Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study)

Abstract

Background— We previously demonstrated that treatment with antiarrhythmic drugs (AADs) during the first 6 weeks after atrial fibrillation (AF) ablation reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion or hospitalization for arrhythmia management. Whether early rhythm suppression decreases longer-term arrhythmia recurrence is unknown. We now report the 6-month follow-up data from this study. Methods and Results— The Antiarrhythmics After Ablation of Atrial Fibrillation study prospectively randomized patients with paroxysmal AF undergoing ablation to either receive (AAD group) or not receive (no-AAD group) AAD treatment for the first 6 weeks after ablation; all patients received atrioventricular nodal blockers. Physicians were encouraged to stop the AADs after the 6-week treatment period. All patients underwent 4 weeks of transtelephonic monitoring to document asymptomatic AF and an evaluation at 6 weeks and 6 months. A total of 110 patients (71% men) aged 55±9 years were randomized, with 53 to AAD and 57 to no AAD. At 6 months, there was no difference in freedom from AF between the early AAD and no-AAD groups (38/53 [72%] versus 39/57 [68%]; P =0.84). Lack of early AF recurrence during the initial 6-week period was the only independent predictor of 6-month freedom from AF (64/76 [84%] without early recurrence versus 13/34 [38%] with early recurrence; P =0.0001). Conclusions— Although short-term use of AADs after AF ablation decreases early recurrence of atrial arrhythmias, early use of AADs does not prevent arrhythmia recurrence at 6 months. Early AF recurrence on or off AADs during the initial 6-week blanking period is a strong independent predictor of long-term AF recurrence. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00408200.