When should antiarrhythmic drugs concomitant with catheter ablation for
persistent atrial fibrillation be discontinued? --The importance of left
atrial reverse remodeling--
Abstract
Introduction: Antiarrhythmic drugs are often administered after
catheter ablation (CA) in patients with atrial fibrillation (AF);
however, it is unclear for how long it should be continued.
Methods: We administered hybrid therapy consisting of CA and
bepridil to 130 patients with persistent AF and left atrial (LA)
enlargement (volume index >48 ml/m 2).
After a 2-month of hybrid therapy, bepridil discontinuation was
attempted. All patients underwent echocardiography 6 months after CA. We
investigated the relationship between the duration of bepridil
administration and the recurrence of AF after bepridil discontinuation.
Results: After excluding patients who were unable to maintain
sinus rhythm during bepridil administration (n=18), and those who
disagreed to bepridil discontinuation (n=17), 95 patients were divided
into the short-term continuation (bepridil discontinued for <6
months [median 3.0 months] after CA [n=63]), and long-term
continuation (bepridil discontinued for >6 months [median
11.4 months] after CA [n=32]) groups. During the mean follow-up
period of 28±15 months, the groups showed a similar incidence of
recurrent AF after bepridil discontinuation. In the long-term
continuation group, 13 patients had recurrence, with 8 (62%) cases
occurring within 4 months after discontinuation. A multivariate Cox
regression analysis revealed that left atrial (LA) reverse remodeling
(>15% decrease in LA volume index at 6 months) was an
independent predictor of recurrent AF after CA (p<0.01).
Conclusions: Long-term bepridil administration after CA did not
affect the recurrence of AF after discontinuation. The assessment of LA
reverse remodeling may be useful for decision-making regarding the
discontinuation of antiarrhythmic drugs after CA.