Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation

Abstract

Background-The mainstay of treatment for atrial fibrillation (AF) remains pharmacological; however, catheter ablation has increasingly been used over the last decade. The relative merits of each strategy have not been extensively studied. Methods and Results-We conducted a randomized multicenter comparison of these 2 treatment strategies in patients with paroxysmal AF resistant to at least 1 antiarrhythmic drug. The primary end point was absence of recurrent AF between months 3 and 12, absence of recurrent AF after up to 3 ablation procedures, or changes in antiarrhythmic drugs during the first 3 months. Ablation consisted of pulmonary vein isolation in all cases, whereas additional extrapulmonary vein lesions were at the discretion of the physician. Crossover was permitted at 3 months in case of failure. Echocardiographic data, symptom score, exercise capacity, quality of life, and AF burden were evaluated at 3, 6, and 12 months by the supervising committee. Of 149 eligible patients, 112 (18 women [16%]; age, 51.1Ϯ11.1 years) were enrolled and randomized to ablation (nϭ53) or "new" antiarrhythmic drugs alone or in combination (nϭ59). Crossover from the antiarrhythmic drugs and ablation groups occurred in 37 (63%) and 5 patients (9%), respectively (Pϭ0.0001). At the 1-year follow-up, 13 of 55 patients (23%) and 46 of 52 patients (89%) had no recurrence of AF in the antiarrhythmic drug and ablation groups, respectively (PϽ0.0001). Symptom score, exercise capacity, and quality of life were significantly higher in the ablation group. Conclusion-This randomized multicenter study demonstrates the superiority of catheter ablation over antiarrhythmic drugs in patients with AF with regard to maintenance of sinus rhythm and improvement in symptoms, exercise capacity, and quality of life. (Circulation. 2008;118:2498-2505.)

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

“…261,377,378,379,684 Investigating catheter ablation as second-line therapy after failed AAD treatment, catheter ablation was associated with significant improvements in SF-36 scores relative to baseline, with restoration to levels at or above population norms. 261,684 QOL scores were significantly higher for patients treated with catheter ablation than for patients treated with drug therapy, in whom there was little change from baseline scores.…”

Catheter Ablation of Lone Atrial Fibrillation

“…Catheter ablation of AF provides a possibility to maintain sinus rhythm without the use of AADs in the large proportion of selected patients with AF, and it represents a promising alternative to available pharmacological therapy for rhythm control. Table 2 presents several randomized studies which compared efficiency and safety of AADs versus catheter ablation for the treatment of patients with AF [90][91][92][93][94][95][96][97][98][99]. Clinical follow-up in these studies most often was 1 year, whilst only one study reported long term results.…”

“…propafenone, flecainide and disopyramide) or class III AAD (i.e. sotalol, amiodarone and dofetilide) [91][92][93][94][95][96][97]99]. In addition, two studies compared the results of transcatheter and pharmacological therapy as the first therapeutic option in patients with previously untreated AF [90,98].…”

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.…”