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
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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“Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent AF, but all point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion.185,717,[723][724][725][726]1039”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [723]
In the citing paper
“Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent AF, but all point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion.185,717,[723][724][725][726]1039”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [723]
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“Pulmonary vein isolation (PVI) continues to emerge as an effective treatment for symptomatic AF [2, 3].”
BackgroundFaryan, M., Buchta, P., Kowalski, O., Wybraniec, M. T., Cieśla, D., Myrda, K., Wnuk-Wojnar, A. M., Kalarus, Z. F., Gąsior, M., & Mizia‐Stec, K. (2020) · Kardiologia Polska · doi:10.33963/kp.15275 · Cited by 9
“AF management by the catheter ablation is significantly more efficient in arrhythmia recurrence reduction and quality of life improvement when comparing to the standard drug therapy, which was proven in big randomized trials [14,15].”
MethodAblation for atrial fibrillation: an evidence-based analysis.
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Morrow, J., & Reiffel, J. A. (2008) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2009.02184.x · Cited by 9
Atrial Fibrillation: Goals of Therapy and Management Strategies to Achieve the Goals
Padanilam, B. J., & Prystowsky, E. N. (2007) · Medical Clinics of North America · doi:10.1016/j.mcna.2007.08.006 · Cited by 9
Cardiac resynchronization therapy in the setting of permanent atrial fibrillation and heart failure
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Asirvatham, S. J., & Packer, D. L. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.922674 · Cited by 9
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“Also, following the removal of Wazni [ 31 ], one of the studies with the smallest popula - tion, a substantial reduction in heterogeneity was observed across the SF-36 score components.”
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Same-day discharge after atrial fibrillation ablation
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“There is growing evidence that AF catheter ablation is more effective than anti-arrhythmic drug therapy in maintaining sinus rhythm; [6 – 8] hence the volume of catheter ablation of AF has increased over time.”
BackgroundNew Technologies for Catheter Ablation of Atrial Fibrillation
Gerstenfeld, E. P. (2011) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-011-0141-x · Cited by 8
Is AF Ablation Cost Effective?
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“Recent clinical trials show that catheter ablation of atrial fibrillation reduces the risk of recurrence of symptomatic AF, atrial flutter, or atrial tachycardia, and may also reduce subsequent hospitalizations and improve quality of life compared to antiarrhythmic drug therapy.(3,4) Catheter ablation has garnered a c…”
BackgroundZhou, W., Wang, L., Zhou, B., & Wu, L. (2018) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13524 · Cited by 8
Du, X., He, X., Jia, Y., Wu, J., Long, D., Yu, R., Sang, C., Yin, H., Xuan, J., Dong, J., et al. (2019) · American Journal of Cardiovascular Drugs · doi:10.1007/s40256-019-00349-1 · Cited by 8
Kato, M., Miake, J., Ogura, K., Iitsuka, K., Okamura, A., Tomomori, T., Tsujimoto, D., Kato, M., & Yamamoto, K. (2019) · International Heart Journal · doi:10.1536/ihj.19-201 · Cited by 8
Impact of Catheter Ablation for Atrial Fibrillation on Quality of Life
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“However, early trials comparing radiofrequency catheter ablation to antiarrhythmic therapy and invasive strategies have shown superiority of invasive therapy in certain populations [99,100].”
BackgroundPostprocedural neuropathy after atrial fibrillation ablation
Reddy, Y. M., Singh, D., Chikkam, V., Bommana, S., Atkins, D., Verma, A., Swarup, V., Khaykin, Y., Nalamachu, S. R., Pasnoor, M., et al. (2012) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9724-z · Cited by 8
“Catheter ablation as a treatment of atrial fibrillation (AF) has evolved into the standard of care for patients with symptomatic drug resistant AF [1, 2].”
BackgroundAtrial fibrillation in heart failure: catheter and surgical interventional therapies
Rabah, A., & Wazni, O. M. (2013) · Heart Failure Reviews · doi:10.1007/s10741-013-9411-x · Cited by 8
“therapy for rhythm control than pharmacological treatment, as shown by several randomized trials [32, 33].”
MethodPharmacotherapy of Atrial Fibrillation: A Pathophysiological Perspective and Review
Jacob, S., Ali, O. A., Pidlaoan, V., Badheka, A. O., & Kerin, N. Z. (2010) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e3181eea7c5 · Cited by 8
“In a trial comparing pulmonary vein isolation vs antiarrhythmic drug treatment, patients randomized to pulmonary vein isolation had fewer recurrences and hospitalizations; however, 43% of patients in the pulmonary vein isolation group still required B blockers.(42) The classic pharmacological approach to the treatment…”
BackgroundPulmonary vein isolation in the treatment of atrial fibrillation
Michaud, G. F., & Kumar, S. (2016) · Research Reports in Clinical Cardiology · doi:10.2147/rrcc.s56549 · Cited by 8
Cihak, R. J., Heinc, P., Haman, L., Fiala, M., Neužil, P., & Toman, O. (2011) · Cor et Vasa · doi:10.33678/cor.2011.193 · Cited by 8
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“Catheter ablation appears to have favorable outcomeswhen compared to suppressive therapy with antiarrhythmic drugs for the treatment of AF [14], and as a result, the number of patients undergoing catheter-based ablation continues to grow.”
