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When should antiarrhythmic drugs concomitant with catheter ablation for persistent atrial fibrillation be discontinued? --The importance of left atrial reverse remodeling--
  • +7
  • Yuki Hasegawa,
  • Rie Akagawa,
  • Naomasa Suzuki,
  • Yasuhiro Ikami,
  • Sou Otsuki,
  • Akiko Sanada,
  • Shinsuke Okada,
  • Hirotaka Sugiura,
  • Masaomi Chinushi,
  • Takayuki Inomata
Yuki Hasegawa
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku

Corresponding Author:yukihasegawa@med.niigata-u.ac.jp

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Rie Akagawa
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku
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Naomasa Suzuki
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku
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Yasuhiro Ikami
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku
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Sou Otsuki
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku
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Akiko Sanada
Niigata Kobari Byoin
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Shinsuke Okada
Niigata Kobari Byoin
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Hirotaka Sugiura
Niigata Kobari Byoin
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Masaomi Chinushi
Niigata Daigaku Daigakuin Hokengaku Kenkyuka
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Takayuki Inomata
Niigata Daigaku Igakubu Igakuka Daigakuin Ishigaku Sogo Kenkyuka Junkanki Naikagaku
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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.
14 Feb 2025Submitted to Journal of Cardiovascular Electrophysiology
15 Feb 2025Submission Checks Completed
15 Feb 2025Assigned to Editor
15 Feb 2025Review(s) Completed, Editorial Evaluation Pending
05 Mar 2025Reviewer(s) Assigned