In patients with atrial fibrillation (AFib) with normal cardiac function and sinus rhythm after catheter ablation, 12% who discontinued guideline-directed medical therapy (GDMT) experienced heart failure (HF) deterioration, while drug-related complications were more likely among patients who continued GDMT, according to a study published June 26 in JAMA Network Open.

Sitong Li, MD, et al., enrolled 50 patients (median age 56 years, 79% male) with suspected AFib-mediated cardiomyopathy at three months post ablation at a single center in China and randomized them to either GDMT withdrawal or continuation. The study's primary endpoint was HF deterioration, defined as LVEF decline more than 10% to less than 55%, LV end-diastolic diameter increase of more than 10% and beyond normal, NT-proBNP levels doubling to more than 400 ng/L, or worsening HF signs and symptoms.

Among the 47 patients who completed six-month follow up, the primary endpoint was observed in three patients (12%) in the withdrawal group and no patients (0%) in the continuation group (p=0.11). For the three patients who exhibited HF deterioration, early reinitiation of GDMT showed recovery in LVEF and NT-proBNP.

Rates of drug-related complications were higher in the continuation group vs. the withdrawal group (20% vs. 0%, respectively; p=0.05) and arrhythmia recurrence rates were comparable (12.5% vs. 12%, respectively).

"These findings were derived from patients with highly suspected [AFib-mediated cardiomyopathy] with recovered cardiac structure and function, an absence of HF symptoms, maintained sinus rhythm, and low NT-proBNP levels after AFib catheter ablation," note the authors. "Given the relatively small sample size and the heterogeneity of populations with AFib and HF, these findings should be interpreted carefully and not generalized to broader populations with AFib or HF with reduced ejection fraction."