Longer diagnosis-to-ablation time is associated with recurrence of atrial fibrillation after catheter ablation-Systematic review and meta-analysis

Early rhythm control compared to rate control in atrial fibrillation - A systematic review, meta-analysis, and meta-regression

BACKGROUND

This meta-analysis aimed to compare the effectiveness of early rhythm control to rate control, and whether catheter ablation derived more benefit compared to other methods of rhythm control.

METHODS

A comprehensive literature search was conducted on PubMed, SCOPUS, and EuropePMC up to July 2, 2024. The primary outcome of this study was major adverse cardio-cerebrovascular events (MACCE), defined as a composite of mortality, stroke/systemic embolism, heart failure hospitalization (HFH), and acute coronary syndrome (ACS) during the follow-up period. Outcome measures were adjusted hazard ratios (aHR).

RESULTS

A total of 504,124 patients from 11 studies were included in this systematic review and meta-analysis. Early rhythm control was significantly associated with reduction in MACCE (aHR 0.85 [95 % CI 0.80, 0.90], p < 0.001; I2: 23 %), stroke (aHR 0.79 [95 % CI 0.72, 0.86], p < 0.001; I2: 25 %), HFH (aHR 0.87 [95 % CI 0.78, 0.96], p = 0.008; I2: 48 %), and ACS (aHR 0.80 [95 % CI 0.66, 0.96], p = 0.018; I2: 40 %). No mortality benefit (aHR 0.93 [95 % CI 0.85, 1.01], p = 0.066; I2: 67 %) was observed; however, mortality benefit became evident (aHR 0.87 [95 % CI 0.85, 0.89], p < 0.001) upon removal of a study during a leave-one-out sensitivity analysis. Meta-regression analysis showed that the benefits of early rhythm control in terms of MACCE were more pronounced with ablation (coefficient -0.004, p = 0.010, R2: 100 %).

CONCLUSION

Early rhythm control was associated with better outcomes compared to rate control in AF, with a more pronounced benefit observed for ablation.

Meta-analysis of Pulsed Field Ablation Versus Thermal Ablation for Pulmonary Vein Isolation in AF: A Broad Overview Focusing on Efficacy, Safety and Outcomes

The recently established non-thermal, single-shot pulsed field ablation (PFA) is a potential tool for achieving rapid pulmonary vein isolation (PVI) to cause cell death by electroporation, yet data regarding this state-of-the-art technology remain sparse. In this meta-analysis, we included 3,857 patients from 20 studies. There was no significant difference in AF recurrence between the PFA and control groups. Subgroup analysis showed that additional ablation beyond PVI has a similar rate of AF recurrence to PVI alone (10% versus 13%, respectively). PVI durability was achieved in 83% (mean), 95% CI [65-99%] of the PFA group and in 79% (mean), 95% CI [60-98%] of the control group, with no significant difference in the rate of PVI durability between the two groups. The PFA group had considerably reduced procedure duration, but not fluoroscopy time. No statistically significant differences in periprocedural complications were observed. PFA is associated with shorter procedural time than thermal ablation. Cardiac complications were uncommon and mainly reversible in both the PFA and control groups.

Very-high-power Short-duration Ablation versus Conventional Ablation for Pulmonary Vein Isolation in Atrial Fibrillation: Systematic Review and Meta-analysis

The aim of this study was to compare the effectiveness and safety of very-high-power short-duration (VHPSD) ablation (70-90 W/4-7 s) with conventional ablation (30-40 W/>20 s, 50 W/7-11 s) for pulmonary vein isolation (PVI) in patients with AF. A total of 13 studies were included in this analysis (1,527 patients). AF recurrence occurred in 14% (95% CI [11-18%]) of the VHPSD group. VHPSD was associated with lower AF recurrence (OR 0.65; 95% CI [0.48-0.89]; p=0.006) compared with the conventional ablation group. Subgroup analysis showed that additional ablation beyond PVI had a similar rate of AF recurrence (16% versus 10%) compared with PVI alone. Procedure and ablation durations were significantly shorter in the VHPSD group with a mean differences of -14.4 minutes (p=0.017) and -14.1 minutes (p<0.001), respectively. Complications occurred in 6% (95% CI [3-9%]) of the VHPSD group, and the rate was similar between the two groups (OR 1.03; 95% CI [0.60-1.80]; p=0.498). VHPSD ablation resulted in less AF recurrence and a shorter procedure time. Additional ablation beyond PVI alone in VHPSD may not provide additional benefits.

