Randomized Study Comparing Radiofrequency Ablation with the PVAC Gold System vs. Antiarrhythmic Drugs in Elderly...

Area of Science:

• Cardiology
• Electrophysiology
• Geriatric Medicine

Background:

• Limited randomized studies exist comparing catheter ablation (CA) versus antiarrhythmic drugs (AA) for maintaining sinus rhythm in elderly patients with paroxysmal atrial fibrillation (AF).
• Elderly patients with paroxysmal AF refractory to at least one AA, and without structural heart disease, represent a population with unmet needs for effective rhythm control strategies.

Purpose of the Study:

• To compare the clinical outcomes of pulmonary vein (PV) isolation using the second-generation PVAC Gold catheter against AA treatment in elderly individuals with recurrent symptomatic paroxysmal AF.
• To assess the AF recurrence-free rate, progression to persistent AF, quality of life (QOLF), and complication rates between CA and AA treatment groups.

Main Methods:

• A randomized study involving sixty patients aged 65 years or older with paroxysmal AF.
• Patients were randomized into two groups: Group 1 underwent CA (PV isolation), and Group 2 received AA drugs.
• The primary outcome was the AF recurrence-free rate at one-year follow-up, with secondary outcomes including AF progression, QOLF, and complications.

Main Results:

• The AF recurrence-free rate was 80% in the CA group versus 65% in the AA group (p=0.119) after an average follow-up of 719 days.
• The persistent AF-free rate was 83.4% for CA and 67.7% for AA (p=0.073).
• Both groups showed improved QOLF (p<0.001), with no significant difference between them. Notably, 25% of CA patients exhibited cerebral embolization signs on MRI, without clinical repercussions.

Conclusions:

• Both catheter ablation and antiarrhythmic drug strategies effectively improve quality of life in elderly patients with symptomatic AF.
• While CA demonstrated a trend towards better recurrence-free rates, there was no statistically significant difference in clinical outcomes compared to AA treatment.
• Further research with advanced technologies focusing on safety profiles is warranted to fully elucidate the benefits of CA in this elderly population.