EAST-AF, BELIEF, UNDER-ATP: New Research Provides Insights Into Treatment of AFib Patients

Research presented Aug. 30 as part of ESC Congress 2015 in London offered new insights into several areas of treatment of patients with atrial fibrillation (AFib).

Results from the EAST-AF Study, presented by Kazuaki Kaitani, MD, from Tenri Hospital, Nara, Japan, found that the addition of antiarrhythmic drugs for 90 days following treatment with radiofrequency catheter ablation did not reduce arrhythmia recurrence rates in AFib patients at one year. The study included 2,044 patients undergoing first radiofrequency catheter ablation for AFib at 19 cardiovascular centers in Japan.

While there was a significantly lower rate of early arrhythmia recurrences in the antiarrhythmic drug group compared with the control group during the treatment period (41.0 percent vs. 47.9 percent, respectively), this benefit did not persist after antiarrhythmic drug discontinuation. The one-year recurrence-free rate was 69.5 percent in the antiarrhythmic drug group and 67.8 percent in the control group, with no significant difference between the two groups.

Meanwhile, in the BELIEF Study, data showed that additional electrical isolation of the left atrial appendage (LAA) may improve freedom from AFib without increasing complications. The study randomly assigned 173 patents with long-standing persistent AFib to undergo standard treatment alone, or standard treatment plus the addition of LAA ablation. At one year, 28 percent of standard treatment patients were recurrence-free compared to 56 percent of patients who had the additional LAA ablation. For patients who were not recurrence-free in either group, LAA isolation was performed in a second procedure. At 24 months, after an average of 1.3 procedures, the cumulative success rate was 76 percent in the LAA ablation group and 56 percent in the standard treatment group.

"Empirical LAA isolation, along with the standard approach of pulmonary vein isolation and ablation of extra-pulmonary triggers is superior to the standard approach alone in enhancing the long-term success rate of catheter ablation," said investigator Luigi Di Biase, MD, PhD, from Montefiore-Albert Einstein Center for Heart & Vascular Care, NY, and Texas Cardiac Arrhythmia Institute at St. David's Medical Center in Austin, TX.

In the UNDER-ATP Trial, which was simultaneously published in the European Heart Journal, late recurrence of AFib was not reduced in patients whose pulmonary vein isolation (PVI) treatment incorporates the addition of adenosine triphosphate (ATP).

The study randomly assigned 2,113 patients undergoing their first PVI for AFib to conventional PVI alone, or to ATP (n=1,112) after PVI. In the ATP group (recommended dose 0.4 mg/kg/one injection), additional ablation was performed if ATP identified extra trouble spots, whereas neither additional ablation or ATP was used in the control group. The primary endpoint of the study was arrhythmias lasting for more than 30 seconds or requiring repeat ablation, hospital admission, cardioversion or antiarrhythmic drugs between three months and one year post-PVI.

Results showed that at one year there was no significant difference in outcomes between the groups, with 68.7 percent of the ATP patients and 67.1 percent of control patients AFib free.

Clinical Topics: Arrhythmias and Clinical EP, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anti-Arrhythmia Agents, Atrial Fibrillation, Atrial Flutter, Catheter Ablation, Pulmonary Veins, ESC Congress

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