ISSN 2996-8215
International Journal of Cardiology | Vol. 2, No. 9, September 2011 | pp. 65–72
DOI: 10.46882/2011/IJC/000030
Original Research Article
Long-Term Outcomes of Catheter Ablation versus Antiarrhythmic Drug Therapy for Paroxysmal Atrial Fibrillation
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) therapy remain necessary. This randomized trial compared the 3-year efficacy, safety, and quality-of-life outcomes between catheter ablation and AAD therapy. We randomized 180 symptomatic patients with paroxysmal AF who failed at least one class I or III AAD to 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 tachyarrhythmia was significantly higher in the catheter ablation group than in the AAD group (71.1% vs. 38.9%, p < 0.001). Repeated procedures were performed in 15.6% of the ablation group. Major periprocedural complications in the ablation arm included 2 cases of cardiac tamponade successfully treated with pericardiocentesis, with no occurrences of stroke or atrioesophageal fistula. Significant adverse drug effects occurred in 18.9% of the AAD arm, necessitating discontinuation or therapy changes. Quality of life, measured via the SF-36 questionnaire, improved significantly more in the catheter ablation cohort across both physical and mental health domains (p < 0.01). Radiofrequency catheter ablation achieves superior long-term freedom from arrhythmia recurrence and substantially improves quality of life compared to continued antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation.
Keywords: Atrial fibrillation, Catheter ablation, Pulmonary vein isolation, Antiarrhythmic drugs, Recurrence, Quality of life
Received: June 04, 2011; Revised: July 19, 2011; Accepted: August 08, 2011; Published: September 20, 2011
Citation: International Journal of Cardiology, 2011, Vol. 2, No. 9, pp. 65–72, DOI: 10.46882/2011/IJC/000030