Catheter Ablation Superior to Drug Therapy for Atrial Fibrillation

A new study concludes that first-line treatment with radiofrequency ablation (RFA) is superior to antiarrhythmic drug therapy (AAD) for reducing atrial fibrillation (AF).

Researchers at Linköping University (Sweden), Aarhus University Hospital (Denmark), and other institutions evaluated the five-year follow-up effects of both treatment modalities on health-related quality of life (HRQoL) and symptom burden in 294 patients, who were randomized to AAD (148 patients) or RFA (146 patients). The primary endpoint was the burden of AF as assessed by seven day Holter recording; secondary endpoints were burden of symptomatic AF, HRQoL assessed via the Short Form-36 (SF-36) questionnaire, and need for additional catheter ablation procedures.

Five year follow up was achieved in 245 (83%) of the patients. The results showed that more patients in the catheter ablation group were free from any AF than those in the AAD group. Remaining AF burden was also significantly lower in the RFA group compared to the AAD group; HRQoL scores at five years, however, did not differ between groups. The results were similar when not compensating for missing Holter recordings. The five-year study results were presented at the European Society of Cardiology (ESC) annual meeting, held during August-September 2015 in London (United Kingdom).

“In clinical practice most doctors choose antiarrhythmic drug therapy for initial treatment of symptomatic atrial fibrillation, and catheter ablation is used for patients who fail drug therapy,” said principal author consultant cardiologist Prof. Jens Cosedis Nielsen, MD, of Aarhus University Hospital. “The findings indicate that first-line treatment with catheter ablation is superior to drug therapy for reducing atrial fibrillation. The choice of first-line treatment strategy still needs to be discussed with individual patients, taking into account their disease burden and risks associated with the different treatment strategies.”

AF occurs when the heart's two upper chambers beat erratically, and can lead to serious adverse events such as thrombi travelling from the heart to obstruct arteries supplying the brain, causing stroke, or other parts of the body causing tissue damage. In one form of the condition, paroxysmal AF, patients have bouts of erratic beats that begin spontaneously and usually last less than a week. While AAD can control the heart rhythm and symptoms of AF, many patients do not respond well to the drugs.

Related Links:
Linköping University
Aarhus University Hospital