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By Marvin Ross

TORONTO -- October 29, 2008 -- Prior failure of rhythm control with amiodarone is associated with a significantly worse prognosis following catheter ablation for atrial fibrillation (AF), according to researchers presenting here at the Canadian Cardiovascular Congress (CCC).

There is some registry and trial data comparing AF ablation to medical therapy, noted lead investigator Yaariv Khaykin, MD, Southlake Regional Health Centre, Newmarket, Ontario, but most ablated patients have failed several antiarrhythmic drugs prior to ablation. Registry data suggests that the number of previously failed drugs correlates with inferior outcomes of ablation, he added, speaking here in a presentation on October 26.

This study was designed to correlate AF-ablation outcomes and the type of previously failed drugs. The study examined 141 patients aged 57 +- 10 years. Over 70% of subjects were male, and 66% had paroxysmal AF. They suffered with AF for an average of 8 +- 6 years and the medium left-atrium (LA) size was 42 +- 6 mm. Prior drug failures were sotalol (124), amiodarone (84), flecainide (74), and propafenone (45).

All patients in this study underwent pulmonary-vein antrum isolation guided by intracardiac echocardiography and circular mapping between February 2004 and January 2007. Amiodarone was discontinued at least 3 months before ablation and all other agents were stopped 5 half-lives before ablation. Irrigated or 8-mm tip catheters were used, and patients were followed for 8 +- 5 months with routine or ambulatory monitoring.

A univariate analysis was performed comparing the relationship between prior drug failure and the procedural success. Success was defined as no further symptomatic or asymptomatic AF (>30 seconds duration) off antiarrhythmic drugs beyond a 3-month blanking period following ablation.

Patients who failed amiodarone were more likely to fail ablation than those not on amiodarone or who were controlled on amiodarone before ablation (61% vs 77% respectively, P = .01).

Prior failure on sotalol, flecainide, and propafenone showed a trend toward worse outcomes, but this was not statistically significant.

[Presentation title: Prior Failure of Rhythm Control With Amiodarone but Not Other Antiarrhythmic Agents Predicts Atrial Fibrillation Recurrence Following Catheter Ablation. Abstract 142-076]
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