Prognostic value of pharmacotherapy in patients with atrial fibrillation after radiofrequency ablation

M S Brynza,O V Bilchenko,M I Shevchuk,O S Makharynska

doi:10.14739/2310-1210.2021.6.229973

Abstract

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events. Materials and methods. Patients with paroxysmal, persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. The primary endpoint was patient survival, secondary – a composite endpoint of freedom from recurrence and/or non-fatal cardiovascular events for 2 years of a follow-up. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Results. 116 patients were consecutively enrolled in the study. In the long-term post-ablation, 23 patients (19.8 %) continued to take amiodarone, 2 patients (1.7 %) – propafenone for arrhythmic events, 38 patients (32.8 %) needed anticoagulants, and 37 patients (31.9 %) received beta-adrenoceptor blockers over the entire follow-up period. The use of RAAS inhibitors decreased from 81.0 % before the ablation to 56.0 % in the long-term period following RFA. Multifactorial logistic regression analysis showed that the prolonged (more than 3 months) anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the long-term post-ablation period were associated with the secondary endpoint. Conclusions. RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively. Independent predictors of survival were the doses of anticoagulants more than 3 months after ablation, arrhythmia recurrence and non-fatal cardiovascular events – the doses of anticoagulants before the procedure, and the use and doses of beta-adrenoceptor blockers in the long-term period after RFA.

Highlights

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events
Multifactorial logistic regression analysis showed that the prolonged anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the longterm post-ablation period were associated with the secondary endpoint
RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively

Summary

Methods

Persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Patients were examined on the basis of the Department of Ultrasound and Clinical and Instrumental Diagnostics and Mini-invasive Interventions of the SI “Zaycev V. Persistent and prolonged persistent forms of AF requiring non-pharmacological rhythm control and preferred choice of patients for mini-invasive interventions. The main exclusion criteria were permanent AF, age younger than 35 years old, clinical hyper- and hypothyroidism, liver failure, severe kidney function impairment (glomerular filtration rate (GFR) ˂30 ml/min/1.73 m2), acute coronary syndrome or recent (˂3 months), left (LA) or right atrium size of mm, severe arterial hypertension, systolic heart failure (HF) with left ventricular ejection fraction (LV EF) ˂40 % or NYHA functional class III–IV.

Results

Discussion

Conclusion