Key result
Antiarrhythmic drug therapy at discharge after catheter ablation for atrial fibrillation did not reduce arrhythmia recurrences (OR 1.13) but was associated with higher reablation rates in paroxysmal AF.
Why the study?
Data on the optimal treatment strategy for antiarrhythmic drug therapy after catheter ablation for AF are inconsistent.
Does antiarrhythmic drug therapy after catheter ablation improve long-term outcomes (recurrences, reablations, cardiovascular events) in patients with atrial fibrillation?
Observational (n=3,275)
Yes
Does antiarrhythmic drug therapy after catheter ablation improve long-term outcomes (recurrences, reablations, cardiovascular events) in patients with atrial fibrillation?
Routine prescription of antiarrhythmic drugs after AF ablation does not improve recurrence rates and may increase reablation rates and reduce patient satisfaction, particularly in paroxysmal AF.
Caution against routine AAD discharge after paroxysmal AF ablation; leaves open causal effects on reablation pending randomized trials.
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after catheter ablation for atrial fibrillation (AF) are inconsistent. The present study investigates whether postinterventional AAD leads to an improved long-term outcome. Patients from the prospective German Ablation Registry (n = 3275) discharged with or without AAD after catheter ablation for AF were compared regarding the rates of recurrences, reablations and cardiovascular events as well as patient reported outcomes during 12 months follow-up. In patients with paroxysmal AF (n = 2138) the recurrence rate did not differ when discharged with (n = 1051) or without (n = 1087) AAD (adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95-1.35]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05-1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20-2.58]). Similar rates of recurrences, reablations and treatment satisfaction were found in patients with persistent AF (n = 1137) discharged with (n = 641) or without (n = 496) AAD (recurrence: OR 1.22, 95% CI [0.95-1.56]; reablation: OR 1.21, 95% CI [0.91-1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74-2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in patients discharged with or without AAD. In conclusion, the rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. Clinical trial registration: The trial has been registered under the number NCT01197638.
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Schleberger et al. (2021) conducted an observational in Atrial fibrillation (n=3,275). Antiarrhythmic drug therapy (Vaughan Williams class I or class III) vs. No antiarrhythmic drug therapy was evaluated on Arrhythmia recurrence in patients with paroxysmal atrial fibrillation (OR 1.13, 95% CI 0.95-1.35, p=0.14). Antiarrhythmic drug therapy at discharge after catheter ablation for atrial fibrillation did not reduce arrhythmia recurrences (OR 1.13) but was associated with higher reablation rates in paroxysmal AF.
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