Preablation treatment with dofetilide followed by PVI alone in persistent AF patients achieved a 12-month AAD-free response of 70%, similar to 75% in paroxysmal AF controls (P=NS).
Cohort (n=106)
Does preablation treatment with dofetilide facilitate reverse atrial remodeling and improve clinical response to PVI alone in patients with persistent atrial fibrillation?
Pre-treatment with dofetilide in persistent AF patients induces reverse atrial electrical remodeling, leading to long-term ablation success rates with PVI alone that are comparable to those seen in paroxysmal AF.
Absolute Event Rate: 70% vs 75%
p-value: p=NS
INTRODUCTION: Pulmonary vein isolation (PVI) alone has been thought to be insufficient in patients with persistent atrial fibrillation (PersAF). We hypothesized that preablation treatment of PersAF with a potent antiarrhythmic drug (AAD) would facilitate reverse atrial remodeling and result in high procedural efficacy after PVI alone. METHODS AND RESULTS: Seventy-one consecutive patients (59.4 ± 9.8 years) with PersAF and prior AAD failure were treated with oral dofetilide (768 ± 291 mcg/day) for a median of 85 days pre-PVI. P-wave duration (Pdur) on ECG was used to assess reverse atrial remodeling. Thirty-five patients with paroxysmal (P) AF not treated with an AAD served as controls. All patients underwent PVI alone; dofetilide was discontinued 1-3 mos postablation. In the PersAF patients, the Pdur decreased from 136.3 ± 21.7 ms (assessed postcardioversion on dofetilide) to 118.6 ± 20.4 ms (assessed immediately prior to PVI) (P < 0.001). In contrast, no change in Pdur (122.6 ± 11.5 ms vs. 121.3 ± 13.7 ms, P = NS) was observed in PAF patients. The 6 and 12 mos AAD-free response to ablation was 76% and 70%, respectively, in PersAF patients, similar to the 80% and 75%, response in PAF patients (P = NS). A decline in Pdur in response to dofetilide was the only predictor of long-term clinical response to PVI in patients with PersAF. CONCLUSIONS: Pre-treatment with AAD resulted in a decrease in Pdur suggesting reverse atrial electrical remodeling in PersAF patients. This may explain the excellent clinical outcomes using PVI alone, and may suggest an alternative ablation strategy for PersAF.
Khan et al. (Tue,) conducted a cohort in Persistent Atrial Fibrillation (n=106). Preablation oral dofetilide followed by PVI alone vs. Paroxysmal AF patients not treated with AAD undergoing PVI alone was evaluated on 12-month AAD-free response to ablation (p=NS). Preablation treatment with dofetilide followed by PVI alone in persistent AF patients achieved a 12-month AAD-free response of 70%, similar to 75% in paroxysmal AF controls (P=NS).