This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 120/12/1036    most recent CIRCULATIONAHA.108.839639v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Roux, J.-F. Articles by Gerstenfeld, E. P. PubMed PubMed Citation Articles by Roux, J.-F. Articles by Gerstenfeld, E. P. Pubmed/NCBI databases Medline Plus Health Information Atrial Fibrillation Related Collections Ablation/ICD/surgery Arrhythmias, clinical electrophysiology, drugs Related Article

(Circulation. 2009;120:1036-1040.)
© 2009 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)

Jean-François Roux, MD; Erica Zado, PA-C; David J. Callans, MD; Fermin Garcia, MD; David Lin, MD; Francis E. Marchlinski, MD; Rupa Bala, MD; Sanjay Dixit, MD; Michael Riley, MD, PhD; Andrea M. Russo, MD; Mathew D. Hutchinson, MD; Joshua Cooper, MD; Ralph Verdino, MD; Vickas Patel, MD, PhD; Parijat S. Joy, MD; Edward P. Gerstenfeld, MD

From the Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa.

Correspondence to Dr Edward P. Gerstenfeld, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce St, Philadelphia, PA 19104. E-mail edward.gerstenfeld{at}uphs.upenn.edu

Received December 3, 2009; accepted July 10, 2009.

Background— Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias.

Methods and Results— We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared.

Conclusions— AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2009 120: 1021-1023. [Extract] [Full Text]