Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial
Abstract
AIM: Although catheter ablation (CA) has replaced antiarrhythmic drugs (AAD) as first-line treatment in selected patients with atrial fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT) after AF ablation remains unclear. This parallel randomized controlled study compared CA vs. AAD for recurrent AT after persistent AF ablation. METHODS AND RESULTS: Two-hundred and one patients (aged 59.1 ± 10.9 years, 68.7% male) with recurrent AT after persistent AF ablation were enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment. Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa, including AT and AF) at 24-month follow-up. Composite secondary endpoints comprised procedural complications, long-term morbidity and improvement in quality of life (QoL). On an intention-to-treat basis, the CA group had a higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001). Adjusted Cox regression analysis showed a significant treatment effect with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There was a higher proportion of periprocedural complications in the CA group (7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group (10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for CA. CONCLUSIONS: This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Catheter ablation for focal AT has a reported success rate of 75-100% and has been shown superior to antiarrhythmic drugs in a randomized study in the context of AF ablation.
“Catheter ablation is reported to have a 75 -100% success rate, 111,120 and has been shown superior to antiarrhythmic drugs in a randomized study in the context of AF ablation.112”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [112]
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) · European Heart Journal · doi:10.1093/eurheartj/ehs253 · Cited by 2,898 · see citing works
Feinberg, W. M. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.155.5.469 · Cited by 2,282 · see citing works
Hohnloser, S. H., Kück, K., & Lilienthal, J. (2000) · The Lancet · doi:10.1016/s0140-6736(00)03230-x · Cited by 1,132 · 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 8× · see citing works
“–7 Wazni et al.(3) first demonstrated thatCAshould be considered as the first-line treatment for symptomatic paroxysmal AF.”
BackgroundResultInfluentialCircumferential 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
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
Ouyang, F. O., Antz, M., Ernst, S., Hachiya, H., Mavrakis, H. E., Deger, F. T., Schaumann, A., Chun, K. R. J., Falk, P., Hennig, D., et al. (2004) · Circulation · doi:10.1161/01.cir.0000151289.73085.36 · Cited by 793 · see citing works
Self-citationPappone, 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
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
Haı̈ssaguerre, M., Sanders, P., Hocini, M., Takahashi, Y., Rotter, M., Sacher, F., Rostock, T., Hsu, L., Bordachar, P., Reuter, S., et al. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00307.x · Cited by 675 · 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
Jones, D. G., Haldar, S. K., Hussain, W., Sharma, R., Francis, D. P., Rahman-Haley, S. L., McDonagh, T. A., Underwood, S. R., Markides, V., & Wong, T. (2013) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.01.069 · Cited by 481 · cited 1× · see citing works
“However, a recent clinical trial has proved a significant benefit from ablation, compared with a rate control strategy.(16) Figure 3 SF-36 scores at baseline and 24 month.”
MethodElectrophysiologic and electroanatomic changes in the human atrium associated with age
Kistler, P. M., Sanders, P., Fynn, S. P., Stevenson, I., Spence, S. J., Vohra, J. K., SPARKS, P. B., & Kalman, J. M. (2004) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.03.044 · Cited by 476 · see citing works
Mont, L., Bisbal, F., Hernández-Madrid, A., Pérez-Castellano, N., Viñolas, X., Arenal, A., Arribas, F., Fernández-Lozano, I., Bodegas, A., Cobos, A., et al. (2014) · European Heart Journal · doi:10.1093/eurheartj/eht457 · Cited by 394 · see citing works
Chugh, A., Oral, H., Lemola, K., Hall, B., Cheung, P., Good, E., Tamirisa, K., Han, J., Bogun, F., Pelosi, F., et al. (2005) · Heart Rhythm · doi:10.1016/j.hrthm.2005.01.027 · Cited by 338 · see citing works
Verma, A., Champagne, J., Sapp, J., Essebag, V., Novak, P., Skanes, A., Morillo, C. A., Khaykin, Y., & Birnie, D. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.1561 · Cited by 315 · see citing works
Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation
Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A. M., Nayak, H., Lin, D., Pulliam, W., Siddique, S., & Marchlinski, F. E. (2004) · Circulation · doi:10.1161/01.cir.0000141369.50476.d3 · Cited by 300 · see citing works
(1988) · ASHE-ERIC Higher Education Report · doi:10.1002/aehe.3640170508 · Cited by 259 · see citing works
Singh, S. N., Tang, X. C., Singh, B. N., Dorian, P., Reda, D. J., Harris, C. L., Fletcher, R. D., Sharma, S. C., Atwood, J. E., Jacobson, A. K., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.03.051 · Cited by 231 · see citing works
Reynolds, 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
Predictors of recurrence following radiofrequency ablation for persistent atrial fibrillation
McCready, J. W., Smedley, T., Lambiase, P. D., Ahsan, S., Segal, O. R., Rowland, E., LOWE, M. D., & CHOW, A. W. C. (2010) · EP Europace · doi:10.1093/europace/euq434 · Cited by 128 · see citing works
Khaykin, Y., Wang, X., Natale, A., Wazni, O. M., Skanes, A. C., Humphries, K. H., Kerr, C. R., Verma, A., & Morillo, C. A. (2008) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2008.01303.x · Cited by 74 · see citing works
Page, S. P., SIDDIQUI, M. S., Finlay, M., Hunter, R. J., Abrams, D. J., Dhinoja, M., Earley, M. J., Sporton, S. C., & SCHILLING, R. J. (2010) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2010.01910.x · Cited by 54 · see citing works
Liu, X., Tan, H.-W., Wang, X.-H., Shi, H., Li, Y.-Z., Li, F., Zhou, L., & Gu, J.-N. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq201 · Cited by 52 · see citing works
Self-citationBlandino, A., Toso, E., Scaglione, M., Anselmino, M., Ferraris, F., SARDI, D., Battaglia, A., & Gaïta, F. (2013) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12126 · Cited by 43 · see citing works
Knecht, S., Veenhuyzen, G. D., O'Neill, M. D., Wright, M. J., Nault, I., Weerasooriya, R., Miyazaki, S., Sacher, F., Hocini, M., Jaı̈s, P., et al. (2009) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2009.02315.x · Cited by 40 · see citing works
Zhang, X.-D., Gu, J., Jiang, W.-F., Zhao, L., Wang, Y.-L., Liu, Y., Zhou, L., Gu, J.-N., Wu, S., Xu, K., et al. (2013) · International Journal of Cardiology · doi:10.1016/j.ijcard.2013.03.025 · Cited by 15 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
- Authors
- Zhang, X.-D., Gu, J., Jiang, W.-F., Zhao, L., Zhou, L., Wang, Y.-L., Liu, Y.-G., & Liu, X.
- Affiliations
- Shanghai Jiao Tong University (CN)
- Corresponding author
- Liu, X.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-02-03
- Volume
- 35
- Issue
- 20
- Pages
- 1327-1334
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2035357171
- Cited by
- 37
- References
- 28
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 2 · 2022: 3 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 4
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (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 electrophysiology and arrhythmias
- Keywords
- persistent atrial fibrillation, catheter ablation, antiarrhythmic drugs, rhythm control, atrial tachyarrhythmia recurrence, procedural complications, long-term safety, quality of life, sinus rhythm maintenance
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Chronic Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Recurrence, Treatment Outcome, Catheter Ablation, Electrophysiologic Techniques, Cardiac, Kaplan-Meier Estimate, Secondary Prevention
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
