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Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial.

Katritsis, DG; Zografos, T; Katritsis, GD; Giazitzoglou, E; Vachliotis, V; Paxinos, G; Camm, AJ; Josephson, ME (2017) Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace, 19 (4). pp. 602-606. ISSN 1532-2092 https://doi.org/10.1093/europace/euw064
SGUL Authors: Camm, Alan John

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Abstract

Aims: To conduct a randomized trial in order to guide the optimum therapy of symptomatic atrioventricular nodal re-entrant tachycardia (AVNRT). Methods and Results: Patients with at least one symptomatic episode of tachycardia per month and an electrophysiologic diagnosis of AVNRT were randomly assigned to catheter ablation or chronic antiarrhythmic drug (AAD) therapy with bisoprolol (5 mg od) and/or diltiazem (120-300 mg od). All patients were properly educated to treat subsequent tachycardia episodes with autonomic manoeuvres or a 'pill in the pocket' approach. The primary endpoint of the study was hospital admission for persistent tachycardia cardioversion, during a follow-up period of 5 years. Sixty-one patients were included in the study. In the ablation group, 1 patient was lost to follow-up, and 29 were free of arrhythmia or conduction disturbances at a 5-year follow-up. In the AAD group, three patients were lost to follow-up. Of the remainder, 10 patients (35.7%) continued with initial therapy, 11 patients (39.2%) remained on diltiazem alone, and 7 patients (25%) interrupted their therapy within the first 3 months following randomization, and subsequently developed an episode requiring cardioversion. During a follow-up of 5 years, 21 patients in the AAD group required hospital admission for cardioversion. Survival free from the study endpoint was significantly higher in the ablation group compared with the AAD group (log-rank test, P < 0.001). Conclusions: Catheter ablation is the therapy of choice for symptomatic AVNRT. Antiarrhythmic drug therapy is ineffective and not well tolerated.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in EP-Europace following peer review. The version of record Katritsis, DG; Zografos, T; Katritsis, GD; Giazitzoglou, E; Vachliotis, V; Paxinos, G; Camm, AJ; Josephson, ME (2017) Catheter ablation vs. antiarrhythmic drug therapy in patients with symptomatic atrioventricular nodal re-entrant tachycardia: a randomized, controlled trial. Europace, 19 (4). pp. 602-606 is available online at: https://doi.org/10.1093/europace/euw064
Keywords: Ablation, Antiarrhythmic drugs, Atrioventricular nodal re-entrant tachycardia, Randomized controlled trial, Ablation, Antiarrhythmic drugs, Atrioventricular nodal re-entrant tachycardia, Randomized controlled trial, Cardiovascular System & Hematology, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: Europace
ISSN: 1532-2092
Language: eng
Dates:
DateEvent
1 April 2017Published
12 May 2016Published Online
12 May 2016Accepted
Publisher License: Publisher's own licence
PubMed ID: 28431060
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/108509
Publisher's version: https://doi.org/10.1093/europace/euw064

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