Antiarrhythmics after ablation of atrial fibrillation (5A study)

Jean François Roux, Erica Zado, David J. Callans, Fermin Garcia, David Lin, Francis E. Marchlinski, Rupa Bala, Sanjay Dixit, Michael Riley, Andrea M. Russo, Mathew D. Hutchinson, Joshua Cooper, Ralph Verdino, Vickas Patel, Parijat S. Joy, Edward P. Gerstenfeld

Research output: Contribution to journalArticlepeer-review

120 Scopus citations


BACKGROUND-: Atrial arrhythmias are common early after atrial fibrillation (AF) ablation. We hypothesized that empirical antiarrhythmic drug (AAD) therapy for 6 weeks after AF ablation would reduce the occurrence of atrial arrhythmias. METHODS AND RESULTS-: We randomized consecutive patients with paroxysmal AF undergoing ablation to empirical antiarrhythmic therapy (AAD group) or no antiarrhythmic therapy (no-AAD group) for the first 6 weeks after ablation. In the no-AAD group, only atrioventricular nodal blocking agents were prescribed. All patients wore a transtelephonic monitor for 4 weeks after discharge and were reevaluated at 6 weeks. The primary end point of the study was a composite of (1) atrial arrhythmias lasting more than 24 hours; (2) atrial arrhythmias associated with severe symptoms requiring hospital admission, cardioversion, or initiation/change of antiarrhythmic drug therapy; and (3) intolerance to antiarrhythmic agent requiring drug cessation. Of 110 enrolled patients (age 55±9 years, 71% male), 53 were randomized to AAD and 57 to no-AAD. There was no difference in baseline characteristics between groups. During the 6 weeks after ablation, fewer patients reached the primary end point in the AAD compared with the no-AAD group (19% versus 42%; P=0.005). There remained fewer events in the AAD group (13% versus 28%; P=0.05) when only end points of AF >24 hours, arrhythmia-related hospitalization, or electrical cardioversion were compared. CONCLUSIONS-: AAD treatment during the first 6 weeks after AF ablation is well tolerated and reduces the incidence of clinically significant atrial arrhythmias and need for cardioversion/hospitalization for arrhythmia management.

Original languageEnglish (US)
Pages (from-to)1036-1040
Number of pages5
Issue number12
StatePublished - Sep 2009
Externally publishedYes


  • Ablation
  • Antiarrhythmia agents
  • Atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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