Efficacy of Antiarrhythmic Drugs Short-term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) Trial

Kazuaki Kaitani; Koichi Inoue; Atsushi Kobori; Yuko Nakazawa; Tomoya Ozawa; Toshiya Kurotobi; Itsuro Morishima; Fumiharu Miura; Tetsuya Watanabe; Masaharu Masuda; Masaki Naito; Hajime Fujimoto; Taku Nishida; Yoshio Furukawa; Takeshi Shirayama; Mariko Tanaka; Katsunori Okajima; Takenori Yao; Yasuyuki Egami; Kazuhiro Satomi; Takashi Noda; Koji Miyamoto; Tetsuya Haruna; Tetsuma Kawaji; Takashi Yoshizawa; Toshiaki Toyota; Mitsuhiko Yahata; Kentaro Nakai; Hiroaki Sugiyama; Yukei Higashi; Makoto Ito; Minoru Horie; Kengo F. Kusano; Wataru Shimizu; Shiro Kamakura; Takeshi Morimoto; Takeshi Kimura; Satoshi Shizuta

Disclosures

Eur Heart J. 2016;37(7):610-618. 

In This Article

Abstract and Introduction

Abstract

Aims Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes.

Methods and results A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73–0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79–1.09; P = 0.38).

Conclusion Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase.

Introduction

Catheter ablation is increasingly performed as a curative therapy for atrial fibrillation (AF), but the high rate of arrhythmia recurrence is a limitation of the procedure.[1–4] Although the major cause of recurrent atrial tachyarrhythmias following AF ablation is considered to be electrical reconnection of pulmonary veins (PVs), a sizable portion of early recurrence is considered to be due to irritability in left atrium (LA) from the ablation procedure. Indeed, previous studies have shown that ~30% of patients with early recurrence had no further recurrent arrhythmias following the first couple of months post ablation.[5,6] At the same time, early arrhythmia recurrence has been shown to be a strong predictor of late arrhythmia recurrence.[6–8] Thus, short-term use of antiarrhythmic drugs (AADs) after ablation has been proposed as adjunctive approach not only to prevent early arrhythmia recurrence, but also to improve long-term outcomes by promoting reverse remodelling of LA through maintenance of sinus rhythm during the first several months after ablation.[7–10] However, previous randomized controlled trials that enrolled only 100–200 patients lacked statistical power to determine the effect of short-term AAD therapy on suppression of late arrhythmia recurrence.[7–10]

Accordingly, we conducted a large-scale multicentre prospective randomized controlled trial, evaluating the efficacy of 90-day use of AAD after catheter ablation for AF.

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