The high early recurrence (ER) rate after radiofrequency catheter ablation (RFCA)
seriously affects the prognosis of patients with atrial fibrillation (AF), and there
are still controversies regarding the best preventive drugs for postoperative recurrence.
A single-center retrospective study was conducted on patients with paroxysmal atrial
fibrillation (PAF) who received metoprolol sustained-release tablets combined with
dronedarone (observation group) and dronedarone alone (control group) after the first
RFCA. A matching cohort was established using a 1:1 propensity score matching method
to compare the incidence of ER, cardiac function, inflammation level, quality of life
(QoL), and antiarrhythmic drugs (AADs)-related adverse reactions between groups. A
total of 56 pairs of patients were successfully matched. The incidence of ER in the
observation group was significantly lower than that in the control group (32% vs 14%,
p = 0.033); the left atrial diameter in the observation group was significantly lower
than that in the control group on Day 90 after RFCA (38 ±4 vs 40 ± 5, p = 0.021),
and the QoL of the observation group was significantly improved on the thirtieth and
ninetieth days after RFCA compared with the control group (72 ± 5 vs 69 ± 9, p = 0.031;
73 ± 4 vs 70 ± 9, p = 0.025). Multifactorial Cox analysis showed that diabetes mellitus,
left atrial diameter >45 mm, ventricular rate >110 beats/min, and postoperative AADs
were independent risk factors for ER in patients with PAF. The incidence of sinus
bradycardia in the observation group was significantly higher than that in the control
group (18% vs 3.6%, p = 0.029), but there was no statistical difference in the overall
incidence of AADs-related adverse reactions between groups. Compared with dronedarone
alone, dronedarone combined with metoprolol sustained-release tablets can significantly
reduce ER after RFCA in patients with PAF and improve cardiac function and QoL, without
increasing the AADs-related adverse reactions.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Global, regional, and national prevalence, incidence, mortality, and risk factors for atrial fibrillation, 1990–2017: results from the Global Burden of Disease Study 2017.Eur Heart J Qual Care Clin Outcomes. 2021; 7: 574-582
- 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC.Eur Heart J. 2020; 42 (Published correction appears in Eur Heart J 2021;42:507. Published correction appears in Eur Heart J 2021;42:546–547. Published correction appears in Eur Heart J 2021;42:4194): 373-498
- Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study.J Interv Card Electrophysiol. 2021; 60: 271-278
- The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set.Sci Rep. 2018; 8: 9875
- Effect and significance of early reablation for the treatment of early recurrence of atrial fibrillation after catheter ablation.Am J Cardiol. 2016; 118: 833-841
- ADVICE Trial Investigators*. Redefining the blanking period After catheter ablation for paroxysmal atrial fibrillation: insights From the ADVICE (adenosine following pulmonary vein isolation to target dormant conduction elimination) trial.Circ Arrhythm Electrophysiol. 2016; 9e003909
- Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications.Herzschrittmacherther Elektrophysiol. 2022; 33: 71-76
- 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.J Am Coll Cardiol. 2014; 64: e1-e76
- Metoprolol in the treatment of cardiovascular disease: a critical reappraisal.Curr Med Res Opin. 2018; 34: 1635-1643
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Effect of atrial fibrillation on quality of life (AFEQT) questionnaire: a Turkish validity and reliability study.Turk Kardiyol Dern Ars. 2021; 49: 223-232
- Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial.JAMA. 2019; 321: 1275-1285
- Effect of catheter ablation vs antiarrhythmic medication on quality of life in patients with atrial fibrillation: the CAPTAF randomized clinical trial.JAMA. 2019; 321: 1059-1068
- Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation: results on health-related quality of life and symptom burden. The MANTRA-PAF trial.Europace. 2015; 17: 215-221
- Early recurrence after pulmonary vein isolation is associated with inferior long-term outcomes: insights from a retrospective cohort study.Pacing Clin Electrophysiol. 2020; 43: 1156-1164
- Recurrences in the blanking period and 12-month success rate by continuous cardiac monitoring after cryoablation of paroxysmal and non-paroxysmal atrial fibrillation.J Cardiovasc Electrophysiol. 2017; 28: 625-633
- Heart failure and atrial fibrillation, like fire and fury.JACC Heart Fail. 2019; 7: 447-456
- Inflammation and the pathogenesis of atrial fibrillation.Nat Rev Cardiol. 2015; 12: 230-243
- Metoprolol exerts a non-class effect against ischaemia-reperfusion injury by abrogating exacerbated inflammation.Eur Heart J. 2020; 41: 4425-4440
- Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation.World J Cardiol. 2016; 8: 638-646
- Effects of sympatho-vagal interaction on ventricular electrophysiology and their modulation during beta-blockade.J Mol Cell Cardiol. 2020; 139: 201-212
- Early recurrences during the blanking period after atrial fibrillation ablation.J Atr Fibrillation. 2018; 10: 1726
- Prediction of electro-anatomical substrate and arrhythmia recurrences using APPLE, DR-FLASH and MB-LATER scores in patients with atrial fibrillation undergoing catheter ablation.Sci Rep. 2018; 8: 12686
- Dronedarone: current evidence for its safety and efficacy in the management of atrial fibrillation.Drug Des Devel Ther. 2011; 5: 27-39
- Dronedarone for the control of ventricular rate in permanent atrial fibrillation: the Efficacy and safety of dRonedArone for the cOntrol of ventricular rate during atrial fibrillation (ERATO) study.Am Heart J. 2008; 156 (527.e1–527.e9)
Article Info
Publication History
Published online: October 15, 2022
Received in revised form:
August 9,
2022
Received:
July 4,
2022
Footnotes
Pei Wang and Dongdong Yan contributed equally to this manuscript.
Funding: This study was supported by the National Key Research and Development Program of China (Lanzhou, China) grant no. 2,018YFC131,1505 and the Cardiovascular Clinical research center of Gansu Province (Lanzhou, China) grant no.18JR2FA005.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
