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Antiarrhythmic drug treatment following AF was well tolerated
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Antiarrhythmic drug treatment during the six weeks after atrial fibrillation reduced the incidence of clinically significant atrial arrhythmias and the need for cardioversion or hospitalization for arrhythmic management. It was also well tolerated.
Researchers from the University of Pennsylvania conducted the prospective, randomized 5A study to examine the differences between using empiric antiarrhythmic drug treatment or not using antiarrhythmic drug treatment in patients with AF who had undergone ablation.
The average age of patients (n=110) was 55 years; 71% were men. The no antiarrhythmic drug treatment group consisted of 57 patients.
The primary endpoint was a composite of atrial arrhythmias lasting .24 hours; requiring antiarrhythmic drug initiation/change; and requiring hospitalization or cardioversion or the endpoint of intolerance requiring drug cessation.
During the six weeks following ablation, 40% of the patients in the no antiarrhythmic drug treatment group reached the primary endpoint compared with the antiarrhythmic drug treatment group (17%; P<.01).
When only the endpoints of AF .24 hours, arrhythmia-related hospitalization or electrical cardioversion were included, there were 26 events in the no antiarrhythmic drug treatment group and 11 events in the antiarrhythmic drug treatment group (P<.05).
The study was terminated prematurely after reaching statistical significance. Adverse events requiring drug termination included rash, headaches and severe fatigue. – by Christen Haigh
Roux JF, Zado E, Callans DJ, et al. SP07. Presented at: Heart Rhythm 2008; May 14-17, 2008; San Francisco
The occurrence of symptomatic atrial arrhythmias early after AF ablation is common, and often disheartening, to patients and physicians alike. The 5A Study results show that antiarrhythmic drug treatment during the six weeks following AF ablation is well tolerated, reduces the incidence of early atrial arrhythmias and the need for cardioversion or hospitalization, with a very low incidence of adverse effects. To avoid proarrhythmia, attention must be paid to the underlying cardiac substrate; Class IC antiarrhythmic drugs (propafenone and flecainide) must be avoided in patients with coronary artery and other structural heart diseases. Alternatively, for patients with normal left ventricular function and CAD, sotalol is the drug of choice, and for those with abnormal LV function, either sotalol or dofetilide can be used.
– Andrew E. Epstein, MD
Cardiology Today Editorial Board member