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Motoc A, Scheirlynck E, Roosens B, Luchian ML, Chameleva H, Gevers M, Galloo X, von Kemp B, de Asmundis C, Magne J, Droogmans S, Cosyns B. Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1103-1111. [PMID: 34919165 DOI: 10.1007/s10554-021-02493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
Cryoballoon ablation (CBA) is a safe and efficient therapeutic option for atrial fibrillation (AF). However, AF recurrence occurs in 25% of the patients, leading to repeated ablations and complications. Previous reports have shown that left atrium (LA) assessed by M-Mode and two-dimensional echocardiography (2DE) predicts AF recurrence. Nevertheless, these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process. We hypothesized that LA remodeling by three-dimensional echocardiography (3DE) has an additional value for AF recurrence prediction post-CBA. 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively recruited. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. 50 (29%) patients had AF recurrence. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34 -22.45, p < 0.001). In patients with non-dilated LA diameter index and LAVI by 2DE, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2. LA remodeling by 3DE predicted AF recurrence, even in patients with non-dilated LA by M-Mode and 2DE, suggesting that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and it should be considered for systematic use to evaluate AF recurrence risk post-CBA.
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Affiliation(s)
- Andreea Motoc
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Esther Scheirlynck
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bram Roosens
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maria-Luiza Luchian
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Hadischat Chameleva
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Maxim Gevers
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Xavier Galloo
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Berlinde von Kemp
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Faculté de Médecine de Limoges, 16 INSERM 1094, 2, rue Marcland, 87000, Limoges, France
| | - Steven Droogmans
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (Centrum Voor Hart-en Vaatziekten), Laarbeeklaan 101, 1090, Brussels, Belgium
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Wu SJ, Li CH, Weng CJ, Lin JC, Chien YS, Chen YH, Lin CH, Hsieh YC, Huang JL, Lo LW, Lin YJ, Chen SA. Efficacy of Cryoballoon Ablation for Atrial Fibrillation and Recurrence Predictors in an Asian Cohort. J Pers Med 2022; 12:jpm12050732. [PMID: 35629154 PMCID: PMC9144244 DOI: 10.3390/jpm12050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Cryoballoon ablation (CBA) for atrial fibrillation (AF) is a rhythm control procedure used in clinical trials, mostly in Western countries. Its efficacy and the predictors of AF recurrence after CBA remain unclear for Asian populations. We aimed to investigate the efficacy of CBA and the predictors of AF recurrence after CBA in Asian AF patients. Methods: We included consecutive AF patients undergoing CBA for rhythm control between 2014 and 2020. The baseline characteristics, including AF types, symptom severity, and left atrial diameter (LAD), were analyzed. Holter’s monitoring and 12-lead ECG were performed to document AF recurrence. A multivariate Cox hazards regression model was used to evaluate the risk of AF recurrence. Results: A total of 120 AF patients (aged 61.9 ± 9.3 years) were included. The percentage of patients free from AF in the year following CBA was 74.2%. Among the three independent predictors of AF recurrence within one year were the presence of persistent AF (p = 0.025), an LAD ≥ 4.75 cm (p = 0.016), and pre-procedural cardioversion (p = 0.025). All patients survived and none had a stroke after CBA. Conclusion: CBA for AF is an effective and safe procedure in Asian populations. The presence of persistent AF, an LAD ≥ 4.75 cm, and severe symptoms are predictors of AF recurrence in the year following CBA.
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Affiliation(s)
- Shang-Ju Wu
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
| | - Cheng-Hung Li
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Data Science and Big Data Analytics, and Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
- Correspondence: (C.-H.L.); (Y.-C.H.); Tel.: +886-4-2251-6648 (C.-H.L. & Y.-C.H.); Fax: +886-4-2359-9257 (C.-H.L. & Y.-C.H.)
| | - Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Data Science and Big Data Analytics, and Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
| | - Jiunn-Cherng Lin
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
| | - Yu-Shan Chien
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Internal Medicine, Taichung Veterans General Hospital Chiayi Branch, Chiayi 60090, Taiwan
| | - Yi-Huei Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.C.); (C.-H.L.)
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.C.); (C.-H.L.)
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Data Science and Big Data Analytics, and Department of Financial Engineering, Providence University, Taichung 43301, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
- Correspondence: (C.-H.L.); (Y.-C.H.); Tel.: +886-4-2251-6648 (C.-H.L. & Y.-C.H.); Fax: +886-4-2359-9257 (C.-H.L. & Y.-C.H.)
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Department of Post-Baccalaureate Medicine, National Chung Hsing University School of Medicine, Taichung 40227, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Li-Wei Lo
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yenn-Jiang Lin
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shih-Ann Chen
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (S.-J.W.); (C.-J.W.); (J.-C.L.); (Y.-S.C.); (J.-L.H.); (S.-A.C.)
- Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan; (L.-W.L.); (Y.-J.L.)
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
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Chen X, Xia Y, Lin Y, Li X, Wang C, Chen Y, Fang P, Liu J. Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure. Front Cardiovasc Med 2022; 9:836392. [PMID: 35571157 PMCID: PMC9091437 DOI: 10.3389/fcvm.2022.836392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.MethodsFrom December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.ResultsThe 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028–2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.ConclusionPulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.
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Affiliation(s)
- Xiongbiao Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yu Xia,
| | - Yuan Lin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun Wang
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanjun Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jun Liu,
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Motoc A, Luchian M, Scheirlynck E, Roosens B, Chameleva H, Gevers M, Galloo X, von Kemp B, Ramak R, Sieira J, de Asmundis C, Chierchia G, Magne J, Weytjens C, Droogmans S, Cosyns B. Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation. PLoS One 2021; 16:e0259999. [PMID: 34797844 PMCID: PMC8604362 DOI: 10.1371/journal.pone.0259999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective Atrial fibrillation (AF) recurrence occurs in approximately 25% of the patients undergoing cryoballoon ablation (CBA), leading to repeated ablations and complications. Left atrial (LA) dilation has been proposed as a predictor of AF recurrence. However, LA strain is a surrogate marker of LA mechanical dysfunction, which might appear before the enlargement of the LA. The purpose of this study was to evaluate the additional predictive value of LA function assessed using strain echocardiography for AF recurrence after CBA. Methods 172 consecutive patients (62.2 ± 12.2 years, 61% male) were prospectively analyzed. Echocardiography was performed before CBA. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤ 17% had the highest incremental predictive value for AF recurrence (HR = 9.45, 95%CI: 3.17–28.13, p < 0.001). In patients with non-dilated LA, PALS≤17% remained an independent predictor of AF recurrence (HR = 5.39, 95%CI: 1.66–17.52, p = 0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non—dilated LA, PALS also predicted AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of AF patients before CBA.
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Affiliation(s)
- Andreea Motoc
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
- * E-mail:
| | - Maria–Luiza Luchian
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Esther Scheirlynck
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bram Roosens
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hadischat Chameleva
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maxim Gevers
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Xavier Galloo
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Berlinde von Kemp
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gian–Battista Chierchia
- Heart Rhythm Management Centre, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Julien Magne
- Service Cardiologie, CHU Limoges, Hôpital Dupuytren, Limoges, France
- 16 INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
| | - Caroline Weytjens
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, (Centrum voor Hart- en Vaatziekten), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
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