title: A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study.
abstract: OBJECTIVE
  We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF).
  
  
  BACKGROUND
  Atrial fibrillation (AF) ablation strategy is superior to ADT in patients with an initial history of PAF, but its role in patients with a long history of AF as compared with ADT remains a challenge.
  
  
  METHODS
  One hundred ninety-eight patients (age, 56 +/- 10 years) with PAF of 6 +/- 5 years' duration (mean AF episodes 3.4/month) who had failed ADT were randomized to AF ablation by circumferential pulmonary vein ablation (CPVA) or to the maximum tolerable doses of another ADT, which included flecainide, sotalol, and amiodarone. Crossover to CPVA was allowed after 3 months of ADT.
  
  
  RESULTS
  By Kaplan-Meier analysis, 86% of patients in the CPVA group and 22% of those in the ADT group who did not require a second ADT were free from recurrent atrial tachyarrhythmias (AT) (p < 0.001); a repeat ablation was performed in 9% of patients in the CPVA group for recurrent AF (6%) or atrial tachycardia (3%). At 1 year, 93% and 35% of the CPVA and ADT groups, respectively, were AT-free. Ejection fraction, hypertension, and age independently predicted AF recurrences in the ADT group. Circumferential pulmonary vein ablation was associated with fewer cardiovascular hospitalizations (p < 0.01). One transient ischemic attack and 1 pericardial effusion occurred in the CPVA group; side effects of ADT were observed in 23 patients.
  
  
  CONCLUSIONS
  Circumferential pulmonary vein ablation is more successful than ADT for prevention of PAF with few complications. Atrial fibrillation ablation warrants consideration in selected patients in whom ADT had already failed and maintenance of sinus rhythm is desired. (A Controlled Randomized Trial of CPVA Versus Antiarrhythmic Drug Therapy in for Paroxysmal AF: APAF/01; http://clinicaltrials.gov/ct/show; NCT00340314).
authors.affiliation: Division of Cardiac Pacing and Electrophysiology, San Raffaele University Hospital, Milan, Italy. carlo.pappone@hsr.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Augello
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.forename: Filippo
authors.initials: F
authors.lastname: Gugliotta
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.forename: Simone
authors.initials: S
authors.lastname: Gulletta
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Sora
authors.forename: Isabelle
authors.initials: I
authors.lastname: Greiss
authors.forename: Andreina
authors.initials: A
authors.lastname: Santagostino
authors.forename: Laura
authors.initials: L
authors.lastname: LiVolsi
authors.forename: Nicola
authors.initials: N
authors.lastname: Pappone
authors.forename: Andrea
authors.initials: A
authors.lastname: Radinovic
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
mesh_terms: D000367:Age Factors; D000368:Aged; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D005424:Flecainide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D019233:Retreatment; D013015:Sotalol / Q000627:therapeutic use; D013318:Stroke Volume; D017211:Treatment Failure
chemical_list: D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D005424:Flecainide; D000638:Amiodarone