Dronedarone after Catheter Ablation of Atrial Fibrillation: A New Option in Hybrid Therapy
Felix Gramley *
Heidelberg Private Clinic for Cardiology, Heidelberg, Germany
Felix Vogt
Department of Cardiology, RWTH Aachen University, Germany
Mohammed Natour
Heidelberg Private Clinic for Cardiology, Heidelberg, Germany
Eva Koellensperger
Ethianum Heidelberg, Germany
Klaus Kettering
Department of Cardiology, JW Goethe University, Frankfurt, Germany
*Author to whom correspondence should be addressed.
Abstract
Background and Aim: Catheter ablation has become the therapy of choice in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). However, frequent AF recurrences often necessitate an adjunctive antiarrhythmic drug (AAD) therapy. Dronedarone is a new class III AAD with modest side effects. We compared a conventional AAD therapy (CAAT) with class I/III AADs to a novel therapy with dronedarone (NAAT)in regard to AF recurrences and improvement of symptoms.
Methodology: One hundred twenty five consecutive patients (84 men; mean age 62.1±12.4 years) with symptomatic paroxysmal (n=70) or persistent (n=55) drug refractory AF were enrolled in an open-label randomized study. Following successful pulmonary vein isolation (PVI) patients were randomized to receive CAAT (n=50), NAAT (n=50) or no AAD therapy (=control; n=25). Follow-up visits were scheduled at 3, 6, 9, and 12 months post ablation. Seven-day-Holter monitoring and patients’ histories served as indicators of treatment success. Bar signs of AF recurrence AADs were discontinued 6 months post ablation.
Results: The pre-ablation European Heart Rhythm Association (EHRA)-score decreased from 2.8±0.4 to 1.4±0.6 (NAAT) and 1.5±0.7 (CAAT) 6 months after PVI (1.7±0.7 in the control group). Fifty patients experienced an arrhythmia recurrence within 3 months. After 6 months, both hybrid therapy groups showed a significant advantage over the control group favoring sinus rhythm (SR).Whereas CAAT could retain its significant benefit at 9 months NAAT lost its relative advantages with only a positive trend remaining over the control group but a significant disadvantage compared to CAAT patients. At this point AF recurrences were found in 34% of NAAT patients, 26% of CAAT patients, and 40% of control patients. At 12 months, however, no group could preserve a significant lead over either of the others.
Conclusion: Dronedarone after PVI is safe and effective. Compared to a CAAT, NAAT reveals similar improvements of EHRA-scores and non-significantly different AF recurrence rates from 9 months on. Despite this, CAAT keeps significantly more patients in SR 9 months after PVI.
Keywords: Atrial fibrillation, dronedarone, catheter, ablation