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Yue X, Zhou L, Li Y, Zhao C. Multidisciplinary management strategies for atrial fibrillation. Curr Probl Cardiol 2024; 49:102514. [PMID: 38518845 DOI: 10.1016/j.cpcardiol.2024.102514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
There has been a significant increase in the prevalence of atrial fibrillation (AF) over the past 30 years. Pulmonary vein isolation (PVI) is an effective treatment for AF, but research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. Heart rhythm outcomes following catheter ablation are correlated with numerous clinical factors, and researchers developed predictive models by integrating risk factors to predict the risk of recurrence of atrial fibrillation. The purpose of this article is to outline the risk scores for predicting cardiac rhythm outcomes after PVI and to discuss the modifiable factors that increase the risk of recurrence of AF, with the hope of further improving catheter ablation efficacy through preoperative identification of high-risk populations and postoperative management of modifiable risk factors.
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Affiliation(s)
- Xindi Yue
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ling Zhou
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yahui Li
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chunxia Zhao
- Division of Cardiology, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Yang J, Song Y, Bian S, Zhang B, Zhang Y, Wang X, Cheng L, Fan Y, Liu C, Tan H. Evaluation of the effectiveness and safety of a novel substrate-based radiofrequency ablation for persistent atrial fibrillation: a prospective, randomised, parallel-controlled, single-blinded study protocol. BMJ Open 2024; 14:e080539. [PMID: 38417952 PMCID: PMC10900394 DOI: 10.1136/bmjopen-2023-080539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is the cornerstone of radiofrequency (RF) ablation for atrial fibrillation (AF). However, a single ablation strategy does not always achieve the desired therapeutic effect in all patients with persistent AF, and individualised strategies are required for different clinical characteristics. METHODS AND ANALYSIS This study aimed to determine the optimal catheter ablation strategy for persistent AF by comparing the efficacy of PVI and BCXL (BC: big circles encircling pulmonary vein isolation; XL: unfixed number of lines based on the left atrial substrate). The BCXL-AF study (clinical trial no. ChiCTR2200067081) was designed as a prospective, randomised, parallel-controlled, single-blinded clinical trial. Overall, 400 patients with persistent AF were randomised in a 1:1 ratio into PVI-only and BCXL-individualised ablation groups. Patients randomised to the individualised ablation group will be further categorised into risk strata according to their clinical condition using the actual ablation method determined by the strata. Seven postoperative visits were conducted from discharge to 24 months of age. The primary observation endpoint will be the incidence of atrial tachyarrhythmia (including AF, atrial flutter and atrial tachycardia with a duration of ≥30 s) without using antiarrhythmic drugs after a blank period of 3 months following a single ablation procedure. The BCXL-AF study will assess an optimal approach for persistent AF RF ablation and evaluate the effectiveness of individualised RF ablation strategies in reducing the recurrence rate of AF. ETHICS AND DISSEMINATION The study protocol was reviewed, and ethical approval was obtained from the Army Medical University Human Ethics Committee (approval number: 2022-484-01). All the participants provided written informed consent. This study was conducted according to the principles of the Declaration of Helsinki and its amendments. The results of this study will be disseminated through manuscript publication and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2200067081.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuanbin Song
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shizhu Bian
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi Zhang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xia Wang
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Cheng
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Fan
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changsong Liu
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hu Tan
- Department of Cardiology, Xinqiao Hospital, Army Medical University, Chongqing, China
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CHA 2DS 2VASc score as a predictor of ablation success defined by continuous long-term monitoring. J Interv Card Electrophysiol 2022; 65:695-700. [PMID: 35917047 DOI: 10.1007/s10840-022-01326-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are few reliable risk stratification tools for successful atrial fibrillation catheter ablation (AFCA) and most prior studies have used short-term external monitors to define success. CHA2DS2VASc score may be useful in predicting AF recurrence. We investigated whether CHA2DS2VASc score correlates with AFCA success as measured by continuous monitoring via cardiac implantable electronic devices (CIEDs). METHODS Using the Optum® de-identified Electronic Health Record dataset (01/2007 to 06/2019) linked with the Medtronic CareLink™ database, we identified patients