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 of Atrial Fibrillation After Cryoballoon Ablation: Insights From the Multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial
Background —Early recurrence of atrial fibrillation ( ERAF ) is common after radiofrequency catheter ablation for AF . We sought to determine the incidence and prognostic significance of ERAF after cryoballoon ablation . Moreover , the benefit of early reablation for ERAF after cryoballoon ablation is undetermined . Methods and Results —The Sustained Treatment of Paroxysmal Atrial Fibrillation ( STOP AF ) trial r and omized 245 patients with paroxysmal AF to medical therapy versus cryoballoon-based pulmonary vein ablation .  Patients were followed for 12 months . ERAF was defined as any recurrence of AF > 30 seconds during the first 3 months of follow-up . Late recurrence ( LR ) was defined as any recurrence of AF > 30 seconds between 3 and 12 months . Of the 163 patients r and omized to cryoablation , 84 patients experienced ERAF ( 51.5 % ) . The only significant factor associated with ERAF was male sex ( hazard ratio [ HR ] , 2.18 ; 95 % confidence interval [ CI ] , 1.03–4.61 ; P=0.041 ) . LR was observed in 41 patients ( 25.1 % ) , and was significantly related to ERAF ( 55.6 % LR with ERAF versus 12.7 % without ERAF ; P<0.001 ) . Among patients with ERAF , only current tobacco use ( HR , 3.84 ; 95 % CI , 1.82–8.11 ; P<0.001 ) was associated with LR . Conversely , early reablation was associated with greater freedom from LR ( 3.3 % LR with early reablation versus 55.6 % without ; HR , 0.04 ; 95 % CI , 0.01–0.32 ; P=0.002 ) . Conclusions —ERAF after cryoballoon ablation occurs in ≈50 % of patients and is strongly associated with LR . Early reablation for ERAF is associated with excellent long-term freedom from recurrent AF
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 .