First-Line Radiofrequency Ablation for AF Yields Good, Not Great, Results

Radiofrequency ablation for atrial fibrillation (AF) is relatively new but already carries a Class I guideline recommendation for patients who have failed to respond to antiarrhythmic drugs (AADs). Now, ablation is being investigated as a first-line therapy for AF (NEJM JW Cardiol Oct 24 2012). In the industry-supported, international RAAFT-2 trial, 127 patients were randomized to treatment with either AADs chosen at investigators' discretion (flecainide, 69%; propafenone, 25%) or AF ablation (radiofrequency pulmonary vein isolation confirmed by entrance block). All patients had experienced ≤4 episodes of AF during the prior 6 months and had no previous history of AAD use or AF ablation. The primary endpoint was AF, atrial flutter, or atrial tachycardia of more than 30 seconds' duration during 2-year follow-up.

The rate of the primary endpoint was 54.6% in the ablation group and 72.1% in the AAD group (hazard ratio, 0.56; 95% confidence interval, 0.35–0.90; P=0.02). No strokes or deaths occurred, but four patients in the ablation group experienced pericardial tamponade. Quality-of-life scores improved in both groups with no significant between-group difference.