Progression of Atrial Fibrillation After a Failed Initial Ablation Procedure in Patients With Paroxysmal Atrial Fibrillation: A Randomized Comparison of Drug Therapy vs. Re-Ablation
Is re-ablation superior to antiarrhythmic drug therapy (AADT) in patients with recurrent atrial fibrillation (AF) after a prior ablation procedure?
One hundred fifty-four patients (mean age 56 years) with paroxysmal AF despite pulmonary vein isolation were randomly assigned to re-do ablation (n = 77) or AADT (n = 77) with propafenone, flecainide, or sotalol. Rhythm assessment during 3 years of follow-up was performed with an implantable loop recorder (ILR). The ILR data were collected every 3 months. Freedom from AF was defined as an AF burden ≤0.5%. The primary endpoint was progression of the AF burden or development of persistent AF.
During follow-up, the AF burden increased from baseline significantly more often in the AADT group (79%) than in the re-ablation group (25%). The mean AF burden at 36 months was significantly higher in the AADT group (18.8%) than in the re-ablation group (5.6%). Progression to persistent AF also occurred significantly more often in the AADT group (23%) than in the re-ablation group (4%). Only 12% of the AADT patients were AF-free during follow-up, whereas 58% of the re-ablation patients were AF-free off AADT.
The authors concluded that re-do ablation is more effective than AADT in preventing AF progression in patients with paroxysmal AF who have failed to respond to an initial ablation procedure.
The two major strengths of this study are the randomization of patients to the two treatment arms and the use of ILRs to quantitate AF burden during follow-up. The study convincingly demonstrates the superiority of re-do ablation over AADT in patients with paroxysmal AF and a failed first ablation procedure.
Keywords: Follow-Up Studies, Pulmonary Veins, Catheter Ablation, Disease Progression, Ovarian Follicle
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