Catheter ablation "feasible" as first-line approach for patients with symptomatic AF

Pulmonary vein isolation appears to be a feasible first-line approach for treating patients with symptomatic AF, a study comparing radiofrequency ablation of AF with standard antiarrhythmic therapy has found. However, the researchers note that larger studies are needed to confirm its safety and efficacy."Treatment with antiarrhythmic drugs and anticoagulation has been considered first-line therapy in patients with symptomatic AF. However, anticoagulation is suboptimal in many cases, and antiarrhythmic drugs are frequently ineffective and have serious potential adverse effects," write Dr Oussama and colleagues in the June edition of JAMA.In order to determine whether pulmonary vein isolation (PVI) is feasible as first-line therapy for treating patients with symptomatic AF, the researchers conducted a multi-centre prospective randomized study of 70 patients aged 18 to 75 years who experienced monthly symptomatic AF episodes for at least three months and had not been treated with antiarrhythmic drugs. Patients were randomized to receive either PVI using radiofrequency ablation (n=33) or antiarrhythmic drug treatment (n=37).After a one-year follow up, 22 (63%) of 35 patients who received antiarrhythmic drugs had at least one recurrence of symptomatic AF compared with four (13%) of 32 patients who received PVI (PHospitalization occurred in 19 (54%) of 35 patients in the antiarrhythmic drug group compared with three (9%) of 32 in the PVI group (PIn the antiarrhythmic drug group, the mean (SD) number of AF episodes decreased from 12 (7) to six (4), after initiating therapy (P = .01).At six-month follow-up, the improvement in quality of life of patients in the PVI group was significantly better than the improvement in the antiarrhythmic drug group in five subclasses of the Short-Form 36 health survey.There were no thromboembolic events in either group. Asymptomatic mild or moderate pulmonary vein stenosis was documented in two (6%) of 32 patients in the PVI group. Oussama and colleagues conclude that PVI is a "feasible firstline approach for the treatment of selected patients with symptomatic AF."They note that a multicentre randomized trial with a larger number of centres and patients, and longer follow-up is needed to further assess whether the benefits of AF ablation outweigh the "inherent risks of an invasive procedure.""Until such a study is performed, PVI should not be considered standard of care as firstline therapy for AF. Nevertheless, the results of our study suggest that ablation to cure AF may become the treatment of first choice in appropriately selected patients with AF," they write.Reference...