TY - JOUR
T1 - Catheter ablation or medical therapy to delay progression of atrial fibrillation
T2 - The randomized controlled atrial fibrillation progression trial (ATTEST)
AU - Kuck, Karl Heinz
AU - Lebedev, Dmitry S.
AU - Mikhaylov, Evgeny N.
AU - Romanov, Alexander
AU - Geller, Laszlo
AU - Kalejs, Oskars
AU - Neumann, Thomas
AU - Davtyan, Karapet
AU - On, Young Keun
AU - Popov, Sergey
AU - Bongiorni, Maria Grazia
AU - Schluter, Michael
AU - Willems, Stephan
AU - Ouyang, Feifan
N1 - Funding Information:
This work was supported by Biosense Webster, Inc.
Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Aims: Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. Methods: This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1: 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. Results: After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan-Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6-9.4%)] than with AAD therapy [17.5% (95% CI, 10.7-27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients <65 years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88-17.00); P = 0.0727]. Primary adverse events were reported for eight patients in the RF ablation group. Conclusions: Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.
AB - Aims: Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. Methods: This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1: 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. Results: After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan-Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6-9.4%)] than with AAD therapy [17.5% (95% CI, 10.7-27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients <65 years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88-17.00); P = 0.0727]. Primary adverse events were reported for eight patients in the RF ablation group. Conclusions: Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.
KW - Antiarrhythmic drugs
KW - Atrial tachycardia
KW - Persistent atrial fibrillation
KW - Progression
KW - Radiofrequency ablation
UR - http://www.scopus.com/inward/record.url?scp=85102908995&partnerID=8YFLogxK
U2 - 10.1093/europace/euaa298
DO - 10.1093/europace/euaa298
M3 - Article
C2 - 33330909
AN - SCOPUS:85102908995
SN - 1099-5129
VL - 23
SP - 362
EP - 369
JO - Europace
JF - Europace
IS - 3
ER -