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Ouchi K, Sakuma T, Kisaki S, Tokutake K, Yamane T, Ojiri H. Changes in pulmonary vein size and narrowing depend on the cardiac cycle before and after pulmonary vein isolation. Heart Vessels 2024; 39:616-625. [PMID: 38526754 DOI: 10.1007/s00380-024-02378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024]
Abstract
Accurate measurement of the pulmonary vein dimension (PVD) is important for determining stenosis and efficacy following pulmonary vein isolation (PVI). Little is known about the quantitative evaluation of the impact of the cardiac cycle on pulmonary vein (PV) morphology before and after PVI. This study aims to investigate variations in the ostial size of the PV during the cardiac cycle before and after PVI and the effect of the cardiac cycle on PV stenosis and reduction rate using cardiac computed tomography (CT). Sixty-eight patients with atrial fibrillation who underwent cardiac CT before and after PVI at our institution between 23 January 2021 and 5 February 2022 were retrospectively analyzed. The maximum and minimum PVD were measured at each segment before and after the PV. Each PV was evaluated according to the PVD reduction rate (ΔPVD), calculated as follows: (1 - post-PVD/pre-PVD) × 100 (%). The average dimension of all PVs at the end-diastolic frame was significantly reduced compared to that at the end-systolic frame before PVI. The average dimensions of the right superior and right inferior PV at the end-diastolic frame were significantly reduced compared with those at the end-systolic frame following PVI. The average reduction rate of dimension-classified stenosis of PVs, except for the left inferior PV at the end-diastolic frame, was significantly reduced compared with that at the end-systolic frame. The cardiac cycle affects PVD assessment, including PV stenosis, after PVI. PVD measurement is recommended to be unified to the end-systolic frame of the cardiac cycle to avoid underestimating PV stenosis before and after PVI, ensuring appropriate management and follow-up.
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Affiliation(s)
- Kotaro Ouchi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Toru Sakuma
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Shunsuke Kisaki
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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Watanabe T, Hoshide S, Hachiya H, Yumita Y, Sato M, Mitama T, Okuyama T, Watanabe H, Yokota A, Kamioka M, Komori T, Makimoto H, Kabutoya T, Imai Y, Kario K. Impact of nocturnal blood pressure dipping on recurrence of atrial fibrillation after pulmonary vein isolation. Hypertens Res 2024; 47:1688-1696. [PMID: 38532036 DOI: 10.1038/s41440-024-01645-3] [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: 09/29/2023] [Revised: 02/04/2024] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
Lack of the typical nocturnal blood pressure (BP) fall, i.e non-dipper, has been known as a cardiovascular risk. However, the influence of non-dipper on atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been unclear. We investigated the clinical impact of non-dipping as evaluated by 24-hour ambulatory BP monitoring on the long-term outcome of AF recurrence post-PVI in 76 AF patients with a history of increased BP. The PVI procedure was successful in all 76 patients (mean age, 66±9years; antihypertensive medication, 89%; non-paroxysmal AF, 24%). Twenty patients had AF recurrence during a median follow-up of 1138 days. There was no difference in BP levels between the AF recurrence and non-recurrence groups (average 24 h systolic BP:126 ± 17 vs.125 ± 14 mmHg; P = 0.84). On the other hand, the patients with non-dipper had a higher AF recurrence than those with dipper (38.9% vs.15.0%; P = 0.018). In Cox hazard analysis adjusted by age, non-paroxysmal AF and average 24-hr systolic BP level, the non-dipper was an independent predictor of AF recurrence (HR 2.78 [95%CI:1.05-7.34], P = 0.039). Non-dipper patients had a larger left atrial (LA) volume index than the dipper patients (45.9 ± 17.3 vs.38.3 ± 10.2 ml/m2, P = 0.037). Among the 58 patients who underwent high-density voltage mapping in LA, 11 patients had a low-voltage area (LVA) defined as an area with a bipolar voltage < 0.5 mV. However, there was no association of LVA with non-dipper or dipper (22.2% vs.16.1%, P = 0.555). Non-dipper is an independent predictor of AF recurrence post-PVI. Management of abnormal diurnal BP variation post-PVI may be important.
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Affiliation(s)
- Tomonori Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hitoshi Hachiya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yoshiyuki Yumita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masafumi Sato
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tadayuki Mitama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Takafumi Okuyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroaki Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ayako Yokota
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masashi Kamioka
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Takahiro Komori
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hisaki Makimoto
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yasushi Imai
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Hao Z, Liu B, Xie X, Fan Y, Wang J, Shao Q, Jiang L, He B. Combining catheter ablation and left atrial appendage occlusion in high-risk patients with atrial fibrillation: a propensity score-matched analysis. Hellenic J Cardiol 2024:S1109-9666(24)00057-5. [PMID: 38460616 DOI: 10.1016/j.hjc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/23/2023] [Accepted: 03/03/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The safety and efficacy of a combined approach of catheter ablation (CA) and left atrial appendage occlusion (LAAO) compared to LAAO alone remain unknown. METHODS Patients with atrial fibrillation (AF) at increased stroke risk who underwent LAAO were divided into either combined (CA and LAAO) procedures or LAAO alone group. Propensity score matching was utilized to balance baseline characteristics. The primary endpoint of the study was a composite of death, thromboembolic events, major bleeding, heart failure (HF) rehospitalization, and major periprocedural complications. RESULTS A total of 707 AF patients who underwent LAAO were included. After 1:1 propensity score matching, 166 patients who underwent LAAO alone (n = 83) or the combined procedure (n = 83) were analyzed. Successful LAAO was achieved in all (100%) patients, with a low incidence of periprocedural complications in both groups (2.4% vs. 4.8%, LAAO vs. combined, p = 0.68). The incidence of peri-device leak post-LAAO was significantly higher in the combined group (25.3% vs. 43.4%, p = 0.01). After a median follow-up of 2 years, there were no significant differences in the rates of the primary composite endpoint between the two strategies (22.2% vs. 14.3%, HR: 1.24 [95% CI: 0.51-2.97], p = 0.63). However, the rate of HF rehospitalization was significantly lower in the combined group (19.6% vs. 3.6%, HR: 4.89 [95% CI: 1.50-15.97], p = 0.024). CONCLUSIONS Combining CA and LAAO in a "one-stop" approach is safe and brings additional benefits in relieving symptoms of heart failure, although peri-device leak was more common compared to LAAO alone.
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Affiliation(s)
- Ziyong Hao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Liu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Xie
- Department of Ultrasonography, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiting Fan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Shao
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisheng Jiang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Nelson DW, Dhorepatil A, Kreidieh O, Mekhael M, Noujaim C, Assaf A, Feng H, Marrouche N. Differences in postablation cardiac MRI scar between radiofrequency and cryoballoon ablation: A DECAAF II subanalysis. J Cardiovasc Electrophysiol 2023; 34:810-822. [PMID: 36871178 DOI: 10.1111/jce.15879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using radiofrequency (RF) and cryoballoon (Cryo) ablation are standard approaches for rhythm control in patients with symptomatic atrial fibrillation. Both strategies create scars in the left atrium (LA). There have been few studies investigating the difference in scar formation between patients undergoing RF and Cryo using cardiac magnetic resonance (CMR) imaging. METHODS The current study is a subanalysis of the control arm of the Delayed-Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation study (DECAAF II). The study was a multicenter, randomized, controlled, single-blinded trial that evaluated atrial arrhythmia recurrence (AAR) between PVI alone and PVI plus CMR atrial fibrosis-guided ablation. Preablation CMR and 3- to 6-month postablation CMR were obtained to assess baseline LA fibrosis and scar formation, respectively. RESULTS Of the 843 patients randomized in the DECAAF II trial, we analyzed the 408 patients in the primary analysis control arm that received standard PVI. Five patients received combined RF and Cryo ablations, so they were excluded from this subanalysis. Of the 403 patients analyzed, 345 underwent RF and 58 Cryo. The average procedure duration was 146 min for RF and 103 min for Cryo (p = .001). The rate of AAR at ~15 months occurred in 151 (43.8%) patients in the RF group and 28 (48.3%) patients in the Cryo group (p = .62). On 3-month post-CMR, the RF arm had significantly more scar (8.8% vs. 6.4%, p = .001) compared to Cryo. Patients with ≥6.5% LA scar (p < .001) and ≥2.3% LA scar around the PV antra (p = .01) on 3-month post-CMR had less AAR independent of the ablation technique. Cryo caused a greater percentage of right and left pulmonary vein (PV) antral scar (p = .04, p = .02) and less non-PV antral scar (p = .009) compared to RF. On Cox regression, Cryo patients free of AAR had a greater percentage of left PV antral scar (p = .01) and less non-PV antral scar (p = .004) compared to RF free of AAR. CONCLUSION In this subanalysis of the control arm of the DECAAF II trial, we observed that Cryo formed a more significant percentage of PV antral scar and less non-PV antral scar compared to RF. Post ablation LA scar ≥6.5% predicted freedom from AAR, independent of ablation technique. These findings may have prognostic implications in ablation technique selection and freedom from AAR.
