Key result
Bepridil plus aprindine is linked to ~78% post-ablation early atrial tachyarrhythmia suppression vs pilsicainide.
Why the study?
Early recurrence of atrial tachyarrhythmia after AF ablation is common during the blanking period, but no standardized management approach exists.
Does bepridil plus aprindine improve ERAT suppression in patients with early recurrence of atrial tachyarrhythmia after AF ablation?
Cohort (n=75)
No
Does bepridil plus aprindine improve ERAT suppression in patients with early recurrence of atrial tachyarrhythmia after AF ablation?
Bepridil combined with aprindine is highly effective for suppressing early atrial tachyarrhythmias post-AF ablation, and poor response to this regimen predicts long-term AF recurrence.
Bepridil plus aprindine was associated with greater ERAT suppression; hypothesis-generating and requires randomized confirmation before changing blanking-period practice.
Background Early recurrence of atrial tachyarrhythmia (ERAT) after ablation for atrial fibrillation (AF) is common during the blanking period; however, no standardized management approach exists. This study aimed to identify effective antiarrhythmic drugs (AADs) during the blanking period and to examine the association between AAD efficacy and long‐term outcomes. Methods Initially, 497 patients who underwent catheter ablation for AF between April 2017 and December 2022 were included. Among these, patients who experienced ERAT after their first AF ablation were analyzed for this retrospective study. During the blanking period, the effectiveness of three AAD regimens, pilsicainide, bepridil, and bepridil plus aprindine, was compared. Patients were followed for 2 years after AAD discontinuation and stratified according to late recurrence. Results Among the 75 patients analyzed, ERAT was suppressed in 29.6% (8/27) with pilsicainide, 38.1% (8/21) with bepridil, and 77.8% (21/27) with bepridil plus aprindine ( p = 0.0009). Among patients without late recurrence, ERAT suppression was higher with bepridil‐based regimens: pilsicainide, 27.8% (5/18); bepridil, 66.7% (6/9); and bepridil plus aprindine, 89.5% (17/19) ( p = 0.0006). Poor response to bepridil‐based therapy was associated with a high late recurrence rate (73.7%, 14/19), whereas lack of response to pilsicainide was not (31.6%, 6/19) ( p = 0.009). Conclusion Bepridil, particularly in combination with aprindine, was effective for managing ERAT after AF ablation. A poor response to bepridil or to bepridil plus aprindine during the blanking period may serve as a marker for identifying patients at higher risk of late recurrence.
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Kashiwa et al. (2026) conducted a cohort in Early recurrence of atrial tachyarrhythmia (ERAT) after atrial fibrillation ablation (n=75). Bepridil plus aprindine vs. Pilsicainide was evaluated on ERAT suppression during the blanking period (p=0.0009). Bepridil plus aprindine significantly suppressed early recurrence of atrial tachyarrhythmia compared to pilsicainide (77.8% vs 29.6%, p=0.0004) during the blanking period after atrial fibrillation ablation.
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