Antiarrhythmics after ablation of atrial fibrillation (5A study)

Jean François Roux, Erica Zado, David J. Callans, Fermin Garcia, David Lin, Francis E. Marchlinski, Rupa Bala, Sanjay Dixit, Michael Riley, Andrea M. Russo, Mathew D. Hutchinson, Joshua Cooper, Ralph Verdino, Vickas Patel, Parijat S. Joy, Edward P. Gerstenfeld

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

BACKGROUND-: Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. METHODS AND RESULTS-: We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. CONCLUSIONS-: AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

Original languageEnglish (US)
Pages (from-to)1036-1040
Number of pages5
JournalCirculation
Volume120
Issue number12
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Anti-Arrhythmia Agents
Atrial Fibrillation
Cardiac Arrhythmias
Electric Countershock
Hospitalization
Drug Therapy
Therapeutics

Keywords

  • Ablation
  • Antiarrhythmia agents
  • Atrial fibrillation

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Roux, J. F., Zado, E., Callans, D. J., Garcia, F., Lin, D., Marchlinski, F. E., ... Gerstenfeld, E. P. (2009). Antiarrhythmics after ablation of atrial fibrillation (5A study). Circulation, 120(12), 1036-1040. https://doi.org/10.1161/CIRCULATIONAHA.108.839639

Antiarrhythmics after ablation of atrial fibrillation (5A study). / Roux, Jean François; Zado, Erica; Callans, David J.; Garcia, Fermin; Lin, David; Marchlinski, Francis E.; Bala, Rupa; Dixit, Sanjay; Riley, Michael; Russo, Andrea M.; Hutchinson, Mathew D.; Cooper, Joshua; Verdino, Ralph; Patel, Vickas; Joy, Parijat S.; Gerstenfeld, Edward P.

In: Circulation, Vol. 120, No. 12, 09.2009, p. 1036-1040.

Research output: Contribution to journalArticle

Roux, JF, Zado, E, Callans, DJ, Garcia, F, Lin, D, Marchlinski, FE, Bala, R, Dixit, S, Riley, M, Russo, AM, Hutchinson, MD, Cooper, J, Verdino, R, Patel, V, Joy, PS & Gerstenfeld, EP 2009, 'Antiarrhythmics after ablation of atrial fibrillation (5A study)', Circulation, vol. 120, no. 12, pp. 1036-1040. https://doi.org/10.1161/CIRCULATIONAHA.108.839639
Roux JF, Zado E, Callans DJ, Garcia F, Lin D, Marchlinski FE et al. Antiarrhythmics after ablation of atrial fibrillation (5A study). Circulation. 2009 Sep;120(12):1036-1040. https://doi.org/10.1161/CIRCULATIONAHA.108.839639
Roux, Jean François ; Zado, Erica ; Callans, David J. ; Garcia, Fermin ; Lin, David ; Marchlinski, Francis E. ; Bala, Rupa ; Dixit, Sanjay ; Riley, Michael ; Russo, Andrea M. ; Hutchinson, Mathew D. ; Cooper, Joshua ; Verdino, Ralph ; Patel, Vickas ; Joy, Parijat S. ; Gerstenfeld, Edward P. / Antiarrhythmics after ablation of atrial fibrillation (5A study). In: Circulation. 2009 ; Vol. 120, No. 12. pp. 1036-1040.
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abstract = "BACKGROUND-: Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. METHODS AND RESULTS-: We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71{\%} male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19{\%} versus 42{\%}; P=0.005). There remained fewer events in the AAD group (13{\%} versus 28{\%}; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. CONCLUSIONS-: AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.",
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AU - Roux, Jean François

AU - Zado, Erica

AU - Callans, David J.

AU - Garcia, Fermin

AU - Lin, David

AU - Marchlinski, Francis E.

AU - Bala, Rupa

AU - Dixit, Sanjay

AU - Riley, Michael

AU - Russo, Andrea M.

AU - Hutchinson, Mathew D.

AU - Cooper, Joshua

AU - Verdino, Ralph

AU - Patel, Vickas

AU - Joy, Parijat S.

AU - Gerstenfeld, Edward P.

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N2 - BACKGROUND-: Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. METHODS AND RESULTS-: We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. CONCLUSIONS-: AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

AB - BACKGROUND-: Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. METHODS AND RESULTS-: We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. CONCLUSIONS-: AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

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KW - Antiarrhythmia agents

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