Antiarrhythmic therapy as an adjuvant to promote post pulmonary vein isolation success—a meta-analysis

Background: Three months of empirical antiarrhythmic drug (AAD) therapy after atrial fibrillation ablation (AFA) is a common practice to prevent early arrhythmia recurrence; the data of influence of this practice on longer term ablation outcomes is limited. Purpose: The aim of this study was to perform a meta-analysis of published controlled trials comparing temporary AAD therapy after AFA with no AAD therapy in patients after AFA. The primary outcome was recurrence of arrhythmia. Results: 1Eight prospective trials were included. Among 2952 patients, 1991 (67 %) had paroxysmal AF, and 967 (32.7 %) had persistent AF. In total, 1502 patients were treated with AADs and 1450 patients served as a control group (no AAD therapy). Various class IC-III antiarrhythmics were used. Length of AAD administration varied between 6 and 12 weeks after start of AFA. The follow-up duration ranged from 1.5 to 17 months after stopping medication. Among AAD treated patients, the recurrence of arrhythmia rate was 30.69 vs. 33.79 % in control patients (odd ratio 0.86, 95 % CI 0.71–1.06, P = 0.15). In patients who received largely amiodarone, there was a trend for difference in recurrence of atrial arrhythmia (odds ratio 0.60, 95 % CI 0.34–1.09, P = 0.09). Conclusions: Short-term post pulmonary vein isolation (PVI) AAD therapy does not substantially reduce overall recurrence of AF after ablation.