Prevention Of Atrial Fibrillation Recurrence Research Articles

Возможности Омакора в профилактике рецидивов фибрилляции предсердий после радиочастотной абляции

Возможности Омакора в профилактике рецидивов фибрилляции предсердий после радиочастотной абляции

Myocardial structure and function and predictors of recurrent atrial fibrillation in hypertensive patients after electrical cardioversion

Objective. To determine predictors of atrial fibrillation (AF) recurrence in patients with persistent AF and arterial hypertension (HTN) after sinus rhythm (SR) restoration by electrical cardioversion (ECV) using data on the dynamics of structural and functional changes in the heart during prolonged preventive antiarrhythmic therapy (AART). Design and methods. The study involved 127 patients with HTN and non-valvular form of persistent AF who underwent ECV leading to the restoration of sinus rhythm. All patients underwent Holter monitoring (HM) and echocardiography, and were randomized into groups for certain anti-arrhythmic drug (propafenone, sotalol, amiodarone). Results and conclusions. There is a strong negative correlation between the duration of sinus rhythm after ECV with the prolonged antiarrhythmic therapy and the value of anteroposterior size of the left atrium referred to the body surface area. There was no change in the structural parameters of the left heart one year after ECV when SR was maintained in patients receiving AART (propafenone, sotalol, amiodarone). Amiodarone is more effective for the prevention of AF recurrence after ECV than sotalol or propafenone; and is associated with a decrease in left ventricular isovolumic relaxation time and deceleration time of mitral flow.

Atrial fibrillation ablation by single ring isolation versus wide antral isolation: Effects on left atrial size and function

BackgroundPulmonary vein isolation (PVI) by single ring isolation (SRI) has been demonstrated to reduce recurrence of atrial fibrillation (AF) compared to the standard technique of wide antral isolation (WAI). In this study, we examine the differential effect of these techniques on left atrial size and function. MethodsWe examined left atrial (LA) size (LA maximum and LA minimum volumes) and function (LA emptying fraction and LA expansion index) over a period of 6months following PVI as measured by transthoracic echocardiography in 187 patients that were enrolled in a randomised controlled trial of SRI vs WAI. ResultsCompared to pre-ablation, at 6months post-PVI, there was a small decrease in the LA maximum volume in the WAI group (67.3 vs 62.7mL, p=0.02). The LA size did not change significantly over 6months in the SRI group. Patients who underwent SRI had a small reduction in the LA expansion index at 6months post-PVI compared to baseline (80.6 vs 66.6%, p=0.02). LA function did not change significantly over 6months in the WAI group. However, at 6months, there was no difference in any measure of LA size or function between the SRI and WAI groups. ConclusionsSRI, whilst previously demonstrated to be more effective than WAI in preventing AF recurrence, is associated with minimal adverse effects on left atrial function at medium term follow-up despite the isolation of a larger region of LA myocardium.

Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis.

Over the past decade, catheter ablation (CA) has become an established therapy for symptomatic atrial fibrillation (AF). Atrial fibrillation is common in hypertrophic cardiomyopathy (HCM) patients, and restoring sinus rhythm is of great clinical benefit to them. Therefore, we conducted a systematic review and meta-analysis of the available data to evaluate the effectiveness and safety of CA for AF in patients with HCM. Six databases were searched to identify studies describing outcomes of CA of AF in HCM patients with a mean follow-up of ≥12 months after the index procedure. The following data were extracted: (i) single-procedure success, (ii) multiple-procedure success, and (iii) drug-free success. Fifteen studies involving 531 patients were included. Single-procedure freedom from atrial arrhythmia at the latest follow-up was 45.5% [95% confidence interval (CI): 34.8-56.2%]. With multiple procedures, the final success rate was 66.1% (95% CI: 55.3-76.9%) overall, 71.8% (95% CI: 61.6-82.0%) in paroxysmal AF, and 47.5% (95% CI: 36.0-59.0%) in non-paroxysmal AF. Without anti-arrhythmic drugs (AADs), single-procedure success rate at latest follow-up was 32.9% (95% CI: 21.7-41.1%); after multiple procedures, this raised to 50.4% (95% CI: 39.2-61.6%). The incidence of serious periprocedural complications was acceptable [5.1% (95% CI: 2.8-9.6%)]. Substantial heterogeneity (I(2)> 50%) was noted in the above groups. Catheter ablation of AF in patients with HCM is feasible, although more repeat procedures and AAD are needed to prevent AF recurrence.

