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No difference after ablation found in AF patients treated with antiarrhythmic drugs
Leong-Sit P. Circ Arrhythm Electrophysiol. 2011;4;11-14.
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At 6 months, patients with paroxysmal atrial fibrillation who underwent ablation and were given antiarrhythmic drugs had no difference in atrial fibrillation freedom compared with those who underwent the procedure but were not given the drugs.
Patients (n=110) of the randomized, prospective Antiarrhythmics After Ablation of Atrial Fibrillation (5A) study underwent ablation for paroxysmal AF and were then randomly assigned to receive or not receive antiarrhythmic drugs (AADs) for 6 weeks. Patients additionally underwent evaluation at 6 weeks and 6 months as well as 4 weeks of transtelephonic monitoring, to ascertain asymptomatic AF.
At the 6-month follow-up, compared with patients who did not receive AADs (n=57), those who received them (n=53) had no significant difference in freedom from AF. After multivariable logistic regression, the only significant predictor of AF recurrence at 6 months was AF recurrence during the first 6 weeks (OR=16.4; 95% CI, 4.6-58.1).
In the clinical perspective, the study’s researchers said their data make a case that although the pathophysiology of early recurrence may be altered by antiarrhythmic medications, later recurrence is likely due to a different mechanism, such as chronic reconnection of the pulmonary veins.
“However, the … findings should not dissuade the use of antiarrhythmic drugs in the early postablation period,” they said. “It remains clear that the early short-term use of antiarrhythmic drugs decreases morbidity by reducing symptomatic episodes and the need for cardioversion or hospitalization. In addition, particular vigilance for late AF recurrence should occur in patients with early AF occurrence after ablation, and continuation of anticoagulation, if indicated, should be considered.”
Cardiology Today’s previous coverage of the 5A study’s 6-week results can be viewed here.
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