Short-term use of antiarrhythmic drugs for 90 days post-AF ablation did not significantly improve 1-year event-free rates compared with control (69.5% vs 67.8%; HR 0.93; 95% CI 0.79-1.09; P=0.38).
RCT (n=2,038)
Does 90-day use of Vaughan Williams class I or III antiarrhythmic drugs reduce recurrent atrial tachyarrhythmias at 1 year in patients who have undergone radiofrequency catheter ablation for atrial fibrillation?
Short-term (90-day) use of antiarrhythmic drugs after AF ablation reduces early recurrences but does not improve 1-year freedom from atrial tachyarrhythmias.
Effect estimate: adjusted HR 0.93 (95% CI 0.79-1.09)
Absolute Event Rate: 69.5% vs 67.8%
p-value: p=0.38
AIMS: Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. METHODS AND RESULTS: A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days 59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73-0.96; P = 0.01. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79-1.09; P = 0.38). CONCLUSION: Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase.
Kaitani et al. (2015) conducted an RCT in Atrial fibrillation (n=2,038). Vaughan Williams class I or III antiarrhythmic drug vs. Control was evaluated on Recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation (adjusted HR 0.93, 95% CI 0.79-1.09, p=0.38). Short-term use of antiarrhythmic drugs for 90 days post-AF ablation did not significantly improve 1-year event-free rates compared with control (69.5% vs 67.8%; HR 0.93; 95% CI 0.79-1.09; P=0.38).