Abstract and Introduction
Abstract
Aims Patients undergoing catheter ablation for atrial fibrillation (AF) often experience recurrent arrhythmias within the first few months post-ablation. We aimed to investigate whether short-term use of amiodarone to prevent early arrhythmias following radiofrequency ablation for AF could reduce later recurrence.
Methods and results In a two-centre, randomized, double-blind, placebo-controlled study, we randomized a total of 212 patients undergoing AF ablation. Patients were stratified according to type of AF (paroxysmal/persistent) and history of previous AF ablation and randomly assigned to 8 weeks of oral amiodarone therapy or matched placebo following catheter ablation. Patients were followed for 6 months. Analyses were performed according to the intention-to-treat principle. Of 212 enrolled patients [median age 61 (inter-quartile range 54–66), 83% male, 50% paroxysmal, 29% with history of previous ablation], 206 patients were available for analysis of the primary end-point which was any documented atrial tachyarrhythmia lasting >30 s following a blanking period of 3 months. This was observed in 42/107 (39%) in the amiodarone group vs. 48/99 (48%) in the placebo group (P = 0.18). Among the secondary end-points, the amiodarone group showed significantly lower rate of atrial tachyarrhythmia-related hospitalizations [rate ratio = 0.43; 95% confidence interval (CI) = 0.23–0.77, P = 0.006] and cardioversions (rate ratio = 0.36; 95% CI = 0.20–0.62, P = 0.0004) within the blanking period.
Conclusion Short-term oral amiodarone treatment following ablation for paroxysmal or persistent AF did not significantly reduce recurrence of atrial tachyarrhythmias at the 6-month follow-up, but it more than halved atrial arrhythmia related hospitalization and cardioversion rates during the blanking period.
Introduction
Patients undergoing ablation for atrial fibrillation (AF) often experience atrial tachyarrhythmias within the first few months post-ablation. Early recurrence of atrial arrhythmias has been associated with later recurrence following AF ablation. In accordance with the concept that 'AF begets AF', reducing AF burden early after ablation could potentially improve the long-term effect of ablation. Amiodarone is considered the most effective antiarrhythmic drug (AAD) for rhythm control of AF. Whether short-term use of amiodarone used to prevent early arrhythmias can affect later recurrence after catheter ablation for AF is unclear.
We aimed to investigate, in a randomized, placebo-controlled, double-blind clinical trial, whether short-term use of amiodarone following radiofrequency ablation for AF could reduce later recurrence.