In several Western reports from large

In several Western reports from large-scale comparative studies and epidemiological surveys, there was no significant difference in the incidence of thromboembolism between paroxysmal and persistent AF patients [46,47]. Data from our institution suggested that the incidence of cardiogenic thromboembolism decreased when sinus rhythm was maintained without AF recurrence in patients with paroxysmal AF receiving rhythm control therapy, even if inadequate anticoagulation therapy was given (Table 4) [48]. Moreover, CHF is closely related to AF [49] and plays an important role in the prognosis of paroxysmal AF patients [50]. The mortality rate among AF patients with congestive faah inhibitors failure 1 year after initial diagnosis is relatively high, between 13% and 20% in Western and countries including the United States [51,52] and 7.3% in Japan [53]. In data from our institute [54], the incidence of new-onset CHF at 1 year in Japanese patients with paroxysmal AF receiving rhythm control therapy was nearly 1.0–2.0%, and the independent predictors of hospitalization for CHF were CHADS2 score, left ventricular ejection fraction, and underlying heart disease (Table 5). When cardiovascular events included the composite of hospitalization for thromboembolism, heart failure, and cardiovascular death, the independent predictors of cardiovascular events in Japanese patients with paroxysmal AF receiving rhythm control therapy were also CHADS2 score, underlying heart disease, left ventricular ejection fraction, conversion to persistent AF, and anticoagulant therapy.
Conclusion The ultimate goal of antiarrhythmic drug therapy to maintain sinus rhythm is to improve QOL and cardiovascular prognosis, while ensuring the safety of antiarrhythmic drugs. Rhythm control therapy is an ideal method for preventing AF recurrence over a long period in patients with paroxysmal AF. However, it should be noted that aimless long-term treatment with Class I drugs may have an adverse effect on cardiovascular prognosis in AF patients with cardiac dysfunction [55]. Physicians should evaluate their paroxysmal AF patients carefully and regularly for the risk of thromboembolism, CHF, and cardiovascular death before considering the suitability of particular treatment regimens, as the use of anticoagulants in combination with antiarrhythmic drugs is an independent predictor for preventing cardiovascular events [56].
Conflict of interest
Introduction Recurrence of tachyarrhythmia is one of the major issues associated with catheter ablation (CA) for atrial fibrillation (AF), and is much more common in persistent AF than in paroxysmal AF [1,2]. Intensive ablation of the left atrium (LA) is often performed in patients with persistent AF to correct electrical and anatomical LA remodeling [3–5], but a substantial portion of these patients still suffer relapse of AF. Anti-arrhythmic drugs (AADs) are often administered after CA to maintain sinus rhythm (SR). There have been a few studies follicles (ovary) have examined the efficacy of AADs in patients with paroxysmal AF [6,7], but their effect on persistent AF is almost unknown. It is also unclear whether AAD treatment could be terminated if no recurrence is observed after CA. In the present study, we studied the efficacy of hybrid therapy consisting of AADs and CA against persistent AF. We also investigated factors that would predict the successful discontinuation of AADs.
Methods
Results
Discussion The present study had 2 aims: to elucidate the efficacy of hybrid therapy for atrial fibrillation, and to investigate the possibility of withdrawal of AADs in patients with successful hybrid therapy. We administered bepridil (131±46mg/day) following CA in 75 patients with persistent AF, and succeeded in maintaining normal SR in 95% of the study subjects, with relatively few repeated ablation sessions (average, 1.17±0.4 sessions). Regarding side effects, QT prolongation was observed in 2 patients during bepridil administration, but no ventricular tachyarrhythmia was seen. Bepridil was subsequently withdrawn in 41 of the 62 patients who maintained SR without any relapse of tachycardia, and 31 (76%) patients maintained SR after the withdrawal. Successful AAD withdrawal was associated with the absence of right atrial ablation, the absence of residual inducibility of tachyarrhythmia after ablation, and the requirement for lower doses of AAD.