title: Use of antiarrhythmic drugs during ablation of persistent atrial fibrillation: observations from a large single-centre cohort.
abstract: Catheter ablation of complex fractionated atrial electrograms (CFAE), also known as defragmentation ablation, may be considered for the treatment of persistent atrial fibrillation (AF) beyond pulmonary vein isolation (PVI). Concomitant antiarrhythmic drug (AAD) therapy is common, but the relevance of AAD administration and its optimal timing during ablation remain unclear. Therefore, we investigated the use and timing of AADs during defragmentation ablation and their possible implications for AF termination and ablation success in a large cohort of patients. Retrospectively, we included 200 consecutive patients (age: 61 ± 12 years, LA diameter: 47 ± 8 mm) with persistent AF (episode duration 47 ± 72 weeks) who underwent de novo ablation including CFAE ablation. In all patients, PVI was performed prior to CFAE ablation. The use and timing of AADs were registered. The follow-ups consisted of Holter ECGs and clinical visits. Termination of AF was achieved in 132 patients (66 %). Intraprocedural AADs were administered in 168/200 patients (84 %) 45 ± 27 min after completion of PVI. Amiodarone was used in the majority of the patients (160/168). The timing of AAD administration was predicted by the atrial fibrillation cycle length (AFCL). At follow-up, 88 patients (46 %) were free from atrial arrhythmia. Multivariate logistic regression analysis revealed that administration of AAD early after PVI, LA size, duration of AF history, sex and AFCL were predictors of AF termination. The administration of AAD and its timing were not predictive of outcome, and age was the sole independent predictor of AF recurrence. The administration of AAD during ablation was common in this large cohort of persistent AF patients. The choice to administer AAD therapy and the timing of the administration during ablation were influenced by AFCL, and these factors did not significantly influence the moderate single procedure success rate in this retrospective analysis.
authors.affiliation: Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany. jakob.lueker@me.com.
authors.forename: Jakob
authors.initials: J
authors.lastname: Lüker
authors.affiliation: Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Arian
authors.initials: A
authors.lastname: Sultan
authors.affiliation: University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sehner
authors.affiliation: University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hoffmann
authors.affiliation: University Hospital Bern, 3010, Bern, Switzerland.
authors.forename: Helge
authors.initials: H
authors.lastname: Servatius
authors.affiliation: University Hospital Eppendorf, Martinistrasse 52, 20249, Hamburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Willems
authors.affiliation: Department of Electrophysiology, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steven
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000628:therapy*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
keywords: Antiarrhythmic drugs; Catheter ablation; Defragmentation; Intraprocedural administration; Persistent atrial fibrillation