When should bepridil concomitant with catheter ablation for persistent atrial fibrillation be discontinued? The importance of left atrial reverse remodeling.

Bepridil are often administered after catheter ablation (CA) in patients with persistent atrial fibrillation (AF); however, it is unclear for how long it should be continued. We administered hybrid therapy consisting of CA and bepridil to 130 patients with persistent AF and left atrial (LA) enlargement (volume index > 48 ml/m). After 2 months of hybrid therapy, bepridil discontinuation was attempted. All patients underwent echocardiography 6 months after CA. We investigated the relationship between the duration of bepridil administration and the recurrence of AF after bepridil discontinuation. After excluding patients who were unable to maintain sinus rhythm during bepridil administration (n = 18), and those who disagreed to bepridil discontinuation (n = 17), 95 patients were divided into the short-term continuation (bepridil discontinued for < 6 months [median 3 months] after CA [n = 63]), and long-term continuation (bepridil discontinued for > 6 months [median 11.4 months] after CA [n = 32]) groups. During the mean follow-up period of 28 ± 15 months, the groups showed a similar incidence of recurrent AF after bepridil discontinuation. In the long-term continuation group, 13 patients had recurrence, with 8 (62%) cases occurring within 4 months after discontinuation. A multivariate Cox regression analysis revealed that left atrial (LA) reverse remodeling (> 15% decrease in LA volume index at 6 months) was an independent predictor of recurrent AF after CA (p < 0.01). Long-term bepridil administration after CA did not affect the recurrence of AF after discontinuation. The assessment of LA reverse remodeling may be useful for decision-making regarding the discontinuation of antiarrhythmic drugs after CA.