BackgroundCatheter Ablation Therapy for Atrial Fibrillation Current Advancements in Strategies
Iesaka, Y., Otomo, K., Nagata, Y., & Uno, K. (2007) · Circulation Journal · doi:10.1253/circj.71.a82 · Cited by 8
Nonpharmacologic Strategies: The Evolving Story of Ablation and Hybrid Therapy
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“Over the last 30 years, evidence for catheter ablation of AF as a viable first-line option for AF management has evolved [20,21] and has demonstrated benefits with or without AAD [22–29].”
Forleo, G. B., Martino, G. D., Mantica, M., Menardi, E., Trevisi, N. M., Faustino, M., Muto, C., Perna, F., Santamaria, M., Pandozi, C., et al. (2013) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9772-4 · Cited by 7
“This could be in part related to the patients’ desire to avoid anticoagulation or because in some cases AF ablation is performed as a first-line therapy [1] or to arrest the progression of heart failure.”
BackgroundAtrial Fibrillation in the Aging Heart: Pharmacological Therapy and Catheter Ablation in the Elderly
Haegeli, L., & Duru, F. (2011) · Future Cardiology · doi:10.2217/fca.11.22 · Cited by 7
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Parlavecchio, A., Vetta, G., Coluccia, G., Pistelli, L., Caminiti, R., Ajello, M., Magnocavallo, M., Dattilo, G., Foti, R., Carerj, S., et al. (2023) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2023.101292 · Cited by 8
Catheter Ablation for Treatment of Atrial Fibrillation
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Pappone, C., & Santinelli, V. (2012) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2011.12.023 · Cited by 7
“The initial excellent results obtained in patients with lone paroxysmal AF or in patients with minimal structural heart disease encouraged many electrophysiologists to include patients with chronic AF, but poorer longterm results were reported using PVI alone(24) while better results were obtained with CPVA that inclu…”
Liu, W. Y., Wu, Q. E., Yang, X., & Huang, J. (2018) · Europe PMC (PubMed Central) · doi:10.11909/j.issn.1671-5411.2018.06.011 · Cited by 7
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“reported focal ablation of pulmonary vein (PV) triggers by single ablation catheter after single trans-septal puncture in 1998, the indications for RFCA have been expanded in light of accumulating clinical experience and evidence.(4) Circumferential pulmonary vein isolation (CPVI) remains the cornerstone of AF ablatio…”
BackgroundDie Behandlung von Vorhofflimmern im Alltag
Meinertz, T., & Willems, S. (2008) · Der Internist · doi:10.1007/s00108-008-2152-6 · Cited by 7
Present concepts in management of atrial fibrillation: From drug therapy to ablation
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Atrial Fibrillation-The Final Frontier
Govindan, M., Savelieva, I., Catanchin, A., & Camm, A. J. (2010) · Journal of Cardiovascular Pharmacology and Therapeutics · doi:10.1177/1074248410371947 · Cited by 7
Pathophysiology of Idiopathic Atrial Fibrillation - Prognostic and Treatment Implications
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“Ever since recent randomized controlled trials have shown that patients randomized to AF ablation were significantly more often free of AF, and more often less symptomatic with an improved quality of life, as compared to those randomized to oral antiarrhythmic drug treatment, catheter ablation of AF may be considered…”
BackgroundElectrophysiological Evaluation of Thoracoscopic Pulmonary Vein Isolation.
de Groot, J. R., Berger, W. R., Krul, S. P. J., van Boven, W. J., Salzberg, S. P., & Driessen, A. H. G. (2013) · Europe PMC (PubMed Central) · doi:10.4022/jafib.899 · Cited by 7
“32 Thirty-one patients (median duration of AF was 8 (1-25) years) were treated with thoracoscopic PVI using the Atricure bipolar system when AF was paroxysmal.”
MethodTao, J. Z., & Oprea, A. D. (2019) · Seminars in Cardiothoracic and Vascular Anesthesia · doi:10.1177/1089253219870627 · Cited by 7
Surgical Treatment of Atrial Fibrillation: Cutting Through the Edges
Harky, A., Bithas, C., Chan, J. S. K., Snosi, M., Pousios, D., & Muir, A. D. (2019) · Brazilian Journal of Cardiovascular Surgery · doi:10.21470/1678-9741-2019-0057 · Cited by 8
“Several randomized controlled trials and, lately, three systematic review and meta-analyses studied the effect of catheter-based ablation versus medical therapy in patients with paroxysmal or persistent symptomatic AF[3-12].”
BackgroundCatheter Ablation of Atrial Fibrillation
Latchamsetty, R., & Morady, F. (2014) · Cardiology Clinics · doi:10.1016/j.ccl.2014.07.005 · Cited by 7
Cost of AF Ablation: Where Do We Stand?
