Catheter ablation vs. antiarrhythmic drug treatment of persistent atrial fibrillation: a multicentre, randomized, controlled trial (SARA study)
Open accessAbstract
BACKGROUND: Catheter ablation (CA) is a highly effective therapy for the treatment of paroxysmal atrial fibrillation (AF) when compared with antiarrhythmic drug therapy (ADT). No randomized studies have compared the two strategies in persistent AF. The present randomized trial aimed to compare the effectiveness of CA vs. ADT in treating persistent AF. METHODS AND RESULTS: Patients with persistent AF were randomly assigned to CA or ADT (excluding patients with long-standing persistent AF). Primary endpoint at 12-month follow-up was defined as any episode of AF or atrial flutter lasting >24 h that occurred after a 3-month blanking period. Secondary endpoints were any atrial tachyarrhythmia lasting >30 s, hospitalization, and electrical cardioversion. In total, 146 patients were included (aged 55 ± 9 years, 77% male). The ADT group received class Ic (43.8%) or class III drugs (56.3%). In an intention-to-treat analysis, 69 of 98 patients (70.4%) in the CA group and 21 of 48 patients (43.7%) in the ADT group were free of the primary endpoint (P = 0.002), implying an absolute risk difference of 26.6% (95% CI 10.0-43.3) in favour of CA. The proportion of patients free of any recurrence (>30 s) was higher in the CA group than in the ADT group (60.2 vs. 29.2%; P < 0.001) and cardioversion was less frequent (34.7 vs. 50%, respectively; P = 0.018). CONCLUSION: Catheter ablation is superior to medical therapy for the maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up. CLINICAL TRIAL REGISTRATION INFORMATION: NCT00863213 (http://clinicaltrials.gov/ct2/show/NCT00863213).
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The complication rate of atrial fibrillation ablation is similar to the complication rate for antiarrhythmic drugs.
“AF ablation, when performed in experienced centres by adequately trained teams, is more effective than antiarrhythmic drug therapy in maintaining sinus rhythm, and the complication rate, though not negligible, is similar to the complication rate for antiarrhythmic drugs.585,717,1042”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [717]
Atrial fibrillation ablation, when performed in experienced centres by adequately trained teams, is more effective than antiarrhythmic drug therapy in maintaining sinus rhythm.
“AF ablation, when performed in experienced centres by adequately trained teams, is more effective than antiarrhythmic drug therapy in maintaining sinus rhythm, and the complication rate, though not negligible, is similar to the complication rate for antiarrhythmic drugs.585,717,1042”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [717]
All available data point to lower recurrence rates after catheter ablation compared to antiarrhythmic drug therapy with or without cardioversion in patients with persistent or long-standing persistent atrial fibrillation.
“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 [717]
Fewer data are available reporting the effectiveness and safety of catheter ablation in patients with persistent or long-standing persistent atrial fibrillation.
“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 [717]
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Cites
2012 focused update of the ESC Guidelines for the management of atrial fibrillation
Authors Task Force Members, Camm, A. J., Lip, G. Y. H., Caterina, R. D., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., Kirchhof, P. F., Bax, J. J., et al. (2012) · EP Europace · doi:10.1093/europace/eus305 · Cited by 3,814 · see citing works
Self-citation2012 focused update of the ESC Guidelines for the management of atrial fibrillation
Authors Task Force Members, Camm, A. J., Lip, G. Y. H., Caterina, R. D., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., Kirchhof, P. F., Bax, J. J., et al. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs253 · Cited by 2,898 · see citing works
Self-citationCappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., Kim, Y.-H., Klein, G., Natale, A., Packer, D., et al. (2010) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.109.859116 · Cited by 2,852 · cited 2× · see citing works
“Furthermore, CA had an acceptable safety profile according to the latest international registries.(17)”
MethodResultCalkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., Crijns, H. J. G., Damiano, R. J., Davies, D. W., DiMarco, J., et al. (2012) · Europace · doi:10.1093/europace/eus027 · Cited by 2,722 · see citing works
Self-citationNademanee, K., McKenzie, J. P., Kosar, E. M., Schwab, M., Sunsaneewitayakul, B., Vasavakul, T., Khunnawat, C., & Ngarmukos, T. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2003.12.054 · Cited by 2,004 · see citing works
Wazni, O. M., Marrouche, N. F., Martin, D. O., Verma, A., Bhargava, M., Saliba, W., Bash, D., Schweikert, R., Brachmann, J., Gunther, J., et al. (2005) · JAMA · doi:10.1001/jama.293.21.2634 · Cited by 1,121 · cited 1× · see citing works
“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.”
