Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation-A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials.

Abstract

BACKGROUND:

The efficacy of short-term antiarrhythmic drugs (AADs) use compared with no-AADs prescription after catheter ablation of atrial fibrillation (AF) in preventing atrial arrhythmia recurrence is uncertain.

METHODS:

We searched PubMed, Embase, and the Cochrane Library through December 2015 to identify randomized controlled trials (RCTs) which evaluated the efficacy of short-term AADs use compared with no-AADs prescription after AF ablation in preventing atrial arrhythmia recurrence. The primary outcome was labeled as early atrial arrhythmia recurrence within 3 months after ablation. Secondary outcome was defined as late recurrence after 3 months of ablation. Random-effects model or fixed-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).

RESULTS:

Six RCTs with 2,667 patients were included into this meta-analysis. Compared with no-AADs administration after AF ablation, short-term AADs use was associated with significant reduction of early atrial arrhythmia recurrence (RR, 0.68; 95% CI, 0.52-0.87; p = 0.003). Trial sequential analysis (TSA) showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. However, compared with no-AADs prescription, short-term AADs use after AF ablation didn't significantly reduce the risk of late atrial arrhythmia recurrence (RR, 0.92; 95% CI, 0.83-1.03; p = 0.15). TSA supported this result; meanwhile the estimated required information size (1,486 patients) was also met.

CONCLUSION:

Short-term use of AADs after AF ablation can significantly decrease the risk of early atrial arrhythmia recurrence but not lead to corresponding reduction in risk of late atrial arrhythmia recurrence.

• Authors: Weijie Chen, Hang Liu, Zhiyu Ling, Yanping Xu, Jinqi Fan, Huaan Du, Peilin Xiao, Li Su, Zengzhang Liu, Xianbin Lan, Bernhard Zrenner, Yuehui Yin
• Journal: PloS one (PLoS One) Vol. 11 Issue 5 Pg. e0156121 ( 2016) ISSN: 1932-6203 [Electronic] United States
• PMID: 27224469 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Anti-Arrhythmia Agents

Topics

• Anti-Arrhythmia Agents (adverse effects, therapeutic use)
• Atrial Fibrillation (pathology, physiopathology, therapy)
• Catheter Ablation
• Female
• Humans
• Male
• Randomized Controlled Trials as Topic
• Recurrence
• Risk Factors