Gustavo R Goldenberg1, Daniel Burd2, Piotr Lodzinski3, Giuseppe Stabile4, Jacob A Udell5,6, David Newman2, Mohammed Shurrab2, Eugene Crystal2,5. 1. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. gustavogoldenberg0@gmail.com. 2. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 3. Medical University of Warsaw, Warsaw, Poland. 4. Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Maddaloni, Italy. 5. Women's College Hospital, University of Toronto, Toronto, Canada. 6. Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is a common practice to prevent early arrhythmia recurrence; the data of influence of this practice on longer term ablation outcomes is limited. PURPOSE: The aim of this study was to perform a meta-analysis of published controlled trials comparing temporary AAD therapy after AFA with no AAD therapy in patients after AFA. The primary outcome was recurrence of arrhythmia. RESULTS: 1Eight prospective trials were included. Among 2952 patients, 1991 (67 %) had paroxysmal AF, and 967 (32.7 %) had persistent AF. In total, 1502 patients were treated with AADs and 1450 patients served as a control group (no AAD therapy). Various class IC-III antiarrhythmics were used. Length of AAD administration varied between 6 and 12 weeks after start of AFA. The follow-up duration ranged from 1.5 to 17 months after stopping medication. Among AAD treated patients, the recurrence of arrhythmia rate was 30.69 vs. 33.79 % in control patients (odd ratio 0.86, 95 % CI 0.71-1.06, P = 0.15). In patients who received largely amiodarone, there was a trend for difference in recurrence of atrial arrhythmia (odds ratio 0.60, 95 % CI 0.34-1.09, P = 0.09). CONCLUSIONS: Short-term post pulmonary vein isolation (PVI) AAD therapy does not substantially reduce overall recurrence of AF after ablation.
BACKGROUND: Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is a common practice to prevent early arrhythmia recurrence; the data of influence of this practice on longer term ablation outcomes is limited. PURPOSE: The aim of this study was to perform a meta-analysis of published controlled trials comparing temporary AAD therapy after AFA with no AAD therapy in patients after AFA. The primary outcome was recurrence of arrhythmia. RESULTS: 1Eight prospective trials were included. Among 2952 patients, 1991 (67 %) had paroxysmal AF, and 967 (32.7 %) had persistent AF. In total, 1502 patients were treated with AADs and 1450 patients served as a control group (no AAD therapy). Various class IC-III antiarrhythmics were used. Length of AAD administration varied between 6 and 12 weeks after start of AFA. The follow-up duration ranged from 1.5 to 17 months after stopping medication. Among AAD treated patients, the recurrence of arrhythmia rate was 30.69 vs. 33.79 % in control patients (odd ratio 0.86, 95 % CI 0.71-1.06, P = 0.15). In patients who received largely amiodarone, there was a trend for difference in recurrence of atrial arrhythmia (odds ratio 0.60, 95 % CI 0.34-1.09, P = 0.09). CONCLUSIONS: Short-term post pulmonary vein isolation (PVI) AAD therapy does not substantially reduce overall recurrence of AF after ablation.
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