Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial

Raatikainen, M.J. Pekka; Hakalahti, Antti; Uusimaa, Paavo; Nielsen, Jens Cosedis; Johannessen, Arne; Hindricks, Gerhard; Walfridsson, Håkan; Pehrson, Steen; Englund, Anders; Hartikainen, Juha; Kongstad, Ole; Mortensen, Leif Spange; Hansen, Peter S.

doi:10.1016/j.ijcard.2015.06.160

Cited by 30 publications

(19 citation statements)

References 29 publications

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“…Patients with paroxysmal AF included in previous studies that validated CA were pseudo characterized as without structural LA alterations using conventional echocardiographic measurements such as LA diameter or LA volume . These orthodox analyses were carried out with the purpose of excluding LA myocardial alterations which could generate recurrence of AF after CA .…”

Section: Discussionmentioning

confidence: 99%

“…The success rate of catheter ablation (CA) in patients with persistent and paroxysmal atrial fibrillation (AF) is variable, with rates that range from 22% to 88% and from 60% to 90%, respectively . These differences in the success rates of CA show an heterogeneity in the factors implicated in AF recurrence.…”

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confidence: 99%

“…These differences in the success rates of CA show an heterogeneity in the factors implicated in AF recurrence. In this regard, while in controlled clinical trials pulmonary vein isolation (PVI) as well as additional left atrial (LA) ablations such as LA linear ablations (LA roof line and mitral isthmus line) and ablation of regions with complex fractionated electrograms (CFE) have been considered effective therapies in patients with AF, in several observational studies as well as in large registries the success rate of these procedures was heterogeneous …”

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confidence: 99%

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Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta‐Analysis

Boldt

Zhang

et al. 2016

Echocardiography

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Background: The purpose of this meta-analysis was to analyze the clinical relevance of left atrial (LA) strain to predict recurrence of atrial fibrillation (AF) after catheter ablation (CA). Methods and Results: We searched in different databases (Medline, EMBASE, and Cochrane) prospective studies that analyzed LA strain before CA. Eight studies (2 with only paroxysmal AF and 6 with mixed population of paroxysmal and persistent AF) were included in the final analysis (total patient number = 686 [66-100%]). In line, these results were similar using LA strain with QRS-analysis and P-analysis as well as using different software package such as Echo-Pac, QLab, TomTec, and VVI. Conclusion: In patients with AF candidate for CA, the analysis of the LA using LA strain could be of great usefulness to identify patients with high risk of AF recurrence. Nonetheless, further studies are needed to establish the clinical relevance of LA strain in patients with persistent AF. (Echocardiography 2016;33:724-733)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta‐Analysis

Boldt

Zhang

et al. 2016

Echocardiography

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“…National and international consensus groups recommend cardiac catheter ablation for AF to improve quality of life where antiarrhythmic therapy has failed to control symptoms. 1,3 There is growing evidence that first-line pulmonary vein isolation may be an acceptable and effective approach compared to AAD therapy to maintain sinus rhythm 19,20 despite a reported complication rate of~2.6%. 21 In Australia, there has been a rapid growth in the number of AF ablations performed and this has been mirrored in Europe and the United States.…”

Section: Catheter Ablationmentioning

confidence: 99%

Trends in outpatient anti‐arrhythmic prescriptions for atrial fibrillation and left atrial ablation in Australia: 1997–2016

Khan

Patel

Nanayakkara

et al. 2018

Internal Medicine Journal

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A rhythm control strategy is frequently utilised for AF management in Australia. Consistent with international guidelines which advocate safety over efficacy when choosing a rhythm control strategy, the prescriptions of amiodarone have been consistently decreasing since 2002, whereas sotalol and flecainide prescriptions have largely increased, with a peak in 2015. Catheter ablation per capita has burgeoned 36-fold.

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“…31 The results indicated the non-inferiority of cryoablation technology compared with RF-based ablation with respect to efficacy and the safety of patients with drug-refractory AF. 32 In a subgroup analysis of the secondary endpoints, such as rehospitalization, a requirement for cardioversion, and repeat PVI, cryoballoon performance appeared to be a slightly better option. 33 Maan et al 34 did an extensive review of AF ablation complications, including of cryoballoon-associated complications, and reported that the most frequent complication was phrenic nerve palsy, which is specifically more likely to occur when a smaller 23 mm (rather than 28 mm) balloon is used to isolate the right superior PV.…”

Section: Data On Complications Reported In Published Studiesmentioning

confidence: 97%

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

Mathew

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Careful patient selection and optimization of the management of active medical conditions prior to proceeding with catheter ablation for atrial fibrillation (AF) is critical to reducing complications and improving ablation success. AF ablation performed on patients who have not been offered appropriate antiarrhythmic drug therapy must be tempered with the procedure risks, particularly for those patients having multiple comorbidities. The inability to comply with systemic anticoagulation for thromboembolic prophylaxis in AF is a contraindication to AF ablation, as premature termination of anticoagulation therapy can lead to catastrophic thromboembolic complications. Successful pulmonary vein isolation (PVI), the cornerstone of AF ablation, is demonstrated by entrance and exit block post ablation, with sustained absence of atrium-to-pulmonary vein conduction in both directions. Beyond PVI, there is no consensus for other endpoints for AF ablation, particularly in patients with persistent or longstanding persistent AF. Complications of PVI for AF have decreased in recent years as technology and knowledge in this field has evolved; however, the risks of cardiac tamponade, thromboembolic complications, esophageal injury, and pulmonary vein stenosis may still be formidable.

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Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial

Cited by 30 publications

References 29 publications

Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta‐Analysis

Clinical Relevance of Left Atrial Strain to Predict Recurrence of Atrial Fibrillation after Catheter Ablation: A Meta‐Analysis

Trends in outpatient anti‐arrhythmic prescriptions for atrial fibrillation and left atrial ablation in Australia: 1997–2016

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

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