Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of antiarrhythmic drug therapy vs re-ablation

• Main Authors: Д. В. Лосик, А. Б. Романов, В. В. Шабанов, С. А. Байрамова, А. А. Якубов, И. Г. Стенин, Е. А. Покушалов
• Format: Article
• Language: Russian
• Published: Meshalkin National Medical Research Center 2015-10-01
• Series: Патология кровообращения и кардиохирургия
• Subjects: Фибрилляция предсердий; Устройство непрерывного мониторирования ЭКГ; Повторная радиочастотная изоляция легочных вен; Антиаритмическая терапия
• Online Access: http://journalmeshalkin.ru/index.php/heartjournal/article/view/229

<p><strong>Background.</strong> Treating atrial fibrillation (AF) with antiarrhythmic drugs (AAD) remains to be the first line therapy. Radiofrequency ablation is an alternative technique; however, in case of AF relapses, patients have to receive AAD. <br /><strong>Objective.</strong> The authors wanted to compare the efficacy of AAD and re-ablation in patients after a previous failed initial RF ablation. <br /><strong>Methods.</strong> 154 patients with AF persistent paroxysms after 3 months since the initial RF ablation were randomized into 2 groups. The first group received AAD therapy (77) and the second group underwent a re-ablation procedure (77). The patients were followed up for 3 years to assess the rhythm by means of an implanted cardiac monitor. <br /><strong>Results.</strong> At the end of follow-up, 18 (23%) patients in the AAD group and 3 (4%) patients in the re-ablation group progressed to persistent AF or increased AF progression by 30% as compared to preoperative data (p&lt;0.01). In the AAD group AF% significantly increased as compared to that in the re-ablation group (at 36 months it was 18.8±11.4% vs 5.6±9.5% respectively (p&lt;0.01). Moreover, 45 (58%) patients of the re-ablation group became AF/AT-free without antiarrhythmic drugs; in contrast, in the AAD group, only 9 (12%) of 77 patients were AF/AT-free (p&lt;0.01). Multivariate logistic regression analysis allowed for finding out that the overage (more than 60 years) (OR 2.1; 95% confidence interval 1.1-4.1; p=0.04), AF anamnesis exceeding 5 years (OR 3.3; 95% confidence interval 1.7-6.3; p&lt;0.01), arterial hypertension (OR 3.1; 95% confidence interval 5.1-6.3; p &lt; 0.01) and diabetes mellitus (OR 4.6; 95% confidence interval 1.3-16.9; p=0.02) are inde-pendent AF progression predictors. When using HATCH score to assess AF progression, it was found out that a 2 points indicator cannot be considered as an independent predictor of AF progression (OR 2.3; 95% confidence interval -0.7-9.3; p=0.24).<br /><strong>Conclusion.</strong> The results demonstrate that AF RF re-ablation is more effective than AAD therapy for preventing AF progression.</p>