Introduction: It has been reported that perioperative use of antiarrhythmic agents may improve the outcome of catheter ablation (CA) for atrial fibrillation (AF). We studied the impact of pre- and post-procedural oral bepridil therapy on the outcome of CA for AF.
Methods: Study subjects are 69 patients with AF who underwent CA as the first session (mean 58 year-old, 65 males, paroxysmal/persistent AF: 43/26). Pulmonary vein isolation (PVI) was completed in all patients, and roof line ablation was additionally performed in 21 patients (30%). Twenty eight patients were administrated oral bepridil at least 3 months before and after the procedure (Bep. Group), and the remaining 41 patients were not given bepridil or used bepridil for less than 3 months before and after the procedure (Non-Bep. Group). We compared the outcome beyond 6 months after the procedure between 2 groups.
Results: AF recurred in 7 patients (25%) in Bep. Group, but AF recurrence was observed in 25 patients (61%) in Non-Bep. Group. The second session was highly required in Non-Bep. Group (12 patients, 29%) than in Bep. Group (2 patients, 7%) with significant differences (p< 0.01). In patients with persistent AF, AF recurrence rate was also significantly higher in Non-Bep. Group (10 patients, 77%) comparing with that in Bep. Group (2 patients, 15%, p< 0.01). Between 2 groups, no significant difference in left atrial diameter before and after CA was found, and additional roof line ablation did not affect the outcome of CA. In patients with persistent AF between 2 groups, there was no significant difference in duration of AF before CA, and the outcome of CA did not related to success in pharmacological cardioversion.
Conclusions: Bepridil is considered to have reversed remodeling effects on fibrillated atrium. This study suggested that long term pre- and post-procedural oral bepridil therapy may improve the outcome of CA, especially PVI alone, in patients with paroxysmal and persistent AF.