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LONDON, UK – In patients with atrial fibrillation (AF) treated with radiofrequency catheter ablation, the addition of antiarrhythmic drugs (AADs) for 90 days after the procedure did not reduce arrhythmia recurrence rates at one year, according to results of the Efficacy of Antiarrhythmic Drugs Short-Term Use after Catheter Ablation for Atrial Fibrillation (EAST-AF) trial.
EMBARGO : 30 August 2015 at 09:00 BST
Results of the study, presented as a Hot Line at ESC Congress 2015, were published simultaneously in The European Heart Journal (to be confirmed).The study did show a temporary benefit of AAD, but the effect disappeared as soon as medication was stopped, suggesting no benefit to making post-ablation AAD therapy standard practice, said study investigator Kazuaki Kaitani, MD, from Tenri Hospital in Tenri, Nara, Japan.
Radiofrequency ablation around the pulmonary veins, known as “pulmonary vein isolation” (PVI), is the standard treatment for AF, but recurrence is common.
Short-term (6 weeks) therapy with AADs after PVI for paroxysmal AF has been previously shown to reduce early arrhythmia recurrence rates compared to no AADs, but this benefit disappeared after treatment discontinuation.
The EAST-AF trial investigated whether a longer treatment period might extend the benefit beyond AAD discontinuation.The study included 2,044 patients (mean age 63 years) undergoing first radiofrequency catheter ablation for AF at 19 cardiovascular centres in Japan.
Patients were randomised to treatment with AADs (n=1,016) or a control group (n=1,022) for 90 days after the procedure.The primary endpoint of the study was arrhythmias lasting for more than 30 seconds or requiring repeat ablation, hospital admission, cardioversion or AADs between 3 months and 1-year post ablation.
While there was a significantly lower rate of early arrhythmia recurrences in the AAD group compared with the control group during the treatment period (41.0% versus 47.9%, respectively; P=0.013), this benefit did not persist after AAD discontinuation.
The 1-year recurrence-free rate was 69.5% in the AAD group and 67.8% in the control group, with no significant difference between the two groups (adjusted hazard-ratio [HR] 0.93; 95% confidence-interval, 0.79 to 1.09; P=0.38).
In addition, this finding was consistent across all prespecified subgroups, including patients with paroxysmal AF versus those with persistent or long-lasting AF.
“Therefore, we concluded that the short-term use of AADs for 90-days following catheter ablation of AF reduces the incidence of recurrent AF during the 90-day treatment period, but does not lead to improved clinical outcomes in the later phase,” he said.
SOURCES OF FUNDING : The study was supported by the Research Institute for Production Development in Kyoto, Japan.DISCLOSURES: Dr. Kaitani reports no conflict of interest.
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About the European Society of CardiologyThe European Society of Cardiology (ESC) represents more than 90 000 cardiology professionals across Europe and worldwide. Its mission is to reduce the burden of cardiovascular disease in Europe. About ESC Congress 2015ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2015 takes place 29 August to 2 September at ExCel London in London, UK. Access the scientific programme. More information is available from the ESC Press Office at firstname.lastname@example.org.To access all the scientific resources from the sessions during the congress, visit ESC Congress 365. This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2015. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.
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