A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

• Published in: Journal of the American College of Cardiology 2006-12, Vol.48 (11), p.2340-2347
• Main Authors: Pappone, Carlo, Augello, Giuseppe, Sala, Simone, Gugliotta, Filippo, Vicedomini, Gabriele, Gulletta, Simone, Paglino, Gabriele, Mazzone, Patrizio, Sora, Nicoleta, Greiss, Isabelle, Santagostino, Andreina, LiVolsi, Laura, Pappone, Nicola, Radinovic, Andrea, Manguso, Francesco, Santinelli, Vincenzo
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2006.08.037

A Randomized Trial of Circumferential Pulmonary Vein Ablation Versus Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation: The APAF (Ablation for Paroxysmal Atrial Fibrillation) Study Carlo Pappone, Giuseppe Augello, Simone Sala, Filippo Gugliotta, Gabriele Vicedomini, Simone Gulletta, Gabriele Paglino, Patrizio Mazzone, Nicoleta Sora, Isabelle Greiss, Andreina Santagostino, Laura LiVolsi, Nicola Pappone, Andrea Radinovic, Francesco Manguso, Vincenzo Santinelli One hundred ninety-eight patients with paroxysmal atrial fibrillation who had already failed antiarrhythmic drug therapy (ADT) were randomized to atrial fibrillation ablation alone by circumferential pulmonary vein ablation (CPVA) or to another ADT. By Kaplan-Meier analysis, 86% of patients in the CPVA group and 22% in the ADT group were free from recurrent atrial tachyarrhythmias (AT) (p < 0.001); a re-do ablation was performed in 9% of patients in the CPVA group. At 1 year, 93% and 35% of the CPVA and ADT groups were AT-free. One transient ischemic attack and 1 pericardial effusion occurred in the CPVA group; side effects of ADT were observed in 23 patients. We compared ablation strategy with antiarrhythmic drug therapy (ADT) in patients with paroxysmal atrial fibrillation (PAF). Atrial fibrillation (AF) ablation strategy is superior to ADT in patients with an initial history of PAF, but its role in patients with a long history of AF as compared with ADT remains a challenge. One hundred ninety-eight patients (age, 56 ± 10 years) with PAF of 6 ± 5 years’ duration (mean AF episodes 3.4/month) who had failed ADT were randomized to AF ablation by circumferential pulmonary vein ablation (CPVA) or to the maximum tolerable doses of another ADT, which included flecainide, sotalol, and amiodarone. Crossover to CPVA was allowed after 3 months of ADT. By Kaplan-Meier analysis, 86% of patients in the CPVA group and 22% of those in the ADT group who did not require a second ADT were free from recurrent atrial tachyarrhythmias (AT) (p < 0.001); a repeat ablation was performed in 9% of patients in the CPVA group for recurrent AF (6%) or atrial tachycardia (3%). At 1 year, 93% and 35% of the CPVA and ADT groups, respectively, were AT-free. Ejection fraction, hypertension, and age independently predicted AF recurrences in the ADT group. Circumferential pulmonary vein ablation was associated with fewer cardiovascular hospitalizations (p < 0.01). One transient ischemic attack and 1 pericardial effusion occu