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Journal Club 27 August 2014

Paper


Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2)A Randomized Trial

Presenter

PM

Summary

IMPORTANCE

Atrial fibrillation (AF) is the most common rhythm disorder seen in clinical
practice. Antiarrhythmic drugs are effective for reduction of recurrence in patients with
symptomatic paroxysmal AF. Radiofrequency ablation is an accepted therapy in patients for
whom antiarrhythmic drugs have failed; however, its role as a first-line therapy needs further
investigation.

OBJECTIVE

To compare radiofrequency ablation with antiarrhythmic drugs (standard
therapy) in treating patients with paroxysmal AF as a first-line therapy.
DESIGN, SETTING, AND PATIENTS A randomized clinical trial involving 127 treatment-naive
patients with paroxysmal AF were randomized at 16 centers in Europe and North America to
received either antiarrhythmic therapy or ablation. The first patient was enrolled July 27,
2006; the last patient, January 29, 2010. The last follow-up was February 16, 2012.

INTERVENTIONS

Sixty-one patients in the antiarrhythmic drug group and 66 in the
radiofrequency ablation group were followed up for 24 months.

MAIN OUTCOMES AND MEASURES

The time to the first documented atrial tachyarrhythmia of
more than 30 seconds (symptomatic or asymptomatic AF, atrial flutter, or atrial tachycardia),
detected by either scheduled or unscheduled electrocardiogram, Holter, transtelephonic
monitor, or rhythm strip, was the primary outcome. Secondary outcomes included
symptomatic recurrences of atrial tachyarrhythmias and quality of life measures assessed by
the EQ-5D tool.

RESULTS

Forty-four patients (72.1%) in the antiarrhythmic group and in 36 patients (54.5%)
in the ablation group experienced the primary efficacy outcome (hazard ratio [HR], 0.56
[95%CI, 0.35-0.90]; P = .02). For the secondary outcomes, 59%in the drug group and 47%
in the ablation group experienced the first recurrence of symptomatic AF, atrial flutter, atrial
tachycardia (HR, 0.56 [95%CI, 0.33-0.95]; P = .03). No deaths or strokes were reported in
either group; 4 cases of cardiac tamponade were reported in the ablation group. In the
standard treatment group, 26 patients (43%) underwent ablation after 1-year. Quality of life
was moderately impaired at baseline in both groups and improved at the 1 year follow-up.
However, improvement was not significantly different among groups.

CONCLUSIONS AND RELEVANCE

Among patients with paroxysmal AF without previous
antiarrhythmic drug treatment, radiofrequency ablation compared with antiarrhythmic drugs
resulted in a lower rate of recurrent atrial tachyarrhythmias at 2 years. However, recurrence
was frequent in both groups.

Supplementary Material

Supplementary material here.

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