Morbidity and Financial Costs of Atrial Fibrillation High and Likely to Grow

MedicalResearch.com Interview with:

Sandra L. Jackson, PhD National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA

Dr. Sandra  Jackson

Sandra L. Jackson, PhD
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Chamblee GA

MedicalResearch.com: What is the background for this study?

Response: People who have atrial fibrillation are at increased risk for having a heart attack or stroke. While we know that the percentage of the population with atrial fibrillation is increasing in the US, there is no national surveillance system to track the burden of emergency department visits, hospitalizations and deaths related to atrial fibrillation across all ages and health insurance provider types. This study combined data from the Healthcare Cost and Utilization Project and the National Vital Statistics System to provide national estimates for atrial fibrillation-related healthcare service use and deaths from 2006-2014.

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Insertable Cardiac Monitors Detect Previously Undiagnosed Atrial Fibrillation

MedicalResearch.com Interview with:
James A. Reiffel, M.D
Professor Emeritus of Medicine
Special Lecturer in Medicine
Dept of Medicine Cardiology
Columbia University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation is a common arrhythmia (multi-millions of Americans) and carries with it a risk of stroke and of heart failure (among others) if not treated preventively. In many people, atrial fibrillation comes to attention because of symptoms, but not in all. The chances of developing Atrial fibrillation are substantially increased in certain populations of patients, such as the ones we enrolled in our study.  Continuous monitoring of such patients, as we did, and as others have also done recently, though in smaller numbers of patients, can detect otherwise unsuspected atrial fibrillation, which can lead to treatment before complications arise.

We found that using such monitoring, when monitored for 18 months, almost 1 in 3 patients had atrial fibrillation detected, as did 40% by 30 months. Intermittent monitoring, including by cell phones, may detect some atrial fibrillation but it is not nearly as effective as the type of monitoring we did and so many patients will be missed by lesser monitoring methods.

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Comparison of NOACs with Warfarin In Atrial Fibrillation Patients With Single Stroke Risk Factor

MedicalResearch.com Interview with:

Gregory Y. H. Lip, MD Professor of Cardiovascular Medicine University of Birmingham, UK; Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark National Institute for Health Research (NIHR) Senior Investigator. Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK Visiting Professor of Cardiology, University of Belgrade, Serbia; Visiting Professor, University of Leeds, UK Honorary Professor, Chinese PLA Medical School, Beijing, China; Honorary Professor, Nanjing Medical University, Nanjing, China; Visiting Professor, National Yang-Ming University, Taipei, Taiwan Institute of Cardiovascular Sciences City Hospital Birmingham England UK

Dr. Lip

Gregory Y. H. Lip, MD
Professor of Cardiovascular Medicine
University of Birmingham
Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark
National Institute for Health Research (NIHR) Senior Investigator.
Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK
Institute of Cardiovascular Sciences
City Hospital
Birmingham England UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The randomized clinical trials comparing non-Vitamin K antagonist oral anticoagulants (NOACs) vs warfarin largely focused on recruitment of high risk atrial fibrillation(AF) patients with >2 stroke risk factors, with only the trials testing dabigatran or apixaban including a minority of patients with 1 stroke risk factor.

Despite this, regulatory approvals of all NOACs have been for stroke prevention in AF patients with ≥1 stroke risk factors. No difference between NOACs compared to warfarin in risk of ischemic stroke/systemic embolism, was seen but for ‘any bleeding’, this was lower for apixaban and dabigatran compared to warfarin.

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Head-to-Head Study Compares All Costs Associated With New Anticoagulants in Non-Valvular AFib

MedicalResearch.com Interview with:

Sabine Luik, M.D.</strong> Senior vice president, Medicine & Regulatory Affairs Boehringer Ingelheim Pharmaceuticals, Inc.

Sabine Luik

Sabine Luik, M.D.
Senior vice president, Medicine & Regulatory Affairs
Boehringer Ingelheim Pharmaceuticals, Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study is the first real-world, matched head-to-head study comparing all cause healthcare costs and healthcare resource utilization (HCRU) among novel oral anticoagulants (NOACs).

The study analyzed claims data from 70,898 newly-diagnosed NVAF patients who were newly treated with Pradaxa, rivaroxaban or apixaban.

The analysis found that Pradaxa was associated with lower all-cause costs and HCRU compared to rivaroxaban. Compared to apixaban, Pradaxa was associated with similar all-cause costs and hospitalizations, but higher all-cause outpatient and pharmacy HCRU.

