Cardiology News / Recent Literature Review / First Quarter 2021
Cardiology Literature Review
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EARLY-AF: Cryoballoon Ablation Lowers Rate of Atrial Fibrillation (AF) Recurrence Among Patients Receiving Initial Treatment for Symptomatic, Paroxysmal AF, Compared With Antiarrhythmic Drug (AAD) Therapy, as Assessed by Continuous Cardiac Rhythm Monitoring
Among 303 patients with symptomatic, paroxysmal, untreated AF randomized to catheter ablation with a cryothermy balloon or antiarrhythmic drug (AAD) therapy for initial rhythm control, at 1 year, 66 of 154 patients (42.9%) assigned to ablation had AF recurrence vs 101 of 149 patients (67.8%) assigned to AAD (hazard ratio-HR, 0.48; P<0.001). Symptomatic AF recurred in 11% vs 26.2% (HR, 0.39). The median percentage of time in AF was 0% with ablation and 0.13% with AAD. Serious adverse events occurred in 5 (3.2%) vs 6 patients (4%) (Andrade JG et al, N Engl J Med 2021; 384:305-315).
STOP AF First: Cryoballoon Ablation as Initial Therapy was Superior to Drug Therapy for Prevention of Recurrence in Patients With Paroxysmal Atrial Fibrillation (AF) with Uncommon Serious Procedure-Related Adverse Events
According to a multicenter trial which randomized 203 patients 18-80 years of age with paroxysmal AF to antiarrhythmic drugs (class I or III agents) (n=99) or pulmonary vein isolation with a cryoballoon (n=104), with initial success of the ablation procedure achieved in 97%, the Kaplan–Meier estimate of treatment success at 1 year was 74.6% in the ablation group and 45% in the drug-therapy group (P<0.001 by log-rank test). Two primary safety end-point events occurred in the ablation group (Kaplan–Meier estimate of the percentage of patients with an event within 12 months, 1.9%) (Wazni OM et al, N Engl J Med 2021; 384:316-324).
GALACTIC-HF: Among Patients with Heart Failure and a Reduced Ejection, Those on Omecamtic Mecarbil Had a Lower Incidence of a Composite of a HF Event or Death from Cardiovascular Causes on Placebo
Among 8256 patients (in- and out-patients) with symptomatic chronic HF and an ejection fraction of <35% assigned to omecamtiv mecarbil (25-50 mg bid) or placebo, in addition to standard HF therapy, over a median of 21.8 months, a primary-outcome event (composite of a first HF event, i.e. hospitalization or urgent visit for HF, or death from CV causes) occurred in 1523 of 4120 patients (37%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio-HR, 0.92; P=0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from CV causes (HR, 1.01). There was no significant difference between groups in the change from baseline on quality-of-life score. At week 24, the change from baseline for the median N-terminal pro–B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng/L higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar (Teerlink JR et al, N Engl J Med 2021; 384:105-116)... (excerpt)
- 2021-04-15 (2)
- 2021-04-15 (1)
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