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Affiliation(s)
- Daniel Wetherbee Nelson
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Aneesh Dhorepatil
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Omar Kreidieh
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Mario Mekhael
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Charbel Noujaim
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Ala Assaf
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Han Feng
- TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
| | - Nassir Marrouche
- Division of Cardiovascular, Tulane University, New Orleans, Louisiana, USA.,TRIAD Research Group, Tulane University, New Orleans, Louisiana, USA
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The first experience of a hybrid approach in the surgical treatment of atrial fibrillation. КЛИНИЧЕСКАЯ ПРАКТИКА 2023. [DOI: 10.17816/clinpract116052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology.
Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF.
Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation.
Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes.
Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.
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Moustafa A, Liu X, Elzanaty A, Meenakshisundaram C, Kancharla K, Kahaly O, Chacko P. Role of adjunctive cryoballoon left atrial posterior wall isolation in non- paroxysmal atrial fibrillation: a meta-analysis. Curr Probl Cardiol 2022; 47:101383. [DOI: 10.1016/j.cpcardiol.2022.101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022]
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Soulat-Dufour L, Lang S, Addetia K, Ederhy S, Adavane-Scheuble S, Chauvet-Droit M, Jean ML, Nhan P, Ben Said R, Kamami I, Issaurat P, Capderou E, Arnaud C, Boccara F, Lang RM, Cohen A. Restoring Sinus Rhythm Reverses Cardiac Remodeling and Reduces Valvular Regurgitation in Patients With Atrial Fibrillation. J Am Coll Cardiol 2022; 79:951-961. [PMID: 35272799 DOI: 10.1016/j.jacc.2021.12.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac chamber remodeling in atrial fibrillation (AF) reflects the progression of cardiac rhythm and may affect functional regurgitation. OBJECTIVES The purpose of this study was to explore the 3-dimensional echocardiographic variables of cardiac cavity remodeling and the impact on functional regurgitation in patients with AF with/without sinus rhythm restoration at 12 months. METHODS A total of 117 consecutive patients hospitalized for AF were examined using serial 3-dimensional transthoracic echocardiography at admission, at 6 months, and at 12 months (337 examinations). RESULTS During follow-up, 47 patients with active restoration of sinus rhythm (SR) (through cardioversion and/or ablation) had a decrease in all atrial indexed volumes (Vi), end-systolic (ES) right ventricular (RV) Vi, an increase in end-diastolic (ED) left ventricular Vi, and an improvement in 4-chambers function (P < 0.05). Patients with absence/failure of restoration of SR (n = 39) had an increase in ED left atrial Vi and ED/ES RV Vi without modification of 4-chambers function, except for a decrease in left atrial emptying fraction (P < 0.05). Patients with spontaneous restoration of SR (n = 31) had no changes in Vi or function. The authors found an improvement vs baseline in severity of functional regurgitation in patients with active restoration of SR (tricuspid and mitral regurgitation) and in spontaneous restoration of SR (tricuspid regurgitation) (P < 0.05). In multivariable analysis, right atrial and/or left atrial reverse remodeling exclusively correlated with intervention (cardioversion and/or ablation) during 12-month follow-up. CONCLUSIONS Management of AF should focus on restoration of SR to induce anatomical (all atrial Vi, ES RV Vi) and/or functional (4 chambers) cardiac cavity reverse remodeling and reduce severity of functional regurgitation. (Thromboembolic and Bleeding Risk Stratification in Patients With Non-valvular Atrial Fibrillation [FASTRHAC]; NCT02741349).
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Affiliation(s)
- Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France. https://twitter.com/lsoulatdufour
| | - Sylvie Lang
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Karima Addetia
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Stephane Ederhy
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Marion Chauvet-Droit
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Marie-Liesse Jean
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pascal Nhan
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Rim Ben Said
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Iris Kamami
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Pauline Issaurat
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Elodie Capderou
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Camille Arnaud
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Franck Boccara
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne Université, GRC n°22, C(2)MV-Complications Cardiovasculaires et Métaboliques chez les patients vivant avec le Virus de l'immunodéficience humaine, Inserm UMR_S 938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago, Chicago, Illinois, USA
| | - Ariel Cohen
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Sorbonne Université, Paris, France; Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), F-75013, Sorbonne Université, Paris, France.
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Pan J, Xu C, Xu B, Lou Y, Wang S, Xing Y. Relationship between the time point of left atrial size change and the outcomes of radiofrequency catheter ablation. J Interv Card Electrophysiol 2022; 64:669-675. [PMID: 34993723 DOI: 10.1007/s10840-021-01097-6] [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: 07/05/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The change in the left atrial anteroposterior diameter (LAD) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has become an independent factor in predicting the postoperative curative effect; however, whether the specific time point of this change is related to the postoperative curative effect is unclear. The purpose of this study was to explore the correlation between the specific time point of LAD change and the recurrence of AF 1 year after RFCA. METHODS Patients with AF who underwent RFCA in our hospital from July 2016 to May 2020 were enrolled in the study. The patients were divided into four groups according to the time point when the LAD decreased by 10% after RFCA: group A, first month after RFCA; group B, second month after RFCA; group C, third month after RFCA; group D, unchanged or changed > 3 months after RFCA. RESULTS In the multivariable Cox analyses, the duration of AF, LAD, and persistent AF were independent risk factors for the recurrence of AF. The recurrence rate of AF 1 year after RFCA were significantly lower in groups A (odds ratio [OR], 0.160; 95% confidence interval [CI]: 0.073-0.352; P < 0.001) and C (OR, 0.388; 95% CI: 0.156-0.963; P = 0.041) than in the control group. CONCLUSIONS Reduction of LAD within 3 months after operation predicts the success rate of RFCA, with reduction within 1 month after operation having a higher success rate. This indicates the necessity of treatment in patients with AF who do not experience an early reduction in the LAD after RFCA.
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Affiliation(s)
- Jie Pan
- Department of Cardiology, Shaoxing University School of Medicine, 312000, Shaoxing, Zhejiang, People's Republic of China
| | - Chao Xu
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Buyun Xu
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Yuanqing Lou
- Department of Cardiology, Shaoxing University School of Medicine, 312000, Shaoxing, Zhejiang, People's Republic of China
| | - Shengkai Wang
- Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China
| | - Yangbo Xing
- Department of Cardiology, The First Affiliated Hospital of Shaoxing University, 312000, Shaoxing, Zhejiang, People's Republic of China. .,Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 # Zhongxing North Road, Shaoxing, Zhejiang Province, 312000, People's Republic of China.
