Efficacy and safety of catheter ablation for paroxysmal atrial fibrillation: A comparison of first-line vs second-line therapy.

BACKGROUND

Catheter ablation (CA) is an effective rhythm control therapy for atrial fibrillation (AF). Recent advancements have improved its efficacy and safety. From 2022 to 2024, guidelines in the United States, Japan, and Europe classify CA as a Class I recommendation for paroxysmal AF (PAF) as a first-line therapy. Previously, CA was recommended as Class I only for the patient refractory to drug therapy. Despite these updates, direct comparative studies between first-line CA and second-line CA remain limited.

OBJECTIVE

This study aimed to evaluate the efficacy and safety of CA as first-line versus second-line therapy using data from the Japan Nationwide Ablation (J-AB) registry.

METHODS

We analyzed patients with PAF who underwent CA from 2017 to 2020 in the J-AB registry. Patients were categorized into a First-line group (CA without prior antiarrhythmic drug [AAD]) and a Second-line group (CA following AAD failure). Efficacy was assessed by recurrence of atrial tachyarrhythmia within 1 year after a 90-day blanking period. Safety was evaluated based on major complications, including severe bleeding, stroke, and gastrointestinal disorders.

RESULTS

Among 5011 patients (median age 69 years, 35% were women), baseline characteristics were similar between groups except for beta-blocker use. Recurrence rates were comparable (10.0% overall; log-rank P = .49), and Cox regression showed no significant difference in efficacy (adjusted hazard ratio: 1.06, 95% confidence interval: 0.88-1.28, P = .55). Safety outcomes were also similar.

CONCLUSION

First-line CA for PAF demonstrated similar efficacy and safety to second-line CA within 1 year. The registry was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN 000028288) and ClinicalTrials.gov (NCT03729232).