title: Effect of periprocedural amiodarone on procedure outcome in patients with longstanding persistent atrial fibrillation undergoing extended pulmonary vein antrum isolation: results from a randomized study (SPECULATE).
abstract: BACKGROUND
  The impact of amiodarone on ablation outcome in longstanding persistent atrial fibrillation (LSPAF) patients is not known yet.
  
  
  OBJECTIVE
  The purpose of this study was to assess the effect of amiodarone on procedural-outcomes in LSPAF patients undergoing catheter ablation.
  
  
  METHODS
  We enrolled 112 LSPAF patients on amiodarone and scheduled to undergo atrial fibrillation (AF) ablation. Patients were randomized to amiodarone discontinuation 4 months before ablation (group 1, n = 56) and a control group (group 2, n = 56) in which ablation was performed without amiodarone discontinuation. All patients underwent pulmonary vein (PV) antrum and posterior wall isolation, defragmentation and extra PV triggers ablation. Patients were followed up for recurrence for 32 ± 8 months post-ablation. Repeat procedures in all recurrent patients were performed off amiodarone.
  
  
  RESULTS
  During ablation, AF termination was more frequent in group 2 compared to group 1 [44 (79%) vs 32 (57%), P = .015]. After high-dosage isoproterenol, more non-PV triggers were disclosed in group 1 compared to group 2 (42 [75%] vs 24 [43%] respectively, P <.001). Group 2 had lower procedure, radiofrequency and fluoroscopy times compared to group 1 (2.7 ± 1 vs 3.1 ± 1 h, 69 ± 13 min vs 87 ± 11 min and 64 ± 14 min vs 85 ± 18 min respectively, p < .05). At 32 ± 8 month follow-up, on or off antiarrhythmic drug success rate was 37 (66%) in group 1 and 27 (48%) in group 2 (P = .04). During redo, new non-PV trigger sites were identified in group 2 patients.
  
  
  CONCLUSIONS
  Periprocedural continuous amiodarone was associated with higher organization rate and lower radiofrequency ablation rate. However, masking non-PV triggers increased the late recurrence rate.
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Sanghamitra
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, Bronx, New York; University of Foggia, Foggia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Prasant
authors.initials: P
authors.lastname: Mohanty
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Chintan
authors.initials: C
authors.lastname: Trivedi
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; University of Foggia, Foggia, Italy; University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: John David
authors.initials: JD
authors.lastname: Burkhardt
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Gallinghouse
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas.
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Javier E
authors.initials: JE
authors.lastname: Sanchez
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Hranitzky
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Jason
authors.initials: J
authors.lastname: Zagrodzky
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.affiliation: Catholic University, Rome, Italy.
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.affiliation: University of Kansas, Kansas City, Kansas.
authors.forename: Dhanunjay
authors.initials: D
authors.lastname: Lakkireddy
authors.affiliation: University of Kansas, Kansas City, Kansas.
authors.forename: Madhu
authors.initials: M
authors.lastname: Reddy
authors.affiliation: University Tor Vergata, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Forleo
authors.affiliation: Ospedale dell'Angelo, Mestre/Venice, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossillo
authors.affiliation: Ospedale dell'Angelo, Mestre/Venice, Italy.
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.affiliation: California Pacific Medical Center, San Francisco, California.
authors.forename: Richard
authors.initials: R
authors.lastname: Hongo
authors.affiliation: California Pacific Medical Center, San Francisco, California.
authors.forename: Salzwa
authors.initials: S
authors.lastname: Beheiry
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dello Russo
authors.affiliation: RCCS Monzino Hospital, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Tondo
authors.affiliation: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas at Austin, Austin, Texas; California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Palo Alto, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California; Department of internal medicine, Dell Medical School, Austin, Texas. Electronic address: dr.natale@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000638:Amiodarone / Q000008:administration & dosage / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007545:Isoproterenol / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000318:Adrenergic beta-Agonists; D000889:Anti-Arrhythmia Agents; D007545:Isoproterenol; D000638:Amiodarone
keywords: Amiodarone; Catheter ablation; Longstanding persistent atrial fibrillation; Nonpulmonary vein trigger; Recurrence