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9
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Current evidence on the safety and efficacy of combined atrial fibrillation ablation and left atrial appendage closure. Curr Opin Cardiol 2022; 37:74-79. [PMID: 34857717 DOI: 10.1097/hco.0000000000000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Combined atrial fibrillation (AF) ablation and left atrial (LA) appendage (LAA) closure (LAAC) has been practiced for management of both the symptoms and the high stroke risk of AF. The purpose of this review is to review recent evidence regarding the combined procedure. RECENT FINDINGS Newly acquired long-term data of combined AF ablation and LAAC supplied satisfactory evidence on the safety and efficacy of the combined procedure. Studies also showed LA structural remodeling following combined procedure was mainly affected by sinus rhythm status post catheter ablation, not by LAAC. A cost-effectiveness study revealed that combined procedure was a cost-effective therapeutic option in symptomatic AF patients with high stroke and bleeding risk. Due to recent evidence of high incidences of LAA thrombus formation after LAA electrical isolation (LAAEI) and benefit of LAAC after LAAEI, an extended combined procedure of standard AF ablation plus LAAEI and LAAC was considered as a potential therapeutic option for persistent AF patients with high stroke risk. SUMMARY In conclusion, combined AF ablation and LAAC serve as a promising option for patients with symptomatic AF and high risk of stroke and/or bleeding.
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Buffle E, Johner N, Namdar M, Shah D. The significance of pulmonary veins isolation radiofrequency time and the evolution of left atrium volume on a twelve-year observational follow-up of paroxysmal atrial fibrillation patients. Indian Heart J 2022; 74:120-126. [PMID: 35101393 PMCID: PMC9039693 DOI: 10.1016/j.ihj.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/17/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Pulmonary vein isolation (PVI) is the treatment of choice of paroxysmal atrial fibrillation (PAF). However, radiofrequency delivery at extra-PV sites may be additionally required. We compared clinical and procedural characteristics of patients undergoing PVI alone versus adjunctive extra-PV substrate modification, at first procedure and repeat procedures for AF recurrence. Methods 587 patients with PAF undergoing radiofrequency (RF) ablation were retrospectively included. Extra-PV ablation was performed in case of sustained AF despite PVI, or at re-do procedures without PV conduction recovery. Demographic, clinical and electrophysiological predictors of survival without re-intervention were analysed in patients’ groups having undergone one (G1), two (G2) or three or more procedures (G3). Results At baseline procedure, PV RF ablation time was shorter in G1 compared to G2/G3 whereas extra-PV RF ablation time was greater in G3 compared to G1. The proportion of patients requiring PV re-isolation decreased with repeat procedures. Smaller LA before procedure 1 (p1) or p2 was associated with PV reconnection at p2. Conversely larger LA before p1 was associated with extra-PV substrate modification at p2. Late re-do procedure timing (>1yr) was associated with increasing LA volume. Only longer PV and total RF time predicted poorer survival free from AF without re-intervention. Conclusion Longer PV RF time predicted requirement for re-ablation during follow-up. Smaller LA size predicted an increased probability of PV reconnection and decreased extra-PV substrate modification at p2. LA size decreased in patients undergoing early re-intervention, whereas it increased in patients undergoing re-intervention later on suggesting ongoing remodelling or progression.
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11
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Liu HT, Yang CH, Lee HL, Chang PC, Wo HT, Wen MS, Wang CC, Yeh SJ, Chou CC. Clinical Outcomes of low-voltage area-guided left atrial linear ablation for non-paroxysmal atrial fibrillation patients. PLoS One 2021; 16:e0260834. [PMID: 34855901 PMCID: PMC8638894 DOI: 10.1371/journal.pone.0260834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background The therapeutic effect of low-voltage area (LVA)-guided left atrial (LA) linear ablation for non-paroxysmal atrial fibrillation (non-PAF) is uncertain. We aimed to investigate the efficacy of LA linear ablation based on the preexisting LVA and its effects on LA reverse remodeling in non-PAF patients. Methods We retrospectively evaluated 145 consecutive patients who underwent radiofrequency catheter ablation for drug-refractory non-PAF. CARTO-guided bipolar voltage mapping was performed in atrial fibrillation (AF). LVA was defined as sites with voltage ≤ 0.5 mV. If circumferential pulmonary vein isolation couldn’t convert AF into sinus rhythm, additional LA linear ablation was performed preferentially at sites within LVA. Results After a mean follow-up duration of 48 ± 33 months, 29 of 145 patients had drugs-refractory AF/LA tachycardia recurrence. Low LA emptying fraction, large LA size and high extent of LVA were associated with AF recurrence. There were 136 patients undergoing LA linear ablation. The rate of linear block at the mitral isthmus was significantly higher via LVA-guided than non-LVA-guided linear ablation. Patients undergoing LVA-guided linear ablation had larger LA size and higher extent of LVA, but the long-term AF/LA tachycardia-free survival rate was higher than the non-LVA-guided group. The LA reverse remodeling effects by resuming sinus rhythm were noted even in patients with a diseased left atrium undergoing extensive LA linear ablation. Conclusions LVA-guided linear ablation through targeting the arrhythmogenic LVA and reducing LA mass provides a better clinical outcome than non-LVA guided linear ablation, and outweighs the harmful effects of iatrogenic scaring in non-PAF patients.
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Affiliation(s)
- Hao-Tien Liu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hui-Ling Lee
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - San-Jou Yeh
- Department of Anesthesia, Chang Gung Memorial Hospital, Taipei Branch, Taipei, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail:
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12
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Ariyaratnam JP, Elliott AD, Mishima RS, Gallagher C, Lau DH, Sanders P. Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation. Heart Rhythm O2 2021; 2:771-783. [PMID: 34988529 PMCID: PMC8710629 DOI: 10.1016/j.hroo.2021.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atrial fibrillation (AF) is associated with exercise intolerance, stroke, and all-cause mortality. However, whether this can be solely attributable to the arrhythmia itself or alternative mechanisms remains controversial. Heart failure with preserved ejection (HFpEF) commonly coexists with AF and may contribute to the poor outcomes associated with AF. Indeed, several invasive hemodynamic studies have confirmed that patients with AF are at increased risk of underlying HFpEF and that the presence of HFpEF may have important prognostic implications in these patients. Mechanistically, AF and HFpEF are closely linked. Both conditions are driven by the presence of common cardiovascular risk factors and are associated with left atrial (LA) myopathy, characterized by mechanical and electrical dysfunction. Progressive worsening of this left atrial (LA) myopathy is associated with both increased AF burden and worsening HFpEF. In addition, there is growing evidence to suggest that worsening LA myopathy is associated with poorer outcomes in both conditions and that reversal of the LA myopathy could improve outcomes. In this review article, we will present the epidemiologic and mechanistic evidence underlying the common coexistence of AF and HFpEF, discuss the importance of a progressive LA myopathy in the pathogenesis of both conditions, and review the evidence from important invasive hemodynamic studies. Finally, we will review the prognostic implications of HFpEF in patients with AF and discuss the relative merits of AF burden reduction vs HFpEF reduction in improving outcomes of patients with AF and HFpEF.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo S Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Gottlieb LA, Al Jefairi N, El Hamrani D, Naulin J, Lamy J, Kachenoura N, Constantin M, Quesson B, Cochet H, Coronel R, Dekker LR. Reduction in left atrial and pulmonary vein dimensions after ablation therapy is mediated by scar. IJC HEART & VASCULATURE 2021; 37:100894. [PMID: 34746362 PMCID: PMC8554268 DOI: 10.1016/j.ijcha.2021.100894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ablative pulmonary vein isolation (PVI) decreases pulmonary vein (PV) and left atrial (LA) dimensions in atrial fibrillation (AF) patients. These changes are attributed to reverse structural remodeling following sinus rhythm restoration but evidence is lacking. We hypothesized that the downsizing is directly caused by the ablative energy and subsequent scar formation. METHODS We studied cardiac magnetic resonance imaging in 21 paroxysmal AF patients before and 3 months after successful PVI and in healthy sheep (n = 12) before and after PVI of the right PV only. RESULTS PVI decreased the PV diameter in patients and sheep by 11.0(10.3) and 9.2(11.0)%, (p < 0.001 and p = 0.020), respectively. The control left PV in sheep were unchanged. A linear correlation existed between the extent of PV scar and PVI-induced decrease in PV diameter in patients.After PVI, the LA volume decreased (103(38) vs. 92(31)ml, pre- vs. post-ablation, respectively, p = 0.006), while the right atrial (RA) volume was unchanged in patients. A decrease in active emptying fraction after ablation (26.5(10.7) vs. 21.8(10.6)%, pre- vs. post-ablation, p = 0.031) was associated with reduced contractility of the PV walls (p = 0.004). The contractility of the LA walls was unaltered (p = 0.749). CONCLUSION The ablation-induced PV diameter reduction was similar in patients with AF and healthy sheep without AF and was associated with PV scar extent. The volume only decreased in LA and not RA after PVI, and wall contractility decreased only in ablated sites. Therefore, the PVI-induced atrial downsizing is caused by the ablative energy and subsequent scar formation.
