LONG-TERM EFFICACY OF ANTIARRHYTHMIC DRUG THERAPY AND ITS INFLUENCE TO THE PROGNOSIS IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION

摘要

We examined the long-term efficacy of serial antiarrhythmic drug therapy (AAT) in 290 patients with paroxysmal AF (mean age, 69 years), and studied the relationship between the response to AAT and long-term prognosis of the patients. After sinus rhythm was restored spontaneously or by cardioversion, one of the following class I drugs, disopyramide (300 mg/day), cibenzoline (300 mg/day), and aprindine (60 mg/day), was selected by an envelope method (the first drug) and was administered orally. When AF recurred, one of the following drugs, flecainide (150 mg/day), pilsicainide (150 mg/day) and bepridil (150 mg/day), was selected by an envelope method (the second drug). When AF recurred, amiodarone or class I antiarrhythmic drug that was not used before was administered (the third drug). After treatment with the first drug, 51%, 47% and 35% of the patients treated with disopyramide, cibenzoiine and aprindine, respectively, were free from AF recurrence at one year. After the second drug, 33%, 33% and 21% of the patients treated with flecainide, pilsicainide and bepridil, respectively, were free from AF recurrence at one year. After the third drug, 43% and 18% of the patients treated with amiodarone and class I antiarrhythmic drug that was not used before, respectively, were free from AF recurrence at one year. During a mean follow-up period of 51+-29 months, 114 patients (39%) had no AF recurrence (Group 1), 113 (39%) had repeated AF recurrence (Group 2), and the remaining 63 (22%) had permanent AF despite AAT (Group 3). Survival rate without any cardiovascular deaths at 60 months was 99% in Group 1, 95% in Group 2 and 94% in Group 3 (p=NS among 3 groups). Survival rate without symptomatic ischemic stroke was 99% in Group 1, 88% in Group 2 and 76% in Group 3 (<0.05 Group 1 versus Groups 2 and 3).