Online Automatic Diagnosis System of Cardiac Arrhythmias Based on MIT-BIH ECG Database

Arrhythmias are a relatively common type of cardiovascular disease. Most cardiovascular diseases are often accompanied by arrhythmias. In clinical practice, an electrocardiogram (ECG) can be used as a primary diagnostic tool for cardiac activity and is commonly used to detect arrhythmias. Based on the hidden and sudden nature of the MIT-BIH ECG database signal and the small-signal amplitude, this paper constructs a hybrid model for the temporal correlation characteristics of the MIT-BIH ECG database data, to learn the deep-seated essential features of the target data, combine the characteristics of the information processing mechanism of the arrhythmia online automatic diagnosis system, and automatically extract the spatial features and temporal characteristics of the diagnostic data. First, a combination of median filter and bandstop filter is used to preprocess the data in the ECG database with individual differences in ECG waveforms, and there are problems of feature inaccuracy and useful feature omission which cannot effectively extract the features implied behind the massive ECG signals. Its diagnostic algorithm integrates feature extraction and classification into one, which avoids some bias in the feature extraction process and provides a new idea for the automatic diagnosis of cardiovascular diseases. To address the problem of feature importance variability in the temporal data of the MIT-BIH ECG database, a hybrid model is constructed by introducing algorithms in deep neural networks, which can enhance its diagnostic efficiency.

Risk factors for late recurrence in patients with nonvalvular atrial fibrillation after radiofrequency catheter ablation

Objective

To identify the risk factors for postoperative atrial fibrillation (AF) recurrence in nonvalvular AF patients undergoing radiofrequency catheter ablation (CA).

Methods

We retrospectively reviewed the data from 426 of 450 AF patients who underwent CA. Patients were divided into two groups according to recurrence after the operation; the risk factors for AF recurrence were analyzed. A stratification system for lesions was created based on the cutoff of the risk factors; the associations among the subgroups and the AF recurrence rate were analyzed.

Results

AF recurrence occurred in 98 (23.0%) patients. Univariate analysis demonstrated that AF type, hypertrophic cardiomyopathy, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), serum albumin, and D‐dimer concentrations were associated with AF recurrence. AF type (OR =2.907, p < .001), serum albumin concentration (OR =1.112, p < .05), and LAD (OR =1.115, p < .001) were independent risk factors for AF recurrence. The area under the ROC curve of LAD for the prediction of AF recurrence was 0.722 (95% CI: 0.664~0.779) and that of serum albumin for the prediction of AF recurrence was 0.608 (95% CI: 0.545~0.672). Further stratification revealed that patients with persistent or paroxysmal AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L had a higher rate of AF recurrence than the reference group.

Conclusion

Atrial fibrillation type, LAD, and serum albumin concentration are risk factors for AF recurrence after CA in patients with nonvalvular AF. Patients with persistent AF with LAD ≥43.5 mm and serum albumin concentration ≥42.2 g/L have a higher risk of late AF recurrence after surgery.

BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis

INTRODUCTION

The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. We aimed to evaluate the dose-response relationship between body mass index (BMI) and AF recurrence and adverse events.

METHODS

A systematic literature search was conducted using PubMed, Europe PMC, EBSCO, ProQuest and Cochrane Library. Obesity was defined as BMI ≥28 kg/m2 . The primary outcome was AF recurrence, and the secondary outcome was adverse events. Adverse events were defined as procedure-related complications and cardio-cerebrovascular events.

RESULTS

There were a total of 52,771 patients from 20 studies. Obesity was associated with higher AF recurrence (Odds ratio [OR] 1.30 [95% confidence interval [CI] 1.16-1.47], P < .001; I2 : 72.7%) and similar rate of adverse events (OR 1.21 [95% CI 0.87-1.67], P = .264; I2 : 23.9%). Meta-regression showed that the association varies by age (coefficient: -0.03, P = .024). Meta-analysis of highest versus lowest BMI showed that the highest group had higher AF recurrence (OR 1.37 [95% CI 1.18-1.58], P < .001; I2 : 64.9%) and adverse events (OR 2.02 [95% CI 1.08-3.76], P = .028; I2 : 49.5%). The linear association analysis for AF recurrence was not significant (P = .544). The dose-response relationship for BMI and AF recurrence was nonlinear (pnonlinearity  < 0.001), the curve became steeper at 30-35 kg/m2 . For adverse events, an increase of 1% for every 1 kg/m2 increase in BMI (OR 1.01 [95% CI 1.00-1.02], P = .001), the relationship was nonlinear (pnonlinearity  = 0.001).