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Increase In Subdural Hematomas Associated With Increase Use of Antithrombotic Drugs


MedicalResearch.com Interview with:

David Gaist, MD, PhD</strong> Department of Neurology Odense University Hospital University of Southern Denmark Odense, Denmark

Dr. David Gaist

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The incidence of subdural hematoma (SDH; a bleed located within the skull, but outside the brain) has been reported to be on the increase. Previous studies have shown an association between use of antithrombotic drugs and SDH. However, studies with updated estimates of this risk and with focus on current more complex and aggressive regimens of antithrombotic treatment are scarce.

We therefore performed this study, where we identified 10,010 patients aged 20-89 years that were admitted with SDH in Denmark in 2000 through 2015. Preadmission use of antithrombotic drugs (low-dose aspirin, clopidogrel, vitamin K antagonist, e.g. warfarin, and direct oral anticoagulants) of these cases was compared to that of 400,380 individuals from the general population with no history of SDH (controls).

We found that use of antithrombotic drugs was associated with an increased risk of subdural hematoma . The magnitude of this risk varied by type of antithrombotic, and was, e.g., low for use of low-dose aspirin, and highest for warfarin. Further, with a single exception (low-dose aspirin and dipyridamole), concurrent use of more than one antithrombotic drug was associated with higher risk of SDH, particularly if warfarin was taken along with an antiplatelet drug, e.g., low-dose aspirin or clopidogrel. Increasing use of antithrombotic drugs was observed in the study period. The incidence of subdural hematomas in the Danish population also increased markedly in the years 2000-2015, particularly among those aged 75+ years. Our study indicates that this increased incidence, can, at least partly, be explained by increased use of antithrombotic drugs.

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Which AFib Patients Should Resume Warfarin After Intracranial Hemorrhage?

MedicalResearch.com Interview with:
Peter Brønnum Nielsen MD PhD
Aalborg Thrombosis Research Unit
Department of Clinical Medicine
Faculty of Health
Department of Cardiology, Atrial Fibrillation Study Group
Aalborg University Hospital
Aalborg, Denmark
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.

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AFib Ablation Generally Successful But Not Exempt from Complication Risk

MedicalResearch.com Interview with:

Dr. Elena Arbelo MD PhD Department of Cardiology, Cardiovascular Institute Hospital Clínic de Barcelona. University of Barcelona Barcelona, Spain

Dr. Elena Arbelo

Dr. Elena Arbelo MD PhD
Department of Cardiology, Cardiovascular Institute
Hospital Clínic de Barcelona
University of Barcelona
Barcelona, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Almost 20 years after its first description, catheter ablation is a widely-used treatment strategy for patients with symptomatic atrial fibrillation (AF) (AFib) resistant to antiarrhythmic drugs (AAD).

If we look at the results of the ESC Pilot Atrial Fibrillation General Registry1, which included about 3000 consecutive in- and outpatients with AF presenting to cardiologists in nine participating countries in Europe, catheter ablation had previously attempted 7.6% overall, most often in those with paroxysmal AF (15.6%). A further 7.8% were prescribed an ablation as part of their management, which went up to a 19.3% in the case of paroxysmal AFib.

On the other hand, several randomised clinical trials (RCTs) have shown better results of AFib ablation compared to antiarrhythmic drugs (AADs)2-6. However, these studies had a rather small sample size of selected patients, and interventions were undertaken by experienced operators with clearly pre-specified protocols. With rising prevalence of AFib and increasingly available treatment options, it was of utmost importance to have an accurate picture of contemporary AFib ablation and its outcomes which will allow the identification of practice gaps and assist evidence-based guidelines for the management of these patients.

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Predicting Unsuccessful Electrical Cardioversion for Acute Atrial Fibrillation

MedicalResearch.com Interview with:
Juhani Airaksinen, MD, PhD

Professor, Chief of Cardiology
Directork Heart Center
Turku University Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Electrical cardioversion (ECV) is an essential part of rhythm control strategy in patients with paroxysmal atrial fibrillation (AF). There is limited information on unsuccessful outcome of ECV (i.e. failure of cardioversion or early recurrence of AF) for acute AF. Our study shows that the risk of unsuccessful outcome of ECV can be predicted using five simple clinical variables. These variables were used to derivate and validate a novel risk stratification tool (the AF-CVS Score) for predicting unsuccessful ECV outcome. Study patients with high AF-CVS Score points (>5) had a high incidence of ECV failure or early AF recurrence.

