Journal Club 11 March 2015

Paper

Effect ofperiproceduralamiodaroneonprocedureoutcome
in patientswithlongstandingpersistentatrial fibrillation
undergoing extendedpulmonaryveinantrumisolation:
Results fromarandomizedstudy(SPECULATE)

Presenter

PM

Summary

BACKGROUND

The impactofamiodaroneonablationoutcomeinlong-
standing persistentatrial fibrillation(LSPAF)patientsisnotknownyet.
OBJECTIVE The purposeofthisstudywastoassesstheeffectof
amiodarone onprocedural-outcomesinLSPAFpatientsundergoing
catheter ablation.

METHODS

We enrolled112LSPAFpatientsonamiodaroneand
scheduled toundergoatrial fibrillation (AF)ablation.Patientswere
randomized toamiodaronediscontinuation4monthsbeforeablation
(group1,n ¼ 56) andacontrolgroup(group2,n ¼ 56)inwhich
ablationwasperformedwithoutamiodaronediscontinuation.All
patientsunderwentpulmonaryvein(PV)antrumandposteriorwall
isolation, defragmentationandextraPVtriggersablation.Patientswere
followedupforrecurrencefor32 8 monthspost-ablation.Repeat
proceduresinallrecurrentpatientswereperformedoffamiodarone.

RESULTS

During ablation,AFterminationwasmorefrequentin
group 2comparedtogroup1[44(79%)vs32(57%), P ¼ .015].
After high-dosageisoproterenol,morenon-PVtriggersweredis-
closed ingroup1comparedtogroup2(42[75%]vs24[43%]
respectively, P o.001). Group2hadlowerprocedure,radiofre-
quency and fluoroscopy timescomparedtogroup1(2.7 1 vs
3.11 h,6913 minvs87 11 minand6414 minvs85 18
min respectively, p o .05). At32 8 monthfollow-up,onoroff
antiarrhythmic drugsuccessratewas37(66%)ingroup1and27
(48%) ingroup2(P ¼ .04). Duringredo,newnon-PVtriggersites
were identified ingroup2patients.

CONCLUSION

Periprocedural continuousamiodaronewasassoci-
ated withhigherorganizationrateandlowerradiofrequency
ablation rate.However,maskingnon-PVtriggersincreasedthelate
recurrence rate.

Advertisements