Antiarrhythmic drugs vs catheter ablation in treatment resistant paroxysmal a-fib

January 01, 0001

Antiarrhythmic drugs vs catheter ablation in treatment resistant paroxysmal a-fib

Paroxysmal atrial fibrillation (AF) can be treated with antiarrhythmic drug therapy (ADT) or more recently with catheter ablation. This multinational group of researchers investigated the efficacy of radiofrequency catheter ablation compared ADT in treating symptomatic paroxysmal AF. They performed a prospective, multicenter, randomized, unblinded, Bayesian-designed study involving 167 patients who failed to respond to at least one antiarrhythmic drug and who experienced at least 3 AF episodes within 6 months prior to randomization. The patients were followed for nine months after the intervention, measuring time to treatment failure.

The researchers report: "At the end of the 9-month effectiveness evaluation period, 66% of patients in the catheter ablation group remained free from protocol-defined treatment failure compared with 16% of patients treated with ADT. The hazard ratio of catheter ablation to ADT was 0.30. Major 30-day treatment-related adverse events occurred in 5 of 57 patients (8.8%) treated with ADT and 5 of 103 patients (4.9%) treated with catheter ablation. Mean quality of life scores improved significantly in patients treated by catheter ablation compared with ADT at 3 months. This improvement was maintained during the course of the study."

They concluded: "Among patients with paroxysmal AF who had not responded to at least 1 antiarrhythmic drug, the use of catheter ablation compared with ADT resulted in a longer time to treatment failure during the 9- month follow-up period."

This study supports a role for catheter ablation in paroxysmal a- fib not controlled with one antiarrhythmic medication.

For the full abstract, click here.

JAMA 303(4):333-340, 27 January 2010
© 2010 American Medical Association
Comparison of Antiarrhythmic Drug Therapy and Radiofrequency Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation-A Randomized Controlled Trial. David J. Wilber, Carlo Pappone, Petr Neuzil, et al.. Correspondence to::

Category: K. Circulatory. Keywords: paroxysmal atrial fibrillation, antiarrhythmic drugs, radiofrequency catheter ablation, quality of life, recurrence, randomized-controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 5 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.