Abstract | BACKGROUND: 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.
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Authors | Kenzo Hirao, Kaoru Okishige, Naohito Yamamoto, Kenichiro Otomo, Kouji Azegami, Mitsuaki Isobe |
Journal | Clinical cardiology
(Clin Cardiol)
Vol. 28
Issue 7
Pg. 338-42
(Jul 2005)
ISSN: 0160-9289 [Print] United States |
PMID | 16075827
(Publication Type: Comparative Study, Journal Article)
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Chemical References |
- Anti-Arrhythmia Agents
- Sodium Channel Blockers
- Lidocaine
- pilsicainide
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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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