Discontinuation of anti-arrhythmic drugs in patients receiving hybrid therapy consisting of catheter ablation and bepridil for persistent atrial fibrillation
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概要
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Background: Anti-arrhythmic drugs (AADs) are often administered following catheter ablation (CA) for persistent atrial fibrillation (peAF) to maintain sinus rhythm (SR). It remains unclear whether AADs can be withdrawn in patients showing no recurrence after CA.Method: We administered hybrid therapy consisting of CA and AAD (bepridil) in 75 patients with peAF. Withdrawal of AADs was attempted in patients who had no recurrence of AF for ≥6 months. We followed them for 22±16 months.Results: Patients received 1.2±0.4 sessions of CA and a mean bepridil dose of 131±46 mg/day. After a 3-month "blanking period," 62 (83%) patients maintained SR without recurrence of tachyarrhythmia for ≥6 months. AADs were discontinued in 41 patients who agreed to medication withdrawal. Ten of these (24%) experienced a relapse of tachycardia, and these patients had a higher incidence of residual inducibility of tachyarrhythmia at the end of the CA procedure (70% vs. 32%; P=0.03) and required a higher dose of bepridil to maintain SR (170±48 mg vs. 106±30 mg; P<0.0001) than those without relapse.Conclusions: Discontinuation of AADs occasionally results in recurrence, especially in patients with residual inducibility and in those requiring higher doses of AADs.
著者
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Inoue Koichi
Cardiovascular Center Sakurabashi Watanabe Hospital
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Koyama Yasushi
Cardiovascular Center Sakurabashi Watanabe Hospital
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DATE Motoo
Cardiovascular Center, Sakurabashi Watanabe Hospital
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HIGUCHI Yoshiharu
Cardiovascular Center, Sakurabashi Watanabe Hospital
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Iwakura Katsuomi
Cardiovascular Center Sakurabashi Watanabe Hospital
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Ito Hiroshi
Department Neurosurgery Tokyo Medical College
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Kimura Ryusuke
Cardiovascular Center Sakurabashi Watanabe Hospital
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Toyoshima Yuko
Cardiovascular Center Sakurabashi Watanabe Hospital
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Fujii Kenshi
Cardiovascular Center Sakurabashi Watanabe Hospital
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Kurotobi Toshiya
Division of Caridiac Rhythm Management, Shiroyama Hospital
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Kurotobi Toshiya
Division of Cardiac Rhthm Management, Shiroyama Hospital
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Itoh Norihisa
Cardiovascular Center, Sakurabashi Watanabe Hospital
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