\u00eancia<\/strong> no grupo que foi submetido a abla\u00e7\u00e3o por cateter de crioterapia quando comparado a estrat\u00e9gia de drogas antiarr\u00edtmicas.<\/p>\n\n\n\n<p><strong>Refer\u00eancia: <\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2029980\">Andrade JG, Wells GA, Deyell MW, Bennett M et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation \u2013 EARLY &#8211; AF. N Engl J Med. 2021;384;4.<\/a><\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"576\" src=\"https:\/\/arritmed.com.br\/wp-content\/uploads\/2019\/08\/curriculo-para-site-1024x576.jpg\" alt=\"\" class=\"wp-image-85\" srcset=\"https:\/\/arritmed.com.br\/wp-content\/uploads\/2019\/08\/curriculo-para-site-1024x576.jpg 1024w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2019\/08\/curriculo-para-site-300x169.jpg 300w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2019\/08\/curriculo-para-site-768x432.jpg 768w, https:\/\/arritmed.com.br\/wp-content\/uploads\/2019\/08\/curriculo-para-site.jpg 1280w\" sizes=\"(max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>No dia 28 de janeiro de 2021 foi publicado no The New England Journal of Medicine o estudo &#8220;Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation \u2013 EARLY AF&#8221;. O Arritmed fez um resumo desse artigo.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[76,75,74,9],"class_list":["post-286","post","type-post","status-publish","format-standard","hentry","category-sem-categoria","tag-controle-do-ritmo","tag-crioablacao","tag-early-af","tag-fibrilacao-atrial"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>EARLY - AF : Crioabla\u00e7\u00e3o ou Terapia Medicamentosa para Tratamento Inicial da Fibrila\u00e7\u00e3o Atrial? -<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arritmed.com.br\/?p=286\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"EARLY - AF : Crioabla\u00e7\u00e3o ou Terapia Medicamentosa para Tratamento Inicial da Fibrila\u00e7\u00e3o Atrial? -\" \/>\n<meta property=\"og:description\" content=\"No dia 28 de janeiro de 2021 foi publicado no The New England Journal of Medicine o estudo &#8220;Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation \u2013 EARLY AF&#8221;. 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