Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)

Abstract

Background-Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. Methods and Results-We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55Ϯ9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; Pϭ0.005). There remained fewer events in the AAD group (13% versus 28%; Pϭ0.05) when only end points of AF Ͼ24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. Conclusions-AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

Does a blanking period after pulmonary vein isolation impact long-term results? Results after 55 months of follow-up

“…This study found no association between antiarrhythmic strategy and PVI results during the early period after radiofrequency ablation, which is opposite to previously published data [11]. In the 5A study Antiarrhythmics After Ablation of Atrial Fibrillation, Roux at al.…”

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

“…1,979 Although the true efficacy of this approach is unknown, studies have suggested that transient AAD use does not prevent late arrhythmia relapses. 935,980 The 5A study randomized 110 consecutive patients with PAF undergoing ablation to empirical AAD therapy vs no AAD therapy for the first 6 weeks after RF catheter ablation.…”

Catheter Ablation of Lone Atrial Fibrillation

“…The early occurrence of atrial tachycardia (during the first 3 months) could be mediated by atrial inflammation, while subsequent maturation of ablative lesions in the first weeks after the procedure could lead to spontaneous disappearance of tachycardia in 39%-50% of patients [3,120,201]. The early occurrence of atrial arrhythmias after AF ablation could be reduced with antiarrhythmic or anti-inflammatory drugs, and in case of persistent forms, elective cardioversion should be performed [57][58][59]. Due to longer atrial cycle length, atrial tachycardia is usually followed by faster ventricular response and more severe symptoms than pre-procedural AF [194].…”