Amiodarone reduces the amount of ablation during catheter ablation for persistent atrial fibrillation.
OBJECTIVE
The step-wise approach to catheter ablation for persistent atrial fibrillation (AF) requires considerable substrate modification targeting at complex fractionated atrial electrograms (CFAEs) in addition to pulmonary vein (PV) isolation. An alternative strategy that minimizes the amount of ablation would be desirable. The aim of this study was to investigate whether the use of pre-procedural amiodarone affects: (i) the amount of ablation required to achieve procedural success, and (ii) long-term outcomes.


RESULTS
We studied 121 consecutive patients with persistent AF who underwent catheter ablation. The patients were divided into two groups: Group 1, amiodarone (n = 31); Group 2, other antiarrhythmic drugs or rate control (n = 90). All the patients underwent a step-wise ablation procedure beginning with PV isolation, then proceeding with ablation of the CFAEs and linear lesions until sinus rhythm was achieved. Mean left atrial cycle length of AF (AFCL) was recorded at each step. The number of CFAE ablation sites was recorded. The number of CFAE sites in Group 1 was significantly less than that in Group 2 (P = 0.0121). The AFCLs after each step in Group 1 were significantly longer than those in Group 2. The procedure time and the radiofrequency time of CFAE ablation in Group 1 were significantly shorter than that in Group 2 (P = 0.0276 and P = 0.0458, respectively). There was no significant difference between the two groups in early and long-term outcomes.


CONCLUSIONS
Use of pre-procedural amiodarone prolongs AFCL during catheter ablation and reduces the number of CFAE sites requiring ablation to achieve procedural success while maintaining equivalent long-term results.
Department of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Third floor, Los Angeles, CA 90017, USA.
Yosuke
Y
Miwa
Department of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Third floor, Los Angeles, CA 90017, USA.
Hitoshi
H
Minamiguchi
Department of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Third floor, Los Angeles, CA 90017, USA.
Anil K
AK
Bhandari
Department of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Third floor, Los Angeles, CA 90017, USA.
David S
DS
Cannom
Department of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Third floor, Los Angeles, CA 90017, USA iho@lacard.com.
Ivan C
IC
Ho
D000368:Aged; D000638:Amiodarone / Q000009:adverse effects / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D003131:Combined Modality Therapy; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011667:Pulmonary Veins / Q000187:drug effects* / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
Amiodarone; Atrial fibrillation; Catheter ablation; Complex fractionated atrial electrograms