ISSN 2996-8215
International Journal of Cardiology | Vol. 15, No. 9, September 2024 | pp. 65–72
DOI: 10.46882/2024/IJC/000185
Original Research Article
Three-Year Efficacy, Safety, and Health-Related Quality-of-Life Outcomes Between Pulmonary Vein Isolation and Optimized Antiarrhythmic Drug Therapy
Arjun Patel¹, Rohan Mehta¹, Vikram Singh²
¹Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
²Division of Electrophysiology, All India Institute of Medical Sciences, New Delhi, India
Abstract:
Catheter ablation is widely utilized for rhythm control in paroxysmal atrial fibrillation (AF), yet comparative long-term data against modern antiarrhythmic drug (AAD) regimens in real-world clinical cohorts remain essential. This randomized trial compared the 3-year efficacy, safety, and health-related quality-of-life outcomes between catheter ablation and optimized AAD therapy. We randomized 180 symptomatic patients with paroxysmal AF who had failed at least one class I or III antiarrhythmic drug to receive either radiofrequency catheter ablation (pulmonary vein isolation, n = 90) or optimized alternative AAD therapy (n = 90). The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting longer than 30 seconds after a 90-day blanking period. At 3 years, freedom from recurrent atrial tachyarrhythmias was significantly higher in the catheter ablation group than in the antiarrhythmic drug cohort (71.1% vs. 38.9%, p < 0.001). Repeat ablation procedures were performed in 15.6% of the ablation group. Major periprocedural complications in the ablation arm included 2 cases of cardiac tamponade successfully managed with pericardiocentesis, with no occurrences of stroke or atrioesophageal fistula. Significant adverse drug effects occurred in 18.9% of the AAD arm, requiring therapy discontinuation. Quality of life, assessed via the SF-36 questionnaire, improved significantly more in the catheter ablation cohort across physical and mental health domains (p < 0.01). Radiofrequency catheter ablation achieves superior long-term freedom from arrhythmia recurrence and substantially improves health-related quality of life compared with optimized antiarrhythmic drug therapy.
Keywords: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Antiarrhythmic drugs, Recurrence, Quality of life
Received: June 04, 2024; Revised: July 19, 2024; Accepted: August 08, 2024; Published: September 20, 2024