# From the Emergency Department, Directly to Ablation of Atrial Fibrillation: Rationale and Design of the EMERGE Cryo Study

## TL;DR

This study investigates whether early catheter ablation is more effective than drug therapy for treating atrial fibrillation in emergency department patients.

## Contribution

The EMERGE Cryo study introduces a novel approach to early treatment of atrial fibrillation in emergency settings by comparing ablation to standard drug therapy.

## Key findings

- The study compares cryoablation to anti-arrhythmic drug therapy in emergency department patients with recent-onset atrial fibrillation.
- Freedom from atrial tachyarrhythmia will be monitored for 9 months following a 3-month blanking period.
- The trial involves 350 patients randomized across two treatment arms.

## Abstract

Evidence is limited on an early treatment strategy for any type of recent-onset atrial fibrillation (AF), comparing anti-arrhythmic drug (AAD) therapy to catheter ablation of patients presenting to the emergency department (ED). The purpose of the EMERGE Cryo study is to investigate the impact of early catheter ablation in patients presenting to the ED with recent-onset AF.

The EMERGE Cryo study is a prospective, 2-arm, randomized, open-label, blinded endpoint, multicentre study to investigate the impact of first-line ablation vs AAD in patients presenting to the ED (within the preceding 2 weeks) with recent-onset (≤ 1 year) paroxysmal or persistent AF (longest AF episode < 6-month duration). All study participants receive an implantable loop recorder. Randomization is based on a 1:1 ratio into 2 study arms: (i) cryo-AF-ablation: pulmonary vein isolation performed with cryoballoon; and (ii) usual care: AAD therapy, including electrical cardioversion, if necessary. A total of 350 patients will be randomized.

Both arms have a blanking period or an AAD optimization period of 3 months, during which adapting the therapy will be allowed. This trial is designed to elaborate whether early AF ablation is superior to usual care. The primary effectiveness endpoint is freedom from any atrial tachyarrhythmia (> 30 seconds) through 3-12 months of follow-up on implantable loop recorder monitoring. Patients will be followed up for 36 months in total.

EMERGE Cryo aims to determine the value of early catheter ablation in AF patients presenting with any type of AF to the ED.

NCT05294445.