© 2002 by European Society of Cardiology
Atrial fibrillation threshold predicted long-term efficacy of pharmacological treatment of patients without structural heart disease
Kyoto Prefectural University of Medicine, Second Department of Medicine Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
AIMS: To ascertain if an electrophysiological study could predict long-term efficacy of anti-arrhythmic drugs in the treatment of lone atrial fibrillation.
METHODS AND RESULTS: Forty-four patients (36 males, 8 females, age 55·5±10·6) with paroxysmal atrial fibrillation were enroled to undergo serial electrophysiological studies at the bedside. Two quadripolar catheters were inserted via the subclavian vein. Disopyramide (D: 2 mg/kg iv), cibenzoline (C: 1·4 mg/kg iv), aprindine (A: 2 mg/kg iv), pilsicainide (P: 2 mg/kg po) and flecainide (F: 3 mg/kg po) were tested. Atrial fibrillation threshold (AFT) was measured as the lowest current amplitude of rapid pacing (50 Hz for 1 s) to induce atrial fibrillation lasting more than 30 s.
Before drug treatment, AFT was 3·9±0·3 mA. Pharmacological treatment raised AFT as follows: D 5·9±0·9 mA, C 7·6±1·2 mA, A 8·1±1·1 mA, P 6·0±0·8 mA, F 7·3±1·1 mA. Recurrence of atrial fibrillation was observed during 1-year follow-up in 12% of cases when they were treated with a drug that raised AFT by 5 mA or more. On the other hand, the recurrence rate was 87% when patients were treated with a drug that raised AFT by less than 5 mA (P=0·001).
CONCLUSION: AFT was a good predictor of long-term efficacy of pharmacological treatment against atrial fibrillation.
Key Words: Atrial fibrillation, threshold, anti-arrhythmic agent
Correspondence: Takeshi Shirayama, Kyoto Prefectural University of Medicine, Second Department of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. Tel.: +81-75-251-5511; Fax: +81-75-251-5514; E-mail: sirayama{at}koto.kpu-m.ac.jp
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