An evaluation of the strategy of maintenance of sinus rhythm by antiarrhythmic drug therapy after ablation and pacing therapy in patients with paroxysmal atrial fibrillation.
OBJECTIVE
Permanent atrial fibrillation develops in many patients after ablation and pacing therapy. We compared a strategy that initially allowed patients to remain in atrial fibrillation with a strategy that initially attempted to restore and maintain sinus rhythm.


RESULTS
In this multicentre randomized controlled trial, 68 patients affected by severely symptomatic paroxysmal atrial fibrillation were assigned, after successful atrioventricular junction ablation and pacing treatment, to antiarrhythmic drug therapy with amiodarone, propafenone, flecainide or sotalol and were compared with 69 patients assigned, after successful AV junction ablation and pacing treatment, to no antiarrhythmic drug therapy. The patients were followed-up for 12 to 24 months (mean 16+/-4). The drug arm patients had a 57% reduction in the risk of developing permanent atrial fibrillation (21% vs 37%, P=0.02). Evaluation after 12 months revealed similar quality of life scores and echocardiographic parameters in the two groups, but the drug arm patients had more episodes of heart failure and hospitalizations (P=0.05). The outcome was similar between the 40 patients who developed permanent atrial fibrillation and the 97 who did not.


CONCLUSIONS
Conventional antiarrhythmic therapy reduces the risk of development of permanent atrial fibrillation after ablation and pacing therapy. The present data do not support the concept that the development of permanent atrial fibrillation is related to an adverse outcome when a perfect control of heart rate is obtained by ablation and pacing.
Brignole
M
M
Department of Cardiology and Arrhythmologic Center, Ospedali Riuniti, Lavagna, Italy.
Menozzi
C
C
Gasparini
M
M
Bongiorni
M G
MG
Botto
G L
GL
Ometto
R
R
Alboni
P
P
Bruna
C
C
Vincenti
A
A
Verlato
R
R
D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000517:prevention & control / Q000628:therapy; D001283:Atrioventricular Node / Q000601:surgery*; D017115:Catheter Ablation; D004452:Echocardiography; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011405:Propafenone / Q000627:therapeutic use; D011446:Prospective Studies; D011788:Quality of Life; D013015:Sotalol / Q000627:therapeutic use; D013997:Time Factors
D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D013015:Sotalol; D005424:Flecainide; D000638:Amiodarone