Cold to treat the most common form of arrhythmia

 (Image: Pixabay CC0) (Image: Pixabay CC0)

Cryoblation results may lead to revised treatment of atrial fibrillation. A study just published in the New England Journal of Medicine demonstrates the long-term effectiveness of a procedure used to treat the most common form of abnormal heart rhythm, atrial fibrillation.

This evidence and the conclusions of previous studies, which demonstrated the safety and medium-term effectiveness of this procedure, could lead to a revision of the recommendations concerning the treatment of atrial fibrillation, and thus allow a greater number of people to benefit from its advantages. This is the belief of one of the authors of the study, Jean Champagne , professor at the Faculty of Medicine and researcher at the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ).

Atrial fibrillation is caused by a disruption of the electrical signals that control the contractions of the heart. The condition, which affects about 200,000 people in Canada, begins with isolated, transient episodes of arrhythmia. "If nothing is done, the disorder evolves into a persistent and then a permanent form of the disease, which increases the risk of heart failure and stroke," says Professor Champagne, who is also an electrophysiologist at the IUCPQ.

Currently, medical authorities recommend the use of medication as the first treatment for atrial fibrillation. This solution is far from suitable for everyone: the problem reappears in 50% of patients within a year of starting medication.

For this reason, a new avenue of treatment has been explored since the late 1990s. It consists of inserting a catheter into a blood vessel in the groin and guiding it to the entrance of the atria to destroy the heart tissue causing the irregular heartbeat. The procedure can be performed using heat or cold. The latter is called cryoblation.

Professor Champagne and other members of the team led by Professor Jason Andrade of the University of British Columbia followed a group of 303 people with atrial fibrillation for 3 years. These people had been treated with either medication or cryoblation. "We put a subcutaneous heart monitor on each participant, which allowed us to detect all arrhythmia episodes during this period," says Jean Champagne.

At follow-up, the researchers found that those treated with cryoblation were 51% less likely to have a recurrence of atrial arrhythmia and 75% less likely to have the disease progress to the persistent form. In addition, individuals in the cryoblation group had less use of health care system resources. The frequency of hospitalizations, emergency room visits, and cardioversions (a procedure that uses an electrical shock to restore normal heart rhythm) were 69%, 16%, and 32% lower in the cryoblation group than in the medication group, respectively.

"It completely changes the progression of the disease and it restores quality of life for patients. "

-- Jean Champagne on the benefits of cryoblation for people with atrial fibrillation "Cryoblation has several benefits for the patient and for the health care system," says Professor Champagne. The earlier it is done, the better the results. It completely changes the progression of the disease and gives patients back their quality of life. Having to start with medication delays the time when this treatment can be offered, which limits its potential impact. The scientific evidence accumulated over the past few years should lead to a revision of treatment recommendations for atrial fibrillation."