Background The catheter ablation of persistent atrial fibrillation is difficult and has a relatively low success rate, amiodarone can reduce atrial remodeling, so some operators have attempted to simplify the procedure and improve success rate by using amiodarone as an adjunct treatment before operation, but the efficacy of this approach is unclear.
Objective To investigate the effect of short-term preoperative use of amiodarone on the efficacy of catheter ablation of persistent atrial fibrillation.
Methods Patients with persistent atrial fibrillation who underwent catheter ablation at the Department of Cardiology, Chinese PLA General Hospital from January 2019 to December 2021 were included, patients were divided into amiodarone group and control group based on the use of amiodarone before operation, the amiodarone group received oral amiodarone treatment until the day before operation, the total course of treatment was 7 days, and the administration method was 0.2g, three times daily, however the control group did not receive amiodarone treatment before operation. All patients underwent pulmonary vein isolation (PVI) as the first step of treatment, if they converted to sinus rhythm spontaneously or by cardioversion, they underwent substrate-based ablation, in principle, areas with low-voltage were homogenized and eliminated, linear ablation would be done if necessary; if they did not convert to sinus rhythm, they underwent stepwise ablation, additional linear ablation of the left atrial roof and the mitral isthmus as well as ablation of complex fractionated atrial electrograms (CFAEs) were performed. Linear ablation of the tricuspid isthmus was performed in patients if typical isthmus-dependent atrial flutter occurred during the operation.
Results There were 53 cases (42 males and 11 females) with mean age of (59.6 ± 9.5) years in the amiodarone group, another 132 cases (109 males and 23 females) with mean age of (58.3 ± 10.4) years in the control group. Except for estimated glomerular filtration rate (P=0.003), brain natriuretic peptide (P＜0.001) and previous use of beta-blockers (P=0.020), there were no statistically significant differences in baseline data between the two groups (P＞0.05). The success rate of amiodarone group who converted to sinus rhythm after pulmonary vein isolation was significantly higher than that of the control group (94.3% vs 79.5%, P=0.014),compared with stepwise ablation, the number of additional linear ablation (excluding the tricuspid isthmus line) and low-voltage area (including CFAEs) homogenization ablation in substrate-based ablation under sinus rhythm was fewer (9.7% vs 80.0%, P＜0.001; 7.1% vs 36.7%, P＜0.001). There was no statistically significant difference in the 12-month recurrence rate (28.3% vs 28.8%, log-rank P=0.966) and blank-period recurrence rate (20.4% vs 21.2%, log-rank P=0.713) between the amiodarone group and the control group.
Conclusion Short-term preoperative administration of amiodarone does not reduce recurrence after catheter ablation of persistent atrial fibrillation, but it can improve the success rate of converting to sinus rhythm after PVI, and the procedure of substrate-based ablation under sinus rhythm is simpler than that of step-wise ablation.
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