ResultCircumferential Pulmonary-Vein Ablation for Chronic Atrial Fibrillation
Oral, H., Pappone, C., Chugh, A., Good, E. D., Bogun, F. M., Pelosi, F., Bates, E., Lehmann, M. H., Vicedomini, G., Augello, G., et al. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa050955 · Cited by 975 · see citing works
Fuster, V., Rydén, L., Cannom, D. S., Crijns, H. J. G. M., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Huezey, J.-Y. L., Lowe, J. E., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.09.013 · Cited by 921 · see citing works
Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation
Jaı̈s, P., CAUCHEMEZ, B., Macle, L., Daoud, E. G., Khairy, P., Subbiah, R. N., Hocini, M., Extramiana, F., Sacher, F., Bordachar, P., et al. (2008) · Circulation · doi:10.1161/circulationaha.108.772582 · Cited by 889 · see citing works
Fuster, V., Rydén, L. E., Cannom, D. S., Crijns, H. J., Curtis, A. B., Ellenbogen, K. A., Halperin, J. L., Kay, G. N., Le Huezey, J.-Y., Lowe, J. E., et al. (2011) · Circulation · doi:10.1161/cir.0b013e318214876d · Cited by 859 · see citing works
Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., Williams, C. J., & Sledge, I. (2009) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.108.824789 · Cited by 847 · cited 2× · see citing works
“Long-term ADT is associated with increased risk of adverse events.(9) In the present study, a very low rate of complication was observed in this group.”
BackgroundResultGanesan, A. N., Shipp, N. J., Brooks, A. G., Kuklik, P., Lau, D. H., Lim, H. S., Sullivan, T., Roberts‐Thomson, K. C., & Sanders, P. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.112.004549 · Cited by 800 · cited 2× · see citing works
“In the present study, the results of CA in persistent AF were comparable with those in paroxysmal AF reported in the literature.(5) This is probably the result of strict patient selection criteria, which recruited”
BackgroundResultPappone, C., Rosanio, S., Augello, G., Gallus, G., Vicedomini, G., Mazzone, P., Gulletta, S., Gugliotta, F., Pappone, A., Santinelli, V., et al. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)00577-1 · Cited by 779 · see citing works
Haı̈ssaguerre, M., Hocini, M., Sanders, P., Sacher, F., Rotter, M., Takahashi, Y., Rostock, T., Hsu, L., Bordachar, P., Reuter, S., et al. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00308.x · Cited by 755 · see citing works
Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation
Cosedis Nielsen, J., Johannessen, A., Raatikainen, P., Hindricks, G., Walfridsson, H., Kongstad, O., Pehrson, S., Englund, A., Hartikainen, J., Mortensen, L. S., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1113566 · Cited by 720 · see citing works
2012 Focused Update of the ESC Guidelines for the Management of Atrial Fibrillation
Camm, A. J., Lip, G. Y. H., Caterina, R. D., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., & Kirchhof, P. F. (2012) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2012.11.003 · Cited by 687 · see citing works
Pappone, C., Augello, G., Sala, S., Gugliotta, F., Vicedomini, G., Gulletta, S., Paglino, G., Mazzone, P., Sora, N., Greiss, I., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.08.037 · Cited by 685 · see citing works
Stabile, G., Bertaglia, E., Senatore, G., Simone, A. D., Zoppo, F., Donnici, G., Turco, P., Pascotto, P., FAZZARI, M., & Vitale, D. F. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi583 · Cited by 502 · see citing works
Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review
Brooks, A. G., Stiles, M. K., Laborderie, J., Lau, D. H., Kuklik, P., SHIPP, N. J., Hsu, L., & Sanders, P. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.01.017 · Cited by 488 · see citing works
Berruezo, A., Tamborero, D., Mont, L., Benito, B., Tolosana, J. M., Sitges, M., Vidal, B., Arriagada, G., Mendez, F., Matiello, M., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm027 · Cited by 407 · see citing works
Self-citation[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) · PubMed · Cited by 356 · see citing works
Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation
Dixit, S., Marchlinski, F. E., Lin, D., Callans, D. J., Bala, R., Riley, M. P., Garcia, F. C., Hutchinson, M. D., Ratcliffe, S. J., Cooper, J. M., et al. (2011) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.966226 · Cited by 281 · see citing works
Balk, E. M., Garlitski, A. C., Alsheikh-Ali, A. A. A., Terasawa, T., Chung, M. C., & Ip, S. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01798.x · Cited by 259 · see citing works
Long-Term Quality of Life After Ablation of Atrial Fibrillation
Wokhlu, A., Monahan, K. H., Hodge, D. O., Asirvatham, S. J., Friedman, P. A., Munger, T. M., Bradley, D. J., Bluhm, C. M., Haroldson, J. M., & Packer, D. L. (2010) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2010.01.040 · Cited by 242 · see citing works
