# Agressieve bloeddrukcontrole en recidief van AF na ablatie: gerandomiseerde trial

*geplaatst 2017-05-09 · Hypertensie · Circulation · doi 10.1161/CIRCULATIONAHA.116.026230 · https://hartvaat.nl/2017/05/09/agressieve-bloeddrukcontrole-en-recidief-van-af-na-ablatie-gerandomiseerde-trial/*

Gerandomiseerde trial die agressieve bloeddrukcontrole onderzocht voor preventie van AF-recidief na katheterablatie. Onderstreept het belang van comorbiditeitsmanagement bij AF.

## English: Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open-Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control]).

This randomized trial showed that aggressive blood pressure control significantly reduces AF recurrence after catheter ablation, establishing blood pressure management as an important adjunctive strategy for rhythm control.

## Abstract (original, from the publication)

BACKGROUND: Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. METHODS: We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. RESULTS: The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). CONCLUSIONS: In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113.

Auteurs: Ratika Parkash, George A Wells, John L Sapp, Jeffrey S Healey, Jean-Claude Tardif, Isabelle Greiss, Lena Rivard, Jean-Francois Roux, Lorne Gula, Isabelle Nault, Paul Novak, David Birnie, Andrew Ha, Stephen B Wilton, Iqwal Mangat, Christopher Gray, Martin Gardner, Anthony S L Tang

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.116.026230. Bijgewerkt 2026-07-03T13:26:00Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.