The effect of short-term amiodarone treatment on the effectiveness of catheter ablation in patients with persistent atrial fibrillation refractory to cardioversion

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BACKGROUND: Little is known about the effect of amiodarone therapy in patients with persistent atrial fibrillation refractory to electrical cardioversion (AF-REC) scheduled for catheter ablation (CA). AIMS: This study aimed to determine whether postulated atrial reverse remodeling achieved through short-term pre- and post-ablation amiodarone therapy with sinus rhythm restoration prior to CA affects the long-term effectiveness of the rhythm control strategy in AF-REC patients. MATERIAL AND METHODS: AF-REC patients scheduled for CA were included in this retrospective study. In patients who received amiodarone (group A), sinus rhythm was restored before CA. In patients without amiodarone (group NA), sinus rhythm was restored at the end of CA. Results of outpatient visits, 72-hour Holter electrocardiography, echocardiography, and perceived symptoms were assessed in follow-up. RESULTS: The study population included 56 patients: 37 from group A and 19 group NA. A median follow-up was 39.5 months. The primary endpoint (AF-free survival) was achieved in 17 (45.9%) patients in group A and in 3 (15.8%) patients in group NA (P = 0.026). Secondary endpoint, conversion of AF from persistent to paroxysmal or no AF was achieved in 32 patients (86.5%) from group A and 9 patients (47.4%) from group NA (odds ratio 8.0; 95% confidence interval, 2.1-30.0; P = 0.002). Age-adjusted left ventricular ejection fraction improvement was greater in group A in comparison to group NA (P = 0.004). Patient's symptoms (European Heart Rhythm Association scale) improved in both groups A and NA (P <0.001). CONCLUSIONS: Short-term amiodarone combined with sinus rhythm restoration prior to AF ablation in AF-REC patients may improve long-term treatment effects.

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