362Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation: the protective role of antiarrhythmic drug therapy

Aim. This prospective randomized study was aimed to assess the progression of atrial fibrillation (AF) after ablation procedure and antiarrhythmic drug therapy (AAD) in patients with paroxysmal AF by means of implantable cardiac monitors (ICM). Methods. The study enrolled 92 patients with paroxysmal AF, who were eligible either for catheter ablation or AAD. The patients were randomized into two groups: 1) AAD + ICM implantation (group I; n=46), and 2) AF catheter ablation (CA) + ICM implantation (group II; n=46), and 2). The primary endpoint was AF progression according to ICM data. The AF progression was defined as AF burden > 30%. A complication rate after ablation procedure and side effects of AAD were determined as the secondary endpoints. The follow up of this study was 24 months. Results. By the end of the follow-up period, AF progression was observed in 27 (58.7%) patients in the AAD group and 10 (21.7%) patients in the CA group (р=0.0003; HR 0.37, 95% CI [0.17-0.76], р=0.007, Cox regression). 13 (28,3%) patients in the AAD group and 2 (4.3%) in the CA group (р=0.002) developed persistent AF. The complication rate in the AAD group was 24% (11 patients) and 6.5 % (3 patients) in the CA group (р=0.02). Conclusion. Radiofrequency ablation of AF leads to a significant decrease in AF progression when compared with antiarrhythmic drug therapy in patients with paroxysmal AF, which was confirmed by implantable cardiac monitors data.Received 12 July 2016. Accepted 22 August 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

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Faculty Opinions recommendation of Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735328400.793558856 ◽

2019 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Atrial Fibrillation ◽

Clinical Trial ◽

Cardiac Arrest ◽

Drug Therapy ◽

Catheter Ablation ◽

Randomized Clinical Trial ◽

Antiarrhythmic Drug ◽

Antiarrhythmic Drug Therapy

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Faculty Opinions recommendation of Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735328400.793558685 ◽

2019 ◽

Author(s):

Barry Borlaug

Keyword(s):

Atrial Fibrillation ◽

Clinical Trial ◽

Cardiac Arrest ◽

Drug Therapy ◽

Catheter Ablation ◽

Randomized Clinical Trial ◽

Antiarrhythmic Drug ◽

Antiarrhythmic Drug Therapy

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Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation has no impact on recurrences, cardiovascular events and mortality – insights from the German Ablation Registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.0357 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Schleberger ◽

A Metzner ◽

K H Kuck ◽

D Andresen ◽

S Willems ◽

...

Keyword(s):

Atrial Fibrillation ◽

Drug Therapy ◽

Catheter Ablation ◽

Antiarrhythmic Drug ◽

Treatment Satisfaction ◽

Cardiovascular Events ◽

Patient Reported Outcome ◽

Antiarrhythmic Drug Therapy ◽

Funding Sources ◽

Patient Reported

Abstract Background Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after atrial fibrillation (AF) catheter ablation are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients' treatment burden. Methods Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after AF catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcome. Results In patients with paroxysmal AF (n=2138) recurrence and rehospitalization rates did not differ when discharged with (n=1051) or without (n=1087) AAD (recurrence: adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95–1.35]; rehospitalization: OR 1.08, 95% CI [0.90–1.30]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05–1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20–2.58]). Similar rates of recurrences, rehospitalisations, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95–1.56]; rehospitalization: OR 1.16, 95% CI [0.90–1.50]; reablation: OR 1.21, 95% CI [0.91–1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74–2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in paroxysmal and persistent AF patients discharged with or without AAD. Conclusion The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. FUNDunding Acknowledgement Type of funding sources: None.

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