Is Continuing Antiarrhythmic Therapy Following AF Ablation Beneficial?

Continued use of previously ineffective antiarrhythmic drug therapy (ADT) following catheter ablation by pulmonary vein isolation for paroxysmal atrial fibrillation (AF) was associated with significantly reduced recurrence of atrial tachyarrhythmias, according to the findings of a recent study. 

The study included 153 patients who underwent contact-force guided pulmonary vein isolation (PVI) for paroxysmal AF 3 months prior, who were then randomly assigned to either continue or to discontinue ADT therapy. After PVI, patients were followed for 1 year and completed 2 day Holter and quality of life questionnaires (QOL) during clinical visits at 6 and 12 months.
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The primary endpoint of the study was documented atrial tachyarrhythmia for more than 30 seconds, and second endpoints included repeat ablation, unscheduled visits, and QOL scores. The baseline clinical and initial ablation procedure characteristics were similar. A total of 6 patients were lost to follow-up.

Of the 74 patients in the ADT group, 2 (2.7%) experienced atrial tachyarrhythmia compared with 16 (21.9%) out of 73 patients who were no longer taking ADT.

Participants in the ADT group had a lower rate of ablation (1.3%) and unscheduled visits (2.6%) compared patients no longer receiving ADT (17.1% and 19.7%, respectively). However, QOL scores were similar between the groups.

“In patients free of AF at the end of the 3 months post-ablation blanking period, continued use of previously ineffective ADT significantly reduces recurrence of atrial tachyarrhythmias in the first year after ablation,” the researchers concluded.

—Melissa Weiss

Reference:

Duytschaever M, Demolder A, Phlips T, et al. Pulmonary vein isolation with verses within continued antiarrhythmic drug treatment in subjects with recurrent atrial fibrillation: results from the Powder AF Multicenter Randomized Trial. Presented at: 2017 Heart Rhythm Scientific Sessions; May 10-13, 2017, Chicago, IL. Abstract C-LBCT02-04.