Antiarrhythmic Drugs In Prevention Research Articles

Identifying patients with reduced risk of recurrences after ablation for persistent atrial fibrillation

Abstract Background Catheter ablation (CA) is a well-established treatment option for recurrent atrial fibrillation (AF), and has shown to outperform antiarrhythmic drugs in prevention of AF recurrences in numerous studies. However, up to 50% of patients with persistent AF (peAF) will experience recurrences after first-time CA. Improving treatment for these patients involves, choosing the right patients for the ablation procedure, optimizing the timing of the procedure, and using the most effective ablation strategy. This will benefit not only the patients, but also target recourse use in the healthcare system. Purpose To identify characteristics and comorbidities of patients with peAF associated with a reduced risk of recurrence after CA. Additionally, to investigate the optimal timing and ablation strategy. Methods This observational cohort study was conducted using real-life data from the Danish healthcare registries. All patients with peAF, >18 years of age, who were assigned to first-time AF ablation, were included within the study period from January 1st 2010 to December 31st 2018. A composite endpoint for AF recurrences was defined as either AF admission, electric cardioversion, use of antiarrhythmic drugs or re-ablation after a 3-month blanking period. We followed the patients in the registries for up to 5 years. A Cox proportional hazards analysis was performed to identify specific patient characteristics, comorbidities, timing of ablation and ablation strategy associated with reduced risk of AF recurrences after ablation. Results The study cohort consisted of 2,123 patients with peAF undergoing first-time CA. Median age was 63 years [IQR: 56.10;68.90], 77.7% were male, and mean BMI was 28.40 (SD: 4.97). Mean diagnosis-to-ablation-time (DAT) was 3.56 years (SD: 4.25) and mean follow-up time was 928.3 days (SD: 829.62). Most prevalent co-morbidities were hypertension (59.1%), ischemic heart disease (16.9%), and heart failure (HF) (27.7%) (Table 1). Patients characterized by male sex (HR: 0.80, 95% CI 0.69-0.93), age 60-70 (HR: 0.79, 95% CI 0.67-0.93), and absence of co-morbidities such as HF (HR: 0.81, 95% CI 0.70-0.94) and chronic obstructive pulmonary disease (COPD) (HR: 0.58, 95% CI 0.44-0-75), were observed with a significantly reduced relative risk of recurrent AF. Short DAT(<1 year) was associated with a 24% lower risk of recurrence compared to longer (>2 years). Furthermore, PVI Plus (additional ablation to PVI) was not significantly associated with a reduced risk of recurrences (HR: 1.10, 95% CI 0,92-1.31) (Figure 1). Conclusion To obtain rhythm control for patients with peAF is a great challenge. This observational study with more than 2,000 patients, identifies patients most likely to benefit from CA. Lower recurrence rates were observed in younger patients (<70 years), absence of especially HF and COPD, and early ablation (<1 year). Notably, PVI plus did not reduce the risk of recurrences.

Revisiting the Role of Antiarrhythmic Drugs in Prevention of Atrial Fibrillation Recurrence: A Single Center Retrospective Review.

BackgroundWe conducted a retrospective analysis to revisit the efficacy of four different commonly used antiarrhythmic drugs (AADs) in a single community hospital setting in the U.S. We used cardiac implantable electronic devices (CIEDs) to continuously monitor the patients for maintenance of sinus rhythm. The CIEDs in our study included insertable cardiac monitor (ICM), permanent pacemaker (PPM) and cardiac resynchronization therapy-defibrillator (CRT-D). The aim was to compare efficacy of commonly used AADs for maintenance of sinus rhythm in atrial fibrillation (AF) patients.MethodsWe conducted our retrospective study in a real world practice setting. We analyzed electronic medical records of 145 consecutive patients with paroxysmal and persistent AF who were treated with AADs for maintenance of sinus rhythm between the period of April 2014 and February 2018.ResultsTotal 34 out of 145 patients (23.45%) had AF recurrence. The mean duration of first AF recurrence in total patient cohort was 18.01 ± 12 months. There was no major difference in efficacy in terms of prevention of first episode of AF recurrence among commonly used class III and class IC AADs.ConclusionsHigher doses clearly seem to be more effective in preventing the recurrence of AF in class III AADs; sotalol and amiodarone. Use of CIEDs helps to continuously monitor patients for recurrence of AF and detects proarrhythmic effects of AADs.

THE POSSIBILITIES OF ANTIARRHYTHMIC THERAPY IN PRIMARY PREVENTION OF DEATH IN PATIENTS WITH VENTRICULAR ARRHYTHMIAS

Highlights of primary prevention of death in patients with ventricular arrhythmias (VA) are discussed. Overview of all main clinical trials exploring various anti-arrhythmic drugs in prevention of death in patients with VA is presented. It is emphasized that in patients with organic heart disease and VA only beta-blockers and amiodarone are able to reduce mortality, while other drugs have no effect on mortality, or they even increase mortality mainly due to arrhythmogenic effect. Recent clinical studies of the cardioverter-defibrillators efficacy in these patients are present￾ed. It is shown that the use of cardioverter defibrillators compared with pharmacotherapy is more effective in prevention of fatal outcomes.

Implantable Cardioverter Defibrillator for Prevention of Sudden Cardiac Deatb in Patients with Ventricular Tachycardia and Ventricular Fibrillation: ICD Therapy In Sudden Cardiac Death

Among the various therapy options for survivors of ventricular tachycardia-ventricular fibrillation (VT-VF), the implantable cardioverter defibrillator (ICD) seems most promising. It reliably terminates VT-VF and thus significantly impacts sudden cardiac death (SCD) survival. It is more effective than any of the known antiarrhythmic drugs in prevention of SCD, particularly among survivors of cardiac arrest. Compared to VT surgery, the ICD therapy can be offered to a larger pool of patients and can be placed at a lower surgical risk. With proper patient selection, ICD therapy is of major benefits to its recipients since it markedly reduces the chances of VT-VF related mortality; the main cause of premature death in this population. The ICD therapy is cost effective when compared to other medical interventions and could be more so if the implant is carried out early in the course of VT-VF management.