Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia
observed in clinical practice. It can occur even in the absence of heart
disease and is associated with a significant burden on patients and
healthcare. Recently, it has been suggested that rhythm control therapy,
including antiarrhythmic drugs (AADs) and catheter ablation (CA), may
prevent not only subjective symptoms such as palpitations and shortness
of breath but also AF-related death, heart failure, and stroke in
high-risk patients.1 However, in patients with an
enlarged left atrium (LA), the sinus rhythm maintenance rate is reported
to be only 40–60%.2,3 A large number of patients are
treated with AADs in combination with CA for refractory
AF.4 Bepridil is effective in terminating long-lasting
persistent AF,5 and is recommended as the standard AAD
for rhythm control in persistent AF in the guidelines for
AF.6 However, it is unclear how long bepridil in
combination with CA should be continued and the benefits of long-term
administration remain to be determined. Prolonged use of bepridil
sometimes causes remarkable QT prolongation and life-threatening
arrhythmias, including torsades de pointes, particularly in the
elderly.7
In some cases of AF, the LA size decreases after rhythm control, which
is considered to indicate LA reverse remodeling.8 In
addition, previous experimental studies have suggested that bepridil has
a reverse electrical remodeling effect.9,10 LA reverse
remodeling could lead to favorable outcomes in the late
phase.11,12 In this study, we investigated the
differences in post-ablation outcomes depending on the duration of the
concomitant use of bepridil, and the impact of LA reverse remodeling on
maintenance of sinus rhythm after hybrid therapy consisting of
CA and bepridil.