Background: Practice guidelines recommend ablation (ABL) in atrial fibrillation (AF) for rhythm control. Guidance for antiarrhythmic drugs (AADs) post-ABL is limited. Objective: The purpose of this study was to determine AAD and ABL practices in the United States and Europe. Methods: An online survey of experienced cardiologists (CDs) (n = 360) and interventional electrophysiologists (EPs) (n = 269) was conducted. AAD- and ABL-related survey questions and responses were analyzed. Results: ABL was preferred more often as first-line AF therapy (Rx) by US CDs/EPs (P ≤.001). ABL was selected to avoid AAD Rx by 46% (50% CDs, 40% EPs); to prevent AF progression by 41% (36% CDs, 47% EPs); and for superior efficacy by 28% (27% CDs, 30% EPs). ABL was used by 9% in asymptomatic AF (9% CDs, 10% EPs), by 14% in subclinical AF (13% CDs, 14% EPs), and by 17% for first AF event (15% CDs, 18% EPs). Primary ABL was preferred in heart failure by 38%. Comorbidities, age, and left atrial size were limitations for ABL by 48%, 40%, and 38%, respectively. AADs were used after ABL for AF/atrial tachycardia (AT) prophylaxis by 34% for 3–6 months and 29% for 1–2 months. AADs were given for a single AF recurrence by 34%, bridging to re-ABL by 32%, and long-term Rx by 34%. AF/AT post-ABL was most often managed with amiodarone (42%–48%). Conclusion: ABL was frequently preferred over AADs in symptomatic AF but notably also was used for asymptomatic and subclinical AF. Post-ABL AAD Rx for AF prophylaxis or recurrence was frequent, with empiric amiodarone being the most often selected AAD.
An international physician survey of current ablation practices in atrial fibrillation: An AIM-AF substudy / Saksena, S.; Slee, A.; Merino, J. L.; Goette, A.; Boriani, G.; Kowey, P. R.; Piccini, J. P.; Reiffel, J. A.; Blomstrom-Lundqvist, C.; Camm, A. J.. - In: HEART RHYTHM. - ISSN 1547-5271. - (2024), pp. N/A-N/A. [10.1016/j.hrthm.2024.10.044]
An international physician survey of current ablation practices in atrial fibrillation: An AIM-AF substudy
Boriani G.;
2024
Abstract
Background: Practice guidelines recommend ablation (ABL) in atrial fibrillation (AF) for rhythm control. Guidance for antiarrhythmic drugs (AADs) post-ABL is limited. Objective: The purpose of this study was to determine AAD and ABL practices in the United States and Europe. Methods: An online survey of experienced cardiologists (CDs) (n = 360) and interventional electrophysiologists (EPs) (n = 269) was conducted. AAD- and ABL-related survey questions and responses were analyzed. Results: ABL was preferred more often as first-line AF therapy (Rx) by US CDs/EPs (P ≤.001). ABL was selected to avoid AAD Rx by 46% (50% CDs, 40% EPs); to prevent AF progression by 41% (36% CDs, 47% EPs); and for superior efficacy by 28% (27% CDs, 30% EPs). ABL was used by 9% in asymptomatic AF (9% CDs, 10% EPs), by 14% in subclinical AF (13% CDs, 14% EPs), and by 17% for first AF event (15% CDs, 18% EPs). Primary ABL was preferred in heart failure by 38%. Comorbidities, age, and left atrial size were limitations for ABL by 48%, 40%, and 38%, respectively. AADs were used after ABL for AF/atrial tachycardia (AT) prophylaxis by 34% for 3–6 months and 29% for 1–2 months. AADs were given for a single AF recurrence by 34%, bridging to re-ABL by 32%, and long-term Rx by 34%. AF/AT post-ABL was most often managed with amiodarone (42%–48%). Conclusion: ABL was frequently preferred over AADs in symptomatic AF but notably also was used for asymptomatic and subclinical AF. Post-ABL AAD Rx for AF prophylaxis or recurrence was frequent, with empiric amiodarone being the most often selected AAD.
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