Table 1.
Long-term outcomes in atrial fibrillation with a rhythm-control strategy
| Study | Patients (n) | Age (mean ± SD), years | Type of AF at baseline, % patients | Rhythm-control method | Duration of follow-up (months) | Details of antiarrhythmic drug therapy or ablation | Study endpoint, number of patients (%) | Complications of therapy, number of patients | Additional factors associated with AF progression |
|---|---|---|---|---|---|---|---|---|---|
| Pappone et al20 | 56 | 57.5 ± 11.5 | PA, 100% | AADT | 60 | Class IC and/or Class III including amiodarone or Sotalol (combination) | Recurrent PA: 21 (37.5%) Remain in PS: 8 (14.2%) Progression to PN: 16 (28.5%) |
Intolerance to AADT, 11† | Age, diabetes, heart failure |
| Pappone et al68 | 99 | 57 ± 10 | PA, 100% | AADT | 48 | Monotherapy or combination of flecainide, Sotalol, amiodarone | Freedom from AF: 56 (56.5%)* | Intolerance to AADT,68† | Left atrial size |
| Weerasooriya et al69 | 100 | 55.7 ± 9.6 | PA 64% PS, 22% LSP, 14% |
CA | 60 | PVI, cavotricuspid isthmus ablation + roof and mitral isthmus in recurrent AF + six patients on amiodarone | Arrhythmia-free survival: 29% | CT, 3 | Valvular heart disease, non-ischemic dilated cardiomyopathy |
| Jongnarangsin et al23 | 504 | 58 ± 10 | PA 100% | CA | 27 | PVI, operator-dependent CFAE and linear ablations |
Patients in sinus rhythm: 86% Progression to persistent AF:7(1.5%) |
NR | Age >75 years, duration of AF > 10 years, diabetes |
| Pappone et al20 | 11 | 57.5 ± 11.5 | PA 100% | CA | 60 | NR | AF recurrence: none | NR | Age, diabetes, heart failure |
| Pappone et al68 | 99 | 55 ± 10 | PA 100% | CA | 48 | PVI, mitral isthmus line, line between right-sided pulmonary vein, cavotricuspid isthmus block + two patients on AADT | Freedom from AF: 72 (72.7%) | FH 3, TIA 1, PE 1‡ | Left atrial size |
| Ouyang et al70 | 161 | 59.8 ± 9.7 | PA 100% | CA | 60 | PVI, right- and left-sided continuous ablation encircling ipsilateral pulmonary vein + 29 patients on AADT | Sinus rhythm: 128 (66.7%) Progression to chronic AF: 4 (2.4%) |
AP: 1 PE: 2‡ |
NR |
| Hussein et al71 | 831 | 58.7 ± 9.9 | DR, 100% | CA | 55 | PVI, SVC potential ablation, additional non pulmonary vein triggers in redo ablations + 87 patients on AADT | Freedom from arrhythmia: 660 (79.4%) | PE: 1 CT: 2 TIA: 3 PVS:6 H: 6 |
NR |
| Hsieh et al72 | 207 | NR | DR, 100% | CA | 30 | PVI + five patients on AADT, amiodarone, propafenone | Recurrent AF: 70 (34%) | NR | NR |
| Bertaglia et al73 | 177 | 59.1 ± 10.5 | DR, 100% | CA | 50 | PVI, mitral isthmus, cavotricuspid isthmus + AADT in 33 patients (amiodarone, flecainide, propafenone, Sotalol) | AF recurrence: 74 (41.8%) | NR | None |
Notes:
Of these, 44.4% crossed over to receive AF ablation while 11.1% were maintained on AADT alone
includmg lack of efficacy or adverse events requiring discontinuation
pericardial effusion did not require pericardiocentesis.
Abbreviations: AADT, antiarrhythmic drug therapy; AF, atrial fibrillation; AP, aspiration pneumonia; CA, catheter ablation; CFAE, complex fractionated atrial electrograms; CT, cardiac tamponade; DR, drug resistant; FH, femoral hematoma; H, hematomas; LSP, long-standing persistent; NR, not reported; PA, paroxysmal AF; PE, pericardial effusion; PN, permanent AF; PS, persistent AF; PVI, pulmonary vein isolation; PVS, pulmonary vein stenosis; SD, standard deviation; SVC, superior vena cava; TIA, transient ischemic attack.