Abstract 93 Antiarrhythmic Drug Therapy after Catheter Ablation for Atrial Fibrillation – Insights from the German Ablation Registry

Background
Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after catheter ablation for atrial fibrillation (AF) are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients’ treatment burden.

Methods

Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcomes.

Results

In patients with paroxysmal AF (n=2138) the recurrence rates did not differ when discharged with (n=1051) or without (n=1087) AAD (adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95-1.35]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05-1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20-2.58]).

Similar rates of recurrences, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95-1.56]; reablation: OR 1.21, 95% CI [0.91-1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74-2.08]).

The incidence of cardiovascular events and mortality did not differ at follow-up in patients discharged with or without AAD.

Conclusions

The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction.

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Antiarrhythmic Drug Therapy after Catheter Ablation for Atrial Fibrillation – Insights from the German Ablation Registry
R. Schleberger¹, A. Metzner¹, K.-H. Kuck², D. Andresen³, S. Willems⁴, E. Hoffmann⁵, T. Deneke⁶, L. Eckardt⁷, J. Brachmann⁸, M. Hochadel⁹, J. Senges¹⁰, A. Rillig¹
¹Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ²Kardiologie, LANS Cardio Hamburg, Hamburg; ³Klinik für Innere Medizin und Angiologie, Evangelisches Krankenhaus Hubertus, Berlin; ⁴Kardiologie, Asklepios Klinik St. Georg, Hamburg; ⁵Klinik für Kardiologie und Internistische Intensivmedizin, München Klinik Bogenhausen, München; ⁶Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; ⁷Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster; ⁸Medical School / Regiomed GmbH, Coburg; ⁹Medizinische Klinik B, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein; ¹⁰Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein;
Background Data on the optimal treatment strategy for antiarrhythmic drug therapy (AAD) after catheter ablation for atrial fibrillation (AF) are inconsistent. While AAD potentially stabilizes sinus rhythm, it also increases the patients’ treatment burden. Methods Patients from the prospective German Ablation Registry (n=3275) discharged with or without AAD after catheter ablation were compared regarding long-term success, cardiovascular events and patient reported outcomes. Results In patients with paroxysmal AF (n=2138) the recurrence rates did not differ when discharged with (n=1051) or without (n=1087) AAD (adjusted odds ratio (OR) 1.13, 95% confidence interval (CI) [0.95-1.35]). The reablation rate was higher and reduced treatment satisfaction was reported more often in those discharged with AAD (reablation: OR 1.30, 95% CI [1.05-1.61]; reduced treatment satisfaction: OR 1.76, 95% CI [1.20-2.58]). Similar rates of recurrences, reablations and treatment satisfaction were found in patients with persistent AF (n=1137) discharged with (n=641) or without (n=496) AAD (recurrence: OR 1.22, 95% CI [0.95-1.56]; reablation: OR 1.21, 95% CI [0.91-1.61]; treatment satisfaction: OR 1.24, 95% CI [0.74-2.08]). The incidence of cardiovascular events and mortality did not differ at follow-up in patients discharged with or without AAD. Conclusions The rates of recurrences, cardiovascular events and mortality did not differ between patients discharged with or without AAD after AF catheter ablation. However, AAD should be considered carefully in patients with paroxysmal AF, in whom it was associated with a higher reablation rate and reduced treatment satisfaction.
https://dgk.org/kongress_programme/ht2021/P442.htm