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Updated: Jun 27, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Catheter Ablation as First-Line Therapy in Persistent Atrial Fibrillation: Patient Characteristics and Clinical
Michael Barkagan1, Anat Milman1, Guy Zahavi2
1Division of Cardiovascular Medicine, Cardiac Electrophysiology Institute, Shamir Medical Center, Be'er Yaakov, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Catheter ablation is a common first-line treatment for persistent atrial fibrillation (PerAF) in the U.S., especially for men with fewer health issues. Outcomes were similar, but early ablation patients used fewer antiarrhythmic drugs.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Persistent atrial fibrillation (PerAF) management often involves antiarrhythmic drugs (AADs) or catheter ablation.
- Catheter ablation is a viable alternative for rhythm control in PerAF patients.
Purpose of the Study:
- To determine the prevalence of catheter ablation as a first or second-line strategy for PerAF.
- To analyze patient characteristics and clinical outcomes associated with early vs. later ablation strategies.
Main Methods:
- A multicenter observational study of 2,083 patients undergoing first-time PerAF ablation (Jan 2020-Sep 2021).
- Patients were stratified into first-line ablation and second-line ablation groups.
- Comparison of demographics, comorbidities, and clinical outcomes between the two groups.
Main Results:
- 52% of patients received ablation as a first-line therapy.
- First-line ablation patients were more likely male and had fewer comorbidities (hypertension, heart failure) compared to second-line.
- Arrhythmia-free survival was similar, but second-line patients more frequently continued AADs.
Conclusions:
- First-line catheter ablation for PerAF is common in the U.S., particularly among men with fewer comorbidities.
- Further research is needed to identify specific patient subgroups who benefit most from early ablation intervention.
Background:
In patients with persistent atrial fibrillation (PerAF), antiarrhythmic drugs (AADs) are considered a first-line rhythm-control strategy, whereas catheter ablation is a reasonable alternative.
Objectives:
This study sought to examine the prevalence, patient characteristics, and clinical outcomes of patients with PerAF who underwent catheter ablation as a first or second-line strategy.
Methods:
This multicenter observational study included consecutive patients with PerAF who underwent first-time ablation between January 2020 and September 2021 in 9 medical centers in the United States. Patients were divided into those who underwent ablation as first-line therapy and those who had ablation as second-line therapy. Patient characteristics and clinical outcomes were compared between the groups.
Results:
A total of 2,083 patients underwent first-time ablation for PerAF. Of these, 1,086 (52%) underwent ablation as a first-line rhythm-control treatment. Compared with patients treated with AADs as first-line therapy, these patients were predominantly male (72.6% vs 68.1%; P = 0.03), with a lower frequency of hypertension (64.0% vs 73.4%; P < 0.001) and heart failure (19.1% vs 30.5%; P < 0.001). During a mean follow-up of 325.9 ± 81.6 days, arrhythmia-free survival was similar between the groups (HR: 1.13; 95% CI: 0.92-1.41); however, patients in the second-line ablation strategy were more likely to continue receiving AAD therapy (41.5% vs 15.9%; P < 0.001).
Conclusions:
A first-line ablation strategy for PerAF is prevalent in the United States, particularly in men with fewer comorbidities. More data are needed to identify patients with PerAF who derive benefit from an early intervention strategy.
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