Table 29.15 Open in new tab Randomized...

Table 29.15

Randomized controlled trials of radiofrequency ablation versus antiarrhythmic drugs or no treatment for atrial fibrillation

Study [reference]	No. of patients	Type of AF	Previous use of AAD	Ablation technique	Patients without AF, %—Ablation vs. AAD or no AAD
Krittayaphong et al. 2003 [483]	30	Paroxysmal or persistent	≥1 AAD failured	PVI + LA lines + CTI ablation + RA lines	79 vs. 40
Wazni et al. 2005 (RAAFT) [484]	70	Mainly paroxysmal	No	PVI	87 vs. 37
Stabile et al. 2006 (CACAF) [485]	137	Paroxysmal or persistent	≥2 AAD failure	PVI + LA lines ± CTI ablation	56 vs. 9
Oral et al. 2006 [486]	146	Persistent	≥1 AAD failure (mean 2.1 ± 1.2)	CPVA	74 vs. 4
Pappone et al. 2006 (APAF) [487]	198	Paroxysmal	≥2 AAD failure (mean 2 ± 1)	CPVA + CTI ablation	86 vs. 22
Jais et al. 2008 (A4 study) [488]	112	Paroxysmal	≥1 AAD failure	PVI ± LA lines ± CTI ablation	89 vs. 23
Forleo et al. 2009 [489]	70	Paroxysmal or persistent	≥1 AAD failure	PVI + CTI ablation ± LA lines	80 vs. 43
Thermocool 2008f	159	Paroxysmal	≥1 AAD failureg	PVI + CTI ablation ± LA lines ± RA focal ablation	66 vs. 17

Study [reference]	No. of patients	Type of AF	Previous use of AAD	Ablation technique	Patients without AF, %—Ablation vs. AAD or no AAD
Krittayaphong et al. 2003 [483]	30	Paroxysmal or persistent	≥1 AAD failured	PVI + LA lines + CTI ablation + RA lines	79 vs. 40
Wazni et al. 2005 (RAAFT) [484]	70	Mainly paroxysmal	No	PVI	87 vs. 37
Stabile et al. 2006 (CACAF) [485]	137	Paroxysmal or persistent	≥2 AAD failure	PVI + LA lines ± CTI ablation	56 vs. 9
Oral et al. 2006 [486]	146	Persistent	≥1 AAD failure (mean 2.1 ± 1.2)	CPVA	74 vs. 4
Pappone et al. 2006 (APAF) [487]	198	Paroxysmal	≥2 AAD failure (mean 2 ± 1)	CPVA + CTI ablation	86 vs. 22
Jais et al. 2008 (A4 study) [488]	112	Paroxysmal	≥1 AAD failure	PVI ± LA lines ± CTI ablation	89 vs. 23
Forleo et al. 2009 [489]	70	Paroxysmal or persistent	≥1 AAD failure	PVI + CTI ablation ± LA lines	80 vs. 43
Thermocool 2008f	159	Paroxysmal	≥1 AAD failureg	PVI + CTI ablation ± LA lines ± RA focal ablation	66 vs. 17

All patients in the ablation arm were treated with antiarrhythmic drugs; ^bpatients in the control group received amiodarone and had up to two electrical cardioversions if required during the first 3 months; amiodarone was discontinued if patients were in sinus rhythm after 3 months; ^cwith type 2 diabetes mellitus; ^dno previous use of amiodarone, but ‘failed’ drugs included beta-blockers, calcium-channel blockers, and digitalis in addition to class IA and IC agents; ^eafter 1 year; not allowed during 1 year-follow-up; ^fpresented at the Heart Rhythm Society meeting in May 2009; ^gincluding beta-blockers and calcium antagonists. All studies had a follow-up period of 1 year.

AAD, antiarrhythmic drugs; AF, atrial fibrillation; APAF, Ablation for Paroxysmal Atrial Fibrillation study; A4, Atrial fibrillation Ablation versus AntiArrhythmic drugs; CACAF, Catheter Ablation for the Cure of Atrial Fibrillation study; CPVA, circumferential pulmonary vein ablation; CTI, cavotricuspid isthmus; LA, left atrial; PVI, pulmonary vein isolation; RAAFT, Radiofrequency Ablation Atrial Fibrillation Trial; RA, right atrial.

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