Short-term Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials

Ann Pharmacother. 2016 Sep;50(9):697-705. doi: 10.1177/1060028016653140. Epub 2016 Jun 16.

Abstract

Background: The incidence of recurrent arrhythmia after catheter ablation (CA) for atrial fibrillation (AF) is unacceptable. Short-term antiarrhythmic drug (AAD) treatment following CA was presumed to be effective in reducing recurrent arrhythmia.

Objective: To fully evaluate the efficacy of short-term use of AADs following CA for AF in preventing recurrence of atrial tachyarrhythmias.

Methods: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched up until May 1, 2016. We enrolled randomized controlled trials (RCTs) that evaluated the efficacy of short-term use of AADs following CA for AF in preventing early and/or late recurrence of atrial tachyarrhythmias. The statistical analyses were performed using Review Manager Version 5.3.

Results: Six RCTs were included in this analysis, involving a total of 2764 patients. The frequency of early recurrence of atrial tachyarrhythmias was 39.5% in the AAD group (556 of 1407) and 47.2% (640 of 1357) in the control group. The pooled risk ratio of the AAD group to the control group was 0.78 (95% CI = 0.62-0.98). Regarding late recurrence of AF (LRAF), the incidence in the AAD group and the control group was 32.5% (420 of 1293) and 34.6% (450 of 1300), respectively. No significant difference was identified between the 2 groups (relative risk = 0.94, 95% CI = 0.85-1.05).

Conclusions: Short-term use of AADs following CA for AF reduced the incidence of early recurrent atrial tachyarrhythmias but did not prevent LRAF.

Keywords: antiarrhythmics; atrial fibrillation; catheter ablation; clinical trials; meta-analysis.

Publication types

  • Meta-Analysis

MeSH terms

  • Anti-Arrhythmia Agents / administration & dosage
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / etiology
  • Catheter Ablation / adverse effects*
  • Dose-Response Relationship, Drug
  • Humans
  • Odds Ratio
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Tachycardia / drug therapy
  • Tachycardia / epidemiology
  • Tachycardia / etiology
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents