Rhythm Control for Management of Patients With Atrial Fibrillation: Balancing the Use of Antiarrhythmic Drugs and Catheter Ablation

Abstract

Antiarrhythmic drug (AAD) therapy may be beneficial for patients with symptoms attributable to atrial fibrillation despite adequate rate control. The limited long-term efficacy of AAD and the relatively large proportion of patients discontinuing therapy because of side effects led to the development of nonpharmacological therapies to achieve rhythm control. Pressing questions remain about the effect of ablation therapy on long-term patient outcomes. Based on recent clinical trials and meta-analyses, ablation appears more effective and possibly safer than AAD for long-term maintenance of sinus rhythm in selected patients, but the evidence is insufficient to recommend ablation in preference to drug therapy as the first AAD therapy for the majority of patients in whom a rhythm control strategy is justified. Herein, we review the most current evidence supporting the use of AAD and catheter ablation in atrial fibrillation.

Nationwide survey of catheter ablation for atrial fibrillation: The Japanese Catheter Ablation Registry of Atrial Fibrillation (J‐CARAF) – Report on antiarrhythmic drug therapy

“…It is not easy to compare the clinical benefits between AADs and catheter ablation because multiple aspects, such as symptoms, prognosis, safety, and cost effectiveness, are involved in the evaluation of their merits [2]. Practically, it is rational to consider that pharmacological and non‐pharmacological treatments work in a cooperative manner to abolish AF or reduce the incidence and duration of arrhythmic events [3,7].…”

“…Although some clinical studies have reported that AF ablation is a better choice than antiarrhythmic drug (AAD) therapy for the maintenance of sinus rhythm, AADs are often prescribed empirically to prevent AF recurrence or to alleviate the AF burden even after catheter ablation [2–5]. In this report, we focus on the use of AADs before and after AF ablation.…”

Guided Antithrombotic Therapy: Current Status and Future Research Direction

“…24, 25 However, further randomized data are needed to determine any impact of catheter ablation on subsequent stroke risk and the durability of any effect. 26 …”

Catheter ablation for atrial fibrillation: who, why and does it work?

“…This can largely be attributed to the poor efficacy and harmful side effects of antiarrhythmic drugs (AADs) 9. AAD therapy carries the risk of proarrhythmia and sudden cardiac death,10 while amiodarone can cause thyroid and liver dysfunction, pneumonitis, corneal deposits and skin pigmentation.…”