Cited by 1,121Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index.

Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation: A Randomized Trial

Wazni, Oussama M., Marrouche, Nassir F., Martin, David O., Verma, Atul, Bhargava, Mandeep, Saliba, Walid, Bash, Dianna, Schweikert, Robert, Brachmann, Johannes, Gunther, Jens, Gutleben, Klaus, Pisano, Ennio, Potenza, Dominico, Fanelli, Raffaele, Raviele, Antonio, Themistoclakis, Sakis, Rossillo, Antonio, Bonso, Aldo, Natale, Andrea·2005·JAMA

DOI 10.1001/jama.293.21.2634

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Abstract

CONTEXT: Treatment with antiarrhythmic drugs and anticoagulation is considered first-line therapy in patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation (PVI) with radiofrequency ablation may cure AF, obviating the need for antiarrhythmic drugs and anticoagulation. OBJECTIVE: To determine whether PVI is feasible as first-line therapy for treating patients with symptomatic AF. DESIGN, SETTING, AND PARTICIPANTS: A multicenter prospective randomized study conducted from December 31, 2001, to July 1, 2002, of 70 patients aged 18 to 75 years who experienced monthly symptomatic AF episodes for at least 3 months and had not been treated with antiarrhythmic drugs. INTERVENTION: Patients were randomized to receive either PVI using radiofrequency ablation (n=33) or antiarrhythmic drug treatment (n=37), with a 1-year follow-up. MAIN OUTCOME MEASURES: Recurrence of AF, hospitalization, and quality of life assessment. RESULTS: Two patients in the antiarrhythmic drug treatment group and 1 patient in the PVI group were lost to follow-up. At the end of 1-year follow-up, 22 (63%) of 35 patients who received antiarrhythmic drugs had at least 1 recurrence of symptomatic AF compared with 4 (13%) of 32 patients who received PVI (P<.001). Hospitalization during 1-year follow-up occurred in 19 (54%) of 35 patients in the antiarrhythmic drug group compared with 3 (9%) of 32 in the PVI group (P<.001). In the antiarrhythmic drug group, the mean (SD) number of AF episodes decreased from 12 (7) to 6 (4), after initiating therapy (P = .01). At 6-month follow-up, the improvement in quality of life of patients in the PVI group was significantly better than the improvement in the antiarrhythmic drug group in 5 subclasses of the Short-Form 36 health survey. There were no thromboembolic events in either group. Asymptomatic mild or moderate pulmonary vein stenosis was documented in 2 (6%) of 32 patients in the PVI group. CONCLUSION: Pulmonary vein isolation appears to be a feasible first-line approach for treating patients with symptomatic AF. Larger studies are needed to confirm its safety and efficacy.

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Untitled work
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Result
Association of Atrial Tissue Fibrosis Identified by Delayed Enhancement MRI and Atrial Fibrillation Catheter Ablation: The DECAAF Study
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Self-citation
2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design
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Self-citation
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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“More important are the results of randomized clinical trials that compared catheter ablation with AAD therapy in patients with PAF, and evaluated QOL as an outcome measure.(261,377,378,379,684)”
BackgroundResult
ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation—Executive Summary
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.07.009 · Cited by 1,161
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“We hoped (1) to provide accurate and broadly representative estimates of the relative safety and efficacy of these 2 treatment options; (2) to gain insights into how the development of new ablation technologies and strategies may have affected the outcomes of catheter ablation over time; and (3) to highlight the size,…”
Background
Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation
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Self-citation
ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Heuzey, J. L., Kay, G. N., Lowe, J. E., et al. (2006) · EP Europace · doi:10.1093/europace/eul097 · Cited by 670
2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation
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Cryoballoon Ablation as Initial Therapy for Atrial Fibrillation
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“Ablation is a well-established treatment for symptomatic drug-refractory paroxysmal AF, supported by a consistent body of evidence.(1,2,9,10) Moreover, a recentpublicationsuggests thepotential benefit of CA as first-line therapy in this population.”
Result
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Atrial fibrillation
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“Indeed, selected patients may benefit from ablation as first-line therapy.(5) A recent study reporting the outcomes of 2 meta-analyses found a 77% success rate for catheter ablation versus 52% for antiarrhythmic drugs.”
Background
Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation
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“Randomized controlled trials have reported AF recurrence in 13% to 44% of AF ablation recipients (12,13), and a worldwide survey of centers offering AF ablation reported recurrence in 48% to 57% of recipients at a median of 12 months’ follow-up (4).”
Background
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“[2,4,5] The difficulties in detecting recurrent AF episodes, particularly when asymptomatic, led to a long period of controversy regarding the actual durability of AF suppression after ablation.”
Background
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Santangeli, P., Zado, E. S., Hutchinson, M. D., Riley, M. P., Lin, D., Frankel, D. S., Supple, G. E., Garcia, F. C., Dixit, S., Callans, D. J., et al. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.10.023 · Cited by 265
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Authors: Wazni, O. M., Marrouche, N. F., Martin, D. O., Verma, A., Bhargava, M., Saliba, W., Bash, D., Schweikert, R., Brachmann, J., Gunther, J., Gutleben, K., Pisano, E., Potenza, D., Fanelli, R., Raviele, A., Themistoclakis, S., Rossillo, A., Bonso, A., & Natale, A.
Affiliations: Cleveland Clinic (US)
Corresponding author: Natale, Andrea
ORCID: Wazni, Oussama M.
Marrouche, Nassir F.
Martin, David O.
Verma, Atul
Bhargava, Mandeep
Saliba, Walid
Brachmann, Johannes
Raviele, Antonio
Themistoclakis, Sakis
Rossillo, Antonio
Natale, Andrea
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2005-06-01
Volume: 293
Issue: 21
Pages: 2634
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.293.21.2634
OpenAlex: W2154269490
Cited by: 1,121
References: 39
Citations by year: 2026: 18 · 2025: 31 · 2024: 38 · 2023: 29 · 2022: 61 · 2021: 52 · 2020: 45 · 2019: 36 · 2018: 53 · 2017: 40 · 2016: 44 · 2015: 52 · 2014: 69 · 2013: 75 · 2012: 78
FWCI: 43.53
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: atrial fibrillation, radiofrequency ablation, pulmonary vein isolation, antiarrhythmic drugs, first-line therapy, atrial fibrillation recurrence, hospitalization, quality of life, pulmonary vein stenosis, anticoagulation, thromboembolic events, Short Form 36 Health Survey, randomized trial comparison, cost-effectiveness, patient satisfaction
MeSH terms: Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Middle Aged, Pilot Projects, Prospective Studies, Pulmonary Veins, Quality of Life, Survival Analysis, Treatment Outcome, Catheter Ablation

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Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation: A Randomized Trial

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