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

被引:49
作者
Katritsis, Demosthenes G. [1 ,2 ]
Zografos, Theodoros [2 ]
Katritsis, George D. [3 ]
Giazitzoglou, Eleftherios [2 ]
Vachliotis, Vasilios [2 ]
Paxinos, George [2 ]
Camm, A. John [4 ]
Josephson, Mark E. [1 ]
机构
[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Div Cardiol, 185 Pilgrim Rd,Baker 4, Boston, MA 02215 USA
[2] Athens Euroclin, Athens, Greece
[3] Univ Oxford, Clin Acad Grad Sch, Oxford, England
[4] St Georges Univ London, London, England
来源
EUROPACE | 2017年 / 19卷 / 04期
关键词
Atrioventricular nodal re-entrant tachycardia; Ablation; Antiarrhythmic drugs; Randomized controlled trial; PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA; LONG-TERM; SAFETY; TACHYARRHYTHMIAS; FLECAINIDE; VERAPAMIL; EFFICACY; PROPAFENONE; MANAGEMENT; OUTCOMES;
D O I
10.1093/europace/euw064
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To conduct a randomized trial in order to guide the optimum therapy of symptomatic atrioventricular nodal re-entrant tachycardia (AVNRT). 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). Catheter ablation is the therapy of choice for symptomatic AVNRT. Antiarrhythmic drug therapy is ineffective and not well tolerated.
引用
收藏
页码:602 / 605
页数:4
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