Antiarrhythmics after ablation of AF (5A Study)

Antiarrhythmics after ablation of AF (5A Study) 

Antiarrhythmic drugs after ablation of atrial fibrillation (5A Study) was published in Circulation in 2009 [1]. One hundred and ten patients after catheter ablation of atrial fibrillation was randomized to receive antiarrhythmic drugs or no antiarrhythmics for six weeks. The drugs used in the 5A study were the class Ic drugs propafenone and flecainide if there was no left ventricular dysfunction or coronary artery disease. In those with coronary artery disease and normal left ventricular function, sotalol was used. In those with abnormal left ventricular function, sotalol or dofetilide were used.

The patients wore a transtelephonic monitor for 4 weeks, and were re-evaluated at 6 weeks of treatment. The primary endpoint was a composite of:

  1. Atrial arrhythmias lasting more than 24 hours
  2. Atrial arrhythmias with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy
  3. Intolerance to antiarrhythmic agent requiring drug cessation

Antiarrhythmic treatment well tolerated and reduced the primary endpoint of clinically significant atrial arrhythmia, and need for cardioversion or hospitalization for treatment of arrhythmia.

The six months follow up results were published in Circulation: Arrhythmia and Electrophysiology [2]. Physicians were encouraged to stop antiarrhythmic agents after the six week treatment period. At six months follow up, there was no difference in the freedom from atrial fibrillation (AF) between the early antiarrhythmic treatment group no antiarrhythmic agents group. The only independent predictor of freedom from AF at 6 months was the absence of early recurrence (84% vs 38%, P=0.0001).

References

  1. Jean-Fran├žois Roux, Erica Zado, David J Callans, Fermin Garcia, David Lin, Francis E Marchlinski, Rupa Bala, Sanjay Dixit, Michael Riley, Andrea M Russo, Mathew D Hutchinson, Joshua Cooper, Ralph Verdino, Vickas Patel, Parijat S Joy, Edward P Gerstenfeld. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation. 2009 Sep 22;120(12):1036-40.
  2. Peter Leong-Sit, Jean-Francois Roux, Erica Zado, David J Callans, Fermin Garcia, David Lin, Francis E Marchlinski, Rupa Bala, Sanjay Dixit, Michael Riley, Mathew D Hutchinson, Joshua Cooper, Andrea M Russo, Ralph Verdino, Edward P Gerstenfeld. Antiarrhythmics after ablation of atrial fibrillation (5A Study): six-month follow-up study.
    Circ Arrhythm Electrophysiol. 2011 Feb;4(1):11-4.