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Affiliation(s)
- Lisa A. Gottlieb
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Nora Al Jefairi
- Department of Cardiac Pacing and Electrophysiology, University Hospital, Bordeaux, Pessac, France
| | - Dounia El Hamrani
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Naulin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Jérôme Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, USA
| | - Nadjia Kachenoura
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, Paris, France
| | - Marion Constantin
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Bruno Quesson
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Hubert Cochet
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
| | - Ruben Coronel
- Electrophysiology and Heart Modeling Institute, University of Bordeaux, Pessac, France
- Department of Experimental Cardiology, AUMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Lukas R.C. Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands
- Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands
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14
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P wave duration ≥150 ms predicts poor left atrial function and ablation outcomes in non-paroxysmal atrial fibrillation. J Electrocardiol 2021; 69:124-131. [PMID: 34695779 DOI: 10.1016/j.jelectrocard.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND It remains unknown whether P wave duration (PWD) ≥ 150 ms measured after extensive radiofrequency catheter ablation (RFCA) can identify non-paroxysmal atrial fibrillation (non-PAF) patients at increased risk of atrial tachyarrhythmia recurrence. We investigated the predicting power of PWD and its association with left atrial (LA) reverse remodeling in patients with non-PAF undergoing pulmonary vein isolation with LA linear ablation. METHODS We retrospectively evaluated 136 patients who underwent RFCA for drug-refractory non-PAF. Electroanatomic mapping was acquired during AF. Low-voltage area (LVA) was defined as an area with bipolar voltage ≤0.5 mV. Electrocardiography and echocardiography were performed during sinus rhythm 1 day and 3 months after RFCA. PWD was measured using amplified 12‑lead electrocardiography. Prolonged PWD was defined as maximum PWD ≥ 150 ms. RESULTS Over a mean follow-up duration of 48 ± 35 months, 28 patients experienced atrial tachyarrhythmia recurrence. PWD was positively correlated with LVA (r = 0.527, p < 0.001) and inversely correlated with LA emptying fraction (r = -0.399, p < 0.001). PWD was shortened and LA emptying fraction (LAEF) was increased in patients without atrial tachyarrhythmia recurrence during follow-up. Atrial tachyarrhythmia-free survival was significantly more likely in patients without a prolonged PWD (83.5% vs 60.7%, p = 0.002). Multivariate analysis showed that LAEF and PWD were independent predictors of atrial tachyarrhythmia recurrence. CONCLUSIONS PWD ≥ 150 ms measured after RFCA can identify patients with non-PAF at increased risk of atrial tachyarrhythmia recurrence. PWD is correlated with LVA and LAEF and reflects LA reverse remodeling.
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15
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Kawakami H, Inoue K, Nagai T, Fujii A, Sasaki Y, Shikano Y, Sakuoka N, Miyazaki M, Takasuka Y, Ikeda S, Yamaguchi O. Persistence of left atrial abnormalities despite left atrial volume normalization after successful ablation of atrial fibrillation. J Arrhythm 2021; 37:1318-1329. [PMID: 34621431 PMCID: PMC8485788 DOI: 10.1002/joa3.12624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left atrial volume index (LAVI) of >34 mL/m2 is the cutoff value for identifying an enlarged left atrium. The definition of left atrial (LA) reverse remodeling after atrial fibrillation (AF) ablation is undetermined. We hypothesized that patients with LA dilatation who achieve normal LA volume (LAVI<34 mL/m2) after AF ablation have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume can also achieve normal LA function with AF ablation. METHODS We enrolled 140 AF patients with baseline LAVI of ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 hour and at 1 year after the procedure. To define the normal range of LA function, age- and sex-matched controls without a history of AF were also enrolled. RESULTS After restoration of sinus rhythm, LA structural and functional parameters significantly improved, and 75 patients (54%) had normal LA volume. During a median follow-up of 44 (31-61) months, 32 patients (23%) experienced a late recurrence of AF (AF recurrence >1 year). Patients who achieved normal LA volume after AF ablation had fewer late recurrences than those who did not (P < .01). However, LA abnormalities, especially LA dysfunction, persisted in AF patients even when the LA volume was normalized compared with controls. CONCLUSION Patients who achieved normal LA volume had better long-term outcomes of AF ablation than those who did not; however, LA abnormalities persisted even after successful ablation of AF.
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Affiliation(s)
- Hiroshi Kawakami
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Takayuki Nagai
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Akira Fujii
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yasuhiro Sasaki
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Yukari Shikano
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Namiko Sakuoka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Maki Miyazaki
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Yasunori Takasuka
- Department of Clinical LaboratoryEhime University HospitalEhimeJapan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension & NephrologyEhime University Graduate School of MedicineEhimeJapan
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16
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Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms. JACC Clin Electrophysiol 2021; 7:416-430. [PMID: 33736761 DOI: 10.1016/j.jacep.2021.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.
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Affiliation(s)
- Lisa A Gottlieb
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands; Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands.
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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17
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One-stop strategy for treatment of atrial fibrillation: feasibility and safety of combining catheter ablation and left atrial appendage closure in a single procedure. Chin Med J (Engl) 2021; 133:1422-1428. [PMID: 32433041 PMCID: PMC7339144 DOI: 10.1097/cm9.0000000000000855] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Catheter ablation is effective in restoring sinus rhythm and left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with atrial fibrillation (AF). We aimed to observe the feasibility and safety of performing AF ablation and LAAC in a single (one-stop) procedure. METHODS Consecutive AF patients who underwent the combined procedure of AF ablation and LAAC with WATCHMAN device between March 2017 and September 2018 were prospectively enrolled. Baseline and intra-procedural parameters were evaluated. Three-month and subsequent 1-year follow-up were performed in all and earlier-enrolled subjects, respectively. RESULTS A total of 178 AF patients (94 males, 68.9 ± 8.1 years) underwent the one-stop procedure with CHA2DS2-VASc score 3.3 ± 1.5 and HAS-BLED score 1.6 ± 1.0, respectively. Pulmonary vein isolation was achieved in all patients while additional linear ablation was applied if the operator deemed necessary, yielding immediate ablation success rate of 98.9% (176/178). In the subsequent LAAC, satisfactory seal (residual leak <5 mm) was achieved in all patients. One stroke and four cardiac perforations occurred peri-operatively. At 3-month follow-up, sinus rhythm and satisfactory seal were maintained in 153/178 (86.0%) and 178/178 (100%) patients, respectively. One stroke and one delayed cardiac tamponade occurred, while no device-related thrombus or device migration was observed. During the 1-year follow-up for the earlier enrolled subjects, 52/72 (72.2%) of the patients maintained sinus rhythm. There was no stroke or systemic embolism observed. CONCLUSION Combining catheter ablation and LAAC in a single procedure can be successfully and safely performed in non-valvular AF patients of Chinese population.
