Prior failure of 0, 1, or ≥2 antiarrhythmic drugs did not significantly affect 12-month atrial fibrillation recurrence after catheter ablation (41.7%, 31.3%, and 40%, respectively; P=0.658).
Cohort (n=103)
No
Does the number of previously failed antiarrhythmic drugs affect the success rate of catheter ablation in patients with paroxysmal or persistent atrial fibrillation?
The number of previously failed antiarrhythmic drugs does not appear to significantly impact the 1-year success rate of initial catheter ablation for atrial fibrillation.
p-value: p=0.658
WHAT IS KNOWN AND OBJECTIVE: Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs to be trialed prior to considering ablation. The objective of this study was to evaluate the effect of CA success based on the number of AADs failed in patients with paroxysmal or persistent AF. METHODS: This retrospective cohort study evaluated patients with paroxysmal or persistent AF who underwent an initial CA at a community hospital. Patients with unknown AAD histories, those who did not achieve acute procedural success, or who were lost to follow-up or death unrelated to thromboembolic stroke within 6 months post-ablation were excluded. Catheter ablation success was defined as freedom from AF. The primary outcome was the incidence of AF or atrial flutter captured on an electrocardiogram or other recording device at 3, 6, 9 and 12 months after the procedure. RESULTS AND DISCUSSION: Overall, 99 out of 103 patients completed 1 year of follow-up. Of those patients, 34 of 99 (34.3%) experienced AF recurrence within 1-year post-ablation. There was no significant difference among the categories of number of failed AADs and the recurrence of AF within 12 months post-ablation for zero AADs, 1 AADs and ≥2 AADs (41.7%, 31.3% and 40%, respectively; P = 0.658). WHAT IS NEW AND CONCLUSION: The results of this study do not support preferentially performing CA on patients who have failed a certain number of AADs. Results are limited by the nature of the study design and a small sample size. Conclusive results would best be addressed by a prospective randomized trial.
Wang et al. (Mon,) conducted a cohort in paroxysmal or persistent atrial fibrillation (n=103). Prior antiarrhythmic drug (AAD) failure vs. 0, 1, or ≥2 failed AADs was evaluated on incidence of AF or atrial flutter captured on an electrocardiogram or other recording device at 3, 6, 9 and 12 months after the procedure (p=0.658). Prior failure of 0, 1, or ≥2 antiarrhythmic drugs did not significantly affect 12-month atrial fibrillation recurrence after catheter ablation (41.7%, 31.3%, and 40%, respectively; P=0.658).