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Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation

AIMS: Atrial fibrillation (AF) ablation is generally performed after patients fail antiarrhythmic drug (AAD) therapy. Some patients have drug contraindications or choose to avoid a lifetime of drug therapy. Little is known about the impact of previous drug therapy on ablation outcomes. We evaluated...

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Autores principales: Winkle, Roger A., Mead, R. Hardwin, Engel, Gregory, Kong, Melissa H., Patrawala, Rob A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051413/
https://www.ncbi.nlm.nih.gov/pubmed/22310154
http://dx.doi.org/10.1093/europace/eur370
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author Winkle, Roger A.
Mead, R. Hardwin
Engel, Gregory
Kong, Melissa H.
Patrawala, Rob A.
author_facet Winkle, Roger A.
Mead, R. Hardwin
Engel, Gregory
Kong, Melissa H.
Patrawala, Rob A.
author_sort Winkle, Roger A.
collection PubMed
description AIMS: Atrial fibrillation (AF) ablation is generally performed after patients fail antiarrhythmic drug (AAD) therapy. Some patients have drug contraindications or choose to avoid a lifetime of drug therapy. Little is known about the impact of previous drug therapy on ablation outcomes. We evaluated AAD use before AF ablation and its impact on ablation outcomes. METHODS AND RESULTS: We evaluated freedom from AF after ablation and patients' clinical characteristics by number of AADs failed in 1125 patients undergoing 1504 ablations. We also evaluated reasons why some patients did not receive prior drug therapy. Cox multivariate analysis examined factors predicting ablation failure. Patients failing more drugs before ablation were older (P = 0.001), had a longer duration of AF (P = 0.0001), were more likely female (P = 0.037), had more repeat ablations (P = 0.045), and less paroxysmal AF (P = 0.003). For patients with either paroxysmal or persistent AF, the number of drugs failed predicted AF recurrence (P = 0.0001). Other factors predicting AF recurrence following final ablation included age (P = 0.004), left atrial size (P = 0.002), female gender (P = 0.0001), and persistent AF (P = 0.0001). The reason for not receiving prior drug therapy was medical in 21.5% and patient choice in 78.5%. Number of drugs failed did not influence ablation outcome for patients with long-standing persistent AF (P = 0.352). CONCLUSIONS: For paroxysmal and persistent AF patients undergoing ablation, those failing fewer AADs have different clinical characteristics than those who fail more drugs. Our study also suggests that the more drugs failed pre-ablation, the lower the freedom from AF post-procedure, possibly due to AF progression during drug trials.
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spelling pubmed-40514132014-06-10 Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation Winkle, Roger A. Mead, R. Hardwin Engel, Gregory Kong, Melissa H. Patrawala, Rob A. Europace CLINICAL RESEARCH AIMS: Atrial fibrillation (AF) ablation is generally performed after patients fail antiarrhythmic drug (AAD) therapy. Some patients have drug contraindications or choose to avoid a lifetime of drug therapy. Little is known about the impact of previous drug therapy on ablation outcomes. We evaluated AAD use before AF ablation and its impact on ablation outcomes. METHODS AND RESULTS: We evaluated freedom from AF after ablation and patients' clinical characteristics by number of AADs failed in 1125 patients undergoing 1504 ablations. We also evaluated reasons why some patients did not receive prior drug therapy. Cox multivariate analysis examined factors predicting ablation failure. Patients failing more drugs before ablation were older (P = 0.001), had a longer duration of AF (P = 0.0001), were more likely female (P = 0.037), had more repeat ablations (P = 0.045), and less paroxysmal AF (P = 0.003). For patients with either paroxysmal or persistent AF, the number of drugs failed predicted AF recurrence (P = 0.0001). Other factors predicting AF recurrence following final ablation included age (P = 0.004), left atrial size (P = 0.002), female gender (P = 0.0001), and persistent AF (P = 0.0001). The reason for not receiving prior drug therapy was medical in 21.5% and patient choice in 78.5%. Number of drugs failed did not influence ablation outcome for patients with long-standing persistent AF (P = 0.352). CONCLUSIONS: For paroxysmal and persistent AF patients undergoing ablation, those failing fewer AADs have different clinical characteristics than those who fail more drugs. Our study also suggests that the more drugs failed pre-ablation, the lower the freedom from AF post-procedure, possibly due to AF progression during drug trials. Oxford University Press 2012-05 2012-02-06 /pmc/articles/PMC4051413/ /pubmed/22310154 http://dx.doi.org/10.1093/europace/eur370 Text en Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2012. For permissions please email: journals.permissions@oup.com http://creativecommons.org/licenses/by-nc/2.0/uk/ The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.
spellingShingle CLINICAL RESEARCH
Winkle, Roger A.
Mead, R. Hardwin
Engel, Gregory
Kong, Melissa H.
Patrawala, Rob A.
Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title_full Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title_fullStr Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title_full_unstemmed Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title_short Prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
title_sort prior antiarrhythmic drug use and the outcome of atrial fibrillation ablation
topic CLINICAL RESEARCH
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051413/
https://www.ncbi.nlm.nih.gov/pubmed/22310154
http://dx.doi.org/10.1093/europace/eur370
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