Repeat ablation with medical therapy significantly reduced arrhythmia recurrences compared to medical therapy alone (HR 0.48; 95% CI 0.35-0.65; P<0.0001).
Cohort (n=682)
No
Does repeat ablation reduce arrhythmia recurrence in patients with recurrent symptomatic arrhythmia after a first ablation for persistent atrial fibrillation compared to medical therapy alone?
In patients with recurrent symptomatic arrhythmias after an initial ablation for persistent atrial fibrillation, repeat ablation significantly improves freedom from arrhythmia recurrence compared to medical management alone.
Effect estimate: HR 0.48 (95% CI 0.35-0.65)
Absolute Event Rate: 41.5% vs 14.5%
p-value: p=<0.0001
INTRODUCTION: Management of persistent atrial fibrillation (PersAF) remains challenging, and many patients are left on medical therapy after a failed first ablation. In patients with recurrent symptomatic arrhythmias after PersAF ablation, we aimed to compare outcomes of repeat ablation and medical therapy versus medical therapy alone. METHODS AND RESULTS: All 682 consecutive patients with recurrent symptomatic arrhythmia after a first ablation for PersAF at our institution (2005-2012) were included. Repeat ablation with continuation of medical therapy was performed in 364 patients (Group 1) and 318 were only medically managed (Group 2). The outcome of interest was freedom from arrhythmia recurrence beyond a 3-month blanking period. Separate analyses were performed to assess this endpoint totally off antiarrhythmics (primary endpoint) or alternatively with/without use of antiarrhythmics (secondary endpoint). Over a median follow-up of 26 months, 41.5% of Group 1 patients met the primary endpoint and remained free from arrhythmia recurrence off antiarrhythmics (vs. 14.5% in Group 2, P < 0.0001). At last follow-up, antiarrhythmics continued to be required for rhythm control in 40.1% and 46.2% of patients in Groups 1 and 2, respectively (P < 0.0001). The secondary endpoint was met in 60.2% versus 32.1% of patients in Groups 1 and 2, respectively (P < 0.0001). In multivariable Cox analyses, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to medical therapy alone (HR 0.48, 95% CI 0.35-0.65, P < 0.0001). CONCLUSION: In patients with recurrent symptomatic arrhythmia after ablation of PersAF, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to routine medical therapy alone.
Barakat et al. (Thu,) conducted a cohort in Recurrent symptomatic arrhythmia after ablation of persistent atrial fibrillation (n=682). Repeat ablation with continuation of medical therapy vs. Medical therapy alone was evaluated on Freedom from arrhythmia recurrence beyond a 3-month blanking period totally off antiarrhythmics (HR 0.48, 95% CI 0.35-0.65, p=<0.0001). Repeat ablation with medical therapy significantly reduced arrhythmia recurrences compared to medical therapy alone (HR 0.48; 95% CI 0.35-0.65; P<0.0001).