who underwent a 1st AFCA procedure following CIED implantation. Success was defined as absence of ≥ 1 h of AF following a 3-month blanking period. RESULTS A total of 632 patients (age 67 ± 9.1 years, 73.3% male, CHA2DS2VASc 3.6 ± 1.8, 36.9% paroxysmal AF) were analyzed and included 35.1% insertable cardiac monitor, 28.8% PPM, 21.4% ICD, 13.6% CRT-D, and 1.1% CRT-P. Success at 24 months post blanking period was 40.3% (95% CI 32.6-49.7%), 36.2% (95% CI 26.9-45.4%), and 21.8% (95% CI 14.6-32.5%) for CHA2DS2VASc subgroups of 0-2, 3-4, and ≥ 5, respectively. Median daily burden of AF was reduced to zero regardless of CHA2DS2VASc score, but there were significant differences in survival free from any AF ≥ 1 h between the three CHA2DS2VASc subgroups (p = 0.013). Patients with a score ≥ 5 had a HR of 1.29 (95% CI 1.00-1.67) for AF recurrence compared to patients with a score of 0-2, with similar results after controlling for AF type. CONCLUSIONS In real-world patients with continuous monitoring undergoing AFCA, only CHA2DS2VASc scores ≥ 5 predicted higher AF recurrence.
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Labarbera MA, Atta-Fosu T, Feeny AK, Firouznia M, Mchale M, Cantlay C, Roach T, Axtell A, Schoenhagen P, Barnard J, Smith JD, Van Wagoner DR, Madabhushi A, Chung MK. New Radiomic Markers of Pulmonary Vein Morphology Associated With Post-Ablation Recurrence of Atrial Fibrillation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2021; 10:1800209. [PMID: 34976444 PMCID: PMC8716081 DOI: 10.1109/jtehm.2021.3134160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
Objective: To identify radiomic and clinical features associated with post-ablation recurrence of AF, given that cardiac morphologic changes are associated with persistent atrial fibrillation (AF), and initiating triggers of AF often arise from the pulmonary veins which are targeted in ablation. Methods: Subjects with pre-ablation contrast CT scans prior to first-time catheter ablation for AF between 2014-2016 were retrospectively identified. A training dataset (D1) was constructed from left atrial and pulmonary vein morphometric features extracted from equal numbers of consecutively included subjects with and without AF recurrence determined at 1 year. The top-performing combination of feature selection and classifier methods based on C-statistic was evaluated on a validation dataset (D2), composed of subjects retrospectively identified between 2005-2010. Clinical models ([Formula: see text]) were similarly evaluated and compared to radiomic ([Formula: see text]) and radiomic-clinical models ([Formula: see text]), each independently validated on D2. Results: Of 150 subjects in D1, 108 received radiofrequency ablation and 42 received cryoballoon. Radiomic features of recurrence included greater right carina angle, reduced anterior-posterior atrial diameter, greater atrial volume normalized to height, and steeper right inferior pulmonary vein angle. Clinical features predicting recurrence included older age, greater BMI, hypertension, and warfarin use; apixaban use was associated with reduced recurrence. AF recurrence was predicted with radio-frequency ablation models on D2 subjects with C-statistics of 0.68, 0.63, and 0.70 for radiomic, clinical, and combined feature models, though these were not prognostic in patients treated with cryoballoon. Conclusions: Pulmonary vein morphology associated with increased likelihood of AF recurrence within 1 year of catheter ablation was identified on cardiac CT. Significance: Radiomic and clinical features-based predictive models may assist in identifying atrial fibrillation ablation candidates with greatest likelihood of successful outcome.
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Affiliation(s)
- Michael A. Labarbera
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Thomas Atta-Fosu
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Albert K. Feeny
- Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOH44106USA
| | - Marjan Firouznia
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
| | - Meghan Mchale
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Catherine Cantlay
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Tyler Roach
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Alexis Axtell
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
| | - John Barnard
- Department of Quantitative Health SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Jonathan D. Smith
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - David R. Van Wagoner
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
| | - Anant Madabhushi
- Department of Biomedical EngineeringCase Western Reserve UniversityClevelandOH44106USA
- Louis Stokes Cleveland Veterans Administration Medical CenterClevelandOH44106USA
| | - Mina K. Chung
- Department of Cardiovascular and Metabolic SciencesLerner Research Institute, Cleveland ClinicClevelandOH44106USA
- Department of Cardiovascular Medicine, Heart, VascularThoracic Institute, Cleveland ClinicClevelandOH44106USA
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Kim JY, Kim Y, Oh GH, Kim SH, Choi Y, Hwang Y, Kim TS, Kim SH, Kim JH, Jang SW, Oh YS, Lee MY. A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00027-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Background and Objectives
The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI.
