Is nifekalant more effective than amiodarone in improving the clinical outcomes of catheter ablation in patients with persistent atrial fibrillation?

BACKGROUND

Traditionally, amiodarone or electrical cardioversion was used if radiofrequency catheter ablation (RFCA) could not terminate atrial fibrillation during the procedure in patients with persistent atrial fibrillation (PeAF).

OBJECTIVE

To investigate whether the nifekalant instead of amiodarone during RFCA improve procedure outcomes in patients with PeAF.

METHODS

This study enrolled patients with PeAF who failed to achieve cardioversion after initial ablation at our center between January 2020 and December 2022. These patients were classified into the nifekalant (N) group and the amiodarone (A) group. And patients were followed for 1 year to evaluate long-term success rates. Subgroup analyses and the logistic regression analyses were performed.

RESULTS

The study comprised 300 participants and included N (n = 121) and A (n = 179) groups. Following propensity score matching (PSM), 101 participants were in each group. Within the N and A groups, 57(56.44 %) and 19(18.81 %) cases successfully terminated AF, 45 (44.56 %) and 15(14.85 %) cases achieved conversion to atrial tachycardia (P < 0.001), respectively. The ventricular tachycardia was observed in only one case in the N group (P > 0.05). The follow-up results demonstrated that one-year success rates were 63.37 % and 49.50 % for the N and A groups (P < 0.05).

CONCLUSION

For patients with PeAF that persists after initial catheter ablation, compared to amiodarone, administration of nifekalant could convert atrial fibrillation into atrial tachycardia, following by target ablation, has the potential to improve the procedure outcomes.