Prevention Of Paroxysmal Atrial Fibrillation Research Articles

Kampo extract goshuyuto for prevention of paroxysmal atrial fibrillation associated with migraine attack

ABSTRACTCaseNot only non‐steroidal anti‐inflammatory drugs (NSAIDs) but also triptans, called a ‘magic bullet’ against migraine attacks, increase the incidence of atrial fibrillation (AF). Additionally, the migraine attack itself may induce AF. A 66‐year‐old man visited hospital, complaining of palpitation after taking NSAIDs containing acetaminophen, ethenzamide and caffeine for a migraine attack. When pilsicainide hydrochloride hydrate was given, the AF was restored to sinus rhythm in 2 h.OutcomeGoshuyuto, a kampo formula used for headache, consists of four constituent drugs: Zizyphus fructus, Evodia fructus, Ginseng radix and Zingiber rhizome; these four crude drugs may induce multiple interactions. After taking goshuyuto combined with sodium valproate, no further migraine occurred for 3 months and no AF was observed.ConclusionThe kampo extract goshuyuto may be an option to prevent paroxysmal AF associated with migraine attack.

A simple method for Bachmann's bundle pacing with indigenous modification of J-stylet

BackgroundPacing in the Bachmann's bundle (BB) area (upper atrial septum) appears superior to right atrial appendage or free wall stimulation for the prevention of paroxysmal atrial fibrillation in patients with atrial conduction delay. However, insertion of active fixation lead in the upper atrial septal position is difficult and time consuming with conventional stylet, inhibiting application of this pacing method in routine practice. MethodsThe technique of positioning the atrial lead in BB with hand-made stylet is presented with emphasis on electrocardiographic P-wave pattern and fluoroscopic landmarks. ResultsThe results demonstrate an acute implantation and short-term success of BB pacing of 14 patients out of 15 patients without major complications. Pacing parameters at implantation and 3 months postprocedure were noted which were within normal limits. ConclusionThese favorable initial results indicate that the positioning of active fixation atrial lead in BB with fluoroscopic landmarks is feasible and reproducible with a simple technique.

Beneficial effects of losartan for prevention of paroxysmal atrial fibrillation in patients with sick sinus syndrome: analysis with memory function of pacemaker.

Renin-angiotensin system (RAS) inhibitors may be useful in preventing the occurrence of paroxysmal atrial fibrillation (PAF). However, evaluation of such effect is difficult because many PAF episodes are asymptomatic and not all episodes are detected by intermittent electrocardiographic monitoring. A pacemaker has been developed with dedicated functions for AF detection and electrocardiogram storage. Accordingly, we examined the effect of losartan, an angiotensin receptor blocker on PAF occurrence using this new modality. We enrolled 70 consecutive patients who had undergone dual-chamber pacemaker implantation for sick sinus syndrome. Finally, 62 patients participated in the study. Thirty patients were randomized to the losartan group (mean 43 ± 12 mg/day) and 32 patients to the control group. They were followed up for 3 months. The frequency, the maximum duration and the total duration of PAF recorded by the stored electrocardiograms for the last 1 month during the observation period and study period were compared between the two groups. The change in the frequency of PAF from the observation period in the losartan and control groups was similar (-35 ± 25 vs. -67 ± 62 times; NS). However, the change in the maximum duration and the total duration of PAF was significantly shorter in the losartan group than in the control group (-493 ± 158 vs. -10 ± 69 min; p < 0.05, and -4007 ± 2334 vs. 1119 ± 714 min; p < 0.05, respectively). Losartan suppressed the maximum duration and the total duration of PAF in patients with sick sinus syndrome without hemodynamic changes. This is the first study to show the effect of a renin-angiotensin system inhibitor on the secondary prevention of PAF using the dedicated functions of a pacemaker for PAF detection and electrocardiogram storage.

GW24-e0428 Atorvastatin therapy in patients with atrial fibrillation ablation to maintain sinus rhythm

ObjectivesThere is little information available on the benefits of selection of statins as upstream therapy for the prevention of paroxysmal atrial fibrillation (AF). The aim of this study was to...

