For many with atrial fibrillation, the standard procedure has long been the administration of one or more antiarrhythmic medications before progressing to catheter ablation. This traditional strategy has long been accepted as the norm, yet it may not be the most effective approach to treating atrial fibrillation, especially when a patient’s quality of life is considered. To test the effectiveness of the common treatment progression, researchers decided to reverse the usual order by assigning patients to early ablation rather than antiarrhythmic drugs.
A total of 303 patients was included in this study, all of whom had symptomatic, paroxysmal, untreated atrial fibrillation. These patients were then randomly assigned to either undergo catheter ablation or receive antiarrhythmic therapy. Every patient also received an implantable device to detect atrial tachyarrhythmia.
After 91 days and over the course of 12 months, any recurrence of atrial tachyarrhythmia was documented. Atrial fibrillation burden, freedom from symptomatic arrhythmia, and quality of life were also examined.
The primary endpoint, a recurrence of atrial tachyarrhythmia, was analyzed at the one-year mark after treatment commenced. Of the 154 patients who underwent ablation, 42.9-percent experienced a recurrence. By comparison, 67.8-percent of patients assigned antiarrhythmic drugs experienced a recurrence of atrial tachyarrhythmia.
Other measured events also seemed to favor treatment via ablation. For example, symptomatic atrial tachyarrhythmia was observed in only 11-percent of ablation patients versus 26.2-percent of those in the antiarrhythmic drug group. Serious adverse effects also occurred less frequently in the ablation group, checking in at 3.2-percent as opposed to 4-percent in the drug group.
What it Means
Patients with atrial fibrillation may benefit from ablation as an initial treatment rather than drug therapy. This is contrary to the traditional progression of treatment, indicating that the common strategy for treating symptomatic, paroxysmal atrial fibrillation may be misleading.
There is more work to be done to determine the extent to which the findings of this study are accurate. However, the discoveries of this particular analysis could provide individuals suffering from atrial fibrillation hope for a brighter future and a higher quality of life. While more invasive than the use of antiarrhythmic drugs, early ablation may be worth it for those seeking the most effective method of treatment.
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