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Relationship Between Amiodarone Response prior to Ablation and One-Year Outcomes of Catheter Ablation for Atrial Fibrillation
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  • Ritu Yadav,
  • Justin Brilliant,
  • Tauseef Akhtar,
  • Jenna Milstein,
  • James R. Sampognaro,
  • Joseph Marine,
  • Ronald Berger,
  • Hugh Calkins,
  • David Spragg
Ritu Yadav
Johns Hopkins Medicine Division of Cardiology

Corresponding Author:[email protected]

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Justin Brilliant
Johns Hopkins Medicine Division of Cardiology
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Tauseef Akhtar
Johns Hopkins Medicine Division of Cardiology
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Jenna Milstein
Johns Hopkins Medicine Division of Cardiology
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James R. Sampognaro
Johns Hopkins Medicine Division of Cardiology
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Joseph Marine
Johns Hopkins Medicine Division of Cardiology
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Ronald Berger
Johns Hopkins Medicine Division of Cardiology
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Hugh Calkins
Johns Hopkins Medicine Division of Cardiology
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David Spragg
Johns Hopkins Medicine Division of Cardiology
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Abstract

Background: Catheter ablation for atrial fibrillation (AF) is a common therapeutic strategy for patients with either paroxysmal or persistent AF, but long-term ablation success rates are imperfect. Maintenance of sinus rhythm immediately prior to ablation with anti-arrhythmic drug (AAD) therapy has been associated with improved outcomes in patients undergoing ablation. Amiodarone has superior efficacy relative to other AADs. Whether failure of amiodarone to maintain sinus rhythm prior to ablation for either paroxysmal or persistent AF is associated with poor outcomes is unknown. Methods: A total of 307 patients who received amiodarone in a one-year window before undergoing catheter ablation for AF were included. Patients were divided into amiodarone success (n=183) and amiodarone failure (n=124) groups based on the response to pre-ablation amiodarone treatment. Analysis of procedural outcomes as a function of response to amiodarone therapy was performed. Patients were followed for at least 12 months post-ablation to assess outcomes (adverse events and arrhythmia recurrence). Procedural success was defined by the absence of documented arrhythmia (>30s) without any anti-arrhythmic agents beyond a 90d blanking period. Results: Following ablation for either paroxysmal or persistent AF, freedom from any recurrent atrial arrhythmia at 1y was 57.7% for the entire cohort. One-year freedom from recurrent arrhythmia in the amiodarone success group was comparable to that in the amiodarone failure group (55.7% vs 60.5%; p=0.54). Success rates following ablation did not vary by the response to amiodarone when analyzed for paroxysmal or persistent AF subgroups. Conclusion: Failure to restore and maintain sinus rhythm with amiodarone prior to ablation for either paroxysmal or persistent AF is not a predictor of ablation procedural failure. Amiodarone failure alone should not deter practitioners from considering ablation therapy for patients with AF.
12 Sep 2022Submitted to Journal of Cardiovascular Electrophysiology
21 Sep 2022Submission Checks Completed
21 Sep 2022Assigned to Editor
26 Sep 2022Reviewer(s) Assigned
19 Oct 2022Review(s) Completed, Editorial Evaluation Pending
20 Oct 2022Editorial Decision: Revise Minor
29 Nov 20221st Revision Received
01 Dec 2022Review(s) Completed, Editorial Evaluation Pending
01 Dec 2022Submission Checks Completed
01 Dec 2022Assigned to Editor
01 Dec 2022Reviewer(s) Assigned
20 Dec 2022Editorial Decision: Revise Minor
05 Jan 20232nd Revision Received
11 Jan 2023Submission Checks Completed
11 Jan 2023Assigned to Editor
11 Jan 2023Review(s) Completed, Editorial Evaluation Pending
11 Jan 2023Reviewer(s) Assigned
25 Jan 2023Editorial Decision: Accept