What role for antiarrhythmic drugs today in patients with recurrent atrial fibrillation without relevant heart disease?

The efficacy of antiarrhythmic drugs (AADs) in the prevention of recurrent (paroxysmal or persistent) atrial fibrillation (AF) is rather low, since 1-year symptomatic recurrences are observed in ~50% of patients. New treatments have been suggested: upstream therapy does not appear to be effective in the prevention of AF recurrences, whereas catheter ablation has shown good results. Consistent data dealing with this procedure are available only in young patients, without relevant heart disease and with recurrent AF, refractory to AADs. In the present paper, an analysis of both systematic reviews of trials/meta-analyses and registries, which better express the real world, was carried out. The 1-year success rate of AF ablation in patients with the above mentioned characteristics was 70-80%. However, the 1-year single-procedure success rate, free of AADs, was only 47-57% in the trials and even lower in the real world (30-40%). The final success was increased by one or more repeated ablations, in 15-40% of patients, and by the use of AADs, ineffective before ablation, in ~40-50% of patients at 1-year and in ~60% at 2-year follow-up. AADs increased the success rate by ~15% in the trials and by a much higher percentage in the real world, even if not clearly definable. Considering that ~10-12% of patients have the first symptomatic recurrences only 1-2 years after ablation and others in the next years, AADs have still an important role in the management of patients with recurrent AF without relevant heart disease, not only as first-line treatment, but also in patients who underwent catheter ablation. Therefore, AF ablation appears to be more a supplementing procedure than a procedure alternative to AADs; in other words, the association ablation-AADs is more effective than AADs alone.

Comparative efficacy of amiodarone with ivabradin combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation recurrence in pa- tients with left ventricular diastolic dysfunction

Aim. To study the efficacy of use of amiodarone with ivabradine combination or amiodarone with bisoprolol combination in the prevention of atrial fibrillation (AF) recurrence in patients (pts) with left ventricular diastolic dysfunction (LVDD) after conversion to sinus rhythm. Material and methods. 65 patients (40 males, 25 females) aged 53±8 years with persistent AF and LVDD were included into the study and randomized into 3 groups to receive ivabradine and amiodarone (22 pts), bisoprolol and amiodarone (22 pts) or amiodarone alone (21 pts). Left atrium (LA) volume indices, LA longitudinal strain rate (LASR) in systole, LV mass index, mean heart rate (HR), 24-hour HR variability and the incidence of AF by 96 h ECG monitoring were measured after the titration period, and after 3 and 6 months of follow-up. Results. After 6 months of follow-up group 1 revealed significantly lower maximum LA volume index (21.3±2.4 vs 25.2±3.0 and 28.7±3.6 ml/m 2 in the 2nd and control groups, respectively), P-wave LA volume index (15.3±3.5 versus 18.1±3.8 and 20.4±4.0 ml/m 2 in the 2nd and control groups, respectively), and LA systolic volume index (7.3±1.2 versus 9.4±1.6 and 9.6±1.7 ml/m 2 in 2nd and control groups, respectively). The incidence of side effects in group 1 was significantly less than that in group 2 and was not different compared with control group. Conclusion. Ivabradine and amiodarone combination provides better prevention of AF recurrence and less side-effects in pts with LVDD and persistent AF after sinus rhythm restoration as compared with bisoprolol and amiodarone combination, it also reduces LA maximum, conduit and systolic volumes, and increases LASR.

Efficacy and safety of dronedarone in patients previously treated with other antiarrhythmic agents.

