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Catheter Ablation Superior to Antiarrhythmic Drugs in Treating Atrial Fibrillation: Presented at AHA

By Deborah Brauser

ORLANDO, Fla -- November 25, 2009 -- Circumferential pulmonary vein ablation is superior to antiarrhythmic drug therapy over the long term in patients with symptomatic paroxysmal atrial fibrillation (AF), according to a prospective follow-up study presented here at the American Heart Association (AHA) Scientific Sessions 2009.

The results were presented on November 16 by Vincenzo Santinelli, MD, San Raffaele University Hospital, Milan, Italy.

In the original Ablation for Paroxysmal Atrial Fibrillation (APAF)-2 trial, 198 patients with AF (mean age, 56 years) were randomly assigned to receive catheter ablation (n = 99) or antiarrhythmic drugs (n = 99).

For the current study, outcomes evaluated included efficacy, quality of life, crossovers, and arrhythmia progression at a 4-year follow-up.

"The superiority that was shown at 1 year for the catheter ablation treatment was maintained up to 4 years, despite a large number of crossovers from antiarrhythmic drugs to catheter ablation [87.9%] during the follow-up period," reported Dr. Santinelli.

A total of 90 patients treated with catheter ablation and 80 with antiarrhythmic drugs maintained sinus rhythm (P = .023). Out of all the patients, only 3 progressed to permanent AF.

The patients who underwent catheter ablation also had significantly fewer cardiovascular hospitalisations and higher quality-of-life scores at the follow-up (P < .01).

"Many of the patients on antiarrhythmic drug therapy who did not cross to catheter ablation experienced arrhythmia progression from recurrent episodes of AF," said Dr. Santinelli. This led to frequent hospitalisations for electrical cardioversion and acute pulmonary oedema episodes.

No thromboembolic events were reported in either group.

"These data indicate that an early catheter ablation strategy is preferable in terms of efficacy, adverse events, quality of life, and arrhythmia progression," said Dr. Santinelli.

[Presentation title: Early Rhythm Control Strategy by Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation: The 4-Year Results of a Randomized Follow-Up Study Comparing Catheter Ablation and Antiarrhythmic Drug Therapy: The APAF 2 Study. Abstract 2542]

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