Clinical Question

Do antiarrhythmic agents (class I and III) prevent the recurrence of atrial fibrillation postablation?

Evidence-Based Answer

Compared with placebo, class I and III antiar-rhythmic agents reduce the recurrence of atrial fibrillation after catheter ablation at three to six months postablation (absolute risk reduction = 6.8%; 95% CI, 3.2% to 10%; number needed to treat [NNT] = 15). There are no differences in all-cause mortality, thromboembolic events, or myocardial infarction during the three- to six-month postablation period in patients using class I and III antiarrhythmics compared with those in the control group.¹ (Strength of Recommendation: C, disease-oriented evidence.)

Discussion

Atrial fibrillation is the primary diagnosis in more than 454,000 hospitalized patients each year; it contributes to approximately 158,000 deaths annually.² In 2019, updates to the American Heart Association guidelines indicated that atrial fibrillation ablation is reasonable in patients with symptomatic atrial fibrillation and heart failure with reduced left ventricular ejection fraction to lower the mortality rate and hospitalizations.³ Recurrent atrial tachyarrhythmias following catheter ablation for atrial fibrillation are a common problem, with an incidence of at least 20% to 40%.⁴ Although antiarrhythmic drugs, particularly class I and III medications, are used to maintain sinus rhythm, it is unclear whether they reduce the risk of recurrent atrial tachyarrhythmias. The authors of this Cochrane review sought to determine whether class I and III antiarrhythmic drugs prevent postablation recurrence of atrial tachyarrhythmias and whether the use of these medications is associated with an increased risk.