Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation

TLDR

Symptomatic atrial fibrillation is traditionally managed with antiarrhythmic drugs and anticoagulation, but larger studies are needed to confirm the safety and efficacy of alternative first‑line approaches. The study aims to determine whether pulmonary vein isolation with radiofrequency ablation can serve as a first‑line therapy for symptomatic atrial fibrillation, potentially eliminating the need for antiarrhythmic drugs and anticoagulation. A multicenter prospective randomized study enrolled 70 symptomatic AF patients, randomizing them to PVI or antiarrhythmic drug treatment, with a 1‑year follow‑up assessing recurrence, hospitalization, and quality of life. In a 1‑year randomized trial, pulmonary vein isolation reduced symptomatic AF recurrence from 63% to 13%, lowered hospitalization from 54% to 9%,.

Abstract

Treatment with antiarrhythmic drugs and anticoagulation is considered first-line therapy in patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation (PVI) with radiofrequency ablation may cure AF, obviating the need for antiarrhythmic drugs and anticoagulation.To determine whether PVI is feasible as first-line therapy for treating patients with symptomatic AF.A multicenter prospective randomized study conducted from December 31, 2001, to July 1, 2002, of 70 patients aged 18 to 75 years who experienced monthly symptomatic AF episodes for at least 3 months and had not been treated with antiarrhythmic drugs.Patients were randomized to receive either PVI using radiofrequency ablation (n=33) or antiarrhythmic drug treatment (n=37), with a 1-year follow-up.Recurrence of AF, hospitalization, and quality of life assessment.Two patients in the antiarrhythmic drug treatment group and 1 patient in the PVI group were lost to follow-up. At the end of 1-year follow-up, 22 (63%) of 35 patients who received antiarrhythmic drugs had at least 1 recurrence of symptomatic AF compared with 4 (13%) of 32 patients who received PVI (P<.001). Hospitalization during 1-year follow-up occurred in 19 (54%) of 35 patients in the antiarrhythmic drug group compared with 3 (9%) of 32 in the PVI group (P<.001). In the antiarrhythmic drug group, the mean (SD) number of AF episodes decreased from 12 (7) to 6 (4), after initiating therapy (P = .01). At 6-month follow-up, the improvement in quality of life of patients in the PVI group was significantly better than the improvement in the antiarrhythmic drug group in 5 subclasses of the Short-Form 36 health survey. There were no thromboembolic events in either group. Asymptomatic mild or moderate pulmonary vein stenosis was documented in 2 (6%) of 32 patients in the PVI group.Pulmonary vein isolation appears to be a feasible first-line approach for treating patients with symptomatic AF. Larger studies are needed to confirm its safety and efficacy.