title: Radiofrequency catheter ablation maintains its efficacy better than antiarrhythmic medication in patients with paroxysmal atrial fibrillation: On-treatment analysis of the randomized controlled MANTRA-PAF trial.
abstract: BACKGROUND
  The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) is a randomized trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drugs (AADs) as first-line treatment of paroxysmal atrial fibrillation (PAF). In order to eliminate the clouding effect of crossover we performed an on-treatment analysis of the data.
  
  
  RESULTS
  Patients (n=294) were divided into three groups: those receiving only the assigned therapy (RFA and AAD groups) and those receiving both therapies (crossover group). The primary end points were AF burden in 7-day Holter recordings at 3, 6, 12, 18, and 24 months and cumulative AF burden in all recordings. At 24 months, AF burden was significantly lower in the RFA (n=110) than in the AAD (n=92) and the crossover (n=84) groups (90th percentile 1% vs. 10% vs. 16%, P=0.007), and more patients were free from any AF (89% vs. 73% vs. 74%, P=0.006). In the RFA, AAD and the crossover groups 63%, 59% and 21% (P<0.001) of the patients had no AF episodes in any Holter recording, respectively. Quality of life improved significantly in all groups. There were no differences in serious adverse events between the RFA, AAD and crossover groups (19% vs. 8% vs. 23%) (P=0.10).
  
  
  CONCLUSIONS
  In the treatment of antiarrhythmic therapy naïve patients with PAF long-term efficacy of RFA was superior to AAD therapy. Thus, it is reasonable to offer RFA as first-line treatment for highly symptomatic patients who accept the risks of the procedure and are aware of frequent need for reablation(s).
authors.affiliation: Central Finland Health Care District, Jyväskylä, Finland and University of Eastern Finland, Kuopio, Finland. Electronic address: pekka.raatikainen@uta.fi.
authors.forename: M J Pekka
authors.initials: MJ
authors.lastname: Raatikainen
authors.affiliation: University of Oulu, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Hakalahti
authors.affiliation: University of Oulu, Finland.
authors.forename: Paavo
authors.initials: P
authors.lastname: Uusimaa
authors.affiliation: Aarhus University Hospital, Århus, Denmark.
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.affiliation: Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Arne
authors.initials: A
authors.lastname: Johannessen
authors.affiliation: Leipzig University Hospital, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Håkan
authors.initials: H
authors.lastname: Walfridsson
authors.affiliation: Rigshospitalet, Copenhagen, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Pehrson
authors.affiliation: University Hospital, Örebro, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Englund
authors.affiliation: Kuopio University Hospital, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.affiliation: Lund University Hospital, Lund, Sweden.
authors.forename: Ole
authors.initials: O
authors.lastname: Kongstad
authors.affiliation: UNI-C, Danish Information Technology Centre for Education and Research, Aarhus, Denmark.
authors.forename: Leif Spange
authors.initials: LS
authors.lastname: Mortensen
authors.affiliation: Aarhus University Hospital, Århus, Denmark.
authors.forename: Peter Steen
authors.initials: PS
authors.lastname: Hansen
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000592:standards; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drug; Atrial fibrillation; Catheter ablation; Long-term efficacy; On-treatment analysis