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Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation.

Abstract：

BACKGROUND:We prospectively compared the efficacy, safety, and quality of life (QoL) impact of catheter ablation versus antiarrhythmic drugs (AAD) in elderly patients with persistent atrial fibrillation (AF). METHODS AND RESULTS:Four hundred and twelve consecutive patients, aged ≥ 70 years, underwent ablation (Group A, 153 patients) or AAD (Group B, 259 patients). Study endpoints: treatment failure (any AF/AT lasting >30 seconds) and treatment-related adverse events (acute when ≤1 month of procedure and long term when >1 month). At a follow-up of 60 ± 17 months, 43% and 46% patients in Group B versus 58% and 76% in Group A were in sinus rhythm (SR), respectively, after one (P = 0.003) and 2 procedures (P < 0.001). Fifteen acute adverse events occurred (6.7% in Group A vs 1% in Group B, P < 0.001), mainly periprocedural cerebral thromboembolism (3.3% in Group A vs 0.7% in Group B, P = 0.058). Previous TIA/stroke resulted the only independent predictor of periprocedural cerebrovascular accidents (OR 1.2, 95%IC 1.1-1.3). At follow-up, 74 long-term adverse events occurred (7.7% in Group A vs 23.9% in Group B, P < 0.001) with Group B patients more often experiencing AAD-related adverse events (12.7% vs 2.6%, P < 0.001). Group A and absence of AF/AT recurrences significantly improved QoL scores (P < 0.001). CONCLUSIONS:In elderly persistent AF patients, catheter ablation is more effective in maintaining SR and in improving QoL than AAD but is affected by a higher risk of embolic complications, particularly in patients with previous TIA/stroke. Over time, Group A patients more likely discontinued AAD with a reduction of long-term adverse events.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Blandino A,Toso E,Scaglione M,Anselmino M,Ferraris F,Sardi D,Battaglia A,Gaita F

doi

10.1111/jce.12126

subject

Has Abstract

pub_date

2013-07-01 00:00:00

pages

731-8

issue

eissn

1045-3873

issn

1540-8167

journal_volume

pub_type

临床试验,杂志文章

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Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation.