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@article{Kanagaratnam:2023:europace/euac253,
author = {Kanagaratnam, P and McCready, J and Tayebjee, M and Shepherd, E and Sasikaran, T and Todd, D and Johnson, N and Kyriacou, A and Hayat, S and Hobson, NA and Mann, I and Balasubramaniam, R and Whinnett, Z and Earley, M and Petkar, S and Veasey, R and Kirubakaran, S and Coyle, C and Kim, M-Y and Lim, PB and O'Neill, J and Davies, DW and Peters, NS and Babalis, D and Linton, N and Falaschetti, E and Tanner, M and Shah, J and Poulter, N},
doi = {europace/euac253},
journal = {EP Europace},
pages = {863--872},
title = {Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial},
url = {http://dx.doi.org/10.1093/europace/euac253},
volume = {25},
year = {2023}
}

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TY  - JOUR
AB  - Aims:There is rising healthcare utilization related to the increasing incidence and prevalence of atrial fibrillation (AF) worldwide. Simplifying therapy and reducing hospital episodes would be a valuable development. The efficacy of a streamlined AF ablation approach was compared to drug therapy and a conventional catheter ablation technique for symptom control in paroxysmal AF.Methods and results:We recruited 321 patients with symptomatic paroxysmal AF to a prospective randomized, multi-centre, open label trial at 13 UK hospitals. Patients were randomized 1:1:1 to cryo-balloon ablation without electrical mapping with patients discharged same day [Ablation Versus Anti-arrhythmic Therapy for Reducing All Hospital Episodes from Recurrent (AVATAR) protocol]; optimization of drug therapy; or cryo-balloon ablation with confirmation of pulmonary vein isolation and overnight hospitalization. The primary endpoint was time to any hospital episode related to treatment for atrial arrhythmia. Secondary endpoints included complications of treatment and quality-of-life measures. The hazard ratio (HR) for a primary endpoint event occurring when comparing AVATAR protocol arm to drug therapy was 0.156 (95% CI, 0.097–0.250; P < 0.0001 by Cox regression). Twenty-three patients (21%) recorded an endpoint event in the AVATAR arm compared to 76 patients (74%) within the drug therapy arm. Comparing AVATAR and conventional ablation arms resulted in a non-significant HR of 1.173 (95% CI, 0.639–2.154; P = 0.61 by Cox regression) with 23 patients (21%) and 19 patients (18%), respectively, recording primary endpoint events (P = 0.61 by log-rank test).Conclusion:The AVATAR protocol was superior to drug therapy for avoiding hospital episodes related to AF treatment, but conventional cryoablation was not superior to the AVATAR protocol. This could have wide-ranging implications on how demand for AF symptom control is met.Trial registrationClinical Trials Registration: NCT02459574.
AU  - Kanagaratnam,P
AU  - McCready,J
AU  - Tayebjee,M
AU  - Shepherd,E
AU  - Sasikaran,T
AU  - Todd,D
AU  - Johnson,N
AU  - Kyriacou,A
AU  - Hayat,S
AU  - Hobson,NA
AU  - Mann,I
AU  - Balasubramaniam,R
AU  - Whinnett,Z
AU  - Earley,M
AU  - Petkar,S
AU  - Veasey,R
AU  - Kirubakaran,S
AU  - Coyle,C
AU  - Kim,M-Y
AU  - Lim,PB
AU  - O'Neill,J
AU  - Davies,DW
AU  - Peters,NS
AU  - Babalis,D
AU  - Linton,N
AU  - Falaschetti,E
AU  - Tanner,M
AU  - Shah,J
AU  - Poulter,N
DO  - europace/euac253
EP  - 872
PY  - 2023///
SN  - 1099-5129
SP  - 863
TI  - Ablation versus anti-arrhythmic therapy for reducing all hospital episodes from recurrent atrial fibrillation: a prospective, randomized, multi-centre, open label trial
T2  - EP Europace
UR  - http://dx.doi.org/10.1093/europace/euac253
UR  - https://academic.oup.com/europace/article/25/3/863/6964492
UR  - http://hdl.handle.net/10044/1/102118
VL  - 25
ER  -

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