Antiarrhythmic Therapy Post-Ablation to Reduce Atrial Fibrillation Recurrence: a Meta-Analysis

Gustavo Goldenberg1, Daniel Burd1, Piotr Lodzinski2, Giussepe Stabile3, Jacob Udell4, David Newman1, Mohammad Shurrab1, Eugene Crystal5
1 /, Sunnybrook Hospital, Canada
2 Department of Cardiology, Medical University of Warsaw, Poland
3 Casa di Cura San Michele, Laboratorio di Elettrofisiologia, Italy
4 Women's College Research Institute and Cardiovascular Division, Department of Medicine, Institute for Clinical Evaluative Sciences, University of Toronto, Canada
5 Women's College Research Institute and Cardiovascular Division, Department of Medicine, Sunnybrook Hospital, University of Toronto, Canada

Introduction: Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is a common practice to prevent early arrhythmia recurrence; the data of influence of this practice on longer term ablation outcomes is limited

Objective: To perform a meta-analysis of published controlled trials comparing temporary AAD therapy after AFA with no AAD therapy in patients after AFA. The primary outcome was recurrence of arrhythmia.

Results: Seven prospective trials were included. Among 919 patients 615 (67 %) had paroxysmal AF, and 304 (33%) had persistent AF. In total, 489 patients were treated with AADs and 422 patients served as a control group (no AAD therapy). Various class IC-III antiarrhythmics were used. Length of AAD administration varied between 6 immediately following AFA to 12 weeks. The follow-up duration ranged from 1.5 to 17 months. Among AAD treated patients, the recurrence of arrhythmia rate was 31.5 % vs 38 % in control patients (odd ratio 0.79, 95% CI 0.58-1.09, P=0.15). Also comparing patients who received Amiodarone, no difference in recurrence of atrial arrhythmia were observed (odds ratio 0.60, 95% CI 0.34-1.09, P=0.09).

Conclusions: antiarrhythmic therapy in early post-ablation after AFA period does not reduce rates of the later arrhythmia recurrence