Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: A randomized clinical trial

Xiao Dong Zhang, Jun Gu, Wei Feng Jiang, Liang Zhao, Li Zhou, Yuan Long Wang, Yu Gang Liu, Xu Liu

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Aim: Although catheter ablation (CA) has replaced antiarrhythmic drugs (AAD) as first-line treatment in selected patients with atrial fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT) after AF ablation remains unclear. This parallel randomized controlled study compared CA vs. AAD for recurrent AT after persistent AF ablation. Methods and results: Two-hundred and one patients (aged 59.1 ± 10.9 years, 68.7% male) with recurrent AT after persistent AF ablation were enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment. Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa, including AT and AF) at 24-month follow-up. Composite secondary endpoints comprised procedural complications, long-term morbidity and improvement in quality of life (QoL). On an intention-to-treat basis, the CA group had a higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001). Adjusted Cox regression analysis showed a significant treatment effect with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There was a higher proportion of periprocedural complications in the CA group (7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group (10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for CA. Conclusions: This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.

Original languageEnglish (US)
Pages (from-to)1327-1334
Number of pages8
JournalEuropean heart journal
Volume35
Issue number20
DOIs
StatePublished - May 21 2014
Externally publishedYes

Keywords

  • Antiarrhythmic drugs
  • Atrial fibrillation
  • Atrial tachycardia
  • Catheter ablation
  • Quality of life
  • Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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