Effectiveness of rhythm control in persistent or permanent atrial fibrillation with overdrive atrial pacing and antiarrhythmic drugs after linear right atrial catheter ablation

Right atrial (RA) maze procedures using linear catheter ablation have had limited efficacy in paroxysmal atrial fibrillation (AF). We hypothesized that “hybrid” therapy using overdrive atrial pacing and antiarrhythmic drugs can improve efficacy of catheter RA maze and expand its role to persistent or permanent AF. Catheter RA maze procedures were performed in 26 patients with persistent or permanent AF refractory to 4.5 ± 2.1 antiarrhythmic drugs. Overdrive dual-site RA pacing (21 patients) or high RA pacing (5 patients) was continued (n = 11) or instituted periablation (n = 15). All patients continued receiving previously ineffective antiarrhythmic drugs. Freedom from permanent AF (rhythm control), symptomatic and/or asymptomatic AF recurrences, the safety of hybrid therapy, and overall survival were assessed. There was no procedure-related mortality or stroke. Rhythm control was achieved in 24 patients (92%) within 3 months. During long-term follow-up (6 to 49 months, mean 17 ± 10), rhythm control was maintained in 20 patients (77%). Nine patients (35%) had no AF recurrences, whereas 11 patients maintained rhythm control with infrequent AF recurrences. Device datalogs at the study cut-off point demonstrated no AF events in 6 patients, nonsustained atrial tachycardia in 2 patients, and brief asymptomatic paroxysmal AF in 12 patients. Actuarial patient survival was 95% at 1 year and 74% at 2 years of follow-up. Thus, hybrid therapy utilizing catheter RA maze procedures with overdrive atrial pacing and antiarrhythmic drugs can be performed safely and can reestablish rhythm control in selected patients with refractory persistent or permanent AF.