Key result
Blanking-period amiodarone is linked to ~83% higher late atrial arrhythmia recurrence vs no AAD.
Why the study?
It was unknown whether specific antiarrhythmic drugs prescribed in the blanking period after catheter ablation of AF are associated with reduced early or late recurrence of atrial arrhythmias.
Does specific antiarrhythmic drug prescription in the post-procedural blanking period reduce recurrent atrial arrhythmias in patients undergoing first-time catheter ablation for atrial fibrillation?
Cohort (n=478)
No
Does specific antiarrhythmic drug prescription in the post-procedural blanking period reduce recurrent atrial arrhythmias in patients undergoing first-time catheter ablation for atrial fibrillation?
Prescription of specific antiarrhythmic drugs during the blanking period after first-time AF ablation was not associated with reduced early recurrence, and amiodarone or dronedarone use was associated with increased late recurrence, likely due to confounding by indication.
Answers are grounded in this paper and cite their sources.
Amiodarone in the blanking period was associated with higher late recurrence; leaves open whether early AADs affect post-ablation outcomes.
PURPOSE: To evaluate if specific AADs prescribed in the blanking period (BP) after catheter ablation of atrial fibrillation (AF) may be associated with reduced risk of early recurrence (ER) and/or late recurrence (LR) of atrial arrhythmias. METHODS: A total of 478 patients undergoing first-time ablation at a single institution were included. Outcomes were: ER, LR, discontinuation of AAD less than 90 days post-ablation, and second ablation. ER was defined as AF, atrial flutter (AFL), or atrial tachycardia (AT) > 30 seconds within BP. LR was defined as AF/AFL/AT > 30 seconds after BP. RESULTS: Of 478 patients, 14.9% were prescribed no AAD, 26.4% propafenone/flecainide, 34.5% sotalol/dofetilide, 10.7% dronedarone, and 13.6% amiodarone. Patients prescribed amiodarone were more likely to have persistent AF, hypertension, diabetes, and other comorbidities. In unadjusted analyses, there were no differences between groups in relation to ER (log rank P = 0.171), discontinuation of AAD before ninety days post-ablation (log rank P = 0.235), or freedom from second ablation (log rank P = 0.147). After multivariable adjustment, patients prescribed amiodarone or dronedarone were more likely to experience LR than those prescribed no AAD [Adjusted Hazard Ratio (AHR) 1.83, 95% CI 1.10-3.04, p = 0.02; AHR 1.79, 95% CI 1.05-3.05, p = 0.03, respectively]. CONCLUSION: Following first-time catheter ablation, there were no differences between specific AAD prescription and risk of ER, while those prescribed amiodarone or dronedarone in the BP were more likely to experience LR than those prescribed no AAD, which may represent an association due to confounding by indication.
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Malladi et al. (2021) conducted a cohort in Atrial fibrillation (n=478). Amiodarone vs. No antiarrhythmic drug (No AAD) was evaluated on Late recurrence (LR) of atrial arrhythmias after the 3-month blanking period (HR 1.83, 95% CI 1.10-3.04, p=0.02). Amiodarone prescribed during the blanking period after catheter ablation was associated with increased risk of late recurrence of atrial arrhythmias compared to no AAD (HR 1.83).
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