Radiofrequency Ablation as Initial Therapy in Paroxysmal Atrial Fibrillation

Abstract

In comparing radiofrequency ablation with antiarrhythmic drug therapy as first-line treatment in patients with paroxysmal atrial fibrillation, we found no significant difference between the treatment groups in the cumulative burden of atrial fibrillation over a period of 2 years. (Funded by the Danish Heart Foundation and others; MANTRA-PAF ClinicalTrials.gov number, NCT00133211.).

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…377,378,379 The outcomes of these three trials have recently been summarized in a meta-analysis. 380 A total of 491 young, generally healthy patients with predominantly PAF were randomized to AF ablation vs pharmacological therapy.…”

“…Many have compared AF ablation with AAD therapy in both “first-line” (AAD-naïve patients) and “second-line” (following the failure of 1 or more drugs) settings. 261,377,378,379,462,529,684,733,1025,1026,1027,1028,1029,1030 In some cases, these trials have supported regulatory approval of specific ablation technologies. 462,503,655,673,684,733 Some trials have compared AF ablation with other standard pharmacological or nonpharmacological approaches to rate control.…”

“…377,378,379 The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) 494 trial compared catheter ablation with AAD therapy for the first-line therapy of symptomatic PAF. 378 The trial did not show a reduction in the cumulative AF burden over 2 years; however, catheter ablation was associated with a lower rate of AF recurrence (15% vs 29%, P =.004) and a similar rate of complications (17% vs 15%) compared with AAD. The unexpected result in the MANTRA-PAF might be explained by the ablation techniques with discretional circumferential ablation without confirmation of PVI with a circular mapping catheter as well as by the choice of reduction in AF burden on 7-day Holter as a primary endpoint.…”

“…261,377,378,379,684 Investigating catheter ablation as second-line therapy after failed AAD treatment, catheter ablation was associated with significant improvements in SF-36 scores relative to baseline, with restoration to levels at or above population norms. 261,684 QOL scores were significantly higher for patients treated with catheter ablation than for patients treated with drug therapy, in whom there was little change from baseline scores.…”

“…In the three trials investigating catheter ablation as first-line therapy for AF, QOL improved with both AAD treatment and catheter ablation, and significantly more with catheter ablation, using the SF-36, 377,378,1091 or 4312 EQ-5D 379 instruments (EuroQOL five dimensions questionnaire).…”