In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .
Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy.
BACKGROUND Early recurrences of atrial tachyarrhythmias ( ERAT ) are common after  atrial fibrillation ( AF ) ablation , and predict late recurrences ( LR ) . We sought to determine the impact of different ablation strategies on ERAT and LR . METHODS AND RESULTS The STAR-AF trial r and omized 100 patients with paroxysmal or persistent AF to ablation of complex fractionated electrograms ( CFAE ) alone , pulmonary vein isolation ( PVI ) alone , or combined PVI + CFAE .  Patients were followed for 12 months . ERAT was defined as any recurrence of AF , atrial tachycardia , or flutter ( AT/AFL ) > 30 seconds during the first 3 months of follow-up . LR was defined as any recurrence of AF/AT/AFL > 30 seconds 3 - 12 months post . Forty-nine patients experienced ERAT . The index ablation strategy was the only independent predictor of ERAT on multivariate analysis ( HR 2.24 PVI vs PVI + CFAE ; and HR 2.65 CFAE vs PVI + CFAE ) . Fifty-two patients experienced LR . The presence of ERAT ( HR 3.23 ) , the use of antiarrhythmic drug ( AAD ) in the first 3 months postablation ( HR 2.85 ) , and the index ablation strategy were independently associated with LR ( HR 3.42 PVI vs PVI + CFAE ; HR 4.72 CFAE vs PVI + CFAE ) . Thirty-five of 49 ( 71 % ) patients with ERAT and 17 ( 33 % ) of 51 patients without ERAT had LR ( P < 0.0001 ) . Among patients with ERAT , increased left atrium size ( HR 1.08 ) , the use of AAD in the first 3 months postablation ( HR 2.86 ) and the index ablation strategy were independently associated with LR ( HR 4.77 PVI vs PVI + CFAE ; HR 4.45 CFAE vs PVI + CFAE ) . CONCLUSION ERAT is common following AF ablation and is strongly associated with LR . Although CFAE ablation alone results in higher rates of early and LR , the addition of CFAE to PVI results in increased long-term success without an increase in ERAT
In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .
BACKGROUND The optimal rhythm management strategy for people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrilation is currently not well defined .
Antiarrhythmic drugs have been the mainstay of therapy .
But recently , in people who have not responded to antiarrhythmic drugs , the use of ablation ( catheter and surgical ) has emerged as an alternative to maintain sinus rhythm to avoid long-term atrial fibrillation complications .
However , evidence from r and omised trials about the efficacy and safety of ablation in non-paroxysmal atrial fibrillation is limited .
OBJECTIVES To determine the efficacy and safety of ablation ( catheter and surgical ) in people with non-paroxysmal ( persistent or long-st and ing persistent ) atrial fibrillation compared to antiarrhythmic drugs .