Early reablation guided by an implantable cardiac monitor significantly increased the maintenance of sinus rhythm at 12 months compared to antiarrhythmic drugs alone (80% vs 33%; P<0.0001).
RCT (n=286)
Does early reablation guided by implantable monitor triggers improve the maintenance of sinus rhythm in patients with early AF recurrences after a first ablation?
Early repeat ablation guided by implantable monitor detection of specific triggers significantly improves the maintenance of sinus rhythm in patients with early AF recurrences after an initial ablation.
Absolute Event Rate: 80% vs 33%
p-value: p=<0.0001
BACKGROUND: Catheter ablation of atrial fibrillation (AF) has proved effective in curing highly symptomatic patients with paroxysmal AF. The aim of this prospective, randomized study was to identify the optimal treatment of patients with AF recurrences after the first ablation. METHODS AND RESULTS: Two hundred eighty-six patients with paroxysmal AF underwent ablation (circumferential pulmonary vein isolation with linear lesions) and were monitored with an implantable cardiac monitor (Reveal XT, Medtronic). Patients without AF recurrences during the 3-month postablation period were assigned to group 1; those with AF recurrences to group 2. Patients in group 2 were randomly assigned to group 3 or group 4. Group 3 patients were treated only with antiarrhythmic drugs for 6 weeks, with no early reablation during the 3-month postablation period. In the case of AF recurrence after the 3-month postablation period, patients underwent reablation. Group 4 patients were treated according to the onset mechanism of AF recurrences, as detected and stored by the implantable cardiac monitor: antiarrhythmic drug therapy, but no reablation if AF was not preceded by triggers; early reablation if premature atrial beats or atrial tachycardias or flutter triggered AF. All patients were followed up for 1 year to assess maintenance of sinus rhythm in each group. On 12-month follow-up examination, of the 119 (42%) patients in group 1, 112 (94%) had no AF recurrences. Among the 83 patients in group 3, only 27 (33%) had no recurrences. Of the 84 group 4 patients, 67 (80%) had no AF recurrences (P<0.0001 versus group 3). CONCLUSIONS: Patients with recurrences after the first AF ablation are likely to respond to a second early ablation when AF is triggered by supraventricular arrhythmias or premature contractions. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01164319.
Pokushalov et al. (2011) conducted an RCT in paroxysmal atrial fibrillation (n=286). Early reablation guided by implantable cardiac monitor vs. Antiarrhythmic drugs with no early reablation was evaluated on Maintenance of sinus rhythm (no AF recurrences) at 12 months (p=<0.0001). Early reablation guided by an implantable cardiac monitor significantly increased the maintenance of sinus rhythm at 12 months compared to antiarrhythmic drugs alone (80% vs 33%; P<0.0001).