title: Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study).
abstract: BACKGROUND
  Catheter ablation (CA) is a highly effective therapy for the treatment of paroxysmal atrial fibrillation (AF) when compared with antiarrhythmic drug therapy (ADT). No randomized studies have compared the two strategies in persistent AF. The present randomized trial aimed to compare the effectiveness of CA vs. ADT in treating persistent AF.
  
  
  RESULTS
  Patients with persistent AF were randomly assigned to CA or ADT (excluding patients with long-standing persistent AF). Primary endpoint at 12-month follow-up was defined as any episode of AF or atrial flutter lasting >24 h that occurred after a 3-month blanking period. Secondary endpoints were any atrial tachyarrhythmia lasting >30 s, hospitalization, and electrical cardioversion. In total, 146 patients were included (aged 55 ± 9 years, 77% male). The ADT group received class Ic (43.8%) or class III drugs (56.3%). In an intention-to-treat analysis, 69 of 98 patients (70.4%) in the CA group and 21 of 48 patients (43.7%) in the ADT group were free of the primary endpoint (P = 0.002), implying an absolute risk difference of 26.6% (95% CI 10.0-43.3) in favour of CA. The proportion of patients free of any recurrence (>30 s) was higher in the CA group than in the ADT group (60.2 vs. 29.2%; P < 0.001) and cardioversion was less frequent (34.7 vs. 50%, respectively; P = 0.018).
  
  
  CONCLUSIONS
  Catheter ablation is superior to medical therapy for the maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up.
  
  
  BACKGROUND
  NCT00863213 (http://clinicaltrials.gov/ct2/show/NCT00863213).
authors.affiliation: Unitat de Fibril·lació Auricular (UFA), Arrhythmia Section - Hospital Clínic, Universitat de Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/ Villarroel, 170, Barcelona, Catalonia 08036, Spain.
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
authors.forename: Felipe
authors.initials: F
authors.lastname: Bisbal
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Madrid
authors.forename: Nicasio
authors.initials: N
authors.lastname: Pérez-Castellano
authors.forename: Xavier
authors.initials: X
authors.lastname: Viñolas
authors.forename: Angel
authors.initials: A
authors.lastname: Arenal
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernández-Lozano
authors.forename: Andrés
authors.initials: A
authors.lastname: Bodegas
authors.forename: Albert
authors.initials: A
authors.lastname: Cobos
authors.forename: Roberto
authors.initials: R
authors.lastname: Matía
authors.forename: Julián
authors.initials: J
authors.lastname: Pérez-Villacastín
authors.forename: José M
authors.initials: JM
authors.lastname: Guerra
authors.forename: Pablo
authors.initials: P
authors.lastname: Ávila
authors.forename: María
authors.initials: M
authors.lastname: López-Gil
authors.forename: Victor
authors.initials: V
authors.lastname: Castro
authors.forename: José Ignacio
authors.initials: JI
authors.lastname: Arana
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D057239:Early Termination of Clinical Trials; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drug; Atrial fibrillation; Atrial flutter; Catheter ablation; Clinical trial