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Smartphone App Can Screen For Atrial Fibrillation

MedicalResearch.com Interview with:

Dr. Ngai-yin Chan Princess Margaret Hospital Lai Chi Kok, Hong Kong

Dr. Ngai-yin Chan

Dr. Ngai-yin Chan
Princess Margaret Hospital
Lai Chi Kok, Hong Kong

MedicalResearch.com: What is the background for this study?

Response: Atrial fibrillation (AF) is the most common sustained heart rhythm disorder which can cause stroke, heart failure and an increased risk of death. The risk of stroke can be reduced substantially with drug treatment. However, a quarter of patients with AF causing stroke have silent and asymptomatic AF before stroke. The current guidelines recommend opportunistic screening for AF. Whether systematic community screening for AF with a convenient smartphone ECG can reduce the burden of AF remains unknown. Continue reading

Effectiveness and Safety of Dabigatran, Rivaroxaban, and Apixaban Versus Warfarin in Nonvalvular Atrial Fibrillation

MedicalResearch.com Interview with:

Xiaoxi Yao, PhD, MPH, MS Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, MN

Dr. Xiaoxi Yao

Xiaoxi Yao, PhD, MPH, MS
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
Mayo Clinic
Rochester, MN

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Atrial fibrillation (AF) is the most common arrhythmia requiring treatment, affecting 3-6 million Americans. AF is associated with a 5 fold risk of stroke, which can be substantially reduced by oral anticoagulants. For over a half century, warfarin was the only option for long-term oral anticoagulation in the U.S., but the use of warfarin can be cumbersome. Warfarin has numerous interactions with food and other drugs, and requires regular lab testing and dose adjustment. Since 2010, four non–vitamin K antagonist oral anticoagulants (NOACs) have been approved by the FDA. In comparison to warfarin, the fixed-dosage NOACs provide more convenient therapeutic options and demonstrated at least equivalent efficacy and safety in large phase III clinical trials. However, the outcomes achieved in idealized clinical trial settings may not necessarily translate to routine clinical practice.

In this large cohort of patients with nonvalvular AF, we assessed the real-world effectiveness and safety of three NOACs (dabigatran, rivaroxaban, and apixaban), comparing each agent with warfarin. We found apixaban was associated with lower risks of both stroke and major bleeding, dabigatran was associated with similar risk of stroke but lower risk of major bleeding, and rivaroxaban was associated with similar risks of both stroke and major bleeding in comparison to warfarin.

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The GLORIA-AF Registry: Two Year Follow Up of Dabigatran for Non-Valvular A Fib Reported

MedicalResearch.com Interview with:

Menno Huisman, MD, PhD Associate professor Department of Medicine Leiden University Medical Center The Netherlands

Dr. Menno Huisman

Menno Huisman, MD, PhD
Associate professor
Department of Medicine
Leiden University Medical Center
The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: GLORIA™-AF is one of the largest ongoing global registry programs examining the use of oral antithrombotic agents in real-world clinical practice. The program is designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation (NVAF) at risk for stroke, and to study patterns, predictors and outcomes of different regimens for stroke prevention.

At the ESC Congress 2016, we presented the first Phase II results of GLORIA-AF from approximately 3,000 NVAF patients, which showed that treatment with PRADAXA was associated with low incidences of stroke, major bleeding and life threatening bleeding. Less than 1% of PRADAXA-treated patients experienced a stroke over two years (0.63%). Major bleeding occurred in 1.12% of PRADAXA-treated patients and 0.54% experienced a life-threatening bleed.

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Diabetics With Atrial Fibrillation Get Significant Benefit From Anticoagulation

MedicalResearch.com Interview with:

Dr. William Frank Peacock MD, FACEP Baylor College of Medicine, Houston

Dr. Frank Peacock

Dr. William Frank Peacock MD, FACEP
Baylor College of Medicine, Houston

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Peacock: ​Patients with atrial fibrillation get strokes but can take anticoagulation which is very effective at preventing strokes.
Patients on anticoagulation bleed, to the point that a very few die.

The higher the CHADSVASC score, the more likely you are to have a stroke.​
​Also the more likely ​you are to bleed.
But the risk of stroke ALWAYS exceeds the risk of bleeding.

