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Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized,

Lluís Mont1, Felipe Bisbal, Antonio Hernández-Madrid

  • 1Unitat de Fibril·lació Auricular (UFA), Arrhythmia Section - Hospital Clínic, Universitat de Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel, 170, Barcelona, Catalonia 08036, Spain.

European Heart Journal
|October 19, 2013
PubMed

Insights

Catheter ablation (CA) is more effective than antiarrhythmic drug therapy (ADT) for maintaining sinus rhythm in patients with persistent atrial fibrillation (AF). This randomized trial demonstrated CA

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Interventions

Background:

  • Catheter ablation (CA) is established as effective for paroxysmal atrial fibrillation (AF).
  • No prior randomized trials have compared CA with antiarrhythmic drug therapy (ADT) for persistent AF.
  • Persistent AF presents unique challenges in rhythm management compared to paroxysmal AF.

Purpose of the Study:

  • To compare the effectiveness of catheter ablation (CA) versus antiarrhythmic drug therapy (ADT) in treating persistent atrial fibrillation (AF).
  • To evaluate the long-term efficacy of CA in maintaining sinus rhythm in patients with persistent AF.
  • To provide evidence-based recommendations for managing persistent AF.

Main Methods:

  • A randomized trial comparing CA and ADT in patients with persistent AF (excluding long-standing cases).
  • Primary endpoint: absence of AF or atrial flutter >24h after a 3-month blanking period, assessed at 12-month follow-up.
  • Secondary endpoints included atrial tachyarrhythmia recurrence, hospitalizations, and need for electrical cardioversion.

Main Results:

  • Catheter ablation (CA) demonstrated significantly higher efficacy, with 70.4% of patients free from the primary endpoint compared to 43.7% in the antiarrhythmic drug therapy (ADT) group (P = 0.002).
  • The proportion of patients free from any atrial tachyarrhythmia recurrence (>30s) was substantially higher in the CA group (60.2%) versus the ADT group (29.2%) (P < 0.001).
  • Fewer patients required electrical cardioversion in the CA group (34.7%) compared to the ADT group (50%) (P = 0.018).

Conclusions:

  • Catheter ablation is superior to antiarrhythmic drug therapy for maintaining sinus rhythm in patients with persistent atrial fibrillation at 12-month follow-up.
  • CA offers a more effective long-term rhythm control strategy for persistent AF compared to medical management.
  • These findings support CA as a primary treatment option for selected patients with persistent AF.
Abstract

Keywords:
Antiarrhythmic drugAtrial fibrillationAtrial flutterCatheter ablationClinical trial

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