Mar 8, 2021

Canadian Study Supports Earlier Intervention for Atrial Fibrillation

Made-in-Canada cryoablation can lead to improved outcomes compared to drug treatment.

Dr. Jason Andrade tells people he’s an electrician of the heart.

But rather than fixing the electrical systems of buildings, as a cardiac electrophysiologist at Vancouver General Hospital, Dr. Andrade repairs the internal circuitry of his patients.

Armed with strong supportive evidence from a new Canadian study he spearheaded, Dr. Andrade is hopeful more patients living with atrial fibrillation will benefit from an innovative made-in-Canada procedure called cryoablation that uses cold energy to bring racing hearts under control.

“I would like to see appropriate patients being referred at a point when we can ensure optimal  outcomes, rather than when they’re too late in the disease,” he said.

Atrial fibrillation is a common form of irregular heartbeat – or cardiac arrhythmia and affects approximately 200,000 Canadians[1]. The chronic condition grows progressively worse over time, dramatically limiting quality of life and raising the risk of stroke and heart failure. It also carried an annual economic impact on Canada’s healthcare system of hundreds of thousands of dollars every year.

In Canada, medication is generally used as the first line of therapy to try to help patients living with atrial fibrillation better control their heart rhythm. However, the potentially lethal condition recurs in approximately half of patients treated with medication within a year[2].

Cryoablation, a minimally invasive procedure which uses extreme cold to destroy tissue within the heart that causes irregular beats, is typically only considered after medication.

Dr. Andrade electrophysiologist
Dr. Jason Andrade, electrophysiologist

But a clinical study by Dr. Andrade and a team of researchers from across Canada showed the majority of patients experienced better outcomes and fewer episodes of erratic heart rates when cryoablation therapy is used first, instead of drugs.

The study – EARLY AF – followed more than 300 Canadian patients from 18 health centres across the country over the course of a year. Roughly half of the patients underwent cryoablation as a first line of therapy, while the others were prescribed medication. All patients received implants to monitor and record cardiac activity around the clock for the full length of the study period.

While people got better with both types of treatment, they improved even more with ablation as a first line of treatment.

Dr. Jason Andrade, Electrophysiologist, Research Lead

The research clearly demonstrates early use of cryoablation resulted in a significantly lower rate of atrial fibrillation recurrence than those prescribed medication. Patients who received cryoablation therapy early had a significantly better improvement in their quality of life, and were much more likely to be asymptomatic.

“What we saw was every single endpoint, no matter how you recorded it, improved more with cryoablation as a first treatment for atrial fibrillation,” said Dr. Andrade. “While people got better with both types of treatment, they improved even more with ablation as a first line of treatment.”

Dr. Stevenson competing in equestrian event at the Barcelona Olympics
Dr. Stevenson competing at the 1992 Olympics (Photo by Elizabeth Furth)

Dr. Rob Stevenson wasn’t part of the EARLY AF study, but he has keen insight into managing atrial fibrillation with both medication and cryoablation.

The 52-year-old New Brunswick cardiologist has lived with AF for more than 15 years.

A former athlete who competed in the 1992 Barcelona Olympics as a member of Canada’s equestrian team, Dr. Stevenson first began to experience heart arrhythmia after running the New York City Marathon in 2005.

The issue came and went intermittently until about five years ago when it began to recur more frequently and became more erratic. Medication allowed him to deal with the condition effectively until about two years ago when his irregular heart rhythms returned.

Otherwise fit and healthy, Dr. Stevenson was a strong candidate for cryoablation and underwent the procedure in November 2019. He hasn’t had any episodes of irregular heart rates since his cryoablation treatment.

“As much as I really tried to treat it as well as I could and avoid any triggers, it got to the point that AF was really controlling me rather than vice versa,” he said.

While AF is a chronic disease and there’s still a possibility that symptoms could eventually recur, Dr. Stevenson hasn’t had any episodes of irregular heart rates since his cryoablation procedure.

According to Dr. Andrade, the EARLY AF study has broad implications for how patients with atrial fibrillation can enjoy better health and improved quality of life, and also positively impacts the health care system.

While up-front costs for cryoablation are higher than medication, adopting the procedure as a first line of therapy for appropriate candidates could significantly reduce long-term healthcare costs and reduce capacity pressure on hospitals.

Dr. Andrade believes the results of the clinical studies supports reconsidering how we could manage atrial fibrillation with cryoablation.

“If we are only encountering patients who have established atrial fibrillation, it becomes more difficult to manage,” he said. “When we can get to them early, before the atrial fibrillation causes structural changes in the heart, the evidence shows we have greater success at halting atrial fibrillation.”