Antiarrhythmic drug therapy and all-cause mortality after catheter ablation of atrial fibrillation: A propensity-matched analysis.
BACKGROUND
It is not clear if antiarrhythmic drug therapy (AAD) after catheter ablation (CA) of atrial fibrillation (AF) increases mortality.


OBJECTIVE
To determine whether there is an association between AAD therapy and mortality after CA of AF.


METHODS
There were 3624 consecutive patients with AF (mean age: 59 ± 11 years, women: 27%, paroxysmal AF: 58%). An AAD was used in 2253 patients (62%, AAD group) for a mean duration of 1.3 ± 0.8 years, during a mean follow-up of 6.7 ± 2.2 years after CA of AF. Using propensity score matching, with every 2 patients using an AAD matched to 1 patient who did not use AAD (NO-AAD group), Cox regression models were utilized to assess the association between AAD use (as a time-variable covariate) and all-cause mortality.


RESULTS
There were a total of 50 deaths (2.2%) in the AAD and 62 deaths (4.5%) in the NO-AAD groups, respectively (P = .02). At the time of death, 46 of 50 patients (92%) who died in the AAD cohort were still using an AAD (P = .21, compared to baseline use). On multivariate analysis, although the risk of death was not statistically significant between the AAD and NO-AAD cohorts, there was a trend towards mortality benefit with AAD therapy (hazard ratio [HR]: 0.66, 95% confidence interval [CI]: 0.43-1.00, P = .05), regardless of the rhythm or anticoagulation status.


CONCLUSION
AAD use after CA of AF is not associated with an increased risk of mortality, suggesting that when carefully chosen and monitored, AADs appear to be safe after CA of AF.
['Shantha|Ghanshyam|G|', 'Alyesh|Daniel|D|', 'Ghanbari|Hamid|H|', 'Yokokawa|Miki|M|', 'Saeed|Mohammed|M|', 'Cunnane|Ryan|R|', 'Latchamsetty|Rakesh|R|', 'Crawford|Thomas|T|', 'Jongnarangsin|Krit|K|', 'Bogun|Frank|F|', 'Pelosi|Frank|F|', 'Chugh|Aman|A|', 'Morady|Fred|F|', 'Oral|Hakan|H|']
D000889:Anti-Arrhythmia Agents D001281:Atrial Fibrillation D017115:Catheter Ablation D002423:Cause of Death D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D008991:Monitoring, Physiologic D009026:Mortality D018579:Patient Selection D011184:Postoperative Period D057216:Propensity Score D018570:Risk Assessment D014481:United States
Antiarrhythmic drugs Mortality Catheter ablation Atrial fibrillation Outcomes