We studied diabetics with atrial fibrillation as a subset, because diabetes is significant predictor for both stroke and bleeding and we wanted to determine if our understanding of the risks and benefits were maintained in real world trial.

What we found was the risk of a fatal major bleed for a diabetic with atrial fibrillation who was taking rivaroxaban was 0.09/100 patient years of treatment.

We know that the risk of having a stroke in a patient with a CHADS score of 2 is about 3% per year (that is 3/100 patients will stroke).

Put in a similar denominator as our study, failing to treat an Afib diabetic will results 300 strokes for every 100 patient years, which compares to the effect of treatment, which will significantly prevent stroke, at the cost of 0.1 major bleed fatality per 100 patient years. Even if the effect of treatment was as low as 50% (which it is not), that is still preventing 150 strokes.

0.1 dead, to prevent 150 strokes seems like easy math to me.  ​

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AFib Increases Hospital Costs For Young and Older Stroke Patients

Guijing Wang, PhD Senior health economist Division for Heart Disease and Stroke Prevention Centers for Disease Control and PreventionMedicalResearch.com Interview with:
Guijing Wang, PhD
Senior health economist
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention

Medical Research: What is the background for this study? What are the main findings?

Dr. Wang: Our study is one of the first to analyze the impact of hospital costs related to atrial fibrillation (or AFib) in a younger stroke population. To determine these findings, we examined more than 40,000 hospital admissions information involving adults between the ages of 18 and 64 with a primary diagnosis of ischemic stroke between 2010 and 2012.

Although AFib is more common among those ages 65 and older, with strokes among younger adults on the rise in the U.S., we wanted to take a comprehensive look at AFib’s impact on hospital costs for these patients. AFib is associated with a 4- to 5-fold increased risk of ischemic stroke, which is the most common type of stroke.

Overall, our research found that AFib substantially increased hospital costs for patients with ischemic stroke – and that was consistent across different age groups and genders of those aged 18-64. Of the 33,500 first-time stroke admissions, more than seven percent had AFib, and these admissions cost nearly $5,000 more than those without the condition. In addition, we found that both the costs of hospitalization, as well as the costs associated with AFib, were higher among younger adults (18-54) than those aged 55 to 64.

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Fish Oil Found Not Effective in Atrial Fibrillation Prevention

MedicalResearch.com Interview with: Dr. Anil Nigam MD MSc FRCPC Director, Research Program in Preventive Cardiology at ÉPIC Centre Montreal Heart Institute Associate Professor, Department of Medicine at Université de MontréalMedicalResearch.com Interview with:
Dr. Anil Nigam MD MSc FRCPC
Director, Research Program in Preventive Cardiology at ÉPIC Centre
Montreal Heart Institute
Associate Professor, Department of Medicine at Université de Montréal

Medical Research: What are the main findings of the study?

Dr. Nigam: The main finding is that high-dose fish oil rich in marine omega-3 fatty acids did not reduce recurrence of atrial fibrillation in individuals with paroxysmal or persistent atrial fibrillation not receiving conventional anti-arrhythmic therapy.
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AFib After TAVI Increases Mortality Risk

MedicalResearch.com Interview with:
Lior Yankelson, MD PhD
Tel Aviv Medical Center

MedicalResearch: What are the main findings of the study?

Dr. Yankelson: The main findings of the study are that new onset atrial fibrillation after TAVI does not confer a significant risk for mortality , and confers somewhat increased risk for stroke. The latter issue is expected to become less significant with new technological advancements coming into the market, such as lower profile devices and emboli protection both mechanical and pharmaceutical. The more significant and alarming finding is that patients with atrial fibrillation have more than 4 fold risk for death at 1 year post TAVI compared to patients without afib. This is very significant and raises questions regarding the benefit for the procedure in these patients.
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Researchers Discuss Atrial Fibrillation and ZIO Service For Detection and Management

MedicalResearch.com Interview with:
Philip Gorelick, M.D., M.P.H, F.A.C.P. Medical Director of the Hauenstein Neuroscience Center Saint Mary’s Health Care, Grand Rapids, MI; Professor, Translational Science and Molecular Medicine Michigan State University College of Human Medicine; Board member of the National Stroke AssociationPhilip Gorelick, M.D., M.P.H, F.A.C.P.
Medical Director of the Hauenstein Neuroscience Center
Saint Mary’s Health Care, Grand Rapids, MI;
Professor, Translational Science and Molecular Medicine
Michigan State University College of Human Medicine;
Board member of the National Stroke Association
and
Judy Lenane, R.N., M.H.A. Chief Clinical Officer of iRhythm Technologies, Inc.

