Catheter Ablation for AF: RCT Review

In this latest ‘Journal Club’ video episode, Prof Dhiraj Gupta (Liverpool, UK) meets withs Dr Jason Andrade (Vancouver, CA) to discuss the latest findings from his EARLY-AF trial that he recently presented at AHA2020.

Together, they consider the differences between EARLY AF and other recent RCTs that have looked at cryoballoon PVI as a first-line therapy option for patients with paroxysmal AF including, STOP-AF, MANTRA-PAF and CAPTAF to assess if it’s time to offer catheter ablation as a first-line therapy option for AF patients.

Questions:

1. What were the headline results of the recent EARLY AF and STOP AF trials?

2. Why are EARLY AF and STOP AF results so different from previous studies looking at ablation as first-line therapy?

3. Absence of Crossover in EARLY AF is truly unique: how did you prevent this?

4. Can these study results be extrapolated to radiofrequency (RF) PVI?

5. Did you specify a minimum operator experience level before enrolment in trial?

6. How readily can the EARLY AF outcomes be applied to the real world? Should we be concerned that a number of small-volume centres and operators may start taking up Cryo PVI now?

7. Can the results be extrapolated to offer catheter ablation as first-line treatment for persistent AF too?

8. With the decrease in Healthcare utilization shown in the ablation arms in both studies, would universal healthcare systems start covering ablation as the first-line treatment? What are the barriers and challenges?

The CIRCA-DOSE Trial


The pivotal CIRCA-DOSE study was a randomized study that examined the AF burden in detail and changed how we conceptualise study endpoints when it published in Circulation back in 2019. Dr Dhiraj Gupta (Liverpool, UK) meets with the principal investigator of the study, Dr Jason Andrade (Vancouver, CA), who presents the data behind the original CIRCA-DOSE study and discusses the results from the recent secondary analysis examining the clinical definition of AF, which has recently been published in JAMA Open. They close by discussing how this research might influence clinical practice going forwards.

Prognosis of iLBBB

In this video presentation and discussion, Prof Dhiraj Gupta (Liverpool Heart and Chest Hospital) meets with senior author, Prof Francisco Leyva (Queen Elizabeth Hospital, UK) to review the results of his retrospective, real-world study that aims to answer the common and clinically important question surrounding how to treat patients with an incidental LBBB (iLBBB), and how imaging can be used to support detection. The results showed that patients with iLBBB should be assessed using cardiac MRI as a tool.

References:
1. Zegard A, Okafor O, Bono J, et al. Prognosis of incidental left branch block. Europace 2020;22:956-963.