Pre-ablation use of metoprolol or diltiazem did not reduce AF recurrence or improve quality of life post-ablation in patients with persistent atrial fibrillation.
Does pre-ablation rate control with metoprolol or diltiazem reduce atrial fibrillation recurrence compared to direct-to-catheter ablation in patients with persistent atrial fibrillation?
Pre-ablation rate control with metoprolol or diltiazem does not improve atrial fibrillation recurrence, left atrial fibrosis, or quality of life compared to direct-to-catheter ablation in patients with persistent atrial fibrillation.
Absolute Event Rate: 0% vs 0%
Abstract Background For patients with persistent atrial fibrillation (PersAF), initial treatment strategies often involve rate or rhythm control before offering ablation. This study compared two approaches: (1) catheter ablation without prior medication (referred to as direct-to-catheter ablation, DTCA) and (2) catheter ablation after initial rate control with either diltiazem or metoprolol. Objective This study included two independentanalyses of patients with persistent atrial fibrillation (PersAF) undergoing catheter ablation. Aimed at evaluating the potential impact of pre-ablation rate control medications including beta blockers and calcium channel blockers on post-ablation outcomes. Comparison 1: DTCA without prior beta-blocker use ( n = 209) vs. metoprolol use prior to ablation ( n = 260). Comparison 2: DTCA without prior calcium channel blocker use ( n = 639) vs. diltiazem use prior to ablation ( n = 55). Methods Patients were followed for 18 months to evaluate primary outcome: recurrence of atrial fibrillation (AF) and secondary outcomes: Pre-ablation and Post-ablation left atrial percent fibrosis as seen on LGE MRI and Quality of life (QoL), measured with the SF-36 questionnaire. The Wilcoxon tests were conducted to compare the QoL and fibrosis among groups. Time to recurrence among the groups post ablation was assessed via Kaplan-Meier curves. Multivariable Cox models were developed to adjust for other confounders of AF recurrence. Results In the beta-blocker analysis ( n = 469), no significant difference in AF recurrence was observed between patients without prior beta-blocker use (DTCA group) and those treated with metoprolol (Kaplan-Meier, p > 0.05). Similarly, in the calcium channel blocker analysis ( n = 694), no difference in recurrence was found between the DTCA group and those with prior diltiazem use ( p > 0.05). Multivariable Cox models confirmed that neither metoprolol ( p = 0.44) nor diltiazem ( p = 0.34) independently predicted AF recurrence. Additionally, no significant differences were found in imaging metrics or QoL between the groups in either comparison (all p > 0.05). Conclusion Prior treatment with diltiazem or metoprolol before ablation of PersAF did not show additional benefits in reducing patient outcomes such as AF recurrence, fibrosis, or improving QoL. Graphical Abstract
Ksayer et al. (Tue,) reported a other. Pre-ablation use of metoprolol or diltiazem did not reduce AF recurrence or improve quality of life post-ablation in patients with persistent atrial fibrillation.