CATHETER ABLATION VERSUS ANTIARRHYTHMIC DRUG THERAPY
Keywords:
Catheter ablation, atrial fibrillation, antiarrhythmic drugs, heart failure Commonly employed drugs to maintain sinus rhythm are amiodarone, sotalol, dofetilide, dronedarone, flecainide, and propafenone. Approximately 25 to 50 percent of people who receive antiarrhythmic medications will have recurrent AF within one year. Important side effects of antiarrhythmics include proarrhythmia, bradyarrhythmia, and organ toxicity in the case of amiodarone.Abstract
Catheter ablation uses either cryoablation (cryotherapy) or radiofrequency ablation (RFA). Pulse-field ablation, another promising energy source, is not yet approved by the United States Food and Drug Administration. AF recurrence, defined as an AF episode >30 seconds in duration on cardiac monitoring, occurs in approximately 20 to 40 percent of patients at one year, although overall AF burden is often markedly decreased [3]. Important complications from catheter ablation include cardiac tamponade (1 percent), pulmonary vein stenosis (<1 percent), phrenic nerve paralysis (up to 3 percent), and rare instances of stroke and atrioesophageal fistula [4-6]. These and other complications are described in detail separately.
A 2017 randomized comparison between cryoablation and RFA showed similar success rates, as did a meta-analysis of observational studies [7,8].
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