Conti Sergio, Verma Atul
Southlake Regional Health Centre, Suite 602, 581 Davis Drive, Newmarket, ON, L3Y 2P6, Canada.
University of Toronto, Toronto, ON, Canada.
Curr Treat Options Cardiovasc Med. 2017 May;19(5):38. doi: 10.1007/s11936-017-0537-3.
Atrial fibrillation is the most common cardiac arrhythmia and the number of patients is expected to continuously increase in the next years. Catheter ablation is an effective, safe, and well-established treatment for patient with symptomatic and drug-resistant paroxysmal atrial fibrillation (PAF). Over the last decade, there was an increasing body of evidence demonstrating superiority of catheter ablation over antiarrhythmic drugs (AADs) in maintaining sinus rhythm. However, randomized clinical trials have not been conclusive to consider catheter ablation as a first-line therapy for PAF. The encouraging results of RAAFT Trial were not confirmed in the MANTRA-PAF Trial and in the RAAFT-2 Trial. Recent meta-analyses showed that catheter ablation is more effective than AAD therapy as a first-line treatment for PAF. In particular, relatively young patients and patients with no or minimal cardiovascular disease are the subpopulation that benefitted more from catheter ablation. On the other hand, the meta-analysis showed that catheter ablation causes more severe side effects than AAD therapy, underling the importance of patient selection and operator experience. To date, there are no univocal evidences to consider catheter ablation as a first-line therapy for PAF. Apart from patients' preference and avoidance of toxicity of AADs, the published data are supportive to consider a first-line catheter ablation in a peculiar subpopulation of patients. In particular, younger patients, patients with sinus node dysfunction related to AF, and patients with tachycardiomyopathy are the subgroups that seem to be good candidates for catheter ablation as a first-line therapy for PAF.
心房颤动是最常见的心律失常，预计在未来几年患者数量将持续增加。导管消融是治疗有症状的耐药性阵发性心房颤动（PAF）患者的一种有效、安全且成熟的治疗方法。在过去十年中，越来越多的证据表明导管消融在维持窦性心律方面优于抗心律失常药物（AADs）。然而，随机临床试验尚未得出确凿结论，将导管消融视为PAF的一线治疗方法。RAAFT试验的令人鼓舞的结果在MANTRA-PAF试验和RAAFT-2试验中未得到证实。最近的荟萃分析表明，作为PAF的一线治疗方法，导管消融比AAD治疗更有效。特别是，相对年轻的患者以及没有或仅有轻微心血管疾病的患者是从导管消融中获益更多的亚人群。另一方面，荟萃分析表明导管消融比AAD治疗引起更严重的副作用，这突出了患者选择和术者经验的重要性。迄今为止，尚无明确证据将导管消融视为PAF的一线治疗方法。除了患者的偏好和避免AADs的毒性外，已发表的数据支持在特定亚组患者中考虑一线导管消融。特别是，年轻患者、与房颤相关的窦房结功能障碍患者以及心动过速性心肌病患者似乎是作为PAF一线治疗方法进行导管消融的良好候选者。
