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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECompared with antiarrhythmic drug therapy (ADT), catheter ablation (CA) is an effective treatment for paroxysmal atrial fibrillation (PAF) [Ja\u00efs P et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. Although CA is recommended as an indication for patients with PAF by current US and European guidelines [Camm A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012; Fuster V et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011], its use by patients with persistent AF is unclear and even controversial. This article reviews data from the Study of Ablation Versus Antiarrhythmic Drugs in Persistent Atrial Fibrillation [SARA; Mont L et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECompared with antiarrhythmic drug therapy (ADT), catheter ablation (CA) is an effective treatment for paroxysmal atrial fibrillation (PAF) [Ja\u00efs P et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. Although CA is recommended as an indication for patients with PAF by current US and European guidelines [Camm A et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2012; Fuster V et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2011], its use by patients with persistent AF is unclear and even controversial. This is due in part to a paucity of data comparing the efficacy of the 2 therapies in patients with symptomatic, persistent AF.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELlu\u00eds Mont, MD, Universitat de Barcelona, Barcelona, Spain, reviewed data from the Study of Ablation Versus Antiarrhythmic Drugs in Persistent Atrial Fibrillation [SARA; Mont L et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2014]. SARA was a multicenter trial conducted at 8 sites in Spain to compare the effectiveness of CA versus ADT among patients with symptomatic, persistent AF at 12 months of follow-up. Eligible patients were those with symptomatic, persistent AF (\u0026gt;7 days or \u22647 days requiring cardioversion) who were refractory to at least 1 class 1 or class 3 antiarrhythmic drug. Exclusion criteria are outlined in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14825\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14825\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14825\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ESARA Exclusion Criteria\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EThe study\u0027s primary outcome measure was any episode of atrial fibrillation (AF) or atrial flutter (AFL) lasting \u0026gt;24 hours or requiring cardioversion after a 3-month blanking period, the time during which recurrences of AF were not included in the data analysis. Secondary outcomes included negative recurrence of AF or AFL, need for cardioversion, arrhythmia-related hospitalizations, and quality-of-life measures. More than 75% of patients were men, with a mean age of 55 years, and patients were randomly assigned to receive either CA (n=98) or ADT (n=48). Patients were seen at 1, 3, 6, and 12 months and underwent 24-hour Holter monitoring at 3, 6, and 12 months.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf. Mont then reviewed the primary endpoint from both the intention-to-treat (ITT) and per protocol (PP) populations. In the ITT analysis, significantly more patients who underwent CA were free of the primary endpoint compared with the ADT group (70.4% vs 43.7%, p=0.002; absolute risk reduction, 26.6%; 95% CI, 10.0 to 43.3). In the PP analysis, CA was again significantly superior to ADT in reducing episodes of AF or AFL lasting \u0026gt;24 hours or requiring cardioversion (72.8% vs 43.8%, p\u0026lt;0.001). Compared with the ADT group, the CA group also showed higher probability of remaining free of sustained AF recurrence or AFL (p\u0026lt;0.001). There were significant differences favoring CA for negative recurrence of AF or AFL and the need for cardioversion, but not the other secondary outcomes.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003ENo deaths or strokes occurred in either group. The incidence of adverse events in the CA group (ITT population) was 6.1% and included pericarditis (n=2), pericardial effusion (n=1), minor vascular complications (n=3), and pulmonary vein stenosis (n=1). In the ADT group, there were 2 adverse events: 1 episode of flecainide intoxication and 1 minor vascular access complication. Although not seen in this analysis, new data suggest that patients who underwent ablation experienced increased quality of life, not seen with patients treated with pharmacotherapy [Wynn GJ et al. \u003Cem\u003EEuropace\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf. Mont concluded that CA is superior to medical therapy as a strategy for maintenance of sinus rhythm in patients with persistent AF at 12-month follow-up. Longer follow-up will determine the durability of CA for persistent AF.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/21\/24.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp0m1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp0m1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}