1670Antiarrhythmic drugs in blanking period after catheter ablation of atrial fibrillation do not change effectiveness of the procedure but add clinical benefit

Abstract

Background: Catheter pulmonary veins isolation (PVI) is one of the recommended standard treatment options for atrial fibrillation. However due to inflammatory process, early post-procedural period is often complicated by atrial tachycardia recurrences when treatment with antiarrhythmic drugs (AAD) is used. There is no definitive data regarding necessity of AAD and length of treatment. Purpose: The aim of this study was to investigate effectiveness of AAD monotherapy for recurrence prevention in early and late periods post PVI ablation. Methods: this is a prospective open, randomized study that included 243 patients. 142 (58%) were males, mean age 56.09±10.14 years, with average time since diagnosis 4.48±2.6 years. For detection of atrial tachycardias we used EKG, Holter monitor, symptoms diary and 112 patients (pts) had an implantable loop recorder for constant monitoring. All pts were subdivided into 4 groups: 61 pts were started on Verapamil (group 1), 62 pts - propafenone (group 2), 60 pts - sotalol (group 3) and 60 pts were monitored without any AAD (group 4- control). All pts were followed for 12 months. Results: PVI ablation effectiveness after first procedure was 66.7% (n=162, 95% CI 61 to 72), with AAD - 67.2% (n=123, 95% CI 60 to 74) vs without AAD - 65% (n=39, 95% CI 52 to 76), p=0.75. In 81 pts first ablation was ineffective and 62 (25.5%) pts were referred for the second procedure. Overall effectiveness after two ablations was 88.5% (n=215, 95% CI 59 to 81), with AAD - 88.55% (n=183, 95% CI 83-92) vs without AAD - 88.33 (n=53, 95% CI 78-94), p=0.83. There were differences noted in pharmacological and electrical cardioversion rates as well as hospitalizations rate due to arrhythmia during the blanking period post-procedure (Table) Conclusions: AAD in the PVI post procedural period does not affect long-term effectiveness of the treatment after one or two procedures, however use of AAD showed clinical improvement during blanking post procedural period by decreasing need for pharmacological or electrical cardioversion as well as reduction of hospitalizations rate due to arrhythmias. (Table presented).