Currently available antiarrhythmic drugs (AADs) for the prevention of atrial fibrillation (AF)/atrial flutter (AFL) suffer from incomplete efficacy and poor tolerability. Dronedarone could represent an effective and safe option in patients previously treated with AADs, especially class Ic AADs and sotalol. Retrospective analysis of 2 double-blind, parallel-group trials (EURIDIS [European Trial in Atrial Fibrillation or Flutter Patients Receiving Dronedarone for the Maintenance of Sinus Rhythm] and ADONIS [American-Australian-African Trial With Dronedarone in Atrial Fibrillation or Flutter Patients for the Maintenance of Sinus Rhythm]) comparing the efficacy and safety of dronedarone with placebo over 12 months. The primary end point was AF/AFL recurrence in patients previously treated with another AAD that was discontinued for whatever reason prior to randomization. In patients previously treated with any AADs, dronedarone decreased the risk of AF recurrence by 30.4% vs placebo (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: 0.59-0.82; P < 0.001). In patients previously treated with a class Ic agent, dronedarone decreased the risk of recurrence by 31.4% (HR: 0.69; 95% CI: 0.53-0.89; P = 0.004), whereas in patients previously treated with sotalol, dronedarone showed a trend toward a decrease of risk of recurrence (HR: 0.86; 95% CI: 0.67-1.11; P = 0.244). Dronedarone was equally effective irrespective of whether class Ic or sotalol were stopped for lack of efficacy or adverse events (AEs). Discontinuation rates were similar in the 2 groups (55.9% vs 43.1%), as were incidence of AEs and serious AEs. Dronedarone seems to be effective in preventing AF recurrences in patients without permanent AF previously treated with other AADs, even if those were discontinued for lack of efficacy. Dronedarone appears to be well tolerated even in patients who already had tolerability issues with AADs.

Effect of Telmisartan on Atrial Fibrillation Recurrences in Patients with Hypertension: A Systematic Review and Meta‐Analysis

The systematic review and meta-analysis are to evaluate the effect of t Telmisartan on atrial fibrillation (AF) recurrences in hypertensive patients with paroxysmal AF. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Random controlled trials (RCTs) were conducted in which telmisartan was compared to other antihypertensive drugs for AF recurrences prevention in hypertensive patients with paroxysmal AF. A systematic review and meta-analysis based on aggregate data extracted from the included studies were carried out to assess the telmisartan in preventing AF relapse. The efficacy outcome was the incidence of AF recurrences. Hazard ratios (HRs) were calculated from published summary statistics and combined to give pooled estimates of efficacy. This meta-analysis comprised four studied including 1050 hypertensive patients (537 men and 513 women; mean age 63; mean blood pressure (BP) 156/94mmHg). With the similar BP control, the AF recurrences rate was significantly lower in the telmisartan-treated patients than in the other antihypertensive drugs-treated patients (HR 0.54, CI 0.34-0.86, P<0.05). The results of this review and meta-analysis indicate that telmisartan seems to be more effective than other antihypertensive drugs in preventing AF recurrences among hypertensive patients with paroxysmal AF.

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Background— Although catheter ablation (CA) is a standard treatment for atrial fibrillation (AF), its long-term efficacy remains unclear. This study aimed to elucidate the incidences of AF recurrence and of progression from paroxysmal to persistent AF, after CA, in patients with paroxysmal AF. Methods and Results— We examined the incidence of AF recurrence and AF progression in 1220 consecutive patients (mean age, 61 years), with symptomatic paroxysmal AF, undergoing CA, based on extensive pulmonary vein isolation and focal ablation for nonpulmonary vein foci. AF recurrence–free survival probabilities at 5 years were 59.4% after the initial CA and 81.1% after the final CA (average, 1.3 procedures). During a median follow-up period of 47.9 (range, 5.3–123.3) months after the initial CA, AF progressed from paroxysmal to persistent in 15 (1.2%) patients (0.3%/y). The duration of AF history (hazard ratio [HR], 1.03; P &lt;0.0001), number of ineffective antiarrhythmics (HR, 1.09; P =0.005), and left atrial diameter indexed by the body surface area (HR, 1.05; P =0.001) were significant predictors of AF recurrence. Patient age (HR, 1.12; P =0.0001) and left atrial diameter indexed by the body surface area (HR, 1.26; P =0.0006) were significantly associated with AF progression. Patients aged ≤65 years and with a left atrial diameter indexed by the body surface area of ≤24.0 mm/m 2 did not develop AF progression for ≤10 years after the initial CA. Conclusions— Although the long-term follow-up revealed the effect of CA on preventing AF recurrence, repeated CA sessions might be required. The rate of progression from paroxysmal to persistent AF was 0.3%/y.

