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Efficacy of Catheter Ablation for Nonparoxysmal Atrial Fibrillation

Educational Objective
To understand the outcome of three randomized trials comparing ablation to medical therapy in the treatment of atrial fibrillation.
1 Credit CME
Abstract

Clinical Question  Is catheter ablation better than antiarrhythmic drugs for the prevention of nonparoxysmal atrial fibrillation?

Bottom Line  Radiofrequency catheter ablation was found to be superior to antiarrhythmic drugs in preventing recurrences of nonparoxysmal atrial fibrillation and reducing hospital admissions.

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Article Information

Corresponding Author: Guy Amit, MD, Division of Cardiology, Department of Medicine, McMaster University, Hamilton Health Sciences, 237 Barton St E, Hamilton, ON L8L2X2, Canada (amit@hhsc.ca).

Published Online: April 19, 2017. doi:10.1001/jamacardio.2017.0901

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

References
1.
Camm  AJ, Lip  GY, De Caterina  R,  et al; ESC Committee for Practice Guidelines (CPG).  2012 Focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation: developed with the special contribution of the European Heart Rhythm Association.  Eur Heart J. 2012;33(21):2719-2747.PubMedGoogle ScholarCrossref
2.
Jaïs  P, Cauchemez  B, Macle  L,  et al.  Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study.  Circulation. 2008;118(24):2498-2505.PubMedGoogle ScholarCrossref
3.
Calkins  H, Kuck  KH, Cappato  R,  et al.  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.  Europace. 2012;14(4):528-606.PubMedGoogle ScholarCrossref
4.
Cappato  R, Calkins  H, Chen  SA,  et al.  Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.  Circ Arrhythm Electrophysiol. 2010;3(1):32-38.PubMedGoogle ScholarCrossref
5.
Nyong  J, Amit  G, Adler  AJ,  et al.  Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation.  Cochrane Database Syst Rev. 2016;11(11):CD012088.PubMedGoogle Scholar
6.
Guyatt  GH, Oxman  AD, Vist  GE,  et al; GRADE Working Group.  GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.  BMJ. 2008;336(7650):924-926.PubMedGoogle ScholarCrossref
7.
January  CT, Wann  LS, Alpert  JS,  et al; ACC/AHA Task Force Members.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.  Circulation. 2014;130(23):2071-2104.PubMedGoogle ScholarCrossref
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