doi: 10.1161/CIRCULATIONAHA.108.191130
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(Circulation. 2008;118:2485-2487.)
© 2008 American Heart Association, Inc.
Clinical Summaries
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: The A4 Study |
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The mainstay of treatment for atrial fibrillation has historically been pharmacological, using drugs to control either the rhythm or the rate. However, nonpharmacological approaches have been effective at restoring sinus rhythm in drug-refractory patients, raising the possibility of using catheter ablation earlier in the management cascade than previously envisaged. Nonrandomized or single-center studies suggesting the superiority of catheter ablation over antiarrhythmic drug treatment have been reported. We performed a prospective randomized controlled trial involving 112 patients in 4 centers, 2 in North America and 2 in Europe, comparing a strategy of additional antiarrhythmic drugs (59 patients) with catheter ablation (53 patients) for patients with paroxysmal atrial fibrillation who had previously failed at least 1 antiarrhythmic drug. At the 1-year follow-up, 13 of 55 patients (23%) and 46 of 52 patients (89%) had no recurrence of atrial fibrillation in the antiarrhythmic drug and ablation groups, respectively (P<0.0001). Symptom score, exercise capacity, and quality-of-life scores were significantly higher in the ablation group. This multicenter randomized trial demonstrates that catheter ablation of atrial fibrillation is superior to antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation who have previously taken and failed antiarrhythmic drugs. The substantial improvement in quality of life, symptoms, and physical performance in this series of relatively young and healthy patients constitutes an important benefit that may support earlier use of catheter ablation in this context. See p 2498.
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Cholesteryl Ester Transfer Protein Inhibition, High-Density Lipoprotein Raising, and Progression of Coronary Atherosclerosis: Insights From ILLUSTRATE (Investigation of Lipid Level Management Using Coronary Ultrasound to Assess Reduction of Atherosclerosis by CETP Inhibition and HDL Elevation) |
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Considerable interest has focused on the development of therapies that raise systemic levels of high-density lipoprotein (HDL) cholesterol.
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