Ratika Parkash1, George A Wells2, John L Sapp2, Jeffrey S Healey2, Jean-Claude Tardif2, Isabelle Greiss2, Lena Rivard2, Jean-Francois Roux2, Lorne Gula2, Isabelle Nault2, Paul Novak2, David Birnie2, Andrew Ha2, Stephen B Wilton2, Iqwal Mangat2, Christopher Gray2, Martin Gardner2, Anthony S L Tang2. 1. From Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S., C.G., M.G.); University of Ottawa Heart Institute, Ontario, Canada, (G.A.W.); Population Health Research Institute, Hamilton, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (J.-C.T., L.R.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (I.G.); Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada (J.-F.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Canada (I.N.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (P.N.); Ottawa Heart Institute, Ontario, Canada (D.B.); University Health Network, Toronto, Ontario, Canada (A.H.); Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.B.W.); and St. Michael's Hospital, Toronto, Ontario, Canada (I.M.). ratika.parkash@nshealth.ca. 2. From Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada (R.P., J.L.S., C.G., M.G.); University of Ottawa Heart Institute, Ontario, Canada, (G.A.W.); Population Health Research Institute, Hamilton, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (J.-C.T., L.R.); Centre Hospitalier de L'Universite de Montreal, Quebec, Canada (I.G.); Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada (J.-F.R.); University of Western Ontario, London, Canada (L.G., A.S.L.T.); Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Canada (I.N.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (P.N.); Ottawa Heart Institute, Ontario, Canada (D.B.); University Health Network, Toronto, Ontario, Canada (A.H.); Libin Cardiovascular Institute of Alberta, Calgary, Canada (S.B.W.); and St. Michael's Hospital, Toronto, Ontario, Canada (I.M.).
Abstract
BACKGROUND:Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. METHODS: We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. RESULTS: The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). CONCLUSIONS: In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113.
RCT Entities:
BACKGROUND: Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. METHODS: We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. RESULTS: The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). CONCLUSIONS: In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113.
Authors: Jonathan S Steinberg; Vitaliy Shabanov; Dmitry Ponomarev; Denis Losik; Eduard Ivanickiy; Evgeny Kropotkin; Konstantin Polyakov; Pawel Ptaszynski; Boris Keweloh; Christopher J Yao; Evgeny A Pokushalov; Alexander B Romanov Journal: JAMA Date: 2020-01-21 Impact factor: 56.272
Authors: Bao Oanh Nguyen; Harry J G M Crijns; Jan G P Tijssen; Bastiaan Geelhoed; Anne H Hobbelt; Martin E W Hemels; W J Myke Mol; Bob Weijs; Marco Alings; Marcelle D Smit; Robert G Tieleman; Raymond Tukkie; Dirk J Van Veldhuisen; Isabelle C Van Gelder; Michiel Rienstra Journal: Europace Date: 2022-07-15 Impact factor: 5.486
Authors: Mathias Hohl; Dennis H Lau; Andreas Müller; Adrian D Elliott; Benedikt Linz; Rajiv Mahajan; Jeroen M L Hendriks; Michael Böhm; Ulrich Schotten; Prashanthan Sanders; Dominik Linz Journal: J Am Heart Assoc Date: 2017-09-17 Impact factor: 5.501
Authors: Maura M Zylla; Matthias Hochadel; Dietrich Andresen; Johannes Brachmann; Lars Eckardt; Ellen Hoffmann; Karl-Heinz Kuck; Thorsten Lewalter; Burghard Schumacher; Stefan G Spitzer; Stephan Willems; Jochen Senges; Hugo A Katus; Dierk Thomas Journal: J Clin Med Date: 2020-07-27 Impact factor: 4.241
Authors: Abdulaziz A Alodhayani; Abdullah Alkhushail; Mashhor Alhantoushi; Saad M Alsaad; Turky H Almigbal; Khalid Alotaibi; Mohammed A Batais; Abdulrahman Altheaby; Sultan Al Dalbhi; Yasser Alghamdi Journal: Int J Health Sci (Qassim) Date: 2019 Nov-Dec