title: Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation.
abstract: BACKGROUND
  The aim of this prospective randomized study was to assess whether an early reablation was superior to antiarrhythmic drug (AAD) therapy in patients with previous failed pulmonary vein isolation.
  
  
  RESULTS
  Patients with paroxysmal atrial fibrillation (AF) eligible for AAD therapy or reablation after a previously failed initial pulmonary vein isolation procedure were eligible for this study and were followed up for 3 years to assess rhythm by means of an implanted cardiac monitor. After the blanking period postablation, 154 patients had symptomatic AF recurrences and were randomized to AAD (n=77) or repulmonary vein isolation (n=77). At the end of follow-up, 61 (79%) patients in the AAD group and 19 (25%) patients in the reablation group demonstrated AF% progression (P<0.01). The AF% at 36 months was significantly greater in the AAD group compared with patients in the reablation group (18.8±11.4% versus 5.6±9.5%, respectively; P<0.01). In addition, 18 (23%) patients in the AAD group and 3 (4%) patients in the reablation group progressed to persistent AF (P<0.01). Furthermore, 45 (58%) of the 77 reablation group patients were free of AF/atrial tachycardia on no AADs; in contrast, in the AAD group, only 9 (12%) of the 77 patients were free of AF/atrial tachycardia (P<0.01) throughout follow-up.
  
  
  CONCLUSIONS
  Redo AF ablation was substantially more effective than AAD in reducing the progression and prevalence of AF after the failure of an initial ablation.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709682.
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.forename: Mirko
authors.initials: M
authors.lastname: De Melis
authors.forename: Sergey
authors.initials: S
authors.lastname: Artyomenko
authors.forename: Vera
authors.initials: V
authors.lastname: Baranova
authors.forename: Denis
authors.initials: D
authors.lastname: Losik
authors.forename: Sevda
authors.initials: S
authors.lastname: Bairamova
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.forename: Suneet
authors.initials: S
authors.lastname: Mittal
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012426:Russia; D013997:Time Factors; D017211:Treatment Failure
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: ablation; antiarrhythmic drug; atrial fibrillation; atrial fibrillation progression; continuous implantable monitor