Judy Lenane, R.N., M.H.A.
Chief Clinical Officer of iRhythm Technologies, Inc.

 

Medical Research: What is atrial fibrillation and how common a problem is it among US adults?

Dr. Gorelick: Nearly 3 million people in the US suffer from Atrial Fibrillation or “Afib,” an abnormal heart rhythm that causes the heart to beat rapidly and irregularly. While Afib can occur at any age, the incidence increases with age and the number of cases is expected to increase significantly in the coming years as the population ages. Approximately 5 percent of people 65 years and older and one in every 10 people over 80 years of age have Afib. It is more common in those with high blood pressure, heart disease or lung disease. Continue reading

Medical Research Citation Rate May Lead To Treatment Bias

Mintu Turakhia, MD MAS, FHRS FACC FAHA Assistant Professor of Medicine and (by courtesy) of Health Research & Policy Stanford University School of Medicine Director of Cardiac Electrophysiology Core Investigator, Center for Innovation to Implementation VA Palo Alto Healthcare SystemMedicalResearch.com Interview with:
Mintu Turakhia, MD MAS, FHRS FACC FAHA
Assistant Professor of Medicine and (by courtesy) of Health Research & Policy
Stanford University School of Medicine
Director of Cardiac Electrophysiology
Core Investigator, Center for Innovation to Implementation
VA Palo Alto Healthcare System

Medical Research: What are the main findings of the study

Dr. Turakhia: We found that the reported success rate of a study correlated with the number of times the study was cited in the literature, even after adjustment for a wide range of factors.

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Acute Atrial Fibrillation: Embolism Complications Lowered By Avoiding Cardioversion Delay

Dr. Juhani Airaksinen, MD, PhD Heart Center, Turku University Hospital Turku, FinlandMedicalResearch.com Interview with:
Dr. Juhani Airaksinen, MD, PhD
Heart Center, Turku University Hospital
Turku, Finland


Medical Research: What are the main findings of the study?

Dr. Airaksinen:  The main result of our study is that the risk of thromboembolic complications in general was low (0.7%). However the risk rose to a 3.7-fold level when the delay to cardioversion exceeded 12 hours. The time-dependent increase in the risk of thromboembolic complications was more pronounced in female patients. In addition, as expected, old age, heart failure and diabetes were the other significant predictors of postcardioversion thromboembolic complications.
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Dialysis Patients with Atrial Fibrillation: Warfarin and Risk of Stroke and Bleeding

Louise Pilote, MD, MPH, PhD Department of Medicine, McGill University Department of Epidemiology and Biostatistics, McGill UniversityMedicalResearch.com Interview with:
Louise Pilote, MD, MPH, PhD
Department of Medicine, McGill University
Department of Epidemiology and Biostatistics, McGill University


MedicalResearch.com: What are the main findings of the study?

Dr. Pilote: Our study found that in patients with atrial fibrillation (AF) undergoing dialysis, warfarin use, compared to no-warfarin use, did not reduce the risk for stroke (adjusted hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.78 to 1.67) but it was associated with a 44% higher risk for bleeding event (adjusted HR: 1.44, 95% CI: 1.13 to 1.85). However, warfarin use in non-dialysis patients with AF was associated with a 13% lower risk for stroke (adjusted HR: 0.87, 95% CI: 0.85 to 0.90) and only a 19% higher risk for bleeding event (adjusted HR: 1.19, 95% CI: 1.16 to 1.22).

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Bisphosphonates: Risks of AFib and Stroke

Abhishek Sharma, M.B.B.S. Maimonides Medical Center in Brooklyn, N.Y.MedicalResearch.com Interview with:
Abhishek Sharma, M.B.B.S.
Maimonides Medical Center in Brooklyn, N.Y.

 

MedicalResearch.com: What are the main findings of the study?

Answer:  Evidence from RCT’s and observational studies suggests a significantly increased risk of atrial fibrillation (AF) requiring hospitalization, but no increase in risk of stroke or cardiovascular mortality with the use of bisphosphonate. Continue reading

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

MedicalResearch.com Interview with:

Dr. Evgeny Pokushalov, MD, PhD
State Research Institute of Circulation Pathology, Rechkunovskaya 15, 630055 Novosibirsk 55, Russia

MedicalResearch.com: 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.
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