Materials and methods
This study was a retrospective cohort study that enrolled consecutive patients who underwent catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recurrence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images.
Results
We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolutional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7).
Conclusion
In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly; therefore, further large-scale study is needed.
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Sano M, Heeger CH, Sciacca V, Große N, Keelani A, Fahimi BHH, Phan HL, Reincke S, Brüggemann B, Fink T, Liosis S, Vogler J, Eitel C, Tilz RR. Evaluation of predictive scores for late and very late recurrence after cryoballoon-based ablation of atrial fibrillation. J Interv Card Electrophysiol 2020; 61:321-332. [PMID: 32638187 PMCID: PMC8324624 DOI: 10.1007/s10840-020-00778-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
Purpose Studies on predictive scores for very late recurrence (VLR) (recurrence later than 12 months) after second-generation cryoballoon-based pulmonary vein isolation (CB2-PVI) are sparse. We aimed to evaluate the frequency of late recurrence (LR) (later than 3 months) and VLR, and to validate predictive scores for LR and VLR after initial CB2-PVI. Methods A total of 288 patients undergoing initial CB2-PVI (66 ± 11 years, 46% paroxysmal) were retrospectively enrolled in the LR cohort. In the VLR cohort, 83 patients with recurrence within 3–12 months or with < 12-month follow-up were excluded. The predictive scores of arrhythmia recurrence were assessed, including the APPLE, DR-FLASH, PLAAF, BASE-AF2, ATLAS, SCALE-CryoAF, and MB-LATER scores. Results During a mean follow-up of 15.3 ± 7.1 months, 188 of 288 (65.2%) patients remained in sinus rhythm without any recurrences. Thirty-two of 205 (15.6%) patients experienced VLR after a mean of 16.6 ± 5.6 months. Comparing the predictive values of these specific scores, the MB-LATER score showed a reliable trend toward greater risk of both LR and VLR (area under the curve in LR; 0.632, 0.637, 0.632, 0.637, 0.604, 0.725, and 0.691 (p = ns), VLR; 0.612, 0.636, 0.644, 0.586, 0.541, 0.633, and 0.680 (p = 0.038, vs. BASE-AF2, respectively)). Kaplan-Meier analysis estimated patients with higher MB-LATER scores which had favorable outcomes (24-month freedom from LR; 26.0% vs. 56.7%, p < 0.0001, VLR; 53.4% vs. 82.1%, p = 0.013). Conclusion The MB-LATER score provided more reliable predictive value for both LR and VLR. Patients with higher MB-LATER scores may benefit from more intensive long-term follow-up.
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Affiliation(s)
- Makoto Sano
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian-Hendrik Heeger
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Sciacca
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Niels Große
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ahmad Keelani
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Behzad Hassan Hosseiny Fahimi
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Huong Lan Phan
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Samuel Reincke
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ben Brüggemann
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Thomas Fink
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Spyridon Liosis
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Vogler
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Charlotte Eitel
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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Dretzke J, Chuchu N, Agarwal R, Herd C, Chua W, Fabritz L, Bayliss S, Kotecha D, Deeks JJ, Kirchhof P, Takwoingi Y. Predicting recurrent atrial fibrillation after catheter ablation: a systematic review of prognostic models. Europace 2020; 22:748-760. [PMID: 32227238 PMCID: PMC7203634 DOI: 10.1093/europace/euaa041] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/05/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS We assessed the performance of modelsf (risk scores) for predicting recurrence of atrial fibrillation (AF) in patients who have undergone catheter ablation. METHODS AND RESULTS Systematic searches of bibliographic databases were conducted (November 2018). Studies were eligible for inclusion if they reported the development, validation, or impact assessment of a model for predicting AF recurrence after ablation. Model performance (discrimination and calibration) measures were extracted. The Prediction Study Risk of Bias Assessment Tool (PROBAST) was used to assess risk of bias. Meta-analysis was not feasible due to clinical and methodological differences between studies, but c-statistics were presented in forest plots. Thirty-three studies developing or validating 13 models were included; eight studies compared two or more models. Common model variables were left atrial parameters, type of AF, and age. Model discriminatory ability was highly variable and no model had consistently poor or good performance. Most studies did not assess model calibration. The main risk of bias concern was the lack of internal validation which may have resulted in overly optimistic and/or biased model performance estimates. No model impact studies were identified. CONCLUSION Our systematic review suggests that clinical risk prediction of AF after ablation has potential, but there remains a need for robust evaluation of risk factors and development of risk scores.
