Clinical efficacy of irrigated catheter application of amiodarone during ablation of persistent atrial fibrillation

Background: Pharmacological treatment during ablation of persistent atrial fibrillation (AF) is common, but utility of irrigated catheter application of amiodarone during ablation of persistent AF remains unclear. Hypothesis: Irrigated catheter application of amiodarone improves quality of ablation and long-term outcomes. Methods: We enrolled 90 persistent AF patients who underwent catheter ablation. Patients were randomized to the amiodarone group (n = 45) or control group (n = 45). All patients underwent stepwise ablation beginning with isolation of the pulmonary veins. Next, we performed ablation of linear lesions and focal triggers until sinus rhythm (SR) was achieved. The primary endpoint was documented atrial arrhythmia during follow-up. The secondary endpoint was cardioversion to SR during ablation. Results: All pulmonary veins were successfully isolated. Conversion of AF to SR occurred more frequently in the amiodarone group than in the control group (33 vs 23 [73.3% vs 51.1%]; P = 0.03). The amiodarone group had lower procedure, radiofrequency, and fluoroscopy times than the control group (167.4 +/- 22.5 min vs 186.7 +/- 25.3 min; 78.3 +/- 14.2 min vs 90.4 +/- 15.5 min; and 6.5 +/- 1.9 min vs 8.6 +/- 2.4 min, respectively; P < 0.05). More importantly, the atrial arrhythmia recurrence-free survival rates were 80% in the amiodarone group and 60% in the control group during the 14.7 +/- 7.5-month follow-up (P = 0.043). Conclusions: Irrigated catheter application of amiodarone during ablation for persistent AF resulted in higher cardioversion rates and lower procedure times and significantly reduced rates of atrial arrhythmia recurrence.