CONCLUSION

Obesity was associated with higher AF recurrence in patients undergoing catheter ablation. High BMI might be associated with a higher risk for adverse events.

PROSPERO ID

CRD42020198787.

Cryoballoon ablation for paroxysmal atrial fibrillation: mid-term outcome evaluated by ECG monitoring with an implantable loop recorder

BACKGROUND

The success rate after cryoballoon ablation (CB-A) performed for paroxysmal atrial fibrillation (PAF) might be overestimated by traditional noninvasive monitoring techniques. The purpose of this study was to evaluate the mid-term outcome of CB-A in patients with PAF implanted with an implantable loop recorder (ILR) after the procedure.

METHODS

Between January 2017 and March 2019, all patients who underwent CB-A for PAF and who were subsequently implanted with an ILR were retrospectively included. All devices were equipped with remote monitoring. All ILR-documented atrial tachycardia (AT) or AF episodes ≥ 6 min were considered as recurrence; both true and false episodes were collected. A 3-month post-procedural blanking period (BP) was applied.

RESULTS

A total of 102 patients (77 men, mean age 60.6 ± 9.6 years) who underwent pulmonary vein isolation (PVI) by CB-A were included; mean time from first diagnosis of AF to PVI was 51.5 ± 46.9 months. Mean follow-up was 29.3 ± 8.1 months; at 12-month follow-up, the success rate was 65.7%, while at 2-year follow-up, freedom from AT/AF recurrences was achieved in 59.3% of the patients. In the follow-up, a total of 4987 ECG strips were analyzed; true-positive episodes were confirmed in 2026 cases (40.6%), whereas 2961 episodes (59.4%) were considered false-positive.

CONCLUSION

In patients with PAF implanted with an ILR, CB-A results in freedom from any AT/AF recurrence in 65.7% of patients at 12-month follow-up and in 59.3% of patients when evaluated at 2-year. Careful adjudication of all ILR-documented AF episodes is required to avoid misdiagnosis.

Efficacy and safety of renal denervation in addition to pulmonary vein isolation for atrial fibrillation and hypertension-Systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

This systematic review and meta-analysis aimed to assess the latest evidence on the use of renal denervation (RDN) + pulmonary vein isolation (PVI) compared to PVI alone for treating atrial fibrillation (AF) with hypertension.

METHODS

A systematic literature search from several electronic databases was performed up until January 2020. The primary outcome was AF recurrence defined as AF/atrial flutter (AFL)/atrial tachycardia (AT) ≥30 seconds at 12-month follow-up and the secondary outcome was procedure-related complications.

RESULTS

There were 568 subjects from five studies. AF recurrence was 90/280 (32.1%) in the RDN + PVI group and 142/274 (51.8%) in the PVI group. RDN + PVI was associated with a lower incidence of AF recurrence (RR 0.62 [0.51, 076], P < .001; I 2: 0%). Pooled analysis of HR showed that RDN + PVI was associated with reduced AF recurrence (HR 0.51 [0.38, 0.70], P < .001; I 2: 0%). Complications were 7/241 (2.9%) in the RDN + PVI group and 8/237 (3.4%) in the PVI group. The rate of complications between the groups was similar (RR 0.87 [0.33, 2.29], P = .77; I 2: 0%). In the subgroup analysis of paroxysmal AF, RDN + PVI was shown to reduce AF recurrence (RR 0.64 [0.49, 0.82], P < .001; I 2: 0% and HR 0.56 [0.38, 0.82], P = .003; I 2: 0%) compared to PVI alone. RDN + PVI has a moderate certainty of evidence in the reducing AF recurrence with an absolute reduction of 197 fewer per 1000 (from 254 fewer to 124 fewer).

CONCLUSION

RDN in addition to PVI, is associated with reduced 12-month AF recurrence and similar procedure-related complications compared to PVI alone.