Oral Class I and III antiarrhythmic drugs for maintaining si | Figure 1
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Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation
We wanted to find out how effective certain classes of antiarrhythmic drugs (medications used to prevent or treat an irregular heart rhythm) are for maintaining sinus rhythm (normal heart rhythm) in people after catheter ablation (a technique using catheters to create controlled burns in the heart to prevent and treat arrhythmia occurrence) for atrial fibrillation (a common type of irregular heart rhythm), compared to catheter ablation alone.
Study characteristics
We conducted the search on 5 August 2022, and identified 4682 citations (papers), out of which nine were eligible randomised controlled trials (a type of study where people are randomly assigned to one of two or more treatment groups). The studies included a total of 3269 participants from six countries, who were assigned to either Class I or III antiarrhythmics (or both) or placebo (sugar pill)/standard treatment. People taking part in the studies were on average 59 years old, and 71% were male. Most people had paroxysmal atrial fibrillation (meaning they were not in atrial fibrillation all the time and alternated with normal rhythms).
Results
We found that the effect of Class I and/or III antiarrhythmic drugs given up to around 3 months after ablation may reduce recurrence of arrhythmia at 0 to 3 months, and likely reduces recurrence at greater than 3 to 6 months, although the benefit does not appear to continue beyond 6 months (the evidence for this last result was very uncertain). We also looked at adverse outcomes (i.e. complications). We found that the use of antiarrhythmics was probably associated with a reduction in hospitalisation at 0 to 3 months. We also found evidence suggesting that antiarrhythmics are not associated with different rates of thromboembolic events (clots in the brain, lungs, or legs), heart attacks, death due to any cause, or requirement for repeat ablation compared with control or standard treatment.
Certainty of the results
Our confidence in the evidence was low for recurrence of arrhythmias at 0 to 3 months, moderate at 3 to 6 months, and very low at greater than 6 months. Our confidence in the evidence for reduction of hospitalisation for arrhythmias was moderate.
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