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Catheter ablation of paroxysmal AF associated with longer time to treatment failure
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Patients with paroxysmal atrial fibrillation refractory to at least one antiarrhythmic drug who were also assigned to catheter ablation had longer time to treatment failure than those assigned to antiarrhythmic drug therapy, study results suggested.
Researchers enrolled 167 patients with symptomatic paroxysmal AF who were unresponsive to at least one antiarrhythmic drug and experienced at least three episodes of AF in the six months prior to being randomly assigned. Patients were randomly assigned at a 2:1 ratio to either catheter ablation (n=106) or antiarrhythmic drug therapy (n=61). The primary outcome measure was the time to protocol-defined treatment failure.
According to the results, 66% of patients in the catheter ablation group remained free from protocol-defined treatment failure vs. 16% of patients in the antiarrhythmic drug therapy group (HR=0.30; 95% CI, 0.19-0.47) after the end of the study’s nine-month effectiveness evaluation period. The researchers reported that 70% of patients assigned to catheter ablation remained free of symptomatic recurrent atrial arrhythmia compared with 19% of patients assigned to drug therapy (HR=0.24; 95% CI, 0.15-0.39).
They also indicated that 63% of patients treated with catheter ablation were free of any recurring atrial arrhythmia vs. 17% of patients treated with antiarrhythmic drugs (HR=0.29; 95% CI, 0.18-0.45). Thirty-day major treatment-related adverse events occurred in five patients in the catheter ablation group and five patients in the antiarrhythmic drug therapy group. Quality of life measurements as assessed by mean SF-36 physical and mental summary scores were significantly improved at three months following treatment in the catheter ablation group vs. the antiarrhythmic drug therapy group.
“Our multicenter randomized trial demonstrates the superiority of catheter ablation over antiarrhythmic drug therapy in the treatment of patients with paroxysmal AF who did not respond to one or more drugs,” the researchers concluded. “Catheter ablation provided significantly better rhythm control and improved quality of life with a favorable safety profile. These findings argue for early use of catheter ablation therapy in patients with paroxysmal AF unresponsive to initial attempts with pharmacologic control.”
Wilber DJ. JAMA. 2010;303:333-340.