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Antiarrhythmic therapy as an adjuvant to promote post pulmonary vein isolation success—a meta-analysis

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Abstract

Background

Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is a common practice to prevent early arrhythmia recurrence; the data of influence of this practice on longer term ablation outcomes is limited.

Purpose

The aim of this study was to perform a meta-analysis of published controlled trials comparing temporary AAD therapy after AFA with no AAD therapy in patients after AFA. The primary outcome was recurrence of arrhythmia.

Results

1Eight prospective trials were included. Among 2952 patients, 1991 (67 %) had paroxysmal AF, and 967 (32.7 %) had persistent AF. In total, 1502 patients were treated with AADs and 1450 patients served as a control group (no AAD therapy). Various class IC-III antiarrhythmics were used. Length of AAD administration varied between 6 and 12 weeks after start of AFA. The follow-up duration ranged from 1.5 to 17 months after stopping medication. Among AAD treated patients, the recurrence of arrhythmia rate was 30.69 vs. 33.79 % in control patients (odd ratio 0.86, 95 % CI 0.71–1.06, P = 0.15). In patients who received largely amiodarone, there was a trend for difference in recurrence of atrial arrhythmia (odds ratio 0.60, 95 % CI 0.34–1.09, P = 0.09).

Conclusions

Short-term post pulmonary vein isolation (PVI) AAD therapy does not substantially reduce overall recurrence of AF after ablation.

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Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada

    Gustavo R. Goldenberg, Daniel Burd, David Newman, Mohammed Shurrab & Eugene Crystal

  2. Medical University of Warsaw, Warsaw, Poland

    Piotr Lodzinski

  3. Laboratorio di Elettrofisiologia, Casa di Cura San Michele, Maddaloni, Italy

    Giuseppe Stabile

  4. Women’s College Hospital, University of Toronto, Toronto, Canada

    Jacob A. Udell & Eugene Crystal

  5. Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada

    Jacob A. Udell

Authors
  1. Gustavo R. Goldenberg
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  2. Daniel Burd
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  3. Piotr Lodzinski
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  4. Giuseppe Stabile
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  5. Jacob A. Udell
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  6. David Newman
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  7. Mohammed Shurrab
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  8. Eugene Crystal
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Correspondence to Gustavo R. Goldenberg.

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Goldenberg, G.R., Burd, D., Lodzinski, P. et al. Antiarrhythmic therapy as an adjuvant to promote post pulmonary vein isolation success—a meta-analysis. J Interv Card Electrophysiol 47, 171–176 (2016). https://doi.org/10.1007/s10840-016-0157-y

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  • DOI: https://doi.org/10.1007/s10840-016-0157-y

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