Hybrid Therapy of Class III Antiarrhythmic Drugs and EEPVI in Patient with Very Long-Lasting Atrial Fibrillation

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Extensive pulmonary vein isolation (EPVI) and Class III anti-arrhythmic drugs (C3D) are established as a therapeutic option for paroxysmal Afib. However, very long-lasting Afib (more than 1 year) is still difficult to manage. We evaluate the effectiveness of combination therapy of EEPVI and C3D. 115 patients with mean Afib duration of 4.4 years were studied. Mean diameter of the left atriam (LA) was 43.8 mm. Before EEPVI multiple (1.6±1.2) anti-arrhythmic drugs including C3D in 52/94 patients were ineffective. In the first procedure EEPVI and cavotricuspid isthmus ablation was performed. In case of Afib recurrence C3D were prescribed and re-PV isolation with substrate modification was performed. With 1.2 procedures Afib did not recur in 94 out of 115 patients (82%) during follow-up period of 1.7 years. Forty-four of 94 patients (47%) were drug free and the remainders were taking C3D (bepridil: mean 100 mg in 57 patients and amiodarone in 9 patients). LA volume index measured by echocardiogram was changed from 44.7 ml to 37.5 ml through procedures (p<0.05). Hybrid therapy of class III antiarrhythmic drugs and EEPVI is effective to restore sinus rhythm and to reverse LA remodeling even in patients with very long-lasting atrial fibrillation.