ASSA13-02-16 Atorvastatin Therapy in Patients with Atrial Fibrillation Ablation to Maintain Sinus Rhythm

Background There is little information available on the benefits of selection of statins as upstream therapy for the prevention of paroxysmal atrial fibrillation (AF). Objective The aim of this study was to investigate recurrence of atrial fibrillation (AF) in patients who will take AF ablation after 7 days, randomised to treatment with atorvastatin 40mg/day or placebo 30.90 and 180 days. Methods We compared the efficacy and safety of atorvastatin (A-group, n = 51) and placebo (P-group, n = 50) as upstream therapy in patients with paroxysmal AF. A total of 101 patients (56 men, mean age, 65 ± 7 years) were retrospectively assigned to receive atorvastatin 7days before AF ablation (n = 51; 40 mg/day) or placebo (n = 50). Results Survival rates free from AF recurrence at 1, 3, and 6 months were 93%, 90% and 81% in A-group, and 88%, 73%, and 59%, respectively, in P-group (P = 0.005, A-group versus P-group). Using a logistic regression model, atorvastatin was found to be associated with a significantly reduced risk of AF recurrence in comparison to placebo (unadjusted odds ratio [OR] = 0.25, 95% confidence interval 0.12–0.45, P = 0.005). This association remained significant after adjustment for potentially confounding variables (OR = 0.24, 95% CI 0.10–0.56, P = 0.017) Adverse effects requiring discontinuation of statins were observed in 1 case (2%, myalgia) in A-group, and 1 case (2%, elevation in CPK level ≥ 500 IU/L) in P-group, respectively (P = NS, A-group versus P-group). Conclusions This randomised study supported that using atorvastatin 7 days before AF ablation was considered to be exactly effective in preventing recurrence of paroxysmal AF.

LONG-TERM EFFICACY OF THE LOW DOSE AMIODARONE THERAPY FOR THE PREVENTION OF RECURRENCE OF PAROXYSMAL ATRIAL FIBRILLATION

ObjectivesTo investigate the efficacy and safety of the low dose oral amiodarone therapy in patients for the long-term prevention of paroxysmal atrial fibrillation (PAF).Methods Usage of AmiodaroneAfter conversion by using...

EFFECT OF IRBESARTAN ON THE BURDEN OF ATRIAL FIBRILLATION IN THE HYPERTENSIVE PATIENTS WITH BRADYCARDIA-TACHYCARDIA SYNDROME UNDERGOING CARDIAC PACEMAKER IMPLANTATION

ObjectivesTo evaluate the effect of irbesartan, an angiotensin-receptor blocker, on the prevention of paroxysmal atrial fibrillation in the hypertensive patients with sick sinus syndrome and paroxysmal atrial fibrillation.Methods336 patients diagnosed...

Revisiting the merits of nifedipine

Randomized trials of blood pressure reduction have shown a reduced risk of stroke and heart failure. Among blood pressure-lowering agents, blockers of the renin-angiotensin system, such as angiotensin-converting enzyme inhibitors (ACEIs) and AT1 receptor antagonists (ARBs), are thought to have specific properties beyond blood pressure control, which reduce cardiovascular complications. However, recent clinical trials indicated that ACEIs and ARBs are not always such all-rounders. ARBs are effective for primary prevention of paroxysmal atrial fibrillation (PAF), but have little benefit on secondary prevention of PAF and persistent or permanent atrial fibrillation. ARBs are cardioprotective in patients with heart failure and reduced ejection fraction, but have no benefits on heart failure patients with preserved ejection fraction. Both patient groups have a similarly poor prognosis, but treatment options for those patients with preserved ejection fraction are limited. Moreover, very little is known about the mode of death in these patients.

Efficacy and safety of amiodarone combined with telmisartan for prevention of paroxysmal atrial fibrillation

