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| |  Catheter Ablation Best for Patients With Atrial Fibrillation Than Drug Therapy CHICAGO -- January 26, 2010 -- Use of catheter ablation resulted in significantly better outcomes in patients with paroxysmal atrial fibrillation (AF) who had not responded previously to antiarrhythmic drug therapy (ADT), according to a study published in the January 27 issue of JAMA. Although antiarrhythmic drugs are generally used as first-line therapy to treat patients with AF, they are associated with cumulative adverse effects over time and their effectiveness remains inconsistent, according to background information in the article. David J. Wilber, MD, Loyola University Medical Center, Maywood, Illinois, and colleagues conducted a study to compare catheter ablation with ADT in patients with symptomatic paroxysmal AF who previously did not respond to at least 1 antiarrhythmic drug. The randomised study was conducted at 19 hospitals and included 167 patients who had experienced at least 3 AF episodes within 6 months before randomisation. Enrollment occurred between October 2004 and October 2007, with the last follow-up on January 19, 2009. Patients were randomised to catheter ablation (n = 106) or ADT (n = 61), with assessment for effectiveness in a 9-month follow-up period. The primary outcome was time to protocol-defined failure, which included documented symptomatic paroxysmal AF during the evaluation period. The researchers found that 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 versus 16% of patients treated with ADT. “Similarly, 70% of patients treated by catheter ablation remained free of symptomatic recurrent atrial arrhythmia versus 19% of patients treated with ADT. In addition, 63% of patients treated by catheter ablation were free of any recurrent atrial arrhythmia versus 17% of patients treated with ADT,” they wrote. Patients in the catheter ablation group also reported significantly better average symptom frequency and severity scores at 3 months on measures of quality of life. 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. “Our multicentre randomised trial demonstrates the superiority of catheter ablation over ADT in the treatment of patients with paroxysmal AF who did not respond to 1 or more drugs,” the authors wrote. “Catheter ablation provided significantly better rhythm control and improved quality of life with a favorable safety profile. These findings argue for early use of catheter ablation therapy in patients with paroxysmal AF unresponsive to initial attempts with pharmacologic control.”
SOURCE: JAMA
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