Long‐term efficacy of hybrid pharmacologic and ablation therapy in patients with pilsicainide‐induced atrial flutter

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 28; no. 7; pp. 338 - 342
• Main Authors: Hirao, Kenzo, Okishige, Kaoru, Yamamoto, Naohito, Otomo, Kenichiro, Azegami, Kouji, Isobe, Mitsuaki
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.07.2005; Wiley
• Subjects: Aged; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - therapeutic use; atrial fibrillation; Atrial Fibrillation - drug therapy; atrial flutter; Atrial Flutter - chemically induced; Atrial Flutter - therapy; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial; Cardiology. Vascular system; Catheter Ablation; class Ic drug; Clinical Investigation; Clinical Investigations; Combined Modality Therapy; Dose-Response Relationship, Drug; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart; Humans; hybrid therapy; Lidocaine - adverse effects; Lidocaine - analogs & derivatives; Lidocaine - therapeutic use; Male; Medical sciences; Middle Aged; pilsicainide; Prospective Studies; Sodium Channel Blockers - adverse effects; Sodium Channel Blockers - therapeutic use; Treatment Outcome; Human; Drug; Arrhythmia; Atrial fibrillation; Catheter; Cardiovascular disease; catheter ablation; Ablation; Long term; Phlebology; Excitability disorder; Pilsicainide; Atrial flutter; class Ic drug; Treatment; Efficiency; hybrid therapy; Heart disease; Circulatory system; Cardiology
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960280707

Background: Combination therapy with catheter ablation of the cavo‐tricuspid isthmus and continued drug therapy, that is, “hybrid therapy,” in patients with atrial fibrillation (AF) and drug‐induced atrial flutter (AFL) is reported to be an alternative means of achieving and maintaining sinus rhythm. With respect to choosing this method among the rhythm control therapies, its long‐term efficacy and the prevalence of AFL in patients with AF are very important and have not been fully elucidated. Hypothesis: The purpose of this study was to investigate the long‐term effectiveness of this hybrid therapy and the dose prevalence inIc drug‐induced AFL. Methods: The subjects were 89 patients (aged 62.4 years, 72 men) with episodes of AF (paroxysmal type: 65, persistent type: 11, permanent type: 13). After 4 weeks of oral pilsicainide administration, the dose was increased in those with no documented AFL. The patients who experienced AFL with pilsicainide (Ic‐AFL) underwent ablation. Results: Pilsicainide administration resulted in the common type AFL in 17 patients (19.1%). The pilsicainide plasma concentration in the patients with Ic‐AFL was significantly higher than in those without AFL (0.79 ± 0.41 vs. 0.51 ± 0.24 μg/ml, respectively, p < 0.01). During a 10–54 (mean 37 ± 14) month follow‐up period, sinus rhythm was maintained in 10 of 12 patients after successful ablation followed by continued antiarrhythmic drug administration. Conclusions: Hybrid therapy with ablation and high doses of pilsicainide was useful in maintaining sinus rhythm in some selected patients with AF and drug‐induced AFL.