Heart rhythm · 2025
Catheter ablation of atrial fibrillation in antiarrhythmic drug-naïve patients.
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Younis Arwa, Demian Joe, Wass Sojin Youn, Tabaja Chadi, Braghieri Lorenzo, Santangeli Pasquale, Taigen Tyler, Bhargava Mandeep, Callahan Thomas, Martin David O, Kanj Mohamed, Sroubek Jakub, Lee Justin, Nakagawa Hiroshi, Saliba Walid I, Wazni Oussama M, Hussein Ayman A
Аннотация
BACKGROUND: Catheter ablation has become the standard of care for atrial fibrillation (AF) and is increasingly performed as first-line therapy.
OBJECTIVE: We aimed to assess freedom from AF after AF ablation in antiarrhythmic drug (AAD)-naïve patients compared with those previously treated with AADs.
METHODS: Patients undergoing AF ablation at the Cleveland Clinic were enrolled in a prospective registry for procedural and clinical outcomes (2013-2022). Patients were grouped based on previous AAD treatment (AAD naïve vs previous AAD) and AF type (paroxysmal AF [PAF] vs persistent AF [PersAF]). The primary endpoint was freedom from AF. AF symptom severity scale surveys were obtained to assess for quality of life benefits.
RESULTS: The study included 4900 patients (age 65 ± 10, 70% men, 30% AAD naïve). The yearly proportion of AAD-naïve patients undergoing ablation followed an increasing trend during the study period. Upon 3 years of follow-up, AAD-naïve patients were more likely to have freedom from AF recurrence if they had PAF, but not PersAF (PAF, AAD naïve 81% vs previous AAD 76%, P < .001; PersAF, AAD naïve 68% vs previous AAD 65%, P = .7). Multivariable Cox regression showed a trend favoring AAD-naïve patients with PAF (AAD naïve vs previous AAD, hazard ratio 0.80, 95% confidence interval 0.66-0.97, P = .02), although it did not reach statistical significance after multivariable adjustment (P = .06). Improvement in quality of life after catheter ablation was seen in all groups, irrespective of previous AAD use.
CONCLUSION: In this large prospective cohort, the proportion of AAD-naïve patients undergoing ablation increased over time. In PAF, AAD-naïve patients had better outcomes than those with previous AAD. In PersAF, AAD-naïve patients had similar outcomes to those with previous AAD.
OBJECTIVE: We aimed to assess freedom from AF after AF ablation in antiarrhythmic drug (AAD)-naïve patients compared with those previously treated with AADs.
METHODS: Patients undergoing AF ablation at the Cleveland Clinic were enrolled in a prospective registry for procedural and clinical outcomes (2013-2022). Patients were grouped based on previous AAD treatment (AAD naïve vs previous AAD) and AF type (paroxysmal AF [PAF] vs persistent AF [PersAF]). The primary endpoint was freedom from AF. AF symptom severity scale surveys were obtained to assess for quality of life benefits.
RESULTS: The study included 4900 patients (age 65 ± 10, 70% men, 30% AAD naïve). The yearly proportion of AAD-naïve patients undergoing ablation followed an increasing trend during the study period. Upon 3 years of follow-up, AAD-naïve patients were more likely to have freedom from AF recurrence if they had PAF, but not PersAF (PAF, AAD naïve 81% vs previous AAD 76%, P < .001; PersAF, AAD naïve 68% vs previous AAD 65%, P = .7). Multivariable Cox regression showed a trend favoring AAD-naïve patients with PAF (AAD naïve vs previous AAD, hazard ratio 0.80, 95% confidence interval 0.66-0.97, P = .02), although it did not reach statistical significance after multivariable adjustment (P = .06). Improvement in quality of life after catheter ablation was seen in all groups, irrespective of previous AAD use.
CONCLUSION: In this large prospective cohort, the proportion of AAD-naïve patients undergoing ablation increased over time. In PAF, AAD-naïve patients had better outcomes than those with previous AAD. In PersAF, AAD-naïve patients had similar outcomes to those with previous AAD.