Vol. 20 No. 3 (2016)
HEART RHYTHM DISORDERS

Progression of atrial fibrillation after catheter ablation procedure and antiarrhythmic drug therapy in patients with paroxysmal AF

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  • A Simonyan,
  • V Kolesnikov,
  • L Vilenskiy,
  • Yu Krivosheev,
  • D Bashta,
  • M Gatilo,
  • T Myznikova,
  • Z Miskhodzheva
A Simonyan
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
V Kolesnikov
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
L Vilenskiy
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
Yu Krivosheev
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
D Bashta
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
M Gatilo
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
T Myznikova
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
Z Miskhodzheva
Regional Clinical Cardiologic Dispensary, 355026 Stavropol, Russian Federation
Bio
DOI: https://doi.org/10.21688/1681-3472-2016-3-72-81

Published 2016-11-10

Keywords

  • paroxysmal atrial fibrillation,
  • continuous ECG monitoring device,
  • pulmonary vein isolation,
  • implantable cardiac monitors,
  • antiarrhythmic drug therapy

How to Cite

Simonyan, A., Kolesnikov, V., Vilenskiy, L., Krivosheev, Y., Bashta, D., Gatilo, M., Myznikova, T., & Miskhodzheva, Z. (2016). Progression of atrial fibrillation after catheter ablation procedure and antiarrhythmic drug therapy in patients with paroxysmal AF. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(3), 72–81. https://doi.org/10.21688/1681-3472-2016-3-72-81

Copyright (c) 2016 Simonyan A.A., Kolesnikov V.N., Vilenskiy L.I., Krivosheev Yu.S., Bashta D.I., Gatilo M.Yu., Myznikova T.A., Miskhodzheva Z.A.

Creative Commons License

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

Abstract

Aim. This prospective randomized study was aimed to assess the progression of atrial fibrillation (AF) after ablation procedure and antiarrhythmic drug therapy (AAD) in patients with paroxysmal AF by means of implantable cardiac monitors (ICM).
Methods. The study enrolled 92 patients with paroxysmal AF, who were eligible either for catheter ablation or AAD. The patients were randomized into two groups: 1) AAD + ICM implantation (group I; n=46), and 2) AF catheter ablation (CA) + ICM implantation (group II; n=46), and 2). The primary endpoint was AF progression according to ICM data. The AF progression was defined as AF burden > 30%. A complication rate after ablation procedure and side effects of AAD were determined as the secondary endpoints. The follow up of this study was 24 months.
Results. By the end of the follow-up period, AF progression was observed in 27 (58.7%) patients in the AAD group and 10 (21.7%) patients in the CA group (р=0.0003; HR 0.37, 95% CI [0.17-0.76], р=0.007, Cox regression). 13 (28,3%) patients in the AAD group and 2 (4.3%) in the CA group (р=0.002) developed persistent AF. The complication rate in the AAD group was 24% (11 patients) and 6.5 % (3 patients) in the CA group (р=0.02).
Conclusion. Radiofrequency ablation of AF leads to a significant decrease in AF progression when compared with antiarrhythmic drug therapy in patients with paroxysmal AF, which was confirmed by implantable cardiac monitors data.

Received 12 July 2016. Accepted 22 August 2016.

Funding: The study had no sponsorship.
Conflict of interest: The authors declare no conflict of interest.

