Ablation aces drug therapy in persistent AF

  • Catheter ablation trumps medical management for maintaining sinus rhythm in patients with persistent atrial fibrillation, a randomised trial finds.


    At one-year follow-up, 70% of patients who underwent ablation were free of sustained AF, compared with 44% of those treated with antiarrhythmic drugs.


    No deaths or major adverse events occurred in either group, Spanish researchers reported in the European Heart Journal.


    "Catheter ablation is superior to medical therapy as a strategy for maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up," they concluded.


    Guidelines recommend catheter ablation for paroxysmal, treatment-resistant AF and the procedure has been extensively studied in this context.


    However, its use in persistent AF is more controversial, the researchers said, claiming theirs was the first randomised trial in this patient group.


    The trial included 146 patients aged 18-70 with symptomatic AF of between one week and one year's duration, in whom at least one antiarrhythmic drug had failed.


    Ninety-three underwent ablation, 48 continued guideline-directed medical therapy and five withdrew.


    Associate Professor Stuart Thomas, a senior staff specialist and director of the cardiac interventional laboratories at Sydney's Westmead Hospital, said the study was high-quality and was likely to apply to Australian patients.


    "For this group of patients, there's a definite benefit in terms of recurrence of atrial fibrillation in undergoing the procedure," he said.


    "That doesn't mean it's going to be good for everybody, as there is still a small risk associated with having the procedure ... but for those failing medical therapy, this shows they're still going to benefit, even if they have persistent AF."


    Ablation for persistent AF was "more technically demanding" than for paroxysmal AF, and was typically performed only in higher-volume centres, Professor Thomas said.


    The procedure carried about a 0.5-1% risk of serious complications such as stroke or MI, he said.



    The study was funded by Medtronic and Biosense Webster. Associate Professor Thomas declared no potential conflicts of interest.

    European Heart Journal 2013; online.


    By David Brill