Pharmacological cardioversion preceding left atrial ablation: bepridil predicts the clinical outcome following ablation in patients with persistent atrial fibrillation.
OBJECTIVE
Bepridil is highly effective in terminating persistent atrial fibrillation (AF). Despite continued treatment, a high rate of AF recurrence after pharmacological cardioversion (PC) with bepridil has been reported. Bepridil therapy is also associated with significant adverse effects.


RESULTS
This retrospective case-control study included 82 patients with persistent AF (PEF). Group 1 (22 patients) comprised cases undergoing AF ablation following attempted PC with bepridil. Group 2 (60 patients) comprised control that underwent AF ablation without bepridil pre-treatment. In Group 1, 15 patients (68%) restored sinus rhythm (SR) with bepridil (SR group) and 7 continued to have AF (AF group). SR group underwent extensive pulmonary vein isolation (EPVI) alone. AF group and Group 2 underwent linear ablation after EPVI, if AF was inducible. At the end of 18 +/- 5 months off antiarrhythmic drugs, the AF-free rate was 87% in SR group, 29% in AF group, and 72% in Group 2 (72 vs. 29%, P = 0.02).


CONCLUSIONS
Following AF ablation in patients who successfully restored SR with bepridil pre-treatment, AF-free rate was significantly higher than in those who failed to do so. Conversion to SR with bepridil might help select the optimal patients with PEF for catheter ablation.
Miyazaki
Shinsuke
S
Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori 1-16, Yokosuka, Kanagawa, Japan. mshinsuke@k3.dion.ne.jp
Kuwahara
Taishi
T
Kobori
Atsushi
A
Takahashi
Yoshihide
Y
Takei
Asumi
A
Sato
Akira
A
Isobe
Mitsuaki
M
Takahashi
Atsushi
A
D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D015764:Bepridil; D017115:Catheter Ablation; D002908:Chronic Disease; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D015764:Bepridil