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References

  1. Feinberg WM, Blackshear JL, Laupacis A, Knomal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Intern Med. 1995;155(5):469-73.
  2. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-5.
  3. de Vos CB, Pisters R, Nieuwlaat R, Prins MH, Tieleman RG, Coelen RJ, van den Heijkant AC, Allessie MA, Crijns HJ. Progression from paroxysmal to persistent atrial fibrillation clinical correlates and prognosis. J Am Coll Cardiol. 2010;55(8):725-31. DOI: 10.1016/j.jacc.2009.11.040
  4. Abe Y, Fukunami M, Yamada T, Ohmori M, Shimonagata T, Kumagai K, Kim J, Sanada S, Hori M, Hoki L. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation by signal averaged electrocardiography: a prospective study. Circulation. 1997;96(8):2612-6.
  5. Sakamoto H, Kurabayashi M, Nagai R, Fujii J. Prediction of transition to chronic atrial fibrillation in patients with paroxysmal atrial fibrillation. Circulation. 1998;98(10):1045-56. DOI: 10.1161/01.CIR.98.10.1045
  6. Scardi S, Mazzone C, Pandullo C, Goldstein D, Poletti A, Humar F. Lone atrial fibrillation: prognostic differences between paroxysmal and chronic forms after 10 years of follow-up. Am Heart J. 1999;137(4 Pt 1):686-91.
  7. Kerr CR, Humphries KH, Talajic M, Klein G, Connolly SJ, Green M, Boone J, Sheldon R, Dorian P, Newman D. Progression to chronic atrial fibrillation after the initial diagnosis of paroxysmal atrial fibrillation: results from the Canadian registry of atrial fibrillation. Am Heart J. 2005;149:489-96.
  8. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 2012;14(4):528-606. DOI: 10.1093/europace/eus027
  9. Khaykin Y, Marrouche NF, Saliba W, Schweikert R, Bash D, Chen MS, Williams-Andrews M, Saad E, Burkhardt DJ, Bhargava M, Joseph G, Rossillo A, Erciyes D, Martin D, Natale A. Pulmonary vein antrum isolation for treatment of atrial fibrillation in patients with valvular heart disease or prior open heart surgery. Heart Rhythm. 2004;1(1):33-9. DOI: 10.1016/j.hrthm.2004.02.007
  10. Ouyang F, Bänsch D, Ernst S, Schaumann A, Hachiya H, Chen M, Chun J, Falk P, Khanedani A, Antz M, Kuck KH. Complete isolation of the left atrium surrounding the pulmonary veins: new insights from the double Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004;110(15):2960-8. DOI: 10.1161/01.CIR.0000144459.37455.EE
  11. Arentz T, Weber R, Bürkle G, Herrera C, Blum T, Stockinger J, Minners J, Neumann FJ, Kalusche D. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation. 2007;115(24):3057-63. DOI: 10.1161/CIRCULATIONAHA.107.690578
  12. Verma A, Natale A, Padanilam BJ, Prystowsky EN. Why atrial fibrillation ablation should be considered first-line therapy for some patients. Circulation. 2005;112(8):1214-22. DOI: 10.1161/CIRCULATIONAHA.104.478263
  13. Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, Gulletta S, Gugliotta F, Pappone A, Santinelli V, Tortoriello V, Sala S, Zangrillo A, Crescenzi G, Benussi S, Alfieri O. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol. 2003;42(2):185-97
  14. Cheema A, Vasamreddy CR, Dalal D, Marine JE, Dong J, Henrikson CA, Spragg D, Cheng A, Nazarian S, Sinha S, Halperin H, Berger R, Calkins H. Long-term single procedure efficacy of catheter ablation of atrial fibrillation. J Interv Card Electrophysiol. 2006;15(3):145-55. DOI: 10.1007/s10840-006-9005-9
  15. Bertaglia E, Tondo C, De Simone A, Zoppo F, Mantica M, Turco P, Iuliano A, Forleo G, La Rocca V, Stabile G. Does catheter ablation cure atrial fibrillation? Single-procedure outcome of drug-refractory atrial fibrillation ablation: a 6-year multicenter experience. Europace. 2009;12(2):181-7. DOI: 10.1093/europace/eup349
  16. Gaita F, Caponi D, Scaglione M, Scaglione M, Montefusco A, Corleto A, Di Monte F, Coin D, Di Donna P, Giustetto C. Long-term clinical results of 2 different ablation strategies in patients with paroxysmal and persistent atrial fibrillation. Circ Arrhythm Electrophysiol. 2008;1(4):269-75. DOI: 10.1161/CIRCEP.108.774885
  17. Artemenko SN, Romanov AB, Shabanov VV, Elesin DA, Strelnikov AG, Kamiev RT, Losik DV, Pokushalov EA. Results of radiofrequency isolation of pulmonary vein orifices combined with ablation of ganglionary plexuses in patients with paroxysmal atrial fibrillation. Annaly aritmologii. 2011;8(4):36-42. (In Russ.)
  18. Calkins H, Reynolds MR, Spector P, Sondhi M, Xu Y, Martin A, Williams CJ, Sledge I. Treatment of atrial fibrillation with antiarrhythmic drugs or radiofrequency ablation: two systematic literature reviews and meta-analyses. Circ Arrhythm Electrophysiol. 2009;2(4):349-61. DOI: 10.1161/CIRCEP.108.824789
  19. Pokushalov E, Romanov A, Corbucci G, Artyomenko S, Turov A, Shirokova N, Karaskov A. Use of an implantable monitor to detect arrhythmia recurrences and select patients for early repeat catheter ablation for atrial fibrillation: a pilot study. Circ Arrhythm Electrophysiol. 2011;4(6):823-31. DOI: 10.1161/CIRCEP.111.964809
  20. Pokushalov E, Romanov A, Katritsis DG, Artyomenko S, Shirokova N, Karaskov A, Mittal S, Steinberg JS. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm. 2013;10(9):1280-6. DOI: 10.1016/j.hrthm.2013.04.016
  21. Pokushalov E, Romanov A, Corbucci G, Bairamova S, Losik D, Turov A, Shirokova N, Karaskov A, Mittal S, Steinberg JS. Does atrial fibrillation burden measured by continuous monitoring during the blanking period predict the response to ablation at 12-month follow-up? Heart Rhythm. 2012;9(9):1375-9. DOI: 10.1016/j.hrthm.2012.03.047
  22. Mittal S, Pokushalov E, Romanov A, Ferrara M, Arshad A, Musat D, Preminger M, Sichrovsky T, Steinberg JS. Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter. Heart Rhythm. 2013;10(11):1598-604. DOI: 10.1016/j.hrthm.2013.07.044
  23. Bayramova SA, Romanov AB, Mittal S, Musat D, Steinberg JS, Pokushalov YeA. Long-term ECG monitoring using an implantable loop recorder for the detection of atrial fibrillation after cavotricuspid isthmus ablation in patients with atrial flutter. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(3):100-9. (In Russ.)
  24. Bairamova SA, Romanov AB, Artemenko SN, Shabanov VV, Losik DV, Karaskov AM, Pokushalov YeA. Preventive pulmonary vein isolation in patients with cavotricuspid isthmus ablation: PREVENT-AF Study I. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015:19(2):93-101. (In Russ.)
  25. Losik DV, Romanov AB, Shabanov VV, Bairamova SA, Yakubov AA, Stenin IG, Pokushalov YeA. 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 = Circulation Pathology and Cardiac Surgery. 2015:19(2):84-92. (In Russ.)