Journal of arrhythmia · 2025
Clinical insights into the role of bepridil in recurrence prevention after ablation of persistent atrial fibrillation.
СтатьяНазвание и аннотация: Перевод в очереди
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Hirata Moyuru, Nagashima Koichi, Watanabe Ryuta, Wakamatsu Yuji, Otsuka Naoto, Hirata Shu, Sawada Masanaru, Saito Yuji, Kurokawa Sayaka, Murotani Kenta, Okumura Yasuo
Аннотация
BACKGROUND: The role of bepridil in preventing atrial fibrillation (AF) recurrence following ablation for persistent atrial fibrillation (PerAF) remains uncertain, particularly in patients with severe atrial substrates.
METHODS: This retrospective study included 232 consecutive PerAF patients who underwent AF ablation between 2014 and 2019. Among them, 162 received bepridil for 3 months post-ablation (Bepridil group), while 70 received no antiarrhythmic drugs (No-AADs group). Baseline characteristics, procedural details, and outcomes were compared. Kaplan-Meier analysis and Cox regression models were used to evaluate AF/atrial tachycardia (AT) recurrence, with bepridil use treated as a time-dependent covariable.
RESULTS: The Bepridil group had a higher body mass index (25.1 ± 3.7 vs. 23.8 ± 3.9), a higher prevalence of patients with a LAD >40 mm and a LAV >50 mL (67.9% vs. 47.1%, 64.2% vs. 48.5%, respectively), and lower left atrial appendage flow velocity (37.6 ± 15.0 vs. 42.7 ± 20.5 cm/min). They more frequently underwent intracardiac atrial cardioversion (61.7% vs. 40.0%) and additional extra-pulmonary vein ablation (35.2% vs. 15.7%), but were less likely to receive balloon-based ablation (39.5% vs. 62.9%) (p < 0.05 for all comparison). During a median follow-up of 23.3 months, AF/AT-free survival at 2 years was comparable between the Bepridil and No-AADs groups (80.4% vs. 81.7%; p = 0.61). This finding remained consistent after adjusting for baseline characteristics and considering bepridil as a time-dependent covariable. No bepridil-related adverse events occurred.
CONCLUSION: Bepridil may have a limited role in preventing AF/AT recurrence in PerAF patients, particularly those with severe atrial substrates. However, its overall impact appears to be small, warranting further investigation.
METHODS: This retrospective study included 232 consecutive PerAF patients who underwent AF ablation between 2014 and 2019. Among them, 162 received bepridil for 3 months post-ablation (Bepridil group), while 70 received no antiarrhythmic drugs (No-AADs group). Baseline characteristics, procedural details, and outcomes were compared. Kaplan-Meier analysis and Cox regression models were used to evaluate AF/atrial tachycardia (AT) recurrence, with bepridil use treated as a time-dependent covariable.
RESULTS: The Bepridil group had a higher body mass index (25.1 ± 3.7 vs. 23.8 ± 3.9), a higher prevalence of patients with a LAD >40 mm and a LAV >50 mL (67.9% vs. 47.1%, 64.2% vs. 48.5%, respectively), and lower left atrial appendage flow velocity (37.6 ± 15.0 vs. 42.7 ± 20.5 cm/min). They more frequently underwent intracardiac atrial cardioversion (61.7% vs. 40.0%) and additional extra-pulmonary vein ablation (35.2% vs. 15.7%), but were less likely to receive balloon-based ablation (39.5% vs. 62.9%) (p < 0.05 for all comparison). During a median follow-up of 23.3 months, AF/AT-free survival at 2 years was comparable between the Bepridil and No-AADs groups (80.4% vs. 81.7%; p = 0.61). This finding remained consistent after adjusting for baseline characteristics and considering bepridil as a time-dependent covariable. No bepridil-related adverse events occurred.
CONCLUSION: Bepridil may have a limited role in preventing AF/AT recurrence in PerAF patients, particularly those with severe atrial substrates. However, its overall impact appears to be small, warranting further investigation.