The Impact of Catheter Ablation in the Interpulmonary Isthmus on Atrial Fibrillation Ablation Outcomes: A Randomized Study

Previous studies have underscored the importance of the interpulmonary isthmus in the initiation and maintenance of atrial fibrillation (AF). The efficacy of additional radiofrequency energy delivery in the interpulmonary isthmus following pulmonary vein antral isolation (PVAI) was investigated. A total of 76 patients (49 males, mean age 56.8 ± 10.3) with drug-resistant paroxysmal (n = 64) and short-lasting persistent AF (n = 12) underwent PVAI. Patients were then randomly assigned to receive either "no further ablation" (group I, n = 38) or additional lesions in the interpulmonary isthmus of both ipsilateral pulmonary veins (group II, n = 38). There were no significant differences between study groups regarding the clinical and echocardiographic data. A trend towards a longer fluoroscopy time was observed in group II (P = 0.076). After a mean follow-up period of 11.1 ± 2.6 months, 22 patients in group I (57.9%) and 25 patients in group II (65.8%) were free from arrhythmia recurrence without any antiarrhythmic drug treatment after a single ablation procedure. The Kaplan-Meier arrhythmia-free survival curves showed no significant differences between study groups (P = 0.460). Additional lesions in the interpulmonary isthmus following PVAI do not have incremental value in preventing AF recurrence.

Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: Mid-term efficacy and effect on quality of life

Our group previously showed that colchicine treatment is associated with decreased early recurrence rate after ablation for atrial fibrillation (AF). The purpose of this study was to test the mid-term efficacy of colchicine in reducing AF recurrences after a single procedure of pulmonary vein isolation in patients with paroxysmal AF. Assessment of quality-of-life (QOL) changes was a secondary objective. Patients with paroxysmal AF who were scheduled for ablation were randomized to a 3-month course of colchicine 0.5 mg twice daily or placebo and were followed for a median of 15 months (with a 3-month blanking period). QOL was assessed with a general-purpose health-related QOL tool (26-item World Health Organization QOL questionnaire) at baseline and after 3 and 12 months. Two hundred twenty-three randomized patients underwent ablation, and 206 patients were available for analysis (144 male, age 62.2 ± 5.8 years). AF recurrence rate in the colchicine group was 31.1% (32/103) vs 49.5% (51/103) in the control group (P = .010), translated in a relative risk reduction of 37% (odds ratio 0.46, 95% confidence interval 0.26-0.81). The number needed to treat was 6 (95% confidence interval 3.2-19.8). Physical domain QOL scores at 12 months were 63.6 ± 13.8 in the colchicine group and 52.5 ± 18.1 in controls, whereas psychological domain scores were 56.1 ± 13.7 vs 44.7 ± 17.3, respectively (P <.001, for both). Colchicine treatment after pulmonary vein isolation for paroxysmal AF is associated with lower AF recurrence rates after a single procedure. This reduction is accompanied by corresponding improvements in physical and psychological health-related QOL scores.

Statin therapy decreased the recurrence frequency of atrial fibrillation after electrical cardioversion: a meta-analysis.

