Comparative Effectiveness of Antiarrhythmic Drugs on Early Atrial Tachyarrhythmias in the Blanking Period After Atrial Fibrillation Catheter Ablation.

Background: Early recurrence of atrial tachyarrhythmia (ERAT) after ablation for atrial fibrillation (AF) is common during the blanking period; however, no standardized management approach exists. This study aimed to identify effective antiarrhythmic drugs (AADs) during the blanking period and to examine the association between AAD efficacy and long-term outcomes. Methods: Initially, 497 patients who underwent catheter ablation for AF between April 2017 and December 2022 were included. Among these, patients who experienced ERAT after their first AF ablation were analyzed for this retrospective study. During the blanking period, the effectiveness of three AAD regimens, pilsicainide, bepridil, and bepridil plus aprindine, was compared. Patients were followed for 2 years after AAD discontinuation and stratified according to late recurrence. Results: Among the 75 patients analyzed, ERAT was suppressed in 29.6% (8/27) with pilsicainide, 38.1% (8/21) with bepridil, and 77.8% (21/27) with bepridil plus aprindine ( Conclusion: Bepridil, particularly in combination with aprindine, was effective for managing ERAT after AF ablation. A poor response to bepridil or to bepridil plus aprindine during the blanking period may serve as a marker for identifying patients at higher risk of late recurrence.