Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation—A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials

Abstract

BackgroundThe efficacy of short-term antiarrhythmic drugs (AADs) use compared with no-AADs prescription after catheter ablation of atrial fibrillation (AF) in preventing atrial arrhythmia recurrence is uncertain.MethodsWe searched PubMed, Embase, and the Cochrane Library through December 2015 to identify randomized controlled trials (RCTs) which evaluated the efficacy of short-term AADs use compared with no-AADs prescription after AF ablation in preventing atrial arrhythmia recurrence. The primary outcome was labeled as early atrial arrhythmia recurrence within 3 months after ablation. Secondary outcome was defined as late recurrence after 3 months of ablation. Random-effects model or fixed-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).ResultsSix RCTs with 2,667 patients were included into this meta-analysis. Compared with no-AADs administration after AF ablation, short-term AADs use was associated with significant reduction of early atrial arrhythmia recurrence (RR, 0.68; 95% CI, 0.52–0.87; p = 0.003). Trial sequential analysis (TSA) showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. However, compared with no-AADs prescription, short-term AADs use after AF ablation didn’t significantly reduce the risk of late atrial arrhythmia recurrence (RR, 0.92; 95% CI, 0.83–1.03; p = 0.15). TSA supported this result; meanwhile the estimated required information size (1,486 patients) was also met.ConclusionShort-term use of AADs after AF ablation can significantly decrease the risk of early atrial arrhythmia recurrence but not lead to corresponding reduction in risk of late atrial arrhythmia recurrence.

Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

“…However, meta-analyses have shown that long-term ablation success remains unaffected by early AAD use[36-38]. This would suggest that AADs might mask the early indicators of failed ablation, which may be allowed to manifest only once AADs are withdrawn.…”

Percutaneous coronary intervention versus cardiac bypass surgery for left main coronary artery disease

“…The following conclusion can be reached with TSA: if the cumulative z -curve crosses the trial sequential monitoring boundary or enters the futility area, a sufficient level of evidence for the anticipated intervention effect may have been obtained and no further trials are needed; if the z -curve does not cross any of the boundaries and the required information size has not been reached, the evidence is insufficient and more trials should be included to clarify this issue; and if the cumulative z -curve exceeds the estimated information size but does not cross the traditional monitoring boundary, the negative conclusion is sufficient and no further trial is required. [ 25 , 26 ]…”

Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation

“…Two recent meta-analyses concluded that anti-arrhythmic drug use after catheter ablation for atrial fibrillation reduced early arrhythmia recurrence but did not prevent late recurrence of atrial arrhythmias. 117,118 A randomized trial of anti-arrhythmic drug treatment after surgical ablation demonstrated reduced early recurrence of atrial arrhythmias in the treatment arm. 119 Any correlation between post-ablation recurrence, drug therapy and biomarkers is not well elucidated.…”