Mid-Term Follow-Up of Amiodarone Medication and Pulmonary Vein Isolation Ablation Hybrids in the Long-Lasting Atrial Fibrillation Patients with Huge Left Atrium

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Long-lasting atrial fibrillation (AF) develops electrical and structural remodeling of atrium, and grandiose ablation for AF substrate could be required in addition to pulmonary vein (PV) isolation in the long-lasting AF patients with huge left atrium (LA). On the other hand, amiodarone (AMD) could reverse the remodeling, and might be an alternative to the overdone ablation. Five long-lasting, non-valvular AF patients with huge LA (LA dimension; 53±4 mm) were included in this study (Age 57±9 y/o, 5 males, 1 with HCM, 1 with DCM, 4 with hypertension, 4 with congestive heart failure). Circumferential PV isolation was underwent after oral AMD 200–400 mg/day for 4–27 months. Neither linear ablation in LA nor continuous fractionated atrial electrocardiogram ablation was done, although cavo-tricuspid isthmus ablation was added in 2 patients. <B>Results:</B> Sinus rhythm had been maintained, and no symptomatic AF had appeared for 6–37 (21±13) months after the PV isolation in all the patients. LA dimension was made shorter (53±4 mm vs. 47±3 mm, p<0.05), and LVEF was improved (0.51±0.20 vs. 0.68±0.04, ns). This hybrid therapy could be useful during mid-term follow-up, and AMD might be an alternative to the overdone ablation for AF substrate in the long-lasting AF patients with huge LA.