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Affiliation(s)
- Janine Dretzke
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Naomi Chuchu
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Ridhi Agarwal
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Clare Herd
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Susan Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH, UK
| | - Yemisi Takwoingi
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
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Furui K, Morishima I, Morita Y, Kanzaki Y, Takagi K, Yoshida R, Nagai H, Watanabe N, Yoshioka N, Yamauchi R, Tsuboi H, Murohara T. Predicting long-term freedom from atrial fibrillation after catheter ablation by a machine learning algorithm: Validation of the CAAP-AF score. J Arrhythm 2020; 36:297-303. [PMID: 32256878 PMCID: PMC7132192 DOI: 10.1002/joa3.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Preprocedural clinical predictors of the successful maintenance of sinus rhythm may contribute to optimal treatment strategies for atrial fibrillation (AF). The CAAP-AF score, a novel simple tool scored as 0-13 points (including six independent variables) has been proposed to predict long-term freedom from AF after catheter ablation. To clarify its reproducibility, we examined the CAAP-AF score's predictive performance and then created subgroups to best predict AF recurrence by using a machine learning algorithm. METHODS We studied 583 consecutive patients who underwent initial AF catheter ablation at our institute (median CAAP-AF score, 5; age, 66 ± 10 years old; female, 28.3%; coronary artery disease, 10.8%; left atrial diameter, 39.9 ± 6.6 mm; number of antiarrhythmic drugs failed, 0.4 ± 0.6; nonparoxysmal AF, 45.3%). All were systematically followed up with an endpoint of atrial tachyarrhythmia recurrence after the last ablation procedure. RESULTS During the 1.8 ± 1.2-year follow-up, 157 patients had atrial tachyarrhythmia recurrence. Repeated procedures were performed (n = 115). Arrhythmia recurrence after the last session occurred in 69 patients. We created Kaplan-Meier curves for freedom from AF after final AF ablation for ranges of CAAP-AF scores; these confirmed the original study results. The machine learning using Classification and Regression Trees divided the patients into three categories by the risk score: low (score ≤5), intermediate (score 6-8), and high (score ≥9). CONCLUSIONS The CAAP-AF score was useful to stratify the atrial tachyarrhythmia recurrence risk in AF patients undergoing catheter ablation into three categories. The score should be considered when deciding whether to perform AF ablation in clinical practice.
