AFib: Progression after Failed Ablation Drug Therapy vs Re-Ablation Interview with:

Dr. Evgeny Pokushalov, MD, PhD
State Research Institute of Circulation Pathology, Rechkunovskaya 15, 630055 Novosibirsk 55, Russia What are the main findings of the study?

Dr. Pokushalov: The main finding of this study is that after the failure of the first catheter ablation procedure for PAF, a redo ablation was more effective at eradicating recurrent AF than treatment with AAD.

In this randomized controlled clinical trial, we observed that:

1. The AF progression rate was considerably higher in patients randomized to AAD (79%) use compared with patients treated with a second ablation procedure (25%).

2. The AF burden significantly increased on AAD during followup compared with patients of reablation group (18.8±11.4% versus 5.6±9.5%, respectively).

3. There was a much greater rate of progression to persistent AF if AAD was used rather than redo ablation (23% versus 4%, respectively).

These findings support the need for consideration of a timely intervention in patients with PAF who have responded inadequately to an initial PVI. Were any of the findings unexpected?

Dr. Pokushalov: The findings, that redo AF ablation was substantially more effective than AAD in reducing the progression and prevalence of AF after the failure of an initial ablation were unexpected. We weren’t absolutely sure that it will be so. It is well known, that catheter ablation is more effective than AAD, but we did not know the impact of catheter ablation on the progression of AF. What should clinicians and patients take away from your report?

Dr. Pokushalov: options after a first ablation failure, demonstrating the superiority of reablation versus AAD as accurately determined by comprehensive monitoring over extended follow-up.In fact, we found that freedom from AF at the end of the 36-month follow-up period was severalfold higher in patients treated with a reablation (58%) compared with patients treated with AAD (12%). In addition, AF progression was suppressed by reablation, but progressed in patients treated with AAD.

Primarily, this study is start-up for future international multicenter studies. If our results will be proved by other studies, it can change guidelines and ablation can be first line therapy in the future. If a patient come to cardiologist after catheter ablation and some paroxysms of atrial fibrillation still happen, nevertheless ablation procedure gives us opportunity to stop progression of AF. What recommendations do you have for future research as a result of this study?

Dr. Pokushalov: It is a pilot study. And results of this study are important finding for all cardiology society and for patients. We have only one recommendation. Researchers should  conduct  more international multicenter studies focusing on progression, that can reveal subgroups of patients needed to be analized accurately in future.


Progression of Atrial Fibrillation After a Failed Initial Ablation Procedure in Patients With Paroxysmal Atrial Fibrillation: A Randomized Comparison of Drug Therapy Versus Reablation

Pokushalov E, Romanov A, De Melis M, Artyomenko S, Baranova V, Losik D, Bairamova S, Karaskov A, Mittal S, Steinberg JS.

State Research Institute of Circulation Pathology, Novosibirsk, Russia.

Circ Arrhythm Electrophysiol. 2013 Aug 1;6(4):754-60. doi: 10.1161/CIRCEP.113.000495. Epub 2013 Jun 7.