Objective: To observe the efficacy and safety of amidarone combined with telmisartan for prevention of paroxysmal atrial fibrillation.Methods: A total of 204 patients with hypertension and paroxysmal atrial fibrillation were randomly divided into test and control groups by digit table.Patients in the two groups took amiodarone 600 mg/d in the first week,400 mg/d in the second week,200 mg/d in the third week and 100 mg/d afterwards.Patients in the test group were also treated with telmisartan at the dose of 20-80 mg/d simultaneously.While patients in the control group were treated with other antihypertensive drugs,excluding angiotensin converting enzyme inhibitors(ACEIs) and angiotensin receptor blockers(ARBs).All the patients were followed up for six months.Number of cases,times and the first time of atrial fibrillation recurrence as well as adverse drug reactions(ADRs) were recorded.Results: Ninety-one patients in the test group and 95 patients in the control group finished the whole trial.There were significant differences in occurrence of ADRs between test and control groups(56 vs 41,P0.05),primarily with a higher incidence of gastrointestinal reactions.However,the numbers of patients who stopped medicine treatment due to serious ADRs were not obviously different between the two groups(P0.05).The first recurrence time of atrial fibrillation was prolonged [(94.59±30.51) d vs(84.54±28.73)d,P0.05] and incidence of atrial fibrillation recurrence was decreased(32 vs 53,P0.05) in the test group than those in the control group.The numbers of cases of atrial fibrillation recurrence were similar in the two groups within 3 months(15 vs 24,P0.05),and they were reduced significantly in 6 months(26 vs 42,P0.05).Conclusion: The treatment of amiodarone combined with telmisartan is safe and effective for preventing atrial fibrillation recurrence.

Long-Term Efficacy of Amiodarone Therapy for the Prevention of Recurrence of Paroxysmal Atrial Fibrillation Analysis Based on Patient Characteristics

There is little information available on factors affecting the long-term prevention of paroxysmal atrial fibrillation (AF) in the Japanese population. A total of 71 patients (49 men, mean age, 68 ± 8 years) with paroxysmal AF refractory to ≥ 2 class I antiarrhythmic drugs received oral amiodarone (50-200 mg/day). All patients were observed for more than 12 months (mean follow-up period, 47 ± 26 months) and were analyzed on the basis of patient profiles. The percentage of patients with AF recurrence despite amiodarone therapy was 54% in all patients. In multivariate logistic regression analysis adjusted for age and sex, the following factors were associated with preventive efficacy for AF recurrence: left ventricular ejection fraction (LVEF) (relative risk [RR] 0.933, 95% confidence interval [CI] 0.877-0.993, P = 0.029), asymptomatic AF (RR 0.068, CI 0.005-0.870, P = 0.039), and AF occurring irrespective of circadian variation (RR 0.115, CI 0.013-0.988, P = 0.049). The percentage of patients with conversion to permanent AF despite amiodarone therapy was 31% in all patients. In multivariate logistic regression analysis adjusted for age and sex, asymptomatic AF (RR 0.085, CI 0.010-0.732, P = 0.025) was the only factor associated with preventive efficacy for conversion to permanent AF. Amiodarone appears to be effective in maintaining sinus rhythm, especially in patients with impaired left ventricular function. In contrast, amiodarone appears to be refractory in those with asymptomatic AF or AF occurring irrespective of circadian variation.

Future easy and physiological cardiac pacing

The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.

Long-term Efficacy of Upstream Therapy With Lipophilic or Hydrophilic Statins on Antiarrhythmic Drugs in Patients With Paroxysmal Atrial Fibrillation Comparison Between Atorvastatin and Pravastatin

There is little information available on the benefits of selection of statins as upstream therapy for the prevention of paroxysmal atrial fibrillation (AF). We compared the efficacy and safety of atorvastatin (A-group, n = 43) and pravastatin (P-group, n = 41) as upstream therapy in patients with paroxysmal AF and dyslipidemia. A total of 84 patients (45 men, mean age, 66 ± 9 years, mean follow-up, 49 ± 32 months) were retrospectively assigned to receive atorvastatin (n = 41;10 mg/day) or pravastatin (n = 43 ; 10 mg/day). Survival rates free from AF recurrence at 1, 6, 12, and 24 months were 93%, 74%, 60%, and 53% in A-group, and 88%, 49%, 37%, and 29%, respectively, in P-group (P = 0.029, A-group versus P-group). Survival rates free from conversion to permanent AF at 12, 36, 60, and 90 months were 100%, 100%, 98%, and 95% in A-group, and 100%, 95%, 88%, and 83%, respectively, in P-group (P = 0.063, A-group versus P-group). Using a logistic regression model, atorvastatin was found to be associated with a significantly reduced risk of AF recurrence in comparison to pravastatin (unadjusted odds ratio [OR] = 0.27, 95% confidence interval 0.11-0.68, P = 0.005). This association remained significant after adjustment for potentially confounding variables (OR = 0.26, 95% CI 0.08-0.86, P = 0.027). Using a logistic regression model, atorvastatin was not associated with a significantly reduced risk of converting to permanent AF in comparison to pravastatin (unadjusted OR = 0.29, 95% CI 0.05-1.50, P = 0.138), but this association did show a significant difference after adjustment for potentially confounding variables in a multivariate model (OR = 0.08, 95% CI 0.06-0.96, P = 0.046). Adverse effects requiring discontinuation of statins were observed in 1 case (2%, myalgia) in A-group, and 1 case (2%, elevation in CPK level ≥ 500 IU/L) in P-group, respectively (P = NS, A-group versus P-group). Atorvastatin, a lipophilic statin, was considered to be more effective in preventing recurrence of paroxysmal AF and conversion to permanent AF than pravastatin, a hydrophilic statin.

