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(Circulation. 2009;120:S657.)
© 2009 American Heart Association, Inc.

Catheter Ablation of Atrial Fibrillation: Outcomes, Complications, and Strategies

Abstract 2542: Early Rhythm Control Strategy by Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation: The 4-year Results of a Randomized Follow-up Study Comparing Catheter Ablation and Antiarrhythmic Drug Therapy: The APAF 2 Study

Vincenzo Santinelli; Andrea Radinovic; Gabriele Vicedomini; Giuseppe Ciconte; Giuseppe Augello; Simone Sala; Alessia Pappone; Massimo Saviano; Cristiano Ciaccio; Simone Gulletta; Patrizio Mazzone; Carlo Pappone

San Raffaele Univ Hosp, Milan, Italy

Introduction: No data are available on potential long-term superiority of catheter ablation (CA) over antiarrhythmic drugs (AADs) in patients with paroxysmal atrial fibrillation (AF).

Methods: This prospective long-term follow-up study (4 years) includes the 198 patients (mean age, 56±10 years) who were randomly assigned to CPVA (99 patients) or to AADs (99 patients) in the APAF study. Efficacy at 4 years after randomization for both groups as well as QoL, number of redo procedures, crossover, complications and arrhythmia progression were evaluated.

Results: The superiority of CA at 1 year was maintained up to 4 years, despite a large number of crossovers from AADs to CA (87/99 patients; 87.9%) throughout the entire follow-up period. At the end of the study, 90 CPVA patients (72 after single and 18 after redo procedures) and 80 AADs patients (68 after switch to CA) maintained sinus rhythm (p=0.023), while considering the first procedure, crossover to CA, redo procedures and AADs, 3/198 patients definitively progressed to permanent AF (Figure 1). Catheter ablation was associated with fewer cardiovascular hospitalizations and higher QoL (p<0.01).

Conclusions: Catheter ablation remains superior to AADs at 4-year follow-up despite crossover to CA for almost all patients initially randomized to AADs. These data indicate that an early CA strategy is preferable in terms of efficacy, adverse events, QoL, and arrhythmia progression.

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