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Affiliation(s)
- Koichi Furui
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | | | | | | | - Kensuke Takagi
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Ruka Yoshida
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Hiroaki Nagai
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Naoki Watanabe
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Naoki Yoshioka
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | - Ryota Yamauchi
- Department of CardiologyOgaki Municipal HospitalOgakiJapan
| | | | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
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Black-Maier E, Parish A, Steinberg BA, Green CL, Loring Z, Barnett AS, Al-Khatib SM, Atwater BD, Daubert JP, Frazier-Mills C, Hegland DD, Jackson KP, Jackson LR, Koontz J, Lewis RK, Pokorney SD, Sun AY, Thomas KL, Bahnson TD, Piccini JP. Predicting atrial fibrillation recurrence after ablation in patients with heart failure: Validity of the APPLE and CAAP-AF risk scoring systems. Pacing Clin Electrophysiol 2019; 42:1440-1447. [PMID: 31544956 PMCID: PMC7534412 DOI: 10.1111/pace.13805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Compared with medical therapy, catheter ablation of atrial fibrillation (AF) in patients with heart failure (HF) improves cardiovascular outcomes. Risk scores (CAAP-AF and APPLE) have been developed to predict the likelihood of AF recurrence after ablation, have not been validated specifically in patients with AF and HF. METHODS We analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in a cohort of 230 consecutive patients with AF and HF undergoing PVI in the Duke Center for Atrial Fibrillation registry from 2009-2013. RESULTS During a follow-up period of 12 months, 76 of 230 (33%) patients with HF experienced recurrent AF after ablation. The median APPLE and CAAP-AF scores were 1.5 ([Q1, Q3]: [1.0, 2.0]) and 4.0 ([Q1, Q3]: [3.0, 5.0]), respectively and were not different from those patients with and without recurrent AF. Freedom from AF was not different according to APPLE and CAAP-AF scores. Discrimination for recurrent AF with the CAAP-AF score was modest with a C-statistic of 0.60 (95% CI 0.52-0.67). Discrimination with the APPLE score was similarly modest, with a C-statistic of 0.54 (95% CI: 0.47-0.62). CONCLUSIONS Validated predictive risk scores for recurrent AF after catheter ablation exhibit limited predictive ability in cohorts of AF and HF. Additional tools are needed to facilitate risk stratification and patient selection for AF ablation in patients with concomitant HF.
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Affiliation(s)
- Eric Black-Maier
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Benjamin A. Steinberg
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Zak Loring
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Adam S. Barnett
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Sana M. Al-Khatib
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Brett D. Atwater
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - James P. Daubert
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | | | - Donald D. Hegland
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Kevin P. Jackson
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Larry R. Jackson
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Jason Koontz
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Robert K. Lewis
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Sean D. Pokorney
- Electrophysiology Section, Duke University Medical Center, Durham, UK
| | - Albert Y. Sun
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
| | - Kevin L. Thomas
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Tristam D. Bahnson
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Jonathan P. Piccini
- Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC
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Akkaya E, Berkowitsch A, Greiss H, Hamm CW, Sperzel J, Neumann T, Kuniss M. PLAAF score as a novel predictor of long-term outcome after second-generation cryoballoon pulmonary vein isolation. Europace 2019; 20:f436-f443. [PMID: 29161372 DOI: 10.1093/europace/eux295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
Aims Predictors of atrial arrhythmia recurrence have not been described in a long-term follow-up study of patients undergoing pulmonary vein isolation (PVI) using the cryoballoon technique. We aimed to evaluate the efficacy of a second-generation cryoballoon and identify pre-procedural predictors of 3-year outcome after PVI. Methods and results For this observational cohort study, we enrolled 440 patients ablated at our institution with a second-generation cryoballoon. The endpoint was the first documented recurrence (>30 s) of atrial fibrillation (AF), atrial flutter, or atrial tachycardia after a 3-month blanking period. The impact of several pre-existing variables on clinical outcome was evaluated by univariate and multivariate analyses using the Cox proportional hazards regression model. The PLAAF (persistent AF, left atrial area, abnormal PV anatomy, AF history, female gender) score was defined to predict outcome. After a median follow-up of 36 months (interquartile range 25/75-27/42), the endpoint was achieved in 95 of 440 (21.6%) patients. Cox regression analysis showed that persistent AF, left atrial (LA) area, abnormal PV anatomy, AF history, and female gender independently predicted recurrence. The calculated optimal cut-offs for LA area and AF history were 21 cm2 and 3 years, respectively. Patients with a PLAAF score of 0 showed the best outcome, with an arrhythmia-free survival of 86.7%. Conclusion PVI using the cryoballoon technique shows acceptable long-term results depending on predictors described by the new PLAAF score, which may facilitate patient selection for PVI.
