What is the clinical evidence from this study?

Study design: Observational. Population: paroxysmal atrial fibrillation (n=74). Intervention: Hybrid therapy with pilsicainide and PV isolation. Primary outcome: Elimination of AF.

January 1, 2005Circulation JournalOpen Access

Hybrid Therapy With Pilsicainide and Pulmonary Vein Isolation for Atrial Fibrillation

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Key result

Hybrid therapy with pilsicainide and pulmonary vein isolation achieved an 86% overall success rate in eliminating atrial fibrillation among patients with initially drug-refractory paroxysmal AF.

Why the study?

Does hybrid therapy with pilsicainide and pulmonary vein isolation improve the elimination of atrial fibrillation in patients with drug-refractory paroxysmal AF?

Population

74 patients with symptomatic drug-refractory paroxysmal atrial fibrillation in whom pilsicainide and a mean…

Design

Cohort

Follow-up

12 months

Authors

HTHideaki TojoTakeda (Japan)KKKoichiro KumagaiElectrophysiology HNHiroo NoguchiUji Hospital

Discussion

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Implication

May support re-testing ineffective antiarrhythmics after PVI in refractory paroxysmal AF; hypothesis-generating and requires randomized confirmation.

Study Design

Type

Observational (n=74)

Structured PICO

Does hybrid therapy with pilsicainide and pulmonary vein isolation improve the elimination of atrial fibrillation in patients with drug-refractory paroxysmal AF?

Population

74 patients (54 men, 20 women; mean age 56±6 years) with symptomatic drug-refractory paroxysmal atrial fibrillation (PAF) in whom pilsicainide and a mean of 3.0±1.0 antiarrhythmic drugs had been administered unsuccessfully.

Intervention

Hybrid therapy consisting of pulmonary vein (PV) isolation followed by re-administration of oral pilsicainide (150 mg/day) for recurrent AF. Intraprocedural intravenous pilsicainide (1 mg/kg over 5 min) was also administered to assess electrophysiological effects.

Outcome

Elimination of atrial fibrillation (freedom from AF at 12-month follow-up without antiarrhythmic drugs, or with pilsicainide for recurrences)

In patients with paroxysmal AF and unsuccessful PV isolation, re-administration of previously ineffective pilsicainide can eliminate AF by modifying LA-PV conduction properties.

Limitations

Pilsicainide may have many other electrophysiologic effects
No data to support assertion that effect is not caused by increasing atrial refractoriness or creation of conduction block at wavefront turn-around points
No evidence in the present study that pilsicainide suppresses non-PV foci

Cite This Study

Tojo et al. (2005) conducted an observational in paroxysmal atrial fibrillation (n=74). Hybrid therapy with pilsicainide and PV isolation was evaluated on Elimination of AF. Hybrid therapy with pilsicainide and pulmonary vein isolation achieved an 86% overall success rate in eliminating atrial fibrillation among patients with initially drug-refractory paroxysmal AF.

synapsesocial.com/papers/6a128ed3f7bd4f5c7da68754 https://doi.org/10.1253/circj.69.1503

Topics

Persistent AF management Atrial fibrillation AF ablation outcomes Anticoagulation in AF

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Implication

May support re-testing ineffective antiarrhythmics after PVI in refractory paroxysmal AF; hypothesis-generating and requires randomized confirmation.

Hybrid Therapy With Pilsicainide and Pulmonary Vein Isolation for Atrial Fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Hybrid Therapy With Pilsicainide and Pulmonary Vein Isolation for Atrial Fibrillation

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider