P430Antiarrhythmic drug therapy in Russian patients undergoing atrial fibrillation ablation: a sub-analysis of the ESC-EHRA EORP registry
Authors: Korobchenko L , Bayramova S , Kharats V , Batalov R , Silin I , Kryzhanovskiy D , Romanov A , Lebedev D , Kolunin G , Zamanov D , Chetverikov S , Yashin S , Ivanitsky E , Mamchur S , Mikhaylov E 
Published: June 2020

Abstract

OnBehalf
EHRA-ESC EORP AFA LT registry

Introduction
Despite the effectiveness of atrial fibrillation (AF) catheter ablation (CA), antiarrhythmic therapy (AAT) remains an important part of the complex treatment.

Purpose
To analyze AAT dynamics in Russian patients undergoing AF ablation, and to reveal potential factors associated with ongoing AAT in patients without arrhythmia recurrence.

Methods
The ESC-EHRA AF ablation registry was conducted in 2012-2016 in EHRA countries. The current analysis included 476 patients (57.1 male; 57.1 ± 8.7 years) who underwent AF ablation in 13 Russian clinics. AAT before, during and at 12-month follow-up (12-FU) was assessed. At baseline, paroxysmal AF was present in 320 (67.2%) patients, persistent AF - in 94 (19.7%), long-standing persistent AF- in 53 (11,1%), in 9 (1.9%) AF type was unknown. Hypertension (H) was present in 355 (74.6%) patients; congestive heart failure (CHF) (NYHA≥2) in 184 (38.7%) patients; coronary artery disease (CAD) in 132 (27.7%) patients. The CA was the first in 396 (83.2%) cases, redo ablation was performed in 80 (16.8%) cases. AF recurrences were registered according to local clinical practice. Any atrial tachyarrhythmia &gt;30s was considered as a recurrence.

Results
A three-month FU (3-FU) visit was performed in 476 (100%) patients, 12-FU - in 390 (81.9%). Prior to PV isolation 439 (92.2%) patients received AAT, while after ablation there was an increase in the number of patients on AAT - 459 (96.4%). The highest number of patients on AAT was detected at 3-FU - 463 (97.3%). During 12 months at least one episode of arrhythmia recurrence was documented in 203 (52.1%) patients, and 370 (94.8%) patients were on AAT at the 12-month visit. After the 12-month visit 307 (78.7%) patients continued to receive AAT, and in 187 (47.9%) of them there was no arrhythmia recurrence after the index ablation. Five (2.7%) of these patients continued a Ic class AAT drug, 35 (18.7%) patients - class III, 129 (69.0%) patients - β-blockers (BB) and 18 (9.6%) patients - calcium channel blockers (CCB). All 187 patients had co-morbidities (75.4% - H; 41.7% - CHF (NYHA≥2; 31.6% - CAD). There were no statistically significant predictors of AAT use in patients without arrhythmia reccurence. According to the univariant regression analysis, the use of AAT III class (mainly-sotalol) at 12 months had a small but statistically significant negative association with left atrial size enlargement (OR = 0.917; 0.860-0.997); class III AAT was negatevely associated with BB therapy (OR = 0.057; 0.016-0.198); CCB therapy was associated with an older age (OR = 1.073; 1.053-1.151).

Conclusions
About one-half of patients without apparent arrhythmia recurrence following AF ablation do receive AAT. There were no clinical or procedure-related factors associated with AAT after effective AF ablation. Paradoxically, patients with a smaller left atrial size and without arrhythmia recurrence had more chances to receive class III AAT, what requires further analysis.