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Evidence-Based Medicine 2006;11:16; doi:10.1136/ebm.11.1.16
Copyright © 2006 by the BMJ Publishing Group Ltd.
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Therapeutics

Pulmonary vein isolation was better than antiarrhythmic drugs for symptomatic atrial fibrillation

Wazni OM, Marrouche NF, Martin DO, et al. Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of symptomatic atrial fibrillation: a randomized trial. JAMA 2005;293:2634–40.[Abstract/Free Full Text]

Q In patients with symptomatic atrial fibrillation (AF), is pulmonary vein isolation (PVI) with radiofrequency ablation more effective than antiarrhythmic drugs as first line treatment?

Clinical impact ratings Internal medicine ******{star} Cardiology *******

Key Words: anti-arrhythmia agents • atrial fibrillation • catheter ablation

The first 150 words of the full text of this article appear below.

METHODS
Formula Design: randomised controlled trial.

Formula Allocation: {concealed}*.{dagger}

Formula Blinding: {unblinded}*.{dagger}

Formula Follow up period: 1 year.

Formula Setting: 44 clinical centres in Italy and 26 clinical centres in Germany.

Formula Patients: 70 patients who were 18–75 years of age and had experienced monthly symptomatic AF >=3 months. Exclusion criteria included previous history of AF or AF ablation, previous treatment with antiarrhythmic drugs, and contraindication to long term anticoagulation.

Formula Intervention: 33 patients were allocated to PVI with radiofrequency ablation (all 4 pulmonary veins were isolated) and were given >=3 months of warfarin, beginning on the evening of PVI (target international normalised ratio [INR] of 2–3). If patients experienced recurrence of AF or >=50% narrowing of a pulmonary vein, warfarin was continued. 37 patients were allocated to antiarrhythmic drugs (recommended regimen: oral flecainide, 100–150 mg twice daily; propafenone, 225–300 mg 3 times/d; or sotalol 120–160 mg twice daily). Patients’ physicians chose the antiarrhythmic drug used. . . . [Full text of this article]

D George Wyse, MD, PhD

Libin Cardiovascular Institute of Alberta
Calgary, Alberta, Canada


Related Article

Glossary
Evid. Based Med. 2006 11: 31. (in Glossary) [Extract] [Full Text] [PDF]





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