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Rettmann ME, Holmes DR, Monahan KH, Breen JF, Bahnson TD, Mark DB, Poole JE, Ellis AM, Silverstein AP, Al-Khalidi HR, Lee KL, Robb RA, Packer DL. Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings From the CABANA Imaging Substudy. Circ Arrhythm Electrophysiol 2021; 14:e008540. [PMID: 33848199 DOI: 10.1161/circep.120.008540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maryam E Rettmann
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - David R Holmes
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Kristi H Monahan
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Jerome F Breen
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Tristram D Bahnson
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle, WA (J.E.P.)
| | - Alicia M Ellis
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Adam P Silverstein
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Kerry L Lee
- Duke Clinical Research Institute, Duke University, Durham, NC (T.D.B., D.B.M., A.M.E., A.P.S., H.R.A.-K., K.L.L.)
| | - Richard A Robb
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
| | - Douglas L Packer
- Mayo Clinic, Rochester, MN (M.E.R., D.R.H., K.H.M., J.F.B., R.A.R., D.L.P.)
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Parkash R, Wells G, Rouleau J, Talajic M, Essebag V, Skanes A, Wilton SB, Verma A, Healey JS, Tang AS. A randomized ablation-based atrial fibrillation rhythm control versus rate control trial in patients with heart failure and high burden atrial fibrillation: The RAFT-AF trial rationale and design. Am Heart J 2021; 234:90-100. [PMID: 33472052 DOI: 10.1016/j.ahj.2021.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
Heart failure (HF) and atrial fibrillation (AF) are 2 cardiac conditions that are increasing in prevalence and incidence. The 2 conditions frequently coexist, and are associated with increased morbidity and mortality. Catheter ablation of AF has been successfully performed in patients with HF, with an improvement in HF and AF, when compared to amiodarone, but further data is required to compare this to rate control. OBJECTIVES: The primary objective is to determine whether AF treated by catheter ablation, with or without antiarrhythmic drugs reduces all-cause mortality and hospitalizations for HF as compared with rate control in patients with HF and a high burden AF. METHODS: This is a multi-center prospective randomized open blinded endpoint (PROBE) study. Patients with NYHA class II-III HF (HF with reduced ejection fraction (<35%) or HF with preserved ejection fraction), and high burden AF are included in the trial. Patients are randomized to either rate control or catheter ablation-based AF rhythm control in a 1:1 ratio. Patients in the rate control group receive optimal HF therapy and rate control measures to achieve a resting hazard ratio (HR) < 80 bpm and 6-minute walk HR < 110 bpm. Patients randomized to catheter ablation-based AF rhythm control group receive optimal HF therapy and one or more aggressive catheter ablation, which include PV antral ablation and LA substrate ablation with or without adjunctive antiarrhythmic drug. The primary outcome is a composite of all-cause mortality and hospitalization for heart failure defined as an admission to a health care facility. The sample size is 600. Enrolment has been completed.
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Affiliation(s)
- Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada.
| | - George Wells
- University of Ottawa Cardiovascular Research Methods Center, Ottawa, ON, Canada
| | | | | | - Vidal Essebag
- McGill University Health Centre, Montreal, QC, Canada
| | - Allan Skanes
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Steve B Wilton
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeff S Healey
- Population Health Research Institute, Hamilton, ON, Canada
| | - Anthony Sl Tang
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Wang X, Song B, Qiu C, Han Z, Wang X, Lu W, Chen X, Chen Y, Pan L, Sun G, Qin X, Li R. The effect of left atrial remodeling after cryoballoon ablation and radiofrequency ablation for paroxysmal atrial fibrillation. Clin Cardiol 2020; 44:78-84. [PMID: 33205849 PMCID: PMC7803361 DOI: 10.1002/clc.23507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the most common procedures used to treat refractory atrial fibrillation (AF) and are performed through pulmonary vein isolation (PVI). Studies have shown that CBA can approximately match the therapeutic effects of RFA against AF. However, few studies have investigated the difference between CBA and RFA of the effects on left atrial remodeling for paroxysmal AF. Objective Atrial remodeling is considered pivotal to the occurrence and development of AF, therefore we sought to assess the influence of atrial remodeling in patients with paroxysmal AF after CBA and RFA in this study. Methods In this nonrandomized retrospective observational study, we enrolled 328 consecutive patients who underwent CBA or RFA for refractory paroxysmal AF in May 2014 to May 2017 in our hospital. After propensity score matching, 96 patients were included in the CBA group, and 96 were included in the RFA group. Patients were asked to undergo a 12‐lead electrocardiogram, a 24‐h Holter monitor, and an echocardiogram and to provide their clinical history and symptoms at 6 months and 1, 2, and 3 years postprocedurally. Electrical remodeling of the left atrium was assessed by P wave dispersion (Pdis); structural remodeling was assessed by the left atrium diameter (LAD) and left atrial volume index (LAVI) during scheduled visits. Results As of January 2020, compared with baseline, at 1 year, 2 years, and 3 years after ablation, the average changes in Pdis (∆Pdis), LAD (∆LAD), and LAVI (∆LAVI) were significant in both the CBA and RFA groups. Six months after ablation, ∆Pdis, ∆LAD, and ∆LAVI were greater in the CBA group than in the RFA group. There was no significant difference between the two groups in AF/flutter recurrence, but the AF/flutter‐free survival time of CBA group may be longer than RFA group after 2 years after ablation. A higher ∆Pdis, ∆LAD, or ∆LAVI at 1 year after ablation may increase AF/flutter‐free survival. Conclusions Although CBA and RFA are both effective in left atrial electrical and structural reverse‐remodeling in paroxysmal AF, CBA may outperform RFA for both purposes 6 months after ablation. However, during long‐term follow‐up, there was no significant intergroup difference.
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Affiliation(s)
- Xule Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Beibei Song
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Chunguang Qiu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Zhanying Han
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xi Wang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Wenjie Lu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xiaojie Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Yingwei Chen
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Liang Pan
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Guoju Sun
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Xiaofei Qin
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ran Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Smietana J, Santangeli P. Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it? JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i2.3399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies.
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Affiliation(s)
- Jeffrey Smietana
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
| | - Pasquale Santangeli
- Hospital of University of Pennsylvania – Cardiovascular Division – Electrophysiology Section – Philadelphia/Pennsylvania – United States of America
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Liu H, Wang K, Lin Y, Liang X, Zhao S, Li M, Chen M. Role of sST2 in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1235-1241. [PMID: 32735032 DOI: 10.1111/pace.14029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Atrial fibrosis is associated with atrial fibrillation (AF) recurrence after ablation. This study aims to determine the relationship between soluble ST2 (sST2), a profibrotic biomarker, and AF recurrence after radiofrequency catheter ablation (RFCA). METHODS AF patients referred for RFCA were consecutively included from October 2017 to May 2019. Baseline characteristics were collected, and sST2 levels were determined before ablation. Left atrial substrate mapping was performed after circumferential pulmonary vein isolation under sinus rhythm, and substrate was modified in low-voltage zones. A second procedure was recommended under recurrence. RESULTS Two hundred fifty-eight patients (146 males, average age 61.0 ± 8.8) were included. After a medium follow-up of 13.5 months, 52 patients (20.2%) had recurrence and received a second procedure. Preoperative sST2 level in patients with recurrence was significantly higher than that in patients without (31.3 ng/mL vs 20.3 ng/mL, P < .001). In those undergoing second ablation, sST2 level in patients with new abnormalities during endocardial mapping was significantly higher than that in patients without (43.0 ng/mL vs 22.1 ng/mL, P < .001). An sST2 level over 26.9 ng/mL could predict AF recurrence with new abnormalities during endocardial mapping with a sensitivity of 100% and a specificity of 75.9%. Multiple logistic analysis showed that sST2 level was an independent predictor of AF recurrence with new abnormalities during endocardial mapping (P < .001). CONCLUSIONS sST2 level was associated with new abnormalities during endocardial mapping and recurrence of AF after ablation. It might have significance in choosing treatment strategies for AF.
