title: Pharmacological cardioversion preceding left atrial ablation: bepridil predicts the clinical outcome following ablation in patients with persistent atrial fibrillation.
abstract: 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.
authors.affiliation: Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori 1-16, Yokosuka, Kanagawa, Japan. mshinsuke@k3.dion.ne.jp
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Taishi
authors.initials: T
authors.lastname: Kuwahara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Asumi
authors.initials: A
authors.lastname: Takei
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
mesh_terms: 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
chemical_list: D000889:Anti-Arrhythmia Agents; D015764:Bepridil