Progression of atrial fibrillation after catheter ablation procedure and antiarrhythmic drug therapy in patients with paroxysmal af

Aim. This prospective randomized study was aimed to assess the progression of atrial fibrillation (AF) after ablation procedure and antiarrhythmic drug therapy (AAD) in patients with paroxysmal AF by means of implantable cardiac monitors (ICM). Methods. The study enrolled 92 patients with paroxysmal AF, who were eligible either for catheter ablation or AAD. The patients were randomized into two groups: 1) AAD + ICM implantation (group I; n=46), and 2) AF catheter ablation (CA) + ICM implantation (group II; n=46), and 2). The primary endpoint was AF progression according to ICM data. The AF progression was defined as AF burden > 30%. A complication rate after ablation procedure and side effects of AAD were determined as the secondary endpoints. The follow up of this study was 24 months. Results. By the end of the follow-up period, AF progression was observed in 27 (58.7%) patients in the AAD group and 10 (21.7%) patients in the CA group (р=0.0003; HR 0.37, 95% CI [0.17-0.76], р=0.007, Cox regression). 13 (28,3%) patients in the AAD group and 2 (4.3%) in the CA group (р=0.002) developed persistent AF. The complication rate in the AAD group was 24% (11 patients) and 6.5 % (3 patients) in the CA group (р=0.02). Conclusion. Radiofrequency ablation of AF leads to a significant decrease in AF progression when compared with antiarrhythmic drug therapy in patients with paroxysmal AF, which was confirmed by implantable cardiac monitors data.