Slower Heart Rates for Healthy Hearts

The management of atrial fibrillation, even in the modern era, remains complex and challenging. Preventing atrial fibrillation occurrence by identifying and favorably improving modifiable risk factors thus assumes great importance. It is well known that hypertension and resultant structural heart disease contributes significantly to the incidence of atrial fibrillation.1,2 The Losartan Intervention For End point reduction in hypertension (LIFE) study thus far has shown us that angiotensin-receptor blockade and reduction in left ventricular hypertrophy, irrespective of blood pressure–lowering, reduces the incidence of new-onset atrial fibrillation.1,3 Article see p 337 In recent years, accumulating evidence has linked high resting sinus heart rates (HR) directly and indirectly to adverse cardiovascular outcomes.4,5 Epidemiological studies show resting HR to be an independent predictor of cardiovascular and all-cause mortality in general population as well as in hypertensive patients.6 The cardiovascular benefits offered by β-blockade in coronary artery disease and heart failure have, in part, been attributed to β-blocker–mediated HR reduction.7,8 Other studies have linked high baseline HR to the development of hypertension, to the progression of coronary artery disease, and to the triggering of myocardial infarction, ventricular dysfunction, and ventricular arrhythmias.6,9–11 In this issue of Circulation: Arrhythmia and Electrophysiology , Okin and colleagues12 examines the relationship of HR changes over time on risk of atrial fibrillation in hypertensive patients as part of the LIFE study. In this post hoc analysis of the prospective LIFE study, 8828 hypertensive patients with left ventricular hypertrophy by ECG but without a history of atrial fibrillation were followed for a mean of 4.7±1.1 years. New onset atrial fibrillation was determined by 12-lead ECG performed on an intermittent, infrequent basis (at baseline, 6 months, and yearly thereafter). Hypertension was treated with losartan or atenolol. Using a variety of analyses, higher in-treatment HR on serial …

Effects of Continuous and Triggered Atrial Overdrive Pacing on Paroxysmal Atrial Fibrillation in Pacemaker Patients

The aim of the study was to compare the effects of different pacing strategies to prevent paroxysmal atrial fibrillation (AF): triggered atrial overdrive pacing versus the combination of triggered and continuous overdrive pacing. Patients with an indication for dual-chamber pacing (Selection 9000, Prevent AF; Vitatron B.V., Arnhem, the Netherlands) and a history of paroxysmal AF were randomized to triggered atrial pacing (three pacing functions, "triggered group": PAC Suppression, Post-PAC Response, and Post-Exercise Response) or to the combination of continuous (Pace Conditioning) and triggered atrial pacing (four pacing functions, "combined group"). After 3 months, there was a crossover to the other pacemaker setting. In 171 enrolled patients, the median AF burden of the combined group was with 2.1% versus 0.1% in the triggered group (P = 0.014). Fewer AF episodes were observed in the triggered (median: 7) than in the combined group (median: 116; P = 0.016). The combined group had more frequent atrial pacing (median 97%) than the triggered group with 85% (P < 0.001), but ventricular pacing was not significantly different with 95% and 96% in the combined and triggered group, respectively. After the crossover, the AF burden increased in the triggered group to 0.3% and decreased in the combined group to 0.4%. Triggered atrial pacing functions alone resulted in a low AF burden. The additional activation of continuous atrial overdrive pacing increased the percentage of atrial pacing, but had no beneficial effects on the prevention of paroxysmal AF.

