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  • Erica S. Zado
    Correspondence
    Address reprint requests and correspondence: Ms Erica S. Zado, Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Founders 9, 3400 Spruce St, Philadelphia, PA 19104.
    Affiliations
    Section of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Published:December 10, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.12.006
      Appearing online on the same day in the New England Journal of Medicine, there was not 1 but 2 randomized controlled trials of cryoballoon pulmonary vein isolation (PVI) vs antiarrhythmic medications (AADs) as first-line treatment of symptomatic paroxysmal atrial fibrillation (PAF) with similar results. In the Early Aggressive Invasive Intervention for Atrial Fibrillation trial, Andrade et al (N Engl J Med 2020; doi:10.1056/NEJMoa2029980, PMID 33197159) randomized patients with symptomatic PAF who had not previously tried class I or III AAD in a 1:1 fashion to PVI with cryoballoon or AAD. All patients received an implantable cardiac monitor (ICM) shortly after randomization. Automatic transmissions from the ICM were received daily with manual transmissions weekly, and patients were also instructed to use the symptom activator to record symptomatic episodes. Patients assigned to AAD were initiated on medication, and dose and medication could be adjusted within the first 90 days. Patients undergoing PVI could be on AAD during the 90-day blanking period only, and repeat ablation even during the blanking period was counted as reaching the primary end point. The primary end point was time to first atrial arrhythmia lasting 30 seconds after the 90-day blanking period. Secondary end points include occurrence of symptomatic arrhythmias, serious adverse events, quality of life assessments, and AF burden on ICM.
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