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Affiliation(s)
- Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kexin Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YongPing Lin
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xichen Liang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuai Zhao
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Hwang J, Park HS, Han S, Jun SW, Kang NY, Jeon JH, Choi SW, Lee CH, Kim IC, Cho YK, Yoon HJ, Kim H, Nam CW, Hur SH. The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: study using three-dimensional echocardiography. J Interv Card Electrophysiol 2019; 57:87-95. [PMID: 31889225 PMCID: PMC7036070 DOI: 10.1007/s10840-019-00696-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
Abstract
Purpose The exact correlation between the baseline left atrial (LA) volume (LAV) and atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) outcomes and changes to the LA after AF RFCA has not yet been fully understood. We sought to evaluate the serial changes in the LAV and LA function after RFCA using 3D echocardiography. Methods Consecutive patients who received RFCA of paroxysmal (PAF) or persistent AF (PeAF) at our center between January 2013 and March 2016 were included. Real-time 3D apical full-volume images were acquired, and a 3D volumetric assessment was performed using an automated three-beat averaging method. The LAV index (LAVI) was calculated and the LA ejection fraction (LAEF) was calculated as [LAVmax − LAVmin]/LAVmax. Results Ninety-nine total patients were enrolled, and the mean age was 58.0 ± 8.2 years and 75 (74.7%) were male. There were 59 (59.6%) PAF patients and the remaining 40 (40.4%) had PeAF. AF recurred in 5 of 59 (8.5%) PAF and in 10 of 40 (25%) PeAF patients. The LAVImax increased on 1 day, decreased at 3 months, and then increased again at 1 year but was lower than that at baseline. The LAEF changes were similar to the volume changes but were more prominent in PeAF than PAF patients. The baseline 3D LAVImax was an independent predictor of AF recurrence after RFCA and the cut-off value was 44.13 ml/m2. Conclusion In our study, even after 3 months of scar formation due to ablation, structural remodeling of the LA continued. The changes were more prominent in the non-recurrent, PeAF patients. Electronic supplementary material The online version of this article (10.1007/s10840-019-00696-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jongmin Hwang
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Hyoung-Seob Park
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea.
| | - Seongwook Han
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Seung-Woon Jun
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Na-Young Kang
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Jin-Hwa Jeon
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Sang-Woong Choi
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Cheol Hyun Lee
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - In-Cheol Kim
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Yun-Kyeong Cho
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Hyuck-Jun Yoon
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Hyungseop Kim
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Chang-Wook Nam
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
| | - Seung-Ho Hur
- Cardiovascular Center, Keimyung University Dongsan Hospital, 1035, Dalgubeol-daero, Daegu, Dalseo-gu,, 42601, South Korea
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Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications. MEDICINA-LITHUANIA 2019; 55:medicina55100709. [PMID: 31640260 PMCID: PMC6843475 DOI: 10.3390/medicina55100709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/16/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.
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Soulat-Dufour L, Lang S, Ederhy S, Ancedy Y, Beraud AS, Adavane-Scheuble S, Chauvet-Droit M, Hammoudi N, Scheuble A, Nhan P, Charbonnier M, Boccara F, Cohen A. Biatrial remodelling in atrial fibrillation: A three-dimensional and strain echocardiography insight. Arch Cardiovasc Dis 2019; 112:585-593. [PMID: 31540880 DOI: 10.1016/j.acvd.2019.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrial remodelling has been poorly investigated in atrial fibrillation (AF), and few studies have focused on biatrial remodelling. AIM To evaluate right atrial (RA) and left atrial (LA) remodelling in AF using global atrial reservoir strain and three-dimensional (3D) atrial volumes, according to rhythm outcome at mid-term follow-up. METHODS Two-dimensional and 3D transthoracic echocardiography (TTE) were performed within 24hours after admission (M0) and at 6-month follow-up (M6) in patients admitted for AF. RA and LA variables were assessed: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and minimum 3D volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF); atrial expansion index (3D RAEI, 3D LAEI); and global RA and LA reservoir strain. RESULTS Forty-eight consecutive patients were included prospectively. Three groups were identified depending on rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) in 25 (52.1%) patients; AF at M0 and AF at M6 (AF-AF) in 13 (27.1%) patients; and SR at M0 (spontaneous cardioversion before first TTE) and SR at M6 (SR-SR) in 10 (20.8%) patients. Between M0 and M6 in the AF-SR group, we found: significant decreases in Max 3D RA Voli (P=0.020), Min 3D RA Voli (P=0.0008), Max 3D LA Voli (P=0.001) and Min 3D LA Voli (P=0.0021); significant increases in 3D RAEF (P=0.037) and 3D RAEI (P=0.034); no significant differences in 3D LAEF and 3D LAEI; and significant increases in global RA and LA reservoir strain (both P<0.0001). There was no significant difference with regard to these variables in the AF-AF and SR-SR groups. CONCLUSION 3D volume and strain analyses were useful in the evaluation of RA and LA reverse remodelling in successfully cardioverted patients with AF.
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Affiliation(s)
- Laurie Soulat-Dufour
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France
| | - Sylvie Lang
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Stephane Ederhy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Yann Ancedy
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | | | - Saroumadi Adavane-Scheuble
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Marion Chauvet-Droit
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Nadjib Hammoudi
- Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France; Service de cardiologie, Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | | | - Pascal Nhan
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Magali Charbonnier
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France
| | - Franck Boccara
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Inserm, UMR S 938, centre de recherche Saint-Antoine, 75012 Paris, France
| | - Ariel Cohen
- Service de cardiologie, Sorbonne universités, hôpital Saint-Antoine, hôpitaux de l'Est Parisien, AP-HP, 75012 Paris, France; Unité de recherche sur les maladies cardiovasculaires, du métabolisme et de la nutrition, UMRS-ICAN 1166, Inserm, 75013 Paris, France.
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Li YG, Gong CQ, Zhao MZ, Sun J, Wang QS, Zhang PP, Feng XF, Yu Y, Yu YC, Liang BE. Determinants of postoperative left atrial structural reverse remodeling in patients undergoing combined catheter ablation of atrial fibrillation and left atrial appendage closure procedure. J Cardiovasc Electrophysiol 2019; 30:1868-1876. [PMID: 31353748 DOI: 10.1111/jce.14094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Catheter ablation of atrial fibrillation (AFCA) and left atrial appendage closure (LAAC) exert opposite effects on left atrial (LA) size. We aim to observe the net impact of combined AFCA and LAAC strategy on LA size and explore those factors which might affect the postprocedure LA structural remodeling. METHODS A total of 53 patients, who underwent combined AFCA and Watchman LAAC in our center from March to December 2017, were enrolled. Atrial fibrillation (AF) recurrence was monitored after the procedure. Left atrial volume (LAV) and left atrial appendage volume (LAAV) were measured by Mimics based on dual-source computed tomography images. RESULTS At 6 months, sinus rhythm (SR) was maintained in 79.2% patients. LAV was significantly reduced (130.2 ± 36.3 mL to 107.1 ± 30.0 ml; P < .001) in SR maintenance group, but not in AF recurrence group (138.8 ± 39.3 mL to 137.9 ± 36.9 mL; P = .671). In SR group, preoperative LAAV/LAV ratio (B = -0.894; P = .015), NT-proBNP (B = 0.005; P = .019) and left ventricular ejection fraction (LVEF) (B = -0.778; P < .001) could interactively affect the extent of postoperative LA structural reverse remodeling, among which LAAV/LAV ratio could independently predict the significance of reverse remodeling (≥15% reduction in LAV) (OR, 0.56; 95% CI, 0.34-0.90; P = .018). A preoperative LAAV/LAV ratio less than 7.1% is indicative of significant LA structural reverse remodeling in this patient cohort. CONCLUSIONS LA structural reverse remodeling could be evidenced in patients with maintained SR following combined AFCA and LAAC. Smaller LAAV/LAV ratio, higher NT-proBNP or lower LVEF at baseline are associated with more significant LA structural reverse remodeling, while LAAV/LAV ratio can predict the significance of the process after one-stop treatment.
