Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial

Eur Heart J. 2014 May 21;35(20):1327-34. doi: 10.1093/eurheartj/ehu017. Epub 2014 Feb 3.

Abstract

Aim: Although catheter ablation (CA) has replaced antiarrhythmic drugs (AAD) as first-line treatment in selected patients with atrial fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT) after AF ablation remains unclear. This parallel randomized controlled study compared CA vs. AAD for recurrent AT after persistent AF ablation.

Methods and results: Two-hundred and one patients (aged 59.1 ± 10.9 years, 68.7% male) with recurrent AT after persistent AF ablation were enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment. Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa, including AT and AF) at 24-month follow-up. Composite secondary endpoints comprised procedural complications, long-term morbidity and improvement in quality of life (QoL). On an intention-to-treat basis, the CA group had a higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001). Adjusted Cox regression analysis showed a significant treatment effect with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There was a higher proportion of periprocedural complications in the CA group (7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group (10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for CA.

Conclusions: This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.

Keywords: Antiarrhythmic drugs; Atrial fibrillation; Atrial tachycardia; Catheter ablation; Quality of life; Recurrence.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / methods*
  • Catheter Ablation / mortality
  • Chronic Disease
  • Electrophysiologic Techniques, Cardiac / methods
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prospective Studies
  • Quality of Life
  • Recurrence
  • Secondary Prevention / methods
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents