Catheter Ablation as First-Line Therapy in Persistent Atrial Fibrillation: Patient Characteristics and Clinical Outcomes.

BACKGROUND

In patients with persistent atrial fibrillation (PerAF), antiarrhythmic drugs (AADs) are considered a first-line rhythm-control strategy, whereas catheter ablation is a reasonable alternative.

OBJECTIVES

This study sought to examine the prevalence, patient characteristics, and clinical outcomes of patients with PerAF who underwent catheter ablation as a first or second-line strategy.

METHODS

This multicenter observational study included consecutive patients with PerAF who underwent first-time ablation between January 2020 and September 2021 in 9 medical centers in the United States. Patients were divided into those who underwent ablation as first-line therapy and those who had ablation as second-line therapy. Patient characteristics and clinical outcomes were compared between the groups.

RESULTS

A total of 2,083 patients underwent first-time ablation for PerAF. Of these, 1,086 (52%) underwent ablation as a first-line rhythm-control treatment. Compared with patients treated with AADs as first-line therapy, these patients were predominantly male (72.6% vs 68.1%; P = 0.03), with a lower frequency of hypertension (64.0% vs 73.4%; P < 0.001) and heart failure (19.1% vs 30.5%; P < 0.001). During a mean follow-up of 325.9 ± 81.6 days, arrhythmia-free survival was similar between the groups (HR: 1.13; 95% CI: 0.92-1.41); however, patients in the second-line ablation strategy were more likely to continue receiving AAD therapy (41.5% vs 15.9%; P < 0.001).

CONCLUSIONS

A first-line ablation strategy for PerAF is prevalent in the United States, particularly in men with fewer comorbidities. More data are needed to identify patients with PerAF who derive benefit from an early intervention strategy.

Informations de copyright

Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Barkagan has received consulting fees from Biosense Webster and Cardiodet. Dr Gerstenfeld has received research grants and speaking honoraria from Abbott Medical; has served on the advisory board of Biosense Webster; and has served on the data safety monitoring board of Abbott Medical. Dr Narayan has served as a consultant for Abbott, LifeSignals, and TDK. Dr Tzou has served as a consultant for Abbott, Biosense Webster, Boston Scientific, and Medtronic. Dr Siddiqui has received consulting fees from Abbott, Biosense Webster, Boston Scientific, Medtronic, and Stereotaxis. Dr Natale has served as a consultant for Abbott, Baylis, Biosense Webster, Biotronik, Boston Scientific, and Medtronic. Dr Anter has received research grants and speaking honoraria from Biosense Webster and Boston Scientific; and has previously held stock in Affera Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.