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Radiofrequency ablation feasible in paroxysmal AF
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AHA Scientific Sessions 2011
ORLANDO, Fla. — Data from the MANTRA-PAF study demonstrate that radiofrequency catheter ablation was associated with significantly lower atrial fibrillation occurrence, atrial fibrillation burden and symptomatic atrial fibrillation compared with antiarrhythmic drug therapy.
Despite decreases, there was no significant difference in cumulative AF burden, according to Jens Cosedis Nielsen, MD, PhD, of department of cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej, Aarhus, Denmark, who presented results at a press conference.
The study included 294 patients (mean age, 55 years) who were randomly assigned to radiofrequency catheter ablation or antiarrhythmic drug therapy as first-line treatment for paroxysmal AF. Patients underwent 7-day Holter monitoring at 3, 6, 12, 18 and 24 months. Primary endpoints were cumulative AF burden during 35 days of Holter monitoring and AF burden at each Holter monitoring time point. Freedom from any AF and symptomatic AF on monitoring after 24 months, as well as adverse events, were secondary endpoints.
In the radiofrequency catheter ablation group, patients underwent 1.5 procedures. Cumulative AF burden (P=.10) and AF burden at 3, 6, 12 and 18 months was not significantly different between the two treatment groups. After 24 months, however, AF burden was significantly lower in the radiofrequency catheter ablation group (P=.007). Similarly, the rate of any AF and symptomatic AF were lower in the radiofrequency catheter ablation group at 24 months (P=.004 and P=.012).
There was no difference in the rate of atrial flutter between groups.
Serious adverse events occurred more often in patients who underwent radiofrequency catheter ablation compared with antiarrhythmic drug therapy; however the rate was not significant (25 vs. 22).
According to Nielsen, these data support radiofrequency catheter ablation as a first-line treatment option in patients with paroxysmal AF. However, this has been demonstrated in a select set of patients and cannot be extrapolated to mean that radiofrequency catheter ablation is the optimum treatment for all patients with paroxysmal AF. Both treatment options should be carefully considered by patients and physicians, he said. – by Stacey L. Fisher
For more information:
- Nielsen. LBCT.03. Presented at: American Heart Association Scientific Sessions 2011; Nov. 12-16, 2011; Orlando, Fla.
Disclosure: The MANTRA-PAF study was supported by unrestricted grants from the Danish Heart Foundation and from Biosense Webster and Johnson & Johnson. Dr. Nielsen reports no relevant financial disclosures.
The MANTRA-PAF study supports recent recommendation from the European Heart Association, which say that, for paroxysmal AF, ‘considering the relative safety of the technique when performed by experienced operators, ablation may be considered as an initial therapy in selected patients.’ I would add to that: after careful consideration of risks and benefits with the patient and their physicians.
- William G. Stevenson, MD
Brigham and
Women’s Hospital, Harvard Medical School
Disclosure: Dr. Stevenson is involved in a patent for needle RF ablation consigned to Brigham and Women’s Hospital.
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