What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=3275). Intervention: Antiarrhythmic drug therapy (Vaughan Williams class I or class III) vs. No antiarrhythmic drug therapy. Primary outcome: Arrhythmia recurrence in patients with paroxysmal atrial fibrillation (OR 1.13, 95% CI 0.95-1.35, p=0.14).

October 19, 2021Open Access

Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation—Insights from the German Ablation Registry

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.

Study Design

Type

Observational (n=3,275)

Multicenter

Yes

Structured PICO

Does antiarrhythmic drug therapy after catheter ablation improve long-term outcomes (recurrences, reablations, cardiovascular events) in patients with atrial fibrillation?

Population

3,275 patients from the prospective German Ablation Registry who underwent catheter ablation for atrial fibrillation, including 2,138 with paroxysmal AF and 1,137 with persistent AF.

Intervention

Antiarrhythmic drug therapy (AAD) prescribed at discharge after catheter ablation.

Comparator

Discharge without antiarrhythmic drug therapy (AAD).

Outcome

Rates of recurrences, reablations, cardiovascular events, and patient reported outcomes (treatment satisfaction) during 12 months follow-up.

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.

Main Result

Effect estimate: OR 1.13 (95% CI 0.95-1.35)

Absolute Event Rate: 43.5% vs 40.2%

p-value: p=0.14

Limitations

Varying duration of the AAD intake, as some patients discontinued AAD while others started it during follow-up
Documentation of the exact duration of intake of antiarrhythmic medication was not part of the study protocol
Ablation procedures were performed several years ago, and technological advances have been made since then
Prescription of antiarrhythmic drugs was at the discretion of the study center, leaving potential for confounding
Retrospective character of the analysis despite being derived from a prospective registry

Abstract

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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