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Long-term efficacy of hybrid pharmacologic and ablation therapy in patients with pilsicainide-induced atrial flutter.

AbstractBACKGROUND:
Combination therapy with catheter ablation of the cavo-tricuspid isthmus and continued drug therapy, that is, "hybrid therapy," in patients with atrial fibrillation (AF) and drug-induced atrial flutter (AFL) is reported to be an alternative means of achieving and maintaining sinus rhythm. With respect to choosing this method among the rhythm control therapies, its long-term efficacy and the prevalence of AFL in patients with AF are very important and have not been fully elucidated.
HYPOTHESIS:
The purpose of this study was to investigate the long-term effectiveness of this hybrid therapy and the dose prevalence in Ic drug-induced AFL.
METHODS:
The subjects were 89 patients (aged 62.4 years, 72 men) with episodes of AF (paroxysmal type: 65, persistent type: 11, permanent type: 13). After 4 weeks of oral pilsicainide administration, the dose was increased in those with no documented AFL. The patients who experienced AFL with pilsicainide (Ic-AFL) underwent ablation.
RESULTS:
Pilsicainide administration resulted in the common type AFL in 17 patients (19.1%). The pilsicainide plasma concentration in the patients with Ic-AFL was significantly higher than in those without AFL (0.79 +/- 0.41 vs. 0.51 +/- 0.24 microg/ml, respectively, p < 0.01). During a 10-54 (mean 37 +/- 14) month follow-up period, sinus rhythm was maintained in 10 of 12 patients after successful ablation followed by continued antiarrhythmic drug administration.
CONCLUSIONS:
Hybrid therapy with ablation and high doses of pilsicainide was useful in maintaining sinus rhythm in some selected patients with AF and drug-induced AFL.
AuthorsKenzo Hirao, Kaoru Okishige, Naohito Yamamoto, Kenichiro Otomo, Kouji Azegami, Mitsuaki Isobe
JournalClinical cardiology (Clin Cardiol) Vol. 28 Issue 7 Pg. 338-42 (Jul 2005) ISSN: 0160-9289 [Print] United States
PMID16075827 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Anti-Arrhythmia Agents
  • Sodium Channel Blockers
  • Lidocaine
  • pilsicainide
Topics
  • Aged
  • Anti-Arrhythmia Agents (adverse effects, therapeutic use)
  • Atrial Fibrillation (drug therapy)
  • Atrial Flutter (chemically induced, therapy)
  • Cardiac Pacing, Artificial
  • Catheter Ablation
  • Combined Modality Therapy
  • Dose-Response Relationship, Drug
  • Electrocardiography
  • Electrophysiologic Techniques, Cardiac
  • Female
  • Follow-Up Studies
  • Humans
  • Lidocaine (adverse effects, analogs & derivatives, therapeutic use)
  • Male
  • Middle Aged
  • Prospective Studies
  • Sodium Channel Blockers (adverse effects, therapeutic use)
  • Treatment Outcome

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