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Fewer Recurrences on Continued Antiarrhythmic Therapy After AF Ablation

Continuing previously ineffective antiarrhythmic drug therapy (AAD) after catheter ablation by pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) can significantly reduce the 1-year rate of tachyarrhythmia recurrence, suggests new research.

153 patients were randomized  still on their AAD but free of AF 3 months after a de novo contact-force–guided PVI for paroxysmal AF to either continue (n=77) or to discontinue (n=76) their antiarrhythmic drug.

The trial"s primary end point was the documented recurrence of any atrial tachyarrhythmia (AF, atrial flutter, or atrial tachycardia) lasting more than 30 seconds from the start of randomization 3 months after ablation to 12 months after the procedure.

One-day Holter monitoring was performed at 3 and 6 months after PVI, and 7-day Holter monitoring was done at 12 months after PVI; additional Holter monitoring could be performed due to symptoms.

At 12 months, there were  significantly fewer documented atrial tachyarrhythmias in patients randomized to continue AAD. Arrhythmias occurred in 2.7% (n=2) patients who continued AAD, compared with 21.9% (n=16) of those who discontinued therapy (P<0.001).

"The freedom from AF in the patients after PVI without drugs was 78%, which confirms a good outcome with cardiac ablation, but by adding drugs, you can reach up to 97% freedom from AF," investigator said.