Aims: Compare catheter ablation (CA) using second-generation pulmonary vein ablation catheter (PVAC) gold technique with clinical treatment in elderly patients with symptomatic paroxysmal AF (PAF), without structural heart diseases.
Methods: Prospective randomized study selected consecutive patients with paroxysmal AF ≥65 years in 2 groups: (1) the PVAC CA group and (2) the antiarrhythmic drug (AAD) therapy group. Primary outcomes were AF recurrences, progression to persistent AF forms and QoL score.
Results: Sixty patients were enrolled (mean age 72 ± 4.9 years, 50% female), and baseline characteristics were similar in both groups. Acute cerebral lesions identified on MRIs (secondary endpoint) occurred in 8 (26.6%) patients undergoing CA, only 1 with transient symptoms, with no impact in a 1-year Mini-Mental State evaluation in any patient. An overall pooled analysis showed that, compared to AADs, CA was associated with no significantly higher freedom from arrhythmia recurrence (80.0% versus 64.3%, P=0,119) or persistent AF (83.4% versus 67.7%, P=0.098) in a median follow-up of 719 days (Q1: 566; Q3: 730). Both strategies presented similar improvement in the QoL score during the follow-up, (P<0.001). However, most patients undergoing CA remained without amiodarone and other AADs (10% versus 40%, P=0.007).
Conclusions: Both strategies showed similar recurrence rates, without differences in QoL scores. CA group suggested a potential for a lower probability of progression to persistent forms of AF and reduced use of amiodarone in the follow-up. However, a significant number of patients presented cerebral lesions on early MRI post-ablation evaluations. ❑
