Antiarrhythmic drug therapy after catheter ablation for atrial fibrillation-Insights from the German Ablation Registry

Ruben Schleberger, Andreas Metzner, Karl-Heinz Kuck, Dietrich Andresen, Stephan Willems, Ellen Hoffmann, Thomas Deneke, Lars Eckardt, Johannes Brachmann, Matthias Hochadel, Jochen Senges, Andreas Rillig, Ruben Schleberger, Andreas Metzner, Karl-Heinz Kuck, Dietrich Andresen, Stephan Willems, Ellen Hoffmann, Thomas Deneke, Lars Eckardt, Johannes Brachmann, Matthias Hochadel, Jochen Senges, Andreas Rillig

Abstract

Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after catheter ablation for atrial fibrillation (AF) are inconsistent. The present study investigates whether postinterventional AAD leads to an improved long-term outcome. Patients from the prospective German Ablation Registry (n = 3275) discharged with or without AAD after catheter ablation for AF were compared regarding the rates of recurrences, reablations and cardiovascular events as well as patient reported outcomes during 12 months follow-up. In patients with paroxysmal AF (n = 2138) the recurrence rate did not differ when discharged with (n = 1051) or without (n = 1087) AAD (adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95-1.35]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05-1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20-2.58]). Similar rates of recurrences, reablations and treatment satisfaction were found in patients with persistent AF (n = 1137) discharged with (n = 641) or without (n = 496) AAD (recurrence: OR 1.22, 95% CI [0.95-1.56]; reablation: OR 1.21, 95% CI [0.91-1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74-2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in patients discharged with or without AAD. In conclusion, the rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction. Clinical trial registration: The trial has been registered under the number NCT01197638.

Keywords: antiarrhythmic drug therapy; atrial fibrillation; catheter ablation; outcome.

© 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.

Figures

FIGURE 1
FIGURE 1
Flow‐chart of the study design. Patients from the German Ablation Registry presenting for their first catheter ablation for atrial fibrillation were included into the analysis. Patients with paroxysmal or persistent atrial fibrillation were analyzed separately. The long‐term outcome of individuals taking antiarrhythmic drug therapy of Vaughan Williams class I or class III at discharge after ablation was compared to the outcome of individuals without prescription of specific antiarrhythmic drugs. Abbreviations: AF, atrial fibrillation
FIGURE 2
FIGURE 2
Adjusted outcome analysis of outcome after catheter ablation for atrial fibrillation. The 12‐months outcome of patients with postinterventional antiarrhythmic drug therapy was compared to patients without postinterventional antiarrhythmic drug therapy. Antiarrhythmic drugs comprised Vaughan Williams Class I and III. Betablocker therapy was allowed in both groups. The upper part of the figure shows patients with paroxysmal atrial fibrillation, the lower part shows patients with persistent atrial fibrillation. The values left of the middle axis stands for a benefit of antiarrhythmic drug therapy. Values right of the axis stand for a disadvantage of antiarrhythmic drug therapy. Adjusted odds ratio or hazard ratio with 95% confidence interval are shown. *Adjusted for age, sex, coronary artery disease, left ventricular ejection fraction>50%, ablation of complex fractionated atrial electrogram, linear lesions, cryo‐ablation, acute procedural success. **Adjusted for above mentioned factors (*) plus long‐standing persistent atrial fibrillation in addition. Abbreviations: AF, atrial fibrillation; CI, confidence interval; MACCE, major adverse cardiac and cerebrovascular event
FIGURE 3
FIGURE 3
12‐Months outcome analysis of patient reported outcome (Univariate Analysis). (A) Patients with paroxysmal atrial fibrillation. (B) Patients with persistent atrial fibrillation. The patient reported outcome parameters symptom status (stacked bars on the left) and treatment satisfaction (stacked bars on the right) at the end of follow‐up after catheter ablation are displayed. Antiarrhythmic drugs comprised Vaughan Williams Class I and III. Betablocker therapy was part of the treatment in both groups. p < .05 was considered statistically significant, there were no significant differences between groups. AAD, antiarrhythmic drugs, p, p‐Value, %, per cent

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