Objectives: The association between the efficacy of AADs and LA size in AF management remains unclear. Methods: 383 patients with symptomatic paroxysmal or persistent AF (PeAF) (282 male, 59±12 years), who were treated with class Ic drug (n=343; flecainide, n=336 or propafenone, n=54) or amiodarone (n = 155), were analyzed. Results: 165 (48%) did not respond to class Ic drug and 92(59%) did not to amiodarone. Class Ic drug failure group had more PeAF (39% vs 14%, p<0.01), larger LA size(42±7 vs 40±6, p<0.01) and more LA AP diameter (LAd)>41mm (61% vs 44%, p<0.01). There was no statistical difference in other clinical and echocardiographic parameters (all p>0.05). Amiodarone failure group had more PeAF (49% vs 29%, p<0.01) but was not related to LA size (p>0.05). PeAF (OR 4.5, 95% CI:2.588~7.823, p<0.01) and LAd>41mm (OR 1.7, 95% CI:1.057~2.703, p=0.03) were independent predictors of class Ic drug failure, whereas only PeAF was an independent predictor of amiodarone failure. Class Ic drug failure rates in paroxysmal AF with LAd<41mm, paroxysmal AF with LAd>41mm, PeAF with LAd<41mm and PeAF with LAd>41mm were 33%, 45%, 70% and 77%. respectively (p<0.01). Conclusions: The efficacy of class Ic AADs was dependent on LA size and AF type synergistically, whereas the efficacy of amiodarone was not associated with LA size.
All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine