Effect of restoration of sinus rhythm by extensive antiarrhythmic drugs in predicting results of catheter ablation of persistent atrial fibrillation.
In patients with persistent atrial fibrillation (AF), an extensive antiarrhythmic drug (AAD) therapy using class III AADs and class I AADs might be more effective in restoring sinus rhythm than class I or III AADs alone. However, the significance and efficacy of this treatment before radiofrequency catheter ablation is unclear. The present study included 51 consecutive patients with long-lasting persistent AF (>12 months) in whom > or =2 previous AADs had failed to restore sinus rhythm (SR). Before performing extensive pulmonary vein isolation, extensive AAD therapy for >3 months was attempted. Before ablation, AF had converted to SR in 33 patients (65%; SR group) and had continued in 18 (35%; AF group). The left ventricular ejection fraction had increased (p <0.01) in association with the improved left atrial diameter (p <0.05) and brain natriuretic peptide plasma level (p <0.001) in the SR group. However, these parameters had not improved in the AF group. The AF-free rate without any AADs at 14 months after a single ablation procedure was greater in the SR group (61%) than in the AF group (22%; hazard ratio 2.62, 95% confidence interval 1.22 to 5.63; p = 0.013). No restoration of SR with extensive AAD therapy (odds ratio 4.493, 95% confidence interval 1.143 to 17.658; p <0.05) and sustained AF lasting for >3 years (odds ratio 4.574, 95% confidence interval 1.027 to 20.368; p <0.05) before ablation were associated with AF recurrence after ablation. In conclusion, restoration of SR with improved cardiac function and structural remodeling after extensive AAD therapy might predict favorable outcomes after ablation in patients with long-lasting, persistent AF.
Igarashi
Miyako
M
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Japan.
Tada
Hiroshi
H
Sekiguchi
Yukio
Y
Yamasaki
Hiro
H
Arimoto
Takanori
T
Kuroki
Kenji
K
Machino
Takeshi
T
Murakoshi
Nobuyuki
N
Aonuma
Kazutaka
K
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents