| Background: The recurrence of atrial tachyarrhythmia after radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation(AF)within 3 months(referred to as early recurrence)is not taken as the procedure failure,thus this period used to be underestimated and considered as a ‘blanking period’.Some special pathogenesis lead to early recurrence after RFCA,which mainly cover inflammation and autonomic denervation.Early recurrence is found to be an independent predictor of late recurrence.The treatment of antiarrhythmic drugs(AAD)within 3 months after RFCA may prevent early recurrence effectively.However it is not clear that which one between amiodarone versus propafenone plays a better role.Objective: To compare the safety and efficacy between amiodarone versus propafenone for preventing early recurrence after RFCA in patients with AF after propensity score matching(PSM).Methods: A total of 492 patients with AF,who underwent RFCA for the first time at the Department of Cardiology of Fujian Union Medical College Hospital from January 2013 to May 2018,were enrolled in this retrospective observational study.These patients regularly completed the 3-month follow-up after RFCA.The patients were grouped in two with different AAD therapy in the blanking period,the amiodarone(n = 187)and propafenone(n = 305)groups.The clinical data of two groups were collected.The patients of the amiodarone and propafenone groups were matched according to propensity score method(135 patients for each).The safety of amiodarone and propafenone was compared via univariate analysis.Freedom from AF early recurrence between two groups was calculated by Kaplan–Meier method.The effectiveness of amiodarone and propafenone was compared via the Cox proportional hazards model.Results: The follow-up results revealed that 4 patient who got amiodarone and 2 patients who got propafenone experienced AAD-associated adverse effects,there was no significant difference between the two groups(P=0.146).After propensity score matching,AAD-associated adverse effects were less frequent in the propafenone group as compared to the amiodarone group(1.5% vs.2.1%),univariate analysis showed that there was no significant difference between the two groups(P= 0.652).Among the 492 patients who underwent RFCA,153 patients(31.1%)had early recurrence [48(25.8%)amiodarone and 105(34.4%)propafenone],there was significant difference between the two groups(P=0.027);Kaplan–Meier method demonstrated that patients in the amiodarone group were more likely free from early recurrence(P=0.027).After propensity score matching,the early recurrence rate of atrial fibrillation was lower in amiodarone group than in propafenone group(23.7% vs.53.3%,P<0.001).Kaplan–Meier method demonstrated that patients in the amiodarone group were more likely free from early recurrence(P<0.001).Cox proportional hazards model analysis revealed that the propafenone therapy approximately tripled the risk of early recurrence after RFCA compared with the amiodarone therapy(OR 2.968,95% CI 1.955–4.505,P < 0.001).Conclusions: There is no significant difference in the safety between amiodarone and propafenone in the blanking period after RFCA.The treatment with amiodarone in blanking period played a better role in preventing the early recurrence compared with the treatment with propafenone. |
