Effect of preprocedural pharmacologic cardioversion on pulmonary vein isolation in patients with persistent atrial fibrillation.
Effect of preprocedural pharmacologic cardioversion on pulmonary vein isolation in patients with persistent atrial fibrillation.
复制标题
术前药物复律对持续性房颤患者肺静脉隔离的影响。
DOI：
10.1016/j.hrthm.2021.04.027
复制
发表时间：
2021
期刊：
影响因子：
5.5
通讯作者：
Morita H and Ito H.
中科院分区：
文献类型：
--
作者：
Okawa K;Hara S;Morimoto T;Tsushima R;Sudo Y;Sogo M;Ozaki M;Takahashi M;Doi M;Morita H and Ito H.
BackgroundThe optimal strategy for catheter ablation of persistent atrial fibrillation (PeAF) remains unknown. A preprocedural additive treatment for patients undergoing pulmonary vein isolation (PVI) alone to optimize catheter ablation should be investigated.ObjectiveThe purpose of this study was to determine whether pharmacologic cardioversion with a fixed low-dose antiarrhythmic drug (AAD) before ablation could stratify the long-term outcome of a PVI-alone strategy.MethodsWe conducted a prospective cohort study of PeAF patients who underwent PVI using contact force-sensing catheters. No substrate modification was performed. Fixed low-dose bepridil was administered before ablation for cardioversion and patients were classified into 2 groups based on obtaining sinus rhythm (SR). The rate of recurrence of atrial fibrillation (AF) and/or atrial tachycardia (AT) within 36 months was compared between the 2 groups.ResultsAmong the 303 PeAF patients who received the AAD, 102 returned to SR (SR group), and the other 201 had persistence of AF (non-SR group). AF persistence duration at baseline and during bepridil administration was similar between the 2 groups. The SR group had a significantly lower 36-month AF/AT recurrence rate than the non-SR group (17 [22.2%] vs 55 [34.0%], log-rankP= .022). AT-type recurrence was observed in 16 patients (2 [3.3%] in the SR group vs 14 [8.9%] in the non-SR group; log-rankP= .051). Nonresponse to AAD was an independent predictor of AF/AT recurrence after adjusting for other risk factors (hazard ratio 1.34; 95% confidence interval 1.01–1.77;P= .040).ConclusionPreprocedural pharmacologic cardioversion could be a useful determinant for patients with treatable PeAF by PVI alone.