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Affiliation(s)
- Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Qi Gong
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Zhe Zhao
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Fei Feng
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Yu
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Chi Yu
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bing-Er Liang
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hasegawa T, Nakanishi K, Yoshida Y, Uetsuhara T, Kosaka M, Shirai N, Yamashita H. Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1125-1132. [PMID: 31216052 DOI: 10.1111/pace.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maintenance of sinus rhythm after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with left atrial (LA) and ventricular (LV) reverse remodeling, although the degree varies among individuals. We hypothesized that frequent premature atrial complex (PAC) after PVI may attenuate the left heart reverse remodeling benefited from maintenance of sinus rhythm. METHODS We included 82 AF patients who underwent first-time PVI and 24-h Holter recordings at 6 months after PVI. All patients had no AF recurrence before this time. The number of PAC was categorized into tertiles: <90, 90-488 and >488 PACs/day. All patients underwent two-dimensional echocardiography and serum plasma B-type natriuretic peptide (BNP) measurement before and 6 months after PVI. LA reverse remodeling was defined as ≥15% decrease in LA volume index. RESULTS There was no significant difference in the baseline characteristics among the PAC tertiles except for sex. Six months after PVI, LA volume index, LV mass index, and serum BNP levels were significantly decreased in lower and middle PAC tertiles (all P < .05), whereas no significant changes were observed in upper PAC tertile. Frequency of LA reverse remodeling was significantly lower in upper tertile of PAC compared with middle and lower tertiles (22.2%, 57.1%, and 59.3%, P < .001). Baseline LA volume index, changes in LV mass index, and the frequency of PAC were independently associated with LA reverse remodeling (all P < .05). CONCLUSIONS Frequent PAC after PVI was associated with less left heart reverse remodeling in AF patients even without AF recurrence.
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Affiliation(s)
- Toshifumi Hasegawa
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan.,Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuto Uetsuhara
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Michihiko Kosaka
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Naoya Shirai
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
| | - Hajime Yamashita
- Department of Cardiovascular Medicine, Baba Memorial Hospital, Sakai, Japan
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Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Hwang C, Pak HN. Atrial Fibrillation Catheter Ablation Increases the Left Atrial Pressure. Circ Arrhythm Electrophysiol 2019; 12:e007073. [DOI: 10.1161/circep.118.007073] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Chun Hwang
- Utah Valley Medical Center, Provo (C.H.)
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea (J.-W.P., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)
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Echocardiographic assessment in patients with atrial fibrillation (AF) and normal systolic left ventricular function before and after catheter ablation: If AF begets AF, does pulmonary vein isolation terminate the vicious circle? Cardiol J 2019; 27:126-135. [PMID: 30701515 DOI: 10.5603/cj.a2019.0004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/13/2019] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) can be curative. There are conflicting data on whether AF associated atrial and ventricular structural remodeling reverses after ablation. The aim of this study was to evaluate the hemodynamic effect of AF ablation in patients with preserved left ventricular ejection fraction (LVEF). METHODS Forty three AF patients were studied (aged 56 ± 11 years; 29 male, 23% persistent AF, LVEF ≥ 50%) in whom RFCA was performed. Echocardiographic evaluation of atrial and ventricular diameters, volumes and strain imaging by two-dimensional speckle tracking were performed before and at least 6 months after RFCA. Nine patients had AF during baseline examination. RESULTS A significant decrease in the left (LA) and right (RA) atrial volume and an increase in the LA strain were observed 15 ± 7 months after RFCA. In the subgroup with baseline sinus rhythm, the increment in LA strain was only borderline significant. An increase in RA, right ventricular (RV) and Biatrial strain was noticed (p < 0.05). LVEF and global longitudinal strain of the left ventricle (LV), however, did not improve substantially. CONCLUSIONS Radiofrequency catheter ablation of AF in patients with preserved LV systolic function results in significant improvement in RA and RV function with a substantial reduction in LA and RA size. No deleterious impact of AF ablation on LA function was revealed.
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Chaudhry MA, Johnson A, Heywood JT. Stiff Left Atrial Syndrome; Prospects and Possibilities. Retrospective Analysis and Review of the Literature. Curr Hypertens Rev 2018; 15:17-21. [PMID: 30221604 DOI: 10.2174/1573402114666180917095654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/24/2018] [Accepted: 09/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Stiff left atrial syndrome is an intriguing clinical phenomena characterized by reduced left atrial compliance, pulmonary venous hypertension and exacerbations of volume overload. We conducted a retrospective review of patients diagnosed with stiff left atrial syndrome at our center. METHODS All patients admitted to our hospital with volume overload and pulmonary venous hypertension who were diagnosed with stiff left atrial syndrome based on evidence by echocardiogram and right heart catheterization between July 2011 and July 2013 were included in this retrospective review. RESULTS Twentythree patients (mean age 73 ± 11 years, 39% male and 61% female) were diagnosed with stiff left atrial syndrome at our center. Thirty-five percent had persistent while 39% had permanent atrial fibrillation. Mean duration of atrial fibrillation was 7.6 ± 2.1 years. Forty-three percent of patients had long standing hypertension. There was no mitral regurgitation in 39% of patients while 48% had mild mitral regurgitation. On right heart catheterization, mean right atrial pressure was 12.6±4.8 mm of Hg, mean pulmonary arterial pressure was 33±7.2 mm of Hg, mean pulmonary capillary wedge pressure was 24.8± 4.2mm of Hg while peak V waves were seen at mean of 37.8± 5.3 mm of Hg. Mean left atrial volume index was 49.8±17.1 mL/m 2. After the initial diagnosis with a two year follow- up, there were no readmissions in 65% of patients who were on appropriate diuretic therapy and had regular clinical visits. Frequent readmissions were seen in 35% of patients inspite of appropriate diuretic therapy. All-cause mortality rate was 4.3% at two year follow up. CONCLUSION In patients with stiff left atrial syndrome, the presence of left atrial dilation, long standing atrial fibrillation and hypertension are the key factors associated with pathogenesis and clinical course. Close follow up and monitoring of volume status is essential to prevent hospital readmissions and improve long term prognosis.
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Affiliation(s)
- Muhammad Ali Chaudhry
- Division of Cardiovascular Medicine, Aultman Hospital, Canton, Ohio-44710 OH, United States
| | - Allen Johnson
- Division of Cardiovascular Medicine, Heart Failure Recovery and Research, Scripps Green Hospital, La Jolla-90033, CA 92037, United States
| | - James Thomas Heywood
- Division of Cardiovascular Medicine, Heart Failure Recovery and Research, Scripps Green Hospital, La Jolla-90033, CA 92037, United States
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Celik AI, Kanadasi M, Demir M, Deniz A, Akilli RE, Deveci OS, Cagliyan CE, Ozmen C, Ikikardes F, Karaaslan MB. Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio. Indian Pacing Electrophysiol J 2018; 19:9-14. [PMID: 30712532 PMCID: PMC6354203 DOI: 10.1016/j.ipej.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/02/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
Background Cryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. Methods 50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). Results In both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 103/μl and 1.98 ± 0.66 103/μl (p = 0.674). Conclusion LAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.
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Affiliation(s)
- Aziz Inan Celik
- Bayburt State Hospital, Department of Cardiology, Bayburt, Turkey.
| | - Mehmet Kanadasi
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Mesut Demir
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Ali Deniz
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Rabia Eker Akilli
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Onur Sinan Deveci
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Emre Cagliyan
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
| | - Caglar Ozmen
- Pazarcık State Hospital, Department of Cardiology, Kahramanmaras, Turkey.
| | - Firat Ikikardes
- Cukurova University, Faculty of Medicine, Department of Cardiology, Adana, Turkey.
