Vol. 19 No. 2 (2015)
CARDIOLOGY

Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of antiarrhythmic drug therapy vs re-ablation

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  • D. Losik,
  • A. Romanov,
  • V. Shabanov,
  • S. Bairamova,
  • A. Yakubov,
  • I. Stenin,
  • Ye. Pokushalov
D. Losik
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
A. Romanov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
V. Shabanov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
S. Bairamova
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
A. Yakubov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
I. Stenin
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
Ye. Pokushalov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, 15 Rechkunovskaya Str., 630055, Novosibirsk, Russian Federation
Bio
DOI: https://doi.org/10.21688/1681-3472-2015-2-84-92

Published 2015-10-12

Keywords

  • atrial fibrillation,
  • ablation,
  • pulmonary veins,
  • implantable cardiac monitor,
  • antiarrhythmic drugs,
  • atrial fibrillation progression
    • ...More
    Less

How to Cite

Losik, D., Romanov, A., Shabanov, V., Bairamova, S., Yakubov, A., Stenin, I., & Pokushalov, Y. (2015). Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of antiarrhythmic drug therapy vs re-ablation. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 19(2), 84–92. https://doi.org/10.21688/1681-3472-2015-2-84-92

Copyright (c) 2015 Losik D.V., Romanov A.B., Shabanov V.V., Bairamova S.A., Yakubov A.A., Stenin I.G., Pokushalov Ye.A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background. Treating atrial fibrillation (AF) with antiarrhythmic drugs (AAD) remains to be the first line therapy. Radiofrequency ablation is an alternative technique; however, in case of AF relapses, patients have to receive AAD.
Objective. The authors wanted to compare the efficacy of AAD and re-ablation in patients after a previous failed initial RF ablation.
Methods. 154 patients with AF persistent paroxysms after 3 months since the initial RF ablation were randomized into 2 groups. The first group received AAD therapy (77) and the second group underwent a re-ablation procedure (77). The patients were followed up for 3 years to assess the rhythm by means of an implanted cardiac monitor.
Results. At the end of follow-up, 18 (23%) patients in the AAD group and 3 (4%) patients in the re-ablation group progressed to persistent AF or increased AF progression by 30% as compared to preoperative data (p<0.01). In the AAD group AF% significantly increased as compared to that in the re-ablation group (at 36 months it was 18.8±11.4% vs 5.6±9.5% respectively (p<0.01). Moreover, 45 (58%) patients of the re-ablation group became AF/AT-free without antiarrhythmic drugs; in contrast, in the AAD group, only 9 (12%) of 77 patients were AF/AT-free (p<0.01). Multivariate logistic regression analysis allowed for finding out that the overage (more than 60 years) (OR 2.1; 95% confidence interval 1.1-4.1; p=0.04), AF anamnesis exceeding 5 years (OR 3.3; 95% confidence interval 1.7-6.3; p<0.01), arterial hypertension (OR 3.1; 95% confidence interval 5.1-6.3; p < 0.01) and diabetes mellitus (OR 4.6; 95% confidence interval 1.3-16.9; p=0.02) are inde-pendent AF progression predictors. When using HATCH score to assess AF progression, it was found out that a 2 points indicator cannot be considered as an independent predictor of AF progression (OR 2.3; 95% confidence interval -0.7-9.3; p=0.24).
Conclusion. The results demonstrate that AF RF re-ablation is more effective than AAD therapy for preventing AF progression.

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