{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:01:51Z","timestamp":1791403311239,"version":"4.3.3"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004374","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004374","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Treatment guidelines for patients with atrial fibrillation (AF) suggest that patients should be managed with an antiarrhythmic drug (AAD) before undergoing catheter ablation (CA). This study evaluated whether pulmonary vein isolation employing cryoballoon CA is superior to AAD therapy for the prevention of atrial arrhythmia (AA) recurrence in rhythm control naive patients with paroxysmal AF (PAF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>A total of 218 treatment naive patients with symptomatic PAF were randomized (1\u2009:\u20091) to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD (Class I or III) and followed for 12\u2009months. The primary endpoint was \u22651 episode of recurrent AA (AF, atrial flutter, or atrial tachycardia) &amp;gt;30\u2009s after a prespecified 90-day blanking period. Secondary endpoints included the rate of serious adverse events (SAEs) and recurrence of symptomatic palpitations (evaluated via patient diaries). Freedom from AA was achieved in 82.2% of subjects in the cryoballoon arm and 67.6% of subjects in the AAD arm (HR\u2009=\u20090.48, P\u2009=\u20090.01). There were no group differences in the time-to-first (HR\u2009=\u20090.76, P\u2009=\u20090.28) or overall incidence [incidence rate ratio (IRR)=0.79, P\u2009=\u20090.28] of SAEs. The incidence rate of symptomatic palpitations was lower in the cryoballoon (7.61\u2009days\/year) compared with the AAD arm (18.96\u2009days\/year; IRR\u2009=\u20090.40, P\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cryoballoon CA was superior to AAD therapy, significantly reducing AA recurrence in treatment naive patients with PAF. Additionally, cryoballoon CA was associated with lower symptom recurrence and a similar rate of SAEs compared with AAD therapy.<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euab029","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T15:03:33Z","timestamp":1611587013000},"page":"1033-1041","source":"Crossref","is-referenced-by-count":205,"title":["Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1593-9657","authenticated-orcid":false,"given":"Malte","family":"Kuniss","sequence":"first","affiliation":[{"name":"Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, 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Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saverio","family":"Iacopino","sequence":"additional","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care&Research, Cotignola, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2130-9790","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric","family":"Anselme","sequence":"additional","affiliation":[{"name":"CHU de Rouen, Rouen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas L.","family":"Packer","sequence":"additional","affiliation":[{"name":"Mayo Clinic Hospital\u2014St. Mary\u2019s Campus, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinz-Friedrich","family":"Pitschner","sequence":"additional","affiliation":[{"name":"Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo de","family":"Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Willems","sequence":"additional","affiliation":[{"name":"University Heart Center, Hamburg, Asklepios Klinik St. Georg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Di Piazza","sequence":"additional","affiliation":[{"name":"Medtronic, Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Becker","sequence":"additional","affiliation":[{"name":"Medtronic, Meerbusch, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian-Battista","family":"Chierchia","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Cryo-FIRST Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"2021081005504465700_euab029-B1","doi-asserted-by":"crossref","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur 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