Cardiac Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Circ Arrhythm Electrophysiol. 2011 Feb;4(1):11-4. doi: 10.1161/CIRCEP.110.955393. Epub 2010 Nov 13.
We previously demonstrated that treatment with antiarrhythmic drugs (AADs) during the first 6 weeks after atrial fibrillation (AF) ablation reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion or hospitalization for arrhythmia management. Whether early rhythm suppression decreases longer-term arrhythmia recurrence is unknown. We now report the 6-month follow-up data from this study.
The Antiarrhythmics After Ablation of Atrial Fibrillation study prospectively randomized patients with paroxysmal AF undergoing ablation to either receive (AAD group) or not receive (no-AAD group) AAD treatment for the first 6 weeks after ablation; all patients received atrioventricular nodal blockers. Physicians were encouraged to stop the AADs after the 6-week treatment period. All patients underwent 4 weeks of transtelephonic monitoring to document asymptomatic AF and an evaluation at 6 weeks and 6 months. A total of 110 patients (71% men) aged 55±9 years were randomized, with 53 to AAD and 57 to no AAD. At 6 months, there was no difference in freedom from AF between the early AAD and no-AAD groups (38/53 [72%] versus 39/57 [68%]; P=0.84). Lack of early AF recurrence during the initial 6-week period was the only independent predictor of 6-month freedom from AF (64/76 [84%] without early recurrence versus 13/34 [38%] with early recurrence; P=0.0001).
Although short-term use of AADs after AF ablation decreases early recurrence of atrial arrhythmias, early use of AADs does not prevent arrhythmia recurrence at 6 months. Early AF recurrence on or off AADs during the initial 6-week blanking period is a strong independent predictor of long-term AF recurrence.
我们之前的研究表明，在心房颤动（AF）消融后的前 6 周内使用抗心律失常药物（AAD）可降低临床显著的房性心律失常的发生率和心律失常管理所需的电复律或住院治疗。早期节律抑制是否可降低长期心律失常复发尚不清楚。我们现在报告该研究的 6 个月随访数据。
AF 消融后的抗心律失常药物研究前瞻性地将阵发性 AF 消融患者随机分为接受（AAD 组）或不接受（无 AAD 组）AAD 治疗的两组，在消融后的前 6 周内接受治疗；所有患者均接受房室结阻滞剂。医生鼓励在 6 周治疗期后停用 AAD。所有患者均接受 4 周的远程心电图监测以记录无症状性 AF，并在 6 周和 6 个月时进行评估。共纳入 110 例（71%为男性）年龄 55±9 岁的患者进行随机分组，其中 53 例接受 AAD 治疗，57 例接受无 AAD 治疗。6 个月时，早期 AAD 组和无 AAD 组之间 AF 无复发率无差异（53/53 [72%] vs 57/57 [68%]；P=0.84）。初始 6 周内无早期 AF 复发是 6 个月时 AF 无复发的唯一独立预测因素（64/76 [84%]无早期复发者与 13/34 [38%]早期复发者；P=0.0001）。
尽管 AF 消融后短期使用 AAD 可降低房性心律失常的早期复发，但早期使用 AAD 并不能预防 6 个月时的心律失常复发。在最初的 6 周空白期内使用或不使用 AAD 时的早期 AF 复发是长期 AF 复发的强有力独立预测因素。
