Central Sympathetic Inhibition to Reduce Post-Ablation Atrial Fibrillation Recurrences in Hypertensive Patients: A Randomized Controlled Study
Background—The autonomic system is an important determinant of atrial arrhythmogenesis. Current evidence indicates that a combined sympathovagal drive is most commonly responsible for eliciting atrial fibrillation (AF) episodes. The purpose of this study was to test whether moxonidine, a centrally acting sympathoinhibitory agent, can lead to reduction in post-ablation AF recurrence.
Methods and Results—This was a prospective, double-blinded, randomized study of 291 hypertensive patients with symptomatic paroxysmal AF scheduled to undergo pulmonary vein isolation (PVI). Patients were randomized to receive either moxonidine (0.2-0.4 mg daily) or placebo, along with standard antihypertensive treatment. No significant differences in blood pressure levels were observed between the two groups. In the primary outcome analysis, mean recurrence-free survival was 467 days (95% confidence interval 445-489 days) in the moxonidine group as compared to 409 days (95% confidence interval 381-437 days) in controls (log rank test p=0.006). The calculated 12-month recurrence rate estimates were 36.9% in the control group and 20.0% in the moxonidine group (p=0.007). Moxonidine treatment was associated with lower recurrence risk after adjustment for age, body-mass index, number of AF episodes in previous year and left atrial diameter (adjusted hazard ratio 0.35; 95% confidence interval 0.22-0.55; p<0.001).
Conclusions—Treatment with moxonidine is associated with less AF recurrences after ablation treatment for drug-refractory AF in patients with hypertension. The observed effect does not appear to be dependent on the antihypertensive action of this agent.
Clinical Trial Registration Information—ClinicalTrials.gov. Identifier: NCT01791699.
- Received May 5, 2014.
- Revision received August 13, 2014.
- Accepted August 18, 2014.