BackgroundIt is unclear whether statin agents provide clinical benefit in preventing the relapse of atrial fibrillation (AF) after electrical cardioversion (EC). The purpose of this study was to assess the effect of statin agents on the recurrence of AF after EC by conducting a meta-analysis of randomized controlled trials (RCTs).Material/MethodsWe conducted a systematic literature search of Medline, EMBASE, ISI Web of Science, and Cochrane databases. RCTs comparing clinical endpoint of the recurrence of AF associated with statin administration vs. no statin treatment (placebo or conventional medical therapy) in patients with AF after EC were eligible. Combined results are presented as risk ratios (RRs) with 95% confidence intervals (CIs).ResultsA total of 5 trials with 524 patients were available for analysis. The pooling analysis showed that statin agents significantly reduced the recurrence of AF after EC compared with no statin treatment (RR=0.76, 95% CI 0.63–0.92; p=0.004; I2=44%). The beneficial effect was shown both in AF subjects receiving atorvastatin or rosuvastatin treatment (atorvastatin 80 mg: RR=0.82, p=0.05; atorvastatin 10 mg: RR=0.27, p=0.03; rosuvastatin: RR=0.38, p=0.04) and in younger patients (<65 years; RR=0.58, p=0.0005). Furthermore, the benefit of statin agents on preventing AF recurrence after EC was demonstrated within 3-month follow-up (p=0.03), and the clinical benefit seemed likely to remain until no less than 12 months after EC (p=0.05).ConclusionsBased on the currently available data, administration of statin agents, especially atorvastatin or rosuvastatin, is beneficial in lowering the frequency of AF recurrence after EC.

Predictors for late recurrences of atrial fibrillation after catheter ablation in patients with early recurrences

Purpose: Catheter ablation for atrial fibrillation (AF) is an effective treatment modality for prevention of AF recurrence and improvement of symptoms. Patients with early recurrences (ERAF) directly after catheter ablation are at higher risk to develop late recurrences (LRAF), although many patients with ERAF remain free from AF during follow-up. Consequently, this study determined clinical predictors for LRAF in patients with ERAF. Methods: Rhythm outcome was assessed using in-hospital and serial 7-day Holter ECG monitoring in 2069 patients undergoing radiofrequency AF catheter ablation. Early recurrence of AF (ERAF) was defined as any atrial arrhythmia > 30 seconds occurring within the first week, whereas late recurrence (LRAF) was defined as any episode of AF between 3 and 12 months after ablation. Results: The study population comprised 710 patients with ERAF (62% male, 62±10 years, 57% paroxysmal AF) who underwent RF catheter ablation at the Heart Center Leipzig. Of those, 184 patients (26%) suffered LRAF. On univariate logistic regression analysis, body mass index, GFR, LA diameter, LAA flow velocity and persistent AF were significantly associated with LRAF. On multivariate analysis after adjusting for age and gender, persistent AF (OR 1.7, 95% CI 1.1 – 2.7, p<0.05) remained as only significant predictor for LRAF. Conclusion: Late recurrence in patients with ERAF after catheter ablation occurs in more than one quarter of patients while the majority remains free of AF. Persistent AF has a predictive value for post-ablation LRAF in this population.

Thromboembolic event rate in paroxysmal and persistent atrial fibrillation: Data from the GISSI-AF trial