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Affiliation(s)
- Ersan Akkaya
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Alexander Berkowitsch
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Harald Greiss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.,Medical Clinic I, Justus-Liebig University, Giessen, Germany
| | - Johannes Sperzel
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Neumann
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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11
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Hamilton RD, Cooper B, Meyers JD. Stratifying risk of recurrence of atrial fibrillation following balloon cryoablation using the CAAP-AF risk scoring system. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:853-858. [PMID: 31045259 DOI: 10.1111/pace.13711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine if the CAAP-AF tool could be applied to a cohort of patients in the United States undergoing cryoablation or AF utilizing second-generation cryoballoons. BACKGROUND Atrial fibrillation (AF) is a major source of morbidity and expense, with over 33 million individuals affected worldwide and over 450 000 hospitalizations annually in the United States. Catheter ablation for AF is a class I indication for patients with symptomatic AF. The ability to predict postablation recurrence would have an enormous impact on both patient outcomes and cost to the health care system. METHODS Our study was an observational, single-center retrospective study to evaluate the utility of the CAAP-AF risk scoring system in predicting recurrence of AF following second-generation balloon cryoablation for AF. RESULTS There were a total of 235 patients. From the initial cohort, 30.2% (71) had a recurrence of AF within 1 year of the cryoablation procedure. There was a statistically significant increase in mean age, left atrial diameter, left atrial volume index, CHADS2 , CHADS2 -VASc, and number of antiarrhythmics failed in the group that had recurrence of AF. There was also a statistically significant increase in the CAAP-AF score in patients who had recurrence of AF. CONCLUSIONS The CAAP-AF score predicted the freedom from AF 1 year following cryoablation for AF. The CAAP-AF score can aid in selecting patients most likely to benefit from cryoablation, which includes patients with a low CAAP-AF score, as they are most likely to remain AF free at 1 year.
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12
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Winkle RA. Atrial fibrillation ablation outcomes: It's not the tool you use, it's the patient you choose. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:859-861. [PMID: 31049973 DOI: 10.1111/pace.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Roger A Winkle
- Silicon Valley Cardiology, Palo Alto Medical Foundation, Sutter Health, Sequoia Hospital, E. Palo Alto, California
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13
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Potpara TS, Mujovic N, Sivasambu B, Shantsila A, Marinkovic M, Calkins H, Spragg D, Lip GYH. Validation of the MB-LATER score for prediction of late recurrence after catheter-ablation of atrial fibrillation. Int J Cardiol 2018; 276:130-135. [PMID: 30126656 DOI: 10.1016/j.ijcard.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Reliable identification of atrial fibrillation (AF) patients more likely to be AF-free long-term post-single catheter ablation (CA) would facilitate appropriate risk communication to patients. We validated the recently proposed MB-LATER score for prediction of late recurrences of AF (LRAF) post-CA. METHODS Patients who underwent CA for symptomatic AF refractory to ≥1 antiarrhythmic drugs at the Johns Hopkins Hospital, Baltimore, between March 2003 and December 2015, for whom ≥1-year post-CA follow-up data were available, were enrolled. RESULTS Of 226 patients (median age 58.5 years [IQR: 52.0-65.0], 163 males [72.1%], 142 [62.8%] with paroxysmal AF), LRAF occurred in 133 patients (58.8%) during a median 2-year follow-up (IQR: 1.1-4.1). The mean MB-LATER score was significantly higher in patients with versus those without LRAF (2.4 ± 1.2 vs. 1.9 ± 1.3, p = 0.002) and showed modest but significant predictive ability for LRAF (AUC: 0.62 [95% CI: 0.54-0.69], p = 0.003). A score cut-off value of >2 showed the best predictive ability for LRAF (70.4% [61.5-77.9]), with modest sensitivity (42.9% [34.3-51.7]) and specificity (74.2% [64.1-82.7]). Kaplan-Meyer survival free from AF was significantly better for patients with a MB-LATER score of ≤2 than for those with a score of >2 (log-rank p = 0.005). CONCLUSION In our study, the MB-LATER score showed a significant but modest predictive ability for LRAF post-AF ablation. Further prospective validation is needed to better define the potential role of the MB-LATER score in patient selection and treatment decision-making post-AF ablation.
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Affiliation(s)
- Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
| | - Nebojsa Mujovic
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bhradeev Sivasambu
- Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | - Hugh Calkins
- Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - David Spragg
- Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Gregory Y H Lip
- School of Medicine, Belgrade University, Belgrade, Serbia; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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