Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)
Why the study?
Does empirical antiarrhythmic drug therapy for 6 weeks after AF ablation reduce the occurrence of clinically significant atrial arrhythmias in patients with paroxysmal AF?
Population
110 consecutive patients with paroxysmal atrial fibrillation undergoing ablation, mean age 55+/-9 years, 71%…
Comparison
Empirical antiarrhythmic drug therapy for 6… vs No antiarrhythmic therapy for 6 weeks after AF…
Design
RCT, randomized
Follow-up
6 weeks
Authors
Discussion
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Member takes
Implication
Supports empirical 6-week AAD post-ablation in paroxysmal AF; extends RCT evidence for periprocedural arrhythmia suppression.
Key Points
- To determine whether empirical antiarrhythmic drug therapy for six weeks after catheter ablation reduces early recurrent atrial arrhythmias in patients with paroxysmal atrial fibrillation.
- Randomized consecutive patients (N=110) undergoing paroxysmal atrial fibrillation ablation to either empirical antiarrhythmic therapy (n=53) or no antiarrhythmic therapy with only AV nodal blocking agents (n=57) for six weeks.
- Tracked cardiac rhythm using transtelephonic monitoring for four weeks post-discharge, with formal clinical follow-up at six weeks.
- Assessed a primary composite endpoint of arrhythmias lasting >24 hours, symptomatic arrhythmias requiring hospital admission, cardioversion, or medication change, and drug intolerance requiring cessation.
- The primary composite endpoint occurred in 19% of patients in the antiarrhythmic group versus 42% in the no-antiarrhythmic group (P=0.005) during the six-week post-ablation period.
- The secondary composite of atrial fibrillation lasting >24 hours, arrhythmia-related hospitalization, or electrical cardioversion occurred in 13% of the antiarrhythmic group versus 28% of the control group (P=0.05).
Structured PICO
Does empirical antiarrhythmic drug therapy for 6 weeks after AF ablation reduce the occurrence of clinically significant atrial arrhythmias in patients with paroxysmal AF?
P
Population
110 consecutive patients with paroxysmal atrial fibrillation (AF) undergoing ablation, mean age 55+/-9 years, 71% male.
I
Intervention
Empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation.
C
Comparator
No antiarrhythmic therapy (only atrioventricular nodal blocking agents prescribed) for 6 weeks after AF ablation.
O
Outcome
Composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation at 6 weeks.composite
Empirical antiarrhythmic drug therapy for 6 weeks after AF ablation significantly reduces the incidence of clinically significant atrial arrhythmias and the need for cardioversion or hospitalization.
Cite This Study
Roux et al. (2009) studied this question.