Aims: Bepridil is highly effective in terminating persistent atrial fibrillation (AF). Despite continued treatment, a high rate of AF recurrence after pharmacological cardioversion (PC) with bepridil has been reported. Bepridil therapy is also associated with significant adverse effects.
Methods and results: This retrospective case-control study included 82 patients with persistent AF (PEF). Group 1 (22 patients) comprised cases undergoing AF ablation following attempted PC with bepridil. Group 2 (60 patients) comprised control that underwent AF ablation without bepridil pre-treatment. In Group 1, 15 patients (68%) restored sinus rhythm (SR) with bepridil (SR group) and 7 continued to have AF (AF group). SR group underwent extensive pulmonary vein isolation (EPVI) alone. AF group and Group 2 underwent linear ablation after EPVI, if AF was inducible. At the end of 18 +/- 5 months off antiarrhythmic drugs, the AF-free rate was 87% in SR group, 29% in AF group, and 72% in Group 2 (72 vs. 29%, P = 0.02).
Conclusion: Following AF ablation in patients who successfully restored SR with bepridil pre-treatment, AF-free rate was significantly higher than in those who failed to do so. Conversion to SR with bepridil might help select the optimal patients with PEF for catheter ablation.