Dronedarone after Catheter Ablation of Atrial Fibrillation: A New Option in Hybrid Therapy
Journal Title: Cardiology and Angiology: An International Journal - Year 2017, Vol 6, Issue 2
Abstract
Background and Aim: Catheter ablation has become the therapy of choice in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, frequent AF recurrences often necessitate an adjunctive antiarrhythmic drug (AAD) therapy. Dronedarone is a new class III AAD with modest side effects. We compared a conventional AAD therapy (CAAT) with class I/III AADs to a novel therapy with dronedarone (NAAT)in regard to AF recurrences and improvement of symptoms. Methodology: One hundred twenty five consecutive patients (84 men; mean age 62.1±12.4 years) with symptomatic paroxysmal (n=70) or persistent (n=55) drug refractory AF were enrolled in an open-label randomized study. Following successful pulmonary vein isolation (PVI) patients were randomized to receive CAAT (n=50), NAAT (n=50) or no AAD therapy (=control; n=25). Follow-up visits were scheduled at 3, 6, 9, and 12 months post ablation. Seven-day-Holter monitoring and patients’ histories served as indicators of treatment success. Bar signs of AF recurrence AADs were discontinued 6 months post ablation. Results: The pre-ablation European Heart Rhythm Association (EHRA)-score decreased from 2.8±0.4 to 1.4±0.6 (NAAT) and 1.5±0.7 (CAAT) 6 months after PVI (1.7±0.7 in the control group). Fifty patients experienced an arrhythmia recurrence within 3 months. After 6 months, both hybrid therapy groups showed a significant advantage over the control group favoring sinus rhythm (SR).Whereas CAAT could retain its significant benefit at 9 months NAAT lost its relative advantages with only a positive trend remaining over the control group but a significant disadvantage compared to CAAT patients. At this point AF recurrences were found in 34% of NAAT patients, 26% of CAAT patients, and 40% of control patients. At 12 months, however, no group could preserve a significant lead over either of the others. Conclusion: Dronedarone after PVI is safe and effective. Compared to a CAAT, NAAT reveals similar improvements of EHRA-scores and non-significantly different AF recurrence rates from 9 months on. Despite this, CAAT keeps significantly more patients in SR 9 months after PVI.
Authors and Affiliations
Felix Gramley, Mohammed Natour, Eva Koellensperger, Klaus Kettering
Keywords
Related Articles
- EP ID EP305734
- DOI 10.9734/CA/2017/32001
- Views 126
- Downloads 0
Carotid Intima-media Thickness and Risk of Cardiovascular Disease among Healthy Adult Volunteers in North Eastern Nigeria
Background: Assessment of carotid intima media thickness (CIMT) have evolved over the years to assume a key role in assessment of cardiovascular risk. However, there is paucity of data on CIMT among Nigerian. We assessed...
The Prevalence of Extra-cranial Carotid Artery Disease in Chronic Heart Failure
Background: The prevalence of carotid disease in patients with heart failure (HF) has not been described. This may be of importance for the implementation of novel interventions for heart failure that require surgery clo...
Effect of an Increase in Global Left Ventricular Afterload on Myocardial Deformation in Patients with Aortic Stenosis, Comparison with Hypertensive Patients
Aims: Left ventricular hypertrophy (LVH) secondary to hypertension and aortic stenosis (AS) are often considered together to be pressure overload hypertrophy. We hypothesized that important differences could e...
β-blockers in Post ST Elevation Myocardial Infarction Patient with Low Left Ventricular Systolic Function: A Retrospective Study at Shahid Gangalal National Heart Centre, Kathmandu, Nepal
Aims: Despite well developed guidelines in the management of ST elevation myocardial infarction with low left ventricular ejection fraction, β-blockers remain an underutilized therapy. We aim to assess the adherence of β...
Catheter Ablation of Atrial Fibrillation: Three-dimensional Transesophageal Echocardiography Provides an Excellent Overview over the Pulmonary Vein Anatomy Facilitating Radiofrequency and Cryoablation Procedures
Background: Catheter of atrial fibrillation is still challenging because of the high degree of variability of the pulmonary vein anatomy. Therefore, 3D imaging systems are frequently used prior to an ablation procedure....