Ataxia caused by amiodarone in older people

Amiodarone is recommended for the cardioversion of atrial fibrillation and prevention of paroxysmal atrial fibrillation in patients with structural heart disease, coronary artery disease or left ventricular dysfunction. It has well-recognised side-effects on the skin, lungs, liver, thyroid and eyes. Neurological side-effects, including ataxia and neuropathy, also occur, and may be more prevalent in older patients. These side-effects are reversible after cessation of amiodarone. Monitoring of amiodarone therapy should include assessment of the central and peripheral nervous system especially in older patients.

Right atrial preventive and antitachycardia pacing for prevention of paroxysmal atrial fibrillation in patients without bradycardia: a randomized study

To investigate the efficacy of preventive and antitachycardia pacing (ATP) in patients with symptomatic paroxysmal atrial fibrillation (AF) without bradyarrhythmias. In this randomized cross-over pilot study, we randomized 38 symptomatic paroxysmal AF patients 'without' bradyarrhythmias to atrial pacing lower rate 70 ppm and prevention and ATP therapies ON or to atrial pacing lower rate 34 ppm and prevention and ATP therapies OFF during 12 weeks with a 4 week washout period in between. The atrial lead was preferably placed in the inter-atrial septum. Antiarrhythmic drugs were continued during the study. Primary endpoint was AF burden. Mean age was 62 +/- 9 years and 27 (71%) patients had lone AF. Septal lead placement was accomplished in 26 (68%) patients. During the treatment ON, there was a trend for AF burden reduction [from median 3.3% (1.0-15.2) to 2.4% (0.2-12.2), P = 0.06, reduction 27%]. If septal lead placement was accomplished, AF burden reduction was statistically significant [44% reduction, from median 2.5% (1.0-8.0) to 1.4% (0.2-8.4), P = 0.03]. Quality of life and symptoms did not change, also not in the septal group. A hybrid therapy of preventive and ATP pacing and antiarrhythmic drugs may significantly reduce but not abolish AF burden if septal pacing is realized.

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

Several preliminary studies have indicated that atrial pacing can prevent atrial tachyarrhythmias. The suggested mechanisms by which pacing may be effective include suppression of premature atrial beats. The Atrial Pacing Preference (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. The preventive effects of APP on paroxysmal atrial fibrillation (AF) were studied in 51 patients (70+/-11 years). Nine patients did not complete the protocol. The pacemaker was programmed in random order to APP off and APP on at 3 different settings (ie, 8, 16 and 32 cycles) for 4 weeks each, using a cross-over design. Percentage atrial pacing was lower in APP off than at the other settings. Premature beat counts were greater in APP off than at the other settings. There was a significant difference in mode switch episode counts between APP off and the most effective setting (3,818+/-15,356 vs 596+/-1,719; p<0.01). The APP algorithm is a promising method for preventing atrial tachyarrhythmia in patients with an implanted pacemaker and AF. Optimizing the setting of the APP algorithm is an important issue in the prevention of AF.

Conventional and dedicated atrial overdrive pacing for the prevention of paroxysmal atrial fibrillation: the AFTherapy study

This investigation was conducted to determine the effectiveness of several conventional overdrive pacing modalities (single rate and rate responsive pacing at various lower rates) and of four dedicated preventive pacing algorithms in the suppression of paroxysmal atrial fibrillation (AF). In this multi-centre, randomized trial, 372 patients with drug-refractory paroxysmal AF were enrolled. Patients received a dual-chamber pacing device capable of delivering conventional pacing therapy as well as dedicated AF prevention pacing therapies and to record detailed AF-related diagnostics. The primary endpoint was AF burden, whereas secondary endpoints were time to first AF episode and averaged sinus rhythm duration. During a conventional pacing phase, patients were randomized to single rate or rate-responsive pacing with lower rates of either 70 or 85 min(-1) or to a control group with single rate pacing at 40 min(-1). In the subsequent preventive pacing phase, patients underwent pacing at a lower rate of 70 min(-1) with or without concomitant application of four preventive pacing algorithms. A substantial amount of data was excluded from the analysis because of atrial-sensing artefacts, identified in the device-captured diagnostics. In the conventional pacing phase, no significant differences were found between various lower rates and the control group receiving single rate pacing at 40 min(-1) or between single rate and rate-responsive pacing. Patients receiving preventive pacing with all four therapies enabled had a similar AF burden compared with patients treated with conventional pacing at 70 min(-1) (P = 0.47). The results do not demonstrate a significant effect of conventional atrial overdrive pacing or preventive pacing therapies. However, the observations provided important information for further consideration with respect to the design and conduct of future studies on the effect of atrial pacing therapies for the reduction of AF.

