Catheter ablation of persistent atrial fibrillation : Beneficial effect of a short-term adjunctive amiodarone therapy on the long-term outcome.

BACKGROUND: Catheter ablation has become the first line therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favorable (especially in patients with persistent atrial fibrillation). Therefore, more complex ablation strategies and the usefulness of (short-term) adjunctive antiarrhythmic drug therapy are a matter of discussion. The aim of this study was to analyze whether short-term amiodarone therapy after catheter ablation (3 months) has a positive effect on the success rates after circumferential pulmonary vein ablation in patients with persistent atrial fibrillation.

METHODS: A total of 230 consecutive patients with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure (using the NAVX or CARTO system). Catheter ablation of the right or left atrial isthmus and a linear lesion in the roof of the left atrium were only performed in selected patients with documented episodes of atrial fibrillation. In 115 patients, a short-term adjunctive antiarrhythmic drug therapy with amiodarone was initiated immediately prior to the ablation procedure (for the first 3 months group A). In the remaining 115 patients, no antiarrhythmic drug therapy was administered except for beta blockers (group B).

RESULTS: Out of 115 patients 19 (16.5%) in group A and 34 (29.6%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring electrical cardioversion (P = 0.03; blanking period). One year after the ablation procedure 81.7% of patients in group A (94/115) and 73.0% of patients in group B (84/115) were free from further arrhythmia recurrences (P = 0.16). The success rate 2 years after catheter ablation was 76.5% (no arrhythmia recurrence in 88/115 patients) in group A and 63.5% in group B (no arrhythmia recurrence in 73/115 patients; P = 0.04). There were no major complications during long-term follow-up.

CONCLUSION: Adjunctive short-term amiodarone therapy improves the success rate after catheter ablation of persistent atrial fibrillation during long-term follow-up. This might be due to a decreased incidence of early arrhythmia recurrences after catheter ablation of atrial fibrillation and an improved reverse remodelling process.