RESEARCH HIGHLIGHTS Nature Reviews Cardiology advance online publication 23 September 2014; doi:10.1038/nrcardio.2014.155


Amiodarone fails to lower AF recurrence in AMIO-CAT trial Transient atrial tachyarrhythmias occur frequently in the first few months after ablation for atrial fibrillation (AF), and this phenomenon is associated with later recurrence of atrial arrhythmias. Investigators of the AMIO-CAT trial sought to determine whether short-term administration of the antiarrhythmic drug amiodarone could prevent early-onset arrhythmias after AF ablation, and thereby reduce later recurrence. In a double-blind, randomized, placebocontrolled study, 212 patients undergoing AF ablation were recruited. Patients were randomly assigned to receive 8 weeks of

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oral amiodarone therapy or a placebo after catheter ablation, and follow-up was performed at 1, 3, and 6 months. The primary end point was any documented cases of AF, and atrial flutter or atrial tachycardia (AF/AT) for >30 s. Amiodarone therapy significantly reduced the number of patients who experienced a recurrent AF/AT episode (34% versus 53%; P = 0.006), and prolonged the time to first documented incidence of AF/AT within the 3-month blanking period. At 6 months, 39% of participants who received amiodarone exhibited an episode of AF/AT lasting >30 s after the blanking period, compared with 48% of patients in the placebo group (P = 0.18). Although amiodarone failed to reduce the recurrence of AF at 6-month follow-up, AF-related hospitalization and cardioversion rates were significantly reduced by amiodarone treatment during the blanking period. According to


Dr Stine Darkner, a lead investigator of the trial, AMIO-CAT is the “first study to look at AF-related hospitalizations and cardioversions as isolated effect parameters”. In an accompanying editorial, Professor Karl-Heinz Kuck and Dr Erik Wissner reiterate that electrical pulmonary vein reconduction is the dominant cause of AF recurrence beyond 6 months after ablation. They believe that “in this scenario, amiodarone ... is unlikely to permanently suppress recurrence of arrhythmia”, and that physicians should instead “aim for durable isolation of all reconducting pulmonary veins during a second ablation procedure”. Karina Huynh Original article Darkner, S. et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind, randomized, placebo-controlled study (AMIO-CAT trial). Eur. Heart J. doi:10.1093/eurheartj/ehu354

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Arrhythmias: Amiodarone fails to lower AF recurrence in AMIO-CAT trial.

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