Catheter Ablation Versus Drug Therapy: The Atrial Fibrillation Showdown

EVIDENCE that catheter ablation is superior to drug therapy for reducing atrial fibrillation (AF) has been newly presented. A recent trial investigating the long-term effects of the two AF treatments showed that more patients who received catheter ablation were free from AF after 5 years than those receiving drug therapy. Despite these results, the researchers noted that use of the treatments will still need to be decided on a case-by-case basis.

AF, a heart condition that causes an irregular and often abnormally fast heart rate, is the most common heart rhythm problem that requires medical treatment. It is more prevalent with higher age, and affects about 7 in 100 people over the age of 65 in the UK. Being associated with increased risk of stroke and disability, the condition reduces both the performance of the heart and general quality of life.

Heart rhythm specialists conducted the 5-year trial MANTRA-PAF (Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) to assess whether antiarrhythmic drug therapy should be used for initial treatment of symptomatic AF (as is most often the case currently) followed by catheter ablation if drug therapy fails, or whether catheter ablation should be used as first-line treatment.

A total of 294 patients with highly symptomatic paroxysmal AF were randomised to receive either catheter ablation or antiarrhythmic drug therapy as first-line treatment. The 5-year follow-up (achieved in 83% of patients tested) of which 125 patients had been randomised to catheter ablation and 120 to antiarrhythmic drug therapy as first-line treatment showed that more patients in the catheter ablation group were free from any AF (126/146 versus 105/148, p=0.001) and symptomatic AF (137/146 versus 126/148, p=0.015) than those in the antiarrhythmic drug therapy group.

“At 5-year follow-up less atrial fibrillation was observed with catheter ablation as first-line treatment,” said principal investigator Prof Jens Cosedis Nielsen, Consultant Cardiologist, Aarhus University Hospital, Aarhus, Denmark. “The findings indicate that the first-line treatment with catheter ablation is superior to drug therapy for reducing AF.” Despite this, the researchers concluded that due to differing disease burdens and risks associated with the different treatment strategies, the choice of first-line treatment strategy must still be discussed with each individual patient.

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