Abstract 2757: Catheter Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation. A Long-term Randomized Follow-up Study. The APAF2 Study
Background: The APAF study demonstrated that ablation strategy is superior to conventional antiarrhythmic drug therapy (ADT) in the short term follow-up (12 months). However, whether this benefit is maintained in the long-term over years is unknown.
Methods: One hundred ninety-eight patients (age, 56 +/− 10 years) with PAF of 6 +/− 5 years’ duration (mean AF episodes 3.4/month) were randomized to AF ablation by circumferential pulmonary vein ablation (CPVA) or to the maximum tolerable doses of conventional ADT, which included flecainide, sotalol, and amiodarone. Primary end point of the study was AF recurrence freedom at 1 and 3 years of follow-up.
Results: At 1 year, 87% and 37% of the CPVA and ADT groups, respectively, were AF-free (p<0.001 by log-rank). The benefit of catheter ablation was maintained in the long-term since at 3 years, 81.8% and 17.2% remained AF-free (p<0.001, by log-rank, Fig. 1⇓). Catheter ablation was associated with fewer cardiovascular hospitalizations (p < 0.01).
Conclusions: Catheter ablation is more effective than ADT in maintaining sinus rhythm and this benefit persists over years.