Themistoclakis, S., Schweikert, R. A., Saliba, W. I., Bonso, A., Rossillo, A., Bader, G., Wazni, O. M., BURKHARDT, D. J., Raviele, A., & Natale, A. (2008) · Heart Rhythm · doi:10.1016/j.hrthm.2008.01.031 · Cited by 200 · see citing works
Bisbal, F., Guiu, E., Calvo, N., Marin, D., Berruezo, A., Arbelo, E., Ortiz-Pérez, J. T., de Caralt, T. M., Tolosana, J. M., Borràs, R., et al. (2013) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12116 · Cited by 156 · see citing works
Self-citationReynolds, M. R., Walczak, J., White, S., Cohen, D. J., & Wilber, D. J. (2010) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.110.957563 · Cited by 129 · see citing works
Arbelo, E., Brugada, J., Hindricks, G., Maggioni, A. P., Tavazzi, L., Vardas, P. E., Anselme, F., Inama, G., Jaı̈s, P., Kalarus, Z. F., et al. (2012) · EP Europace · doi:10.1093/europace/eus153 · Cited by 125 · see citing works
Self-citationClinical Outcome of Catheter Ablation in Patients With Nonparoxysmal Atrial Fibrillation
Chao, T., Tsao, H.-M., Lin, Y., Tsai, C.-F., Lin, W., Chang, S., Lo, L., Hu, Y., Tuan, T., Suenari, K., et al. (2012) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.111.968032 · Cited by 116 · see citing works
Arribas, F., Ormaetxe, J. M., Peinado, R., Perulero, N., Ramirez, P., & Badia, X. (2010) · Europace · doi:10.1093/europace/eup421 · Cited by 91 · see citing works
Self-citation
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Cited by
Sorted by citations
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
Approaches to catheter ablation for persistent atrial fibrillation
Verma, A., Jiang, C.-Y., Betts, T. R., Chen, J., Deisenhofer, I., Mantovan, R., Macle, L., Morillo, C. A., Haverkamp, W., Weerasooriya, R., et al. (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1408288 · Cited by 2,339 · see citing works
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Circulation · doi:10.1161/cir.0000000000000040 · Cited by 2,056 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
Rate- and Rhythm-Control Therapies in Patients With Atrial Fibrillation: A Systematic Review
Al-Khatib, S. M., Allen LaPointe, N. M., Chatterjee, R., Crowley, M. J., Dupre, M. E., Kong, D. F., Lopes, R. D., Povsic, T. J., Raju, S. S., Shah, B., et al. (2014) · Annals of Internal Medicine · doi:10.7326/m13-1467 · Cited by 178 · see citing works
Wynn, G. J., Das, M., Bonnett, L. J., Panikker, S., Wong, T., & Gupta, D. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.114.001759 · Cited by 146 · see citing works
Lane, D. A., Aguinaga, L., Blomström-Lundqvist, C., Boriani, G., Dan, G.-A., Hills, M. T., Hylek, E. M., LaHaye, S. A., Lip, G. Y. H., Lobban, T., et al. (2015) · Europace · doi:10.1093/europace/euv233 · Cited by 142 · see citing works
Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects
Rienstra, M., Tzeis, S., Bunting, K. V., Caso, V., Crijns, H. J. G. M., De Potter, T. J. R., Sanders, P., Svennberg, E., Casado-Arroyo, R., Dwight, J., et al. (2024) · Europace · doi:10.1093/europace/euae298 · Cited by 128 · see citing works
Zhang, X.-D., Gu, J., Jiang, W.-F., Zhao, L., Zhou, L., Wang, Y.-L., Liu, Y.-G., & Liu, X. (2014) · European Heart Journal · doi:10.1093/eurheartj/ehu017 · Cited by 37 · see citing works
- Authors
- Mont, L., Bisbal, F., Hernández-Madrid, A., Pérez-Castellano, N., Viñolas, X., Arenal, A., Arribas, F., Fernández-Lozano, I., Bodegas, A., Cobos, A., Matía, R., Pérez-Villacastín, J., Guerra, J. M., Ávila, P., López-Gil, M., Castro, V., Arana, J. I., & Brugada, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Hospital de Sant Pau (ES)
- Hospital Universitario 12 De Octubre (ES)
- Hospital de Cruces (ES)
- Universitat de Barcelona (ES)
- Hospital Universitario Ramón y Cajal (ES)
- Hospital General Universitario Gregorio Marañón (ES)
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-17
- Volume
- 35
- Issue
- 8
- Pages
- 501-507
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC3930872
- OpenAlex
- W2151645874
- Cited by
- 394
- References
- 30
- Citations by year
- 2026: 23 · 2025: 27 · 2024: 55 · 2023: 24 · 2022: 33 · 2021: 25 · 2020: 37 · 2019: 28 · 2018: 26 · 2017: 38 · 2016: 34 · 2015: 24 · 2014: 16 · 2013: 2
- FWCI
- 17.24
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- European Heart Journal (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
- Funders
- Eli Lilly and Company
- Biosense Webster
- 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 electrophysiology and arrhythmias
- Keywords
- persistent atrial fibrillation, catheter ablation, antiarrhythmic drugs, class Ic antiarrhythmic drugs, class III antiarrhythmic agents, atrial flutter, atrial tachyarrhythmia recurrence, sinus rhythm maintenance, electrical cardioversion, hospitalization
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Reoperation, Treatment Outcome, Catheter Ablation, Early Termination of Clinical Trials
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