http://www.theheart.org/web_slides/1413467.do A Study on Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Therapy of Atrial Fibrillation (RAAFT-2) to determine whether catheter-based pulmonary vein isolation is superior to antiarrhythmic drug (AAD) as first-line in patients with symptomatic paroxysmal recurrent AF not previously treated with therapeutic foses of AAD.

1. RAAFT-2 (Radiofrequency Ablation vs
Antiarrhythmic Drugs as First-Line
Therapy of Atrial Fibrillation)

2. RAAFT-2 (Radiofrequency Ablation vs Antiarrhythmic
Drugs as First-Line Therapy of Atrial Fibrillation)
C Morillo (Hamilton Health Sciences-McMaster University, ON)
Heart Rhythm Society 2012 Scientific Sessions
• A study to determine whether catheter-based pulmonary vein isolation is
superior to antiarrhythmic drugs (AAD) as first-line therapy in patients with
symptomatic paroxysmal recurrent AF not previously treated with therapeutic
doses of AAD
• Population and design:
127 patients not previously treated with AAD randomized either to undergo
RF ablation within 4 to 6 weeks or to initiate AAD, with 90 days allowed for
titrating doses
Patients had normal systolic function, and none had hypertension or heart
failure; all were followed with transtelephonic monitoring (TTM)
• Primary outcome:
Time to first episode of symptomatic atrial fibrillation
AAD=antiarrhythmic drug; AF= atrial fibrillation; TTM=transtelephonic monitoring;
RF=radiofrequency

3. RAAFT-2: Results
• In the ablation group, 15.2% required additional ablation; seven patients
(10.6%) went on AAD therapy
• In the AAD group, 59% had to discontinue at least one antiarrhythmic drug and
29 patients (47.5%) underwent catheter ablation during the follow-up
Recurrence rates at two years for symptomatic or asymptomatic AF, atrial flutter, or
atrial tachycardia lasting >30 seconds
End point Ablation, n=66 (%) AAD, n=61 (%) HR (95% CI), p
Recurrence of AF, atrial flutter, or atrial tachycardia 55 72 0.56 (0.35–0.90), 0.02
Symptomatic recurrence of AF, atrial flutter, or atrial tachycardia 47 59 0.56 (0.33–0.95), 0.03
Symptomatic AF only 41 58 0.52 (0.30–0.89), 0.01
Recurrence by clinical criteria only 24 31 0.86 (0.42–1.72), 0.66

4. RAAFT-2: Commentary*
"To be able to claim victory with ablation, you really need to monitor these patients
very judiciously. . . . These findings support the indication of radiofrequency
pulmonary vein isolation as first-line therapy in patients with paroxysmal atrial
fibrillation."
- Dr Carlos Morillo
*All comments from RAAFT 2: Catheter ablation can be first line of defense against paroxysmal AF
(http://www.theheart.org/article/1397545.do)

5. Become a member of http://www.theheart.org
Become a fan on Facebook: http://www.facebook.com/theheartorg
Follow us on Twitter: http://www.twitter.com/theheartorg
theheart.org is the leading online source of independent cardiology news.
We are the top provider of news and opinions for over 100 000 physicians.