A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

Abstract

Circumferential pulmonary vein ablation is more successful than ADT for prevention of PAF with few complications. Atrial fibrillation ablation warrants consideration in selected patients in whom ADT had already failed and maintenance of sinus rhythm is desired. (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show; NCT00340314).

Rhythm Control for Management of Patients With Atrial Fibrillation: Balancing the Use of Antiarrhythmic Drugs and Catheter Ablation

“…Ablation was associated with fewer cardiovascular deaths, episodes of heart failure, and ischemic cerebrovascular events, and with improvement in quality of life. Similar findings were noted in 4 randomized trials comparing ablation with AAD therapy in patients with newly diagnosed AF, 29 paroxysmal AF, 29,34 and persistent AF, 36 although each had notable limitations. An international survey of catheter ablation for AF at 181 electrophysiology laboratories reported a major complication rate of 6%.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…Many have compared AF ablation with AAD therapy in both “first-line” (AAD-naïve patients) and “second-line” (following the failure of 1 or more drugs) settings. 261,377,378,379,462,529,684,733,1025,1026,1027,1028,1029,1030 In some cases, these trials have supported regulatory approval of specific ablation technologies. 462,503,655,673,684,733 Some trials have compared AF ablation with other standard pharmacological or nonpharmacological approaches to rate control.…”

“…In addition to the trials for FDA approval listed in Table 7, four of these trials exclusively enrolled patients with paroxysmal (or “early persistent”) AF, three trials enrolled only patients with persistent AF, and three trials enrolled patients with either AF pattern. 261,462,684,733,1025,1026,1027,1028,1029,1030 Additional randomized trials in patients with HF and persistent AF have been completed, comparing ablation with rate control, amiodarone, or AV junction ablation with biventricular pacing. 235,236,237,390,529 The HF trials will be reviewed in a later section of this document.…”

The National Heart Foundation of Australia Consensus Statement on Catheter Ablation as a Therapy for Atrial Fibrillation

“…[15][16][17][18] These studies consistently show a highly significant increase in freedom from AF in the ablation arm, with success rates of 70%-80%. Most of these studies included follow-up of around 12 months and were conducted in a younger group of patients with paroxysmal AF and without advanced structural heart disease.…”