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Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial

2015; Oxford University Press; Volume: 37; Issue: 7 Linguagem: Inglês

10.1093/eurheartj/ehv501

1522-9645

Kazuaki Kaitani, Koichi Inoue, Atsushi Kobori, Yuko Nakazawa, Tomoya Ozawa, Toshiya Kurotobi, Itsuro Morishima, Fumiharu Miura, Tetsuya Watanabe, Masaharu Masuda, Masaki Naito, Hajime Fujimoto, Taku Nishida, Yoshio Furukawa, Takeshi Shirayama, Mariko Tanaka, Katsunori Okajima, Takenori Yao, Yasuyuki Egami, Kazuhiro Satomi, Takashi Noda, Koji Miyamoto, Tetsuya Haruna, Tetsuma Kawaji, Takashi Yoshizawa, Toshiaki Toyota, Mitsuhiko Yahata, Kentaro Nakai, Hiroaki Sugiyama, Yukei Higashi, Makoto Ito, Minoru Horie, Kengo Kusano, Wataru Shimizu, Shiro Kamakura, Takeshi Morimoto, Takeshi Kimura, Satoshi Shizuta,

Cardiac electrophysiology and arrhythmias

Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73–0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79–1.09; P = 0.38). Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase.