title: Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study).
abstract: BACKGROUND
  Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias.
  
  
  RESULTS
  We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55+/-9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared.
  
  
  CONCLUSIONS
  AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
authors.forename: Erica
authors.initials: E
authors.lastname: Zado
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.forename: Fermin
authors.initials: F
authors.lastname: Garcia
authors.forename: David
authors.initials: D
authors.lastname: Lin
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
authors.forename: Rupa
authors.initials: R
authors.lastname: Bala
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.forename: Michael
authors.initials: M
authors.lastname: Riley
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Russo
authors.forename: Mathew D
authors.initials: MD
authors.lastname: Hutchinson
authors.forename: Joshua
authors.initials: J
authors.lastname: Cooper
authors.forename: Ralph
authors.initials: R
authors.lastname: Verdino
authors.forename: Vickas
authors.initials: V
authors.lastname: Patel
authors.forename: Parijat S
authors.initials: PS
authors.lastname: Joy
authors.forename: Edward P
authors.initials: EP
authors.lastname: Gerstenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D012008:Recurrence
chemical_list: D000889:Anti-Arrhythmia Agents