BackgroundFew data on the thromboembolic (TE) risk of paroxysmal and persistent atrial fibrillation (AF) are available. This study aimed to assess the incidence of TE events in paroxysmal and persistent AF.MethodsWe performed a subset post hoc analysis of 771 patients with paroxysmal and 463 with persistent AF enrolled in the multicenter, prospective, randomized, double-blind, placebo-controlled GISSI-AF trial - comparing the efficacy of valsartan versus placebo in preventing AF recurrences – where the choice of antithrombotic treatment was left to the judgment of the referring physician. TE and major outcome events were centrally validated. AF recurrences were detected by frequent clinic visits and a transtelephonic monitoring device with weekly and symptomatic transmissions.ResultsEighty-five percent of patients had a history of hypertension, and the 7.7% had heart failure, left ventricular dysfunction, or both. The mean CHADS2 score was 1.41±0.84. TE and major bleeding events were observed at a low incidence among the overall population at 1-year follow-up (0.97% and 0.81%, respectively). The univariate and multivariable analyses revealed no statistically significant differences in the incidence of TE, major bleeding events or mortality in paroxysmal and persistent AF patients. TE events were more common among women than men (p=0.02). The follow-up examination showed under- or overtreatment with warfarin in many patients, according to guideline suggestions. Warfarin was more frequently prescribed to patients with persistent AF (p<0.0001) and patients with AF recurrences (p<0.0001). AF recurrences were noninvasively detected in 632 (51.2%) patients. In patients without AF recurrences, the TE event rate was 0.5% versus 1.74%, 1.28%, and 1.18% for those with only symptomatic, only asymptomatic or both symptomatic and asymptomatic AF recurrences, respectively, but the difference was not statistically significant, even after adjusting for warfarin treatment and the CHADS2 score (HR 2.93; CI 95%; 0.8-10.9; p=0.11).ConclusionsTE and major bleeding events showed a very low incidence in the GISSI-AF trial population, despite under- or overtreatment with warfarin in many patients. TE events had a similar rate in paroxysmal and persistent AF.Trial registrationTrial registration number: NCT00376272

Renin-angiotensin system inhibitors for prevention of recurrent atrial fibrillation: a meta-analysis

Conflicting results exist now on the clinical utility of renin-angiotensin system (RAS) inhibitors in patients with atrial fibrillation (AF). This study aimed to elaborate the efficacy and safety of RAS blockade on preventing the relapse of AF by a meta-analysis based on randomised controlled trials (RCTs). We searched Medline, ISI web of science and Cochrane databases through Jan 2012. We included RCTs comparing RAS inhibition treatment vs. placebo or alternative therapy after cardioversion of persistent AF or conventional medical therapy for paroxysmal AF and reporting outcome of recurrent AF. Odds ratios (OR) were calculated using a random effects model. Fifteen trials involving 3972 AF patients were included in the analysis. The pooling analysis showed that RAS inhibitors significantly reduced the recurrence of AF compared with non-RAS inhibitors (OR=0.50, 95% CI: 0.37-0.69, p<0.01), and the beneficial effect was shown consistently both in patients with paroxysmal and in those with persistent AF after cardoversion. However, administration of RAS inhibitors did not provide a greater survival advantage and a lower incidence of adverse effects than the control (OR=1.17, 95% CI, 0.65-2.10, p=0.59; OR=0.94, 95% CI: 0.65-1.35, p=0.73 respectively). In addition, clinical factors potentially affecting AF relapsing had no pronounced impacts on the above clinical outcomes. Based on the currently available data, inhibition of RAS is effective, safe and well tolerated for preventing the recurrence of AF.

Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients

It is controversial whether angiotensin II receptor blockers provide better protection than calcium antagonists against atrial fibrillation (AF) recurrence in hypertensive patients. This study was designed to compare the effect of nifedipine- and telmisartan-based antihypertensive treatments for preventing AF recurrence in hypertensive patients with paroxysmal AF. A total of 149 hypertensive patients with paroxysmal AF were randomized to nifedipine- or telmisartan-based antihypertensive treatment groups. The target blood pressure (BP) was <130/80 mm Hg. Clinic BP, ECG, Holter monitoring, and echocardiography were followed up for 2 years. The primary end point was the incidence of overall and persistent AF recurrence. During follow-up, there was no statistical difference in the rate of patients lowering to target BP between both groups, whereas nifedipine group had slightly better BP control but similar heart rate control at 24 months. The incidence of AF recurrence was similar in both groups (nifedipine versus telmisartan: 58.7% versus 55.4%; P=0.742), and Kaplan-Meier analysis showed no significant difference in the freedom from AF recurrence (log-rank test; P=0.48). However, the rate of developing persistent AF in telmisartan group was lower than that in nifedipine group (5.4% versus 16.0%; P=0.035). Patients in telmisartan group had lower values of left atrial diameter, left atrial volume index, and left ventricular mass index at the end of follow-up. The effects of telmisartan in preventing AF recurrences in hypertensive patients with paroxysmal AF after intensive lowering BP is similar to that of nifedipine, but telmisartan has more potent effects on preventing progression to persistent AF.

