Catheter ablation vs. antiarrhythmic drugs as ‘first-line’ initial therapy for atrial fibrillation: a pooled analysis of randomized data

“…Catheter ablation is an effective treatment option for patients with symptomatic atrial fibrillation (AF) (1)(2)(3)(4)(5). Electrical reconnection between the pulmonary veins and left atrium has been recognized as an important factor responsible for AF recurrence after ablation (6,7).…”

Section: Introductionmentioning

confidence: 99%

Tailored Target Ablation Index Guided Pulmonary Vein Isolation in Treating Paroxysmal Atrial Fibrillation: A Single Center Randomized Study in Asian Population (AI-Asian-I)

Xiong

Liao

Chen

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo evaluate the efficacy and safety of lower ablation indexes (AI) guided pulmonary vein isolation (PVI) in treating paroxysmal atrial fibrillation (AF).MethodsNinety patients with paroxysmal AF scheduled for radiofrequency ablation were randomly divided into three groups. The AI targets for PVI were as follows: In group A/B/C, 550/500/450 for roof and anterior wall, and 400/350/300 for posterior/inferior wall. The first-pass PVI rate, ablation time, complications and recurrence of atrial tachyarrhythmia (ATa) were compared.ResultsThe mean age was 62.5 years (male: 63.0%), mean body mass index (BMI): 24.35 ± 3.66 kg/m2. The baseline characteristics were comparable. There was no significant difference in the first-pass PVI rate among the three groups (left-sided-PV: 66.7% vs. 80% vs. 73.3%, P = 0.51; right-sided-PV: 70% vs. 83.3% vs. 73.3%, P = 0.64), also with similar gap rate during the procedural waiting time. At 1-year follow-up there was no significant difference in the recurrence rate of ATa among the three groups (10% vs. 13.3% vs. 13.3%, P = 1.00). The ablation time in the Group C was significantly less than that in the other two groups (47.8 min. vs. 47.0 min. vs. 36.6 min, P < 0.001). Higher AI seemed to link a non-significant trend toward higher rate of pericardial effusion (group A + B vs. group C:6.7% vs. 0%, P = 0.30), although the rate of overall complications was not different among the three groups.ConclusionThis randomized study shows that, a relatively lower target AI guided ablation may be similarly effective to achieve PVI with significantly reduced ablation time and obtain similar clinical outcome in treating paroxysmal AF in Asian population.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT:04549714].

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“…Catheter ablation (CA) is a valid therapeutic option for AF treatment, historically and currently recommended for patients who have failed or are intolerant of antiarrhythmic drugs (AAD) 1,3 …”

Section: Introductionmentioning

confidence: 99%

Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity score-based analysis with a younger cohort

Cecchini

Mugnai

Kazawa

et al. 2023

Journal of Cardiovascular Medicine

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Background In terms of safety and efficacy, cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation. However, CB-A data in octogenarians are still scarce and limited to single-centre experiences. The present multicentre study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years with a cohort of younger patients. Methods and results We retrospectively enrolled 97 consecutive patients aged ≥80 years who underwent PVI using the second-generation CB-A. This group was compared with a younger cohort of patients using a 1:1 propensity score matching. After the matching, 70 patients from the elderly group were analysed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow-up of 23 [18–32.5] months was 60.0% in the elderly group and 71.4% in the control group (P = 0.17). Phrenic nerve palsy was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients in the elderly group and in 5 patients (7.1%) in the younger group (P = 0.51). Only two (1.4%) major complications occurred: one (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage, and one (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period and the need for electrical cardioversion to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses. Conclusions The present study showed that CB-A PVI is as feasible, safe and effective among appropriately selected octogenarians as it is in younger patients.

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Catheter ablation vs. antiarrhythmic drugs as ‘first-line’ initial therapy for atrial fibrillation: a pooled analysis of randomized data

Cited by 23 publications

References 37 publications

Pulsed field ablation-based pulmonary vein isolation in atrial fibrillation patients with cardiac implantable electronic devices: practical approach and device interrogation (PFA in CIEDs)

Pulsed field ablation-based pulmonary vein isolation in atrial fibrillation patients with cardiac implantable electronic devices: practical approach and device interrogation (PFA in CIEDs)

Tailored Target Ablation Index Guided Pulmonary Vein Isolation in Treating Paroxysmal Atrial Fibrillation: A Single Center Randomized Study in Asian Population (AI-Asian-I)

Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity score-based analysis with a younger cohort

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