Dual‐Site Right Atrial Pacing Increases Left Atrial Appendage Flow in Patients with Sick Sinus Syndrome and Paroxysmal Atrial Fibrillation

Dual-site right atrial pacing has been proposed as a promising concept for prevention of paroxysmal atrial fibrillation (PAF). Effects of this pacing configuration on left atrial appendage (LAA) flow and transmitral flow may be of prognostic and hemodynamic relevance. This study aims to characterize acute changes in left atrial flow depending on dual-site right atrial pacing. In 12 patients (66 +/- 8.8 years, 4 women) with PAF and sinus bradycardia a pacemaker with a right atrial dual-site lead configuration (right atrial lateral and coronary sinus ostium) was implanted. Flow velocities in the left pulmonary vein (LPV), LAA, and across the mitral valve were assessed by transesophageal echocardiography and compared during sinus rhythm (SR) and dual-site (DS) pacing. Dual-site pacing resulted in higher maximum (SR: 0.57 m/s; pacing: 0.77 m/s; P < 0.02) and mean (SR: 0.33 m/s; DS: 0.47 m/s; P < 0.01) LAA emptying flow when compared with SR. The passive transmitral flow component (maximum E-wave velocity) was lower during dual-site pacing (SR: 0.53 m/s vs DS: 0.44 m/s, P < 0.02). The E/A ratio tended to be lower during dual-site pacing (SR: 1.21 vs DS: 1.01, P = 0,10). LPV flow velocities during SR and DS pacing did not differ. DS right atrial stimulation in patients with PAF increases the LAA emptying flow velocity and shifts the transmitral flow pattern towards a lower passive component when compared with sinus rhythm. The change in LAA flow may contribute to a lower incidence of thromboembolism and merits further investigation.

Randomized Crossover Study of the Long-Term Effects of Pilsicainide and Cibenzoline in Preventing Recurrence of Symptomatic Paroxysmal Atrial Fibrillation Influence of the Duration of Arrhythmia Before Therapy

There is little information on the selection of antiarrhythmic agents for long-term prevention of paroxysmal atrial fibrillation (PAF). In the present study the preventive effects of pilsicainide (Pil) and cibenzoline (Cib) were compared in patients with PAF that was defibrillated at <48 h or >or=48 h after onset. A total of 60 patients (45 men, 15 women, mean age 66+/-10 years) were divided into 2 groups: Group I consisted of 22 patients in whom atrial fibrillation (AF) lasted for <48 h before cardioversion and Group II consisted of 38 patients in whom AF lasted for >or=48 h. A randomized, crossover protocol of treatment with Pil (150 mg/day) and Cib (300 mg/day) was used. Mean follow-up was 35+/-18 months. In Group I, the mean duration of maintenance of sinus rhythm was 12.3+/-2.9 months in patients treated with Pil, compared with 12.9+/-2.5 months in those givem Cib (p=NS between 2 groups). Actuarial event-free rates at 1, 3, 6, 12 months were 82%, 68%, 59% and 41%, respectively, in patients treated with Pil, and 91%, 77%, 68% and 50%, respectively, in those givenh Cib (p=NS between 2 groups). In Group II, the mean duration of maintenance of sinus rhythm was 1.6+/-0.5 months in patients treated with Pil, compared with 5.9+/-1.7 months in those given Cib (p<0.01). Actuarial event-free rates at 1, 3, 6, 12 months were 45%, 18%, 8% and 3%, respectively, in patients treated with Pil, and 63%, 45%, 29% and 16%, respectively, in those given Cib (p<0.05, at 12 months). Prolonged tachycardia (>or=48 h) in patients with PAF seems to cause electrical remodeling. Cib, a multichannel blocker, is considered to be more effective in preventing the recurrence of PAF in the electrically remodeled atria than Pil, a pure sodium-channel blocker.