Key result
Pre-ablation amiodarone failure does not predict worse one-year freedom from recurrent atrial arrhythmia versus success.
Why the study?
It was unknown whether failure of amiodarone to maintain sinus rhythm prior to catheter ablation for paroxysmal or persistent AF is associated with poor outcomes.
Does failure of amiodarone to maintain sinus rhythm prior to ablation predict worse one-year outcomes of catheter ablation in patients with atrial fibrillation?
Cohort (n=307)
Does failure of amiodarone to maintain sinus rhythm prior to ablation predict worse one-year outcomes of catheter ablation in patients with atrial fibrillation?
Absolute Event Rate: 55.7% vs 60.5%
p-value: p=0.54
Failure of amiodarone to maintain sinus rhythm prior to catheter ablation for atrial fibrillation does not predict worse one-year procedural outcomes, suggesting amiodarone failure should not deter practitioners from considering ablation.
Amiodarone failure before AF ablation was not associated with worse 1-year outcomes; hypothesis-generating and requires prospective validation.
Background : Catheter ablation for atrial fibrillation (AF) is a common therapeutic strategy for patients with either paroxysmal or persistent AF, but long-term ablation success rates are imperfect. Maintenance of sinus rhythm immediately prior to ablation with anti-arrhythmic drug (AAD) therapy has been associated with improved outcomes in patients undergoing ablation. Amiodarone has superior efficacy relative to other AADs. Whether failure of amiodarone to maintain sinus rhythm prior to ablation for either paroxysmal or persistent AF is associated with poor outcomes is unknown. Methods : A total of 307 patients who received amiodarone in a one-year window before undergoing catheter ablation for AF were included. Patients were divided into amiodarone success (n=183) and amiodarone failure (n=124) groups based on the response to pre-ablation amiodarone treatment. Analysis of procedural outcomes as a function of response to amiodarone therapy was performed. Patients were followed for at least 12 months post-ablation to assess outcomes (adverse events and arrhythmia recurrence). Procedural success was defined by the absence of documented arrhythmia (>30s) without any anti-arrhythmic agents beyond a 90d blanking period. Results : Following ablation for either paroxysmal or persistent AF, freedom from any recurrent atrial arrhythmia at 1y was 57.7% for the entire cohort. One-year freedom from recurrent arrhythmia in the amiodarone success group was comparable to that in the amiodarone failure group (55.7% vs 60.5%; p=0.54). Success rates following ablation did not vary by the response to amiodarone when analyzed for paroxysmal or persistent AF subgroups. Conclusion : Failure to restore and maintain sinus rhythm with amiodarone prior to ablation for either paroxysmal or persistent AF is not a predictor of ablation procedural failure. Amiodarone failure alone should not deter practitioners from considering ablation therapy for patients with AF.
No takes yet. Share an insight, caveat, or question.
Yadav et al. (2022) conducted a cohort in Atrial fibrillation (n=307). Amiodarone success prior to ablation vs. Amiodarone failure prior to ablation was evaluated on Freedom from any recurrent atrial arrhythmia at 1 year (p=0.54). Pre-ablation amiodarone failure did not predict worse 1-year freedom from recurrent atrial arrhythmia compared to amiodarone success (60.5% vs 55.7%; p=0.54).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: