Karl H. Kuck

Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial.

IMPORTANCE Atrial fibrillation (AF) is the most common rhythm disorder seen in clinical practice. Antiarrhythmic drugs are effective for reduction of recurrence in patients with symptomatic paroxysmal AF. Radiofrequency ablation is an accepted therapy in patients for whom antiarrhythmic drugs have failed; however, its role as a first-line therapy needs further investigation. OBJECTIVE To compare radiofrequency ablation with antiarrhythmic drugs (standard therapy) in treating patients with paroxysmal AF as a first-line therapy. DESIGN, SETTING, AND PATIENTS A randomized clinical trial involving 127 treatment-naive patients with paroxysmal AF were randomized at 16 centers in Europe and North America to received either antiarrhythmic therapy or ablation. The first patient was enrolled July 27, 2006; the last patient, January 29, 2010. The last follow-up was February 16, 2012. INTERVENTIONS Sixty-one patients in the antiarrhythmic drug group and 66 in the radiofrequency ablation group were followed up for 24 months. MAIN OUTCOMES AND MEASURES The time to the first documented atrial tachyarrhythmia of more than 30 seconds (symptomatic or asymptomatic AF, atrial flutter, or atrial tachycardia), detected by either scheduled or unscheduled electrocardiogram, Holter, transtelephonic monitor, or rhythm strip, was the primary outcome. Secondary outcomes included symptomatic recurrences of atrial tachyarrhythmias and quality of life measures assessed by the EQ-5D tool. RESULTS Forty-four patients (72.1%) in the antiarrhythmic group and in 36 patients (54.5%) in the ablation group experienced the primary efficacy outcome (hazard ratio [HR], 0.56 [95% CI, 0.35-0.90]; P = .02). For the secondary outcomes, 59% in the drug group and 47% in the ablation group experienced the first recurrence of symptomatic AF, atrial flutter, atrial tachycardia (HR, 0.56 [95% CI, 0.33-0.95]; P = .03). No deaths or strokes were reported in either group; 4 cases of cardiac tamponade were reported in the ablation group. In the standard treatment group, 26 patients (43%) underwent ablation after 1-year. Quality of life was moderately impaired at baseline in both groups and improved at the 1 year follow-up. However, improvement was not significantly different among groups. CONCLUSIONS AND RELEVANCE Among patients with paroxysmal AF without previous antiarrhythmic drug treatment, radiofrequency ablation compared with antiarrhythmic drugs resulted in a lower rate of recurrent atrial tachyarrhythmias at 2 years. However, recurrence was frequent in both groups. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00392054.

Preliminary results of the Cardiac Arrest Study Hamburg (CASH)

Sodium channel blockers and class III antiarrhythmic compounds, as well as beta blockers, have been used in preventing recurrences of sudden cardiac death. In recent years, implantable cardioverter-defibrillators (ICDs) have been used increasingly, but no data from randomized trials comparing antiarrhythmic drug and ICD therapy have been reported in this setting. In 1987, the Cardiac Arrest Study Hamburg (CASH), a prospective, randomized trial, was initiated to compare metoprolol, amiodarone, propafenone, and ICD implantation in patients surviving sudden cardiac death due to documented ventricular tachycardia and/or ventricular fibrillation. The details of the study design and preliminary results are presented herein. The primary endpoint of the study is total mortality. The data reviewed in March 1992, representing a mean follow-up period of 11 months, indicated no significant differences among patients randomized to metoprolol, amiodarone, and ICDs. However, there was a significantly higher total mortality and cardiac arrest recurrence in patients randomized to propafenone compared with those randomized to the ICD treatment limb. The study continues with the deletion of the propafenone treatment limb.

Venice Chart International Consensus Document on Ventricular Tachycardia/Ventricular Fibrillation Ablation

(J Cardiovasc Electrophysiol, Vol. 21, pp. 339–379, March 2010)

Venice chart international consensus document on atrial fibrillation ablation: 2011 update

Venice Chart International Consensus Document on Atrial Fibrillation Ablation : 2011 Update