Antiarrhythmic Drug Therapy After Atrial Fibrillation Ablation

Aug 07, 2015
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Authors:
Noseworthy PA, Van Houten HK, Sangaralingham LS, et al.
Citation:
Effect of Antiarrhythmic Drug Initiation on Readmission After Catheter Ablation for Atrial Fibrillation. JACC Clin Electrophysiol 2015;Jul 29:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does antiarrhythmic drug therapy (AADT) reduce the probability of readmission to the hospital within the first 90 days after catheter ablation (CA) of atrial fibrillation (AF)?

Methods:

This was a retrospective analysis of a database containing administrative claims data. The authors identified 2,542 patients (mean age 59 years) who underwent catheter ablation of AF and who had not received AADT within the prior 90 days. Initiation of AADT at discharge was defined as a prescription for a Class I or III antiarrhythmic drug. The main outcome measure was all-cause and AF-related hospitalizations in the 90 days post-ablation.

Results:

AADT, most commonly amiodarone, sotalol, dronedarone, or flecainide, was prescribed for 519 patients. The other 2,023 patients did not receive AADT at discharge. After correction for confounding variables, all-cause hospitalizations in the 90 days post-ablation were 27% lower in the patients who received AADT. The prevalence of AF-related hospitalization also was significantly lower in the AADT group (3.9% vs. 7%). Analysis of individual antiarrhythmic drugs indicated that amiodarone was the only agent that had a significant effect on hospitalizations.

Conclusions:

Initiation of AADT at discharge, particularly with amiodarone, after catheter ablation of AF is associated with a lower probability of re-hospitalization within the next 90 days.

Perspective:

Because of the limitations of an analysis based on claims data, it is unclear whether AADT was associated with a reduction in hospitalizations because of suppression of AF or because of attenuation of AF-related symptoms. Perhaps beta-blockers also lowered the probability of re-hospitalization, but unfortunately, these were not factored into the analysis.

Keywords: Adrenergic beta-Antagonists, Amiodarone, Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Flecainide, Hospitalization, Outcome Assessment, Health Care, Sotalol


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