Antiarrhythmic Medication and AF Ablation Outcomes
Antiarrhythmic Medication and AF Ablation Outcomes
The Effect of Antiarrhythmic Drugs Ablation Outcomes
Background Patients commonly present for atrial fibrillation (AF) ablation while taking antiarrhythmic (AA) medications. It is unknown if AA use at the time of ablation affects procedural outcome. This study compares the AF ablation outcomes of patients who underwent ablation while on AA medications to those who were not on AA medications.
Methods and Results A total of 180 consecutive patients who underwent their first catheter ablation of AF were identified from the Johns Hopkins Hospital AF registry and divided into 2 cohorts: those On AA at the time of ablation (127 patients, mean follow-up 24.6 months) and those Off AA at the time of ablation (53 patients, mean follow-up 20.3 months). Follow-up was performed to identify recurrent AF. There was no statistically significant difference in the percentage of patients without a recurrence of symptomatic AF (single procedure success rate) in the On and Off AA groups at 6 months postablation (53.5% vs 50.1%, P = 0.75), or by the end of follow-up (37.8% vs 41.5%, P = 0.64). For those patients who had symptomatic AF recurrence, the average time to recurrence was 6.2 ± 9.0 months in the On AA group and 4.2 ± 7.2 months in the Off AA group (P = 0.27).
Conclusions There was no statistically significant difference in the rate of symptomatic AF recurrence between the On AA and Off AA groups in this study. The use of AA medications at the time of ablation does not appear to affect procedural outcomes in this population.
Pulmonary vein isolation (PVI) by radiofrequency ablation has become an established treatment modality for patients with atrial fibrillation (AF) who are poorly tolerant of standard medical therapy. PVI was developed on the premise that by electrically isolating the pulmonary veins (PVs), where the great majority of ectopic foci appear to arise, AF episodes can be broken and future episodes prevented. Following the creation of circumferential ablation lines around the PVs by radiofrequency ablation, identification of residual areas of atrial conduction within the ablation lines is performed through the use of a circumferential multielectrode catheter. This allows for targeted ablation of those areas to ensure complete isolation of the PVs. At many institutions it is standard therapy to have patients on antiarrhythmic (AA) medications at the time of ablation and for the first 3 months following the ablation to prevent early recurrences of AF. Unfortunately, AF recurrence following the discontinuation of AA medications is still relatively common, with reported recurrence rates of 14–80% after a single procedure.
Since AF ablation is generally used as a second line treatment after the failure of medical therapy, most patients referred for ablation have previously been initiated on AA agents. To date, it is unknown if AA use at the time of ablation affects procedural outcome so the decision to continue or hold a patient's AA medications at the time of AF ablation is not standardized. Since AA medications change the refractory period of atrial tissue and suppress electrical conduction, there has been some concern that AA medications taken at the time of ablation may inhibit PV potentials from crossing an incomplete ablation line. This would prevent the circumferential multielectrode catheter from identifying areas of residual conduction, which may lead to procedural failure when the AA medications are discontinued. Alternatively, AA medications may help suppress AF during the healing process. The purpose of this study was to compare the outcomes of AF ablation by PVI according to intraablation AA drug status.
Abstract and Introduction
Abstract
The Effect of Antiarrhythmic Drugs Ablation Outcomes
Background Patients commonly present for atrial fibrillation (AF) ablation while taking antiarrhythmic (AA) medications. It is unknown if AA use at the time of ablation affects procedural outcome. This study compares the AF ablation outcomes of patients who underwent ablation while on AA medications to those who were not on AA medications.
Methods and Results A total of 180 consecutive patients who underwent their first catheter ablation of AF were identified from the Johns Hopkins Hospital AF registry and divided into 2 cohorts: those On AA at the time of ablation (127 patients, mean follow-up 24.6 months) and those Off AA at the time of ablation (53 patients, mean follow-up 20.3 months). Follow-up was performed to identify recurrent AF. There was no statistically significant difference in the percentage of patients without a recurrence of symptomatic AF (single procedure success rate) in the On and Off AA groups at 6 months postablation (53.5% vs 50.1%, P = 0.75), or by the end of follow-up (37.8% vs 41.5%, P = 0.64). For those patients who had symptomatic AF recurrence, the average time to recurrence was 6.2 ± 9.0 months in the On AA group and 4.2 ± 7.2 months in the Off AA group (P = 0.27).
Conclusions There was no statistically significant difference in the rate of symptomatic AF recurrence between the On AA and Off AA groups in this study. The use of AA medications at the time of ablation does not appear to affect procedural outcomes in this population.
Introduction
Pulmonary vein isolation (PVI) by radiofrequency ablation has become an established treatment modality for patients with atrial fibrillation (AF) who are poorly tolerant of standard medical therapy. PVI was developed on the premise that by electrically isolating the pulmonary veins (PVs), where the great majority of ectopic foci appear to arise, AF episodes can be broken and future episodes prevented. Following the creation of circumferential ablation lines around the PVs by radiofrequency ablation, identification of residual areas of atrial conduction within the ablation lines is performed through the use of a circumferential multielectrode catheter. This allows for targeted ablation of those areas to ensure complete isolation of the PVs. At many institutions it is standard therapy to have patients on antiarrhythmic (AA) medications at the time of ablation and for the first 3 months following the ablation to prevent early recurrences of AF. Unfortunately, AF recurrence following the discontinuation of AA medications is still relatively common, with reported recurrence rates of 14–80% after a single procedure.
Since AF ablation is generally used as a second line treatment after the failure of medical therapy, most patients referred for ablation have previously been initiated on AA agents. To date, it is unknown if AA use at the time of ablation affects procedural outcome so the decision to continue or hold a patient's AA medications at the time of AF ablation is not standardized. Since AA medications change the refractory period of atrial tissue and suppress electrical conduction, there has been some concern that AA medications taken at the time of ablation may inhibit PV potentials from crossing an incomplete ablation line. This would prevent the circumferential multielectrode catheter from identifying areas of residual conduction, which may lead to procedural failure when the AA medications are discontinued. Alternatively, AA medications may help suppress AF during the healing process. The purpose of this study was to compare the outcomes of AF ablation by PVI according to intraablation AA drug status.
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