Dronedarone-induced optic neuropathy

Atrial fibrillation (AF) is a major cause of morbidity worldwide. Amiodarone has often been used to prevent AF recurrences, but is often complicated by adverse toxic effects. Optic neuropathy has been found in 1.79% of patients treated with amiodarone compared to 0.3% of the general population [1]. Optic neuropathy from amiodarone typically has a more insidious onset, milder degree of visual loss, longer duration of disc edema and more often bilateral than nonarteritic anterior ischemic optic neuropathy (NAION).

Effect of Eplerenone on Maintenance of Sinus Rhythm After Catheter Ablation in Patients With Long-Standing Persistent Atrial Fibrillation

Several studies have demonstrated a relation between the rennin-angiotensin-aldosterone system and atrial fibrillation (AF), but there are no reports on the effect of eplerenone, a selective aldosterone blocker, on the prevention of AF recurrence after radiofrequency catheter ablation (RFCA). The aim of this study was to evaluate the effects of eplerenone on clinical outcomes after RFCA in patients with long-standing persistent AF. A total of 161 consecutive patients with long-standing persistent AF (sustained AF duration 1 to 20 years, mean 3.4 ± 3.8) who underwent RFCA were investigated. Eplerenone was used in 55 patients and not used in the remaining 106 patients. Other conventional pharmacologic agents, including angiotensin-converting enzyme inhibitors or angiotensin type 1 receptor blockers, were used equally in the 2 groups. After 24 months of follow-up, 47% of the patients were free from AF recurrence. The rate of freedom from AF recurrence was significantly greater in the eplerenone group (60%) than in the noneplerenone group (40%) (p = 0.011). By univariate analysis, the duration of sustained AF (p <0.001), left atrial diameter (p = 0.010), left atrial volume index (p = 0.017), and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and the use of eplerenone was associated with maintenance of sinus rhythm after RFCA (p = 0.022). Multivariate Cox regression analysis showed that longer duration of sustained AF (>3 years) (p <0.001) and early AF recurrence (p <0.001) were significantly associated with AF recurrence, and only eplerenone therapy significantly improved maintenance of sinus rhythm (p = 0.017). In conclusion, eplerenone significantly improved maintenance of sinus rhythm after RFCA in patients with long-standing persistent AF.

Omega-3 Fatty Acids for the Prevention of Recurrent Symptomatic Atrial Fibrillation

The aim of this study was to evaluate the efficacy of polyunsaturated fatty acids (n-3 PUFA) for the prevention of recurrent atrial fibrillation (AF) in patients with normal sinus rhythm.

Safety and efficacy of vernakalant for acute cardioversion of atrial fibrillation: an update

Intravenous vernakalant has recently been approved in Europe as an atrial-selective antiarrhythmic drug for the conversion of recent-onset atrial fibrillation (AF). It inhibits atrial-selective K+ currents (IK,ACh and IKur) and causes rate-dependent atrial-predominant Na+ channel block, with only a small inhibitory effect on the rapid delayed rectifier K+ current (IKr) in the ventricle. Due to its atrial-selective properties, vernakalant prolongs the effective refractory period of the atria with minimal effects on the ventricles, being associated with a low proarrhythmic risk for torsades de pointes arrhythmias. Five pivotal clinical trials consistently demonstrated that vernakalant rapidly terminates AF with stable maintenance of sinus rhythm for up to 24 hours. A head-to-head comparative trial showed that the 90-minute conversion rate of vernakalant was substantially higher than that of amiodarone. Initially, a longer-acting oral formulation of vernakalant was shown to be effective and safe in preventing AF recurrence after cardioversion in a Phase IIb study. However, the clinical studies testing oral vernakalant for maintenance of sinus rhythm after AF cardioversion were prematurely halted for undisclosed reasons. This review article provides an update on the safety and efficacy of intravenous vernakalant for the rapid cardioversion of AF.