Cryoablation used first line for paroxysmal atrial fibrillation (AF) is associated with reduced recurrence compared with pharmacotherapy, according to two North American trials.

Although ablation is recommended in international guidelines for treatment after antiarrhythmic drugs fail, its usefulness first line has been uncertain, according to the authors of both studies, which were published simultaneously in the New England Journal of Medicine.

In the EARLY-AF trial conducted at 18 centres in Canada, 303 patients who had not received regular antiarrhythmic medications were randomised to either pulmonary vein isolation by cryoablation or to antiarrhythmic drugs prescribed according to local practice.

A strength of the trial was that all patients (mean age 59, 71% male) were implanted with a cardiac monitor which enabled detection of any recurrence of AF and measurement of the AF burden, the authors said.