Prognostic value of pharmacotherapy in patients with atrial fibrillation after radiofrequency ablation

Abstract

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events. Materials and methods. Patients with paroxysmal, persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. The primary endpoint was patient survival, secondary – a composite endpoint of freedom from recurrence and/or non-fatal cardiovascular events for 2 years of a follow-up. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Results. 116 patients were consecutively enrolled in the study. In the long-term post-ablation, 23 patients (19.8 %) continued to take amiodarone, 2 patients (1.7 %) – propafenone for arrhythmic events, 38 patients (32.8 %) needed anticoagulants, and 37 patients (31.9 %) received beta-adrenoceptor blockers over the entire follow-up period. The use of RAAS inhibitors decreased from 81.0 % before the ablation to 56.0 % in the long-term period following RFA. Multifactorial logistic regression analysis showed that the prolonged (more than 3 months) anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the long-term post-ablation period were associated with the secondary endpoint. Conclusions. RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively. Independent predictors of survival were the doses of anticoagulants more than 3 months after ablation, arrhythmia recurrence and non-fatal cardiovascular events – the doses of anticoagulants before the procedure, and the use and doses of beta-adrenoceptor blockers in the long-term period after RFA.