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Normal Quality of Life after the Cox-Maze Procedure for Atrial Fibrillation
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Effectiveness of catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation
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Improvement in Quality of Life after Radiofrequency Ablation
Hlatky, M. A., & Wang, P. J. (2006) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2006.00350.x · Cited by 7
Has the Time Come to Recommend Catheter Ablation of Atrial Fibrillation as First-Line Therapy?
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Rubenstein, J., & Kadish, A. H. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00449.x · Cited by 7
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Ablación de la fibrilación auricular en la vida real: ¿cuanto menos sabemos, más quemamos?
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Cunha, P. S., Teixeira, B. L., Laranjo, S. M., Portugal, G., Valente, B. T., Delgado, A. S., Pereira, M. B., Rocha, A. C., Brás, M., Cruz, M. C., et al. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1309900 · Cited by 6
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Discordant Treatment Goals for Patients With Atrial Fibrillation and Clinical Trials Metrics
Zenger, B., Spertus, J. A., Torre, M., Lyons, A., Bunch, T. J., Hess, R., Zhang, Y., Piccini, J. P., Millar, M. M., Lobban, T., et al. (2024) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2024.06.026 · Cited by 6
Contact‐Force Catheters: Efficacy Versus Safety? Case Report of 2 Atrioesophageal Fistulae
Gitenay, E., O’Hara, G. E., SARRAZIN, J., Nault, I., Philippon, F., Blaye-Felice, M. S., Laaouaj, J., & Champagne, J. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13079 · Cited by 6
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Gilge, J. L., Ahmed, A. S., Clark, B. A., Slaten, A., Devathu, R., Olson, J., Padanilam, B. J., Nair, G. V., Joshi, S. A., Ravichandran, A. K., et al. (2020) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.14829 · Cited by 6
“Atrial fibrillation (AF) is the commonest arrhythmia worldwide and is projected to increase in frequency as the population ages.1,2 The cornerstone of AF management is symptom control, and multiple studies suggest catheter ablation (CA) is a safe and effective procedure to reduce symptoms from AF.3,4 Procedure efficac…”
InfluentialAndrade, J. G., Chierchia, G., Kuniss, M., & Wazni, O. M. (2021) · EP Europace · doi:10.1093/europace/euab246 · Cited by 6
Li, G., Wang, X., Han, J., & Guo, X. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1042573 · Cited by 6
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Ablation versus medical therapy for patients with atrial fibrillation: An updated meta‐analysis
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“9 In a recent randomized controlled clinical trial (RCT) conducted to find if there is a superiority of cryo ‐ balloon ablation over antiarrhythmic drugs (AADs) as initial therapy for symptomatic paroxysmal AF, was seen that AF recurrence was significantly lower.”
BackgroundLan, X., Su, L., Ling, Z., Liu, Z., Wu, J., Yang, X., Zrenner, B., & Yin, Y. (2009) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2009.02160.x · Cited by 6
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“D atrial CT and/or MR volumes and intra-operative fluoroscopic image sequences is introduced during radio-frequency catheter ab lation (RFCA) therapy, an accepted option for treating AF [2] [3].”
BackgroundManaging atrial fibrillation in the global community: The European perspective
Kaba, R. A., Camm, A. J., Williams, T. M., & Sharma, R. (2013) · Global Cardiology Science and Practice · doi:10.5339/gcsp.2013.24 · Cited by 6
“001).(52) Further evidence on this subject is expected to emerge upon completion of the Catheter Ablation vs Anti-arrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial in 2015.”
BackgroundKalarus, Z. F., Zembala, M. O., Kowalski, O., Lenarczyk, R., Suwalski, P., Czapla, J., Nagajewski, A., Filipiak, K. J., Hrapkowicz, T., Foremny, J., et al. (2009) · PubMed · Cited by 6
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Monitoring Atrial Fibrillation After Catheter Ablation.
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Atrial Fibrillation Ablation and its Impact on Stroke
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“Previous stroke, n (%) 8 (13) 7 (4) 2.”
InfluentialWang, H., Du, X., Guo, L., Guo, X., Chen, Y., Xia, S., Chang, S., Pan, J., Dong, J., & Ma, C. (2019) · Medical Science Monitor · doi:10.12659/msm.917755 · Cited by 6
Effect Of Catheter Ablation On Quality Of Life In Atrial Fibrillation.
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Atrial Fibrillation in Hypertrophic Obstructive Cardiomyopathy - Antiarrhythmics, Ablation and More!
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Percutaneous catheter ablation of atrial fibrillation
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“Catheter ablation is an effective approach for the management of patients with atrial fibrillation (AF) [1–7].”
BackgroundAmiodarone or Dronedarone for Atrial Fibrillation
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Circumferential Pulmonary-Vein Ablation for Atrial Fibrillation
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Comparative Studies of Different Ablation Techniques for Atrial Fibrillation
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“[12], where patients with both paroxysmal and persistent AF and without previous ADT were included, suggesting that RFA can be a feasible first-line approach.”
Pulsed field ablation vs sham ablation to treat atrial fibrillation (the PFA-SHAM trial)
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Metadata
- 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
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2005-06-01
- Volume
- 293
- Issue
- 21
- Pages
- 2634
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- 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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