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  • N.A. Mark Estes III
    Correspondence
    Address reprint requests and correspondence: Dr N.A. Mark Estes III, UPMC Heart and Vascular Institute, Presbyterian Hospital, 200 Lothrop St, 3rd Floor South Tower (WE352.1) Pittsburgh, PA 15213.
    Affiliations
    UPMC Heart and Vascular Institute, Presbyterian Hospital, Pittsburgh, Pennsylvania
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Published:December 04, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.12.001
      Wasni et al (N Engl J Med November 16, 2020; https://doi.org/10.1056/NEJMoa2029554, PMID 33197158) investigated therapy for paroxysmal atrial fibrillation in a randomized trial of initial treatment with antiarrhythmic drugs (class I or III agents) or pulmonary vein isolation with a cryoballoon. The primary efficacy end point was treatment success, which was defined as freedom from initial failure of the procedure or atrial arrhythmia recurrence after a 90-day blanking period. Of the 203 participants who underwent randomization and received treatment, 104 underwent ablation and 99 initially received drug therapy. In the ablation group, initial success of the procedure was achieved in 97% of patients. The Kaplan-Meier estimate of the percentage of patients with treatment success at 12 months was 74.6% in the ablation group and 45.0% in the drug therapy group (P < .001). The authors conclude that cryoballoon ablation as initial therapy was superior to drug therapy for the prevention of atrial arrhythmia recurrence in patients with paroxysmal atrial fibrillation.
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