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Yarlagadda B, Dar T, Parikh V, Lakkireddy D. An interesting case of reverse electrical remodeling of the left atrium after radiofrequency ablation. HeartRhythm Case Rep 2018; 4:177-179. [PMID: 29915712 PMCID: PMC6003785 DOI: 10.1016/j.hrcr.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Bharath Yarlagadda
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Tawseef Dar
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Valay Parikh
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, Kansas
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Fiala M, Bulková V, Šknouril L, Nevralová R, Toman O, Januška J, Špinar J, Wichterle D. Functional improvement after successful catheter ablation for long-standing persistent atrial fibrillation. Europace 2018; 19:1781-1789. [PMID: 27707782 DOI: 10.1093/europace/euw282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/13/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Identifying patients who benefit from restored sinus rhythm (SR) would optimize the selection of candidates for ablation of long-standing persistent atrial fibrillation (LSPAF). This prospective study sought to identify the hitherto unknown factors associated with global functional improvement after successful radiofrequency catheter ablation of LSPAF. Methods and results In 171 LSPAF patients (84% of the total consecutive 203 patients) who were examined in SR 12 months after ablation, the individual per cent change from baseline value in maximum oxygen consumption at exercise test (VO2 max), left ventricular ejection fraction (LVEF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and five-dimensional descriptive system (EQ-5D) of quality-of-life questionnaire were classified in quartiles by 0 (worse) to 3 (best) grades. The individual grades were summed into a composite score (SCORE, 0 … 12) reflecting global functional improvement. Significant improvement in VO2 max (3.4 ± 4.7 mL/kg/min), LVEF (7.5 ± 9.1%), NT-proBNP (-861 ± 809 pg/mL), and EQ-5D (0.7 ± 0.12) was observed (all P < 0.0001). On multivariable analysis, younger age (P = 0.001), male gender (P = 0.02), timely post-ablation left atrial appendage (LAA) outflow (P = 0.005) with improvement in outflow velocity (P = 0.0002), and withdrawal of Class I/III antiarrhythmic drugs (P < 0.05) were positively and independently correlated with the SCORE. Conclusions Younger male patients benefited most from catheter ablation of LSPAF. Delayed or non-improved LAA outflow and inability to discontinue Class I/III antiarrhythmic medication reduced the post-ablation functional improvement.
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Affiliation(s)
- Martin Fiala
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic.,Department of Cardiology, Hospital Podlesí, Třinec, Czech Republic
| | - Veronika Bulková
- Department of Cardiology and Angiology, St. Anne's University Hospital and International, Clinical Research Centre, Brno, Czech Republic
| | - Libor Šknouril
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Renáta Nevralová
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Ondrej Toman
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic
| | - Jaroslav Januška
- Department of Cardiology, Hospital Podlesí, Trinec, Czech Republic
| | - Jindrich Špinar
- Department of Internal Medicine and Cardiology, University Hospital, Jihlavská 53, Brno 659 91, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1392] [Impact Index Per Article: 198.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Baran J, Lewandowski P, Smarż K, Sikorska A, Zaborska B, Kułakowski P. Acute Hemodynamic and Tissue Effects of Cryoballoon Ablation on Pulmonary Vessels: The IVUS-Cryo Study. J Am Heart Assoc 2017. [PMID: 28649087 PMCID: PMC5669196 DOI: 10.1161/jaha.117.005988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Cryoballoon‐based pulmonary vein isolation (CB‐PVI) has been widely used for the treatment of atrial fibrillation. Although generally safe and effective, the procedure may be associated with pulmonary vein (PV) stenosis and bronchial or esophageal injury. The mechanisms leading to these complications have not been studied in detail. Our aim was to examine acute effects of cryoballoon on the pulmonary vessel and right heart pressures as well as PV wall morphology. Methods and Results In 8 patients (5 men, mean age 55±14 years) undergoing CB‐PVI, pressure in each PV was measured by catheter located inside the PV directly before and after CB‐PVI. The right atrial, right ventricular, and pulmonary artery pressures as well as pulmonary arterial wedge capillary pressure in the pulmonary artery branch corresponding to target PV were also measured. Morphological changes in PVs were assessed using intravascular ultrasonography. There were no significant differences in PV pressures before and after ablation. The pulmonary arterial wedge capillary pressure significantly increased during cryoapplication (left superior: 20±10 versus 29±8.5 mm Hg, P=0.004; left inferior: 24±10 versus 32±6 mm Hg, P=0.012; right superior: 25±9 versus 35±10 mm Hg, P=0.002; right inferior: 24±10 versus 37±12 mm Hg, P=0.0036). The right atrial and pulmonary artery pressures increased significantly after CB‐PVI (9±6 versus 13±8 mm Hg, P=0.004, and 20±9 versus 24±10 mm Hg, P=0.048, respectively). Intravascular ultrasonography showed acute edema and dissection‐like changes causing relative lumen narrowing in 90% of PVs. Conclusions CB‐PVI causes significant rise in pulmonary artery and right atrial pressures as well as PV wall damage. The clinical significance of these findings warrants further investigations.
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Affiliation(s)
- Jakub Baran
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Paweł Lewandowski
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Krzysztof Smarż
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Beata Zaborska
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Piotr Kułakowski
- Cardiology Department, Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
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Acute decompensated heart failure as a reason of premature chemotherapy discontinuation may be independent of a lifetime doxorubicin dose in lymphoma patients with cardiovascular disorders. Int J Cardiol 2017; 235:147-153. [DOI: 10.1016/j.ijcard.2017.02.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 12/12/2022]
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Nührich JM, Geisler AC, Steven D, Hoffmann BA, Schäffer B, Lund G, Stehning C, Radunski UK, Sultan A, Schwarzl M, Adam G, Willems S, Muellerleile K. Active Atrial Function and Atrial Scar Burden After Multiple Catheter Ablations of Persistent Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 40:175-182. [PMID: 27995637 DOI: 10.1111/pace.13004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage-mapping after multiple persAF ablation procedures. METHODS We included 16 persAF patients who had ≥2 SM procedures and a control group (CG) of 21 persAF patients without prior ablation. CMR was performed in sinus rhythm at least 4 weeks after the last cardioversion. Active left and right (RA) atrial emptying fractions (AEF) as well as peak active left atrial appendage (LAA) emptying velocities were obtained by CMR flow measurements. Furthermore, LA scar burden was quantified on electroanatomical voltage maps by the portion of points with local voltage amplitude <0.2 mV. RESULTS We found median LA-AEF to be lower (13 [9-22] vs 32 [26-36] %, P < 0.001) and median LA scar burden to be higher (40 [20-68] vs nine [3-18] %, P < 0.05) in the SM group compared with the CG. Furthermore, a significant correlation was found between mean LA voltage and LA-AEF (r2 = 0.62, P < 0.001). No significant differences were detected with respect to median RA-AEF (41 [28-48] vs 47 [35-50] %, P = 0.43) and median peak LAA emptying velocities (30 [16-40] vs 17 [13-28] cm/s, P = 0.07). CONCLUSIONS Active LA function is preserved but significantly impaired and associated with ablation-related LA scar burden after multiple extensive persAF ablations.
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Affiliation(s)
- Jana M Nührich
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany
| | - Anne C Geisler
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany
| | - Daniel Steven
- University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany
| | - Boris A Hoffmann
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany
| | - Benjamin Schäffer
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany
| | - Gunnar Lund
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany
| | | | - Ulf K Radunski
- University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany
| | - Arian Sultan
- University Hospital Cologne, Heart Center, Department of Electrophysiology, Cologne, Germany
| | - Michael Schwarzl
- University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany
| | - Gerhard Adam
- University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg, Germany
| | - Stephan Willems
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany
| | - Kai Muellerleile
- University Heart Center, Department of Cardiology - Electrophysiology, Hamburg, Germany.,University Heart Center, Department of General and Interventional Cardiology, Hamburg, Germany
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Kim JS, Im SI, Shin SY, Kang JH, Na JO, Choi CU, Kim SH, Kim EJ, Rha SW, Park CG, Seo HS, Oh DJ, Hwang C, Kim YH, Yong HS, Lim HE. Changes in Left Atrial Transport Function in Patients Who Maintained Sinus Rhythm After Successful Radiofrequency Catheter Ablation for Atrial Fibrillation: A 1-Year Follow-Up Multislice Computed Tomography Study. J Cardiovasc Electrophysiol 2016; 28:167-176. [PMID: 27859888 DOI: 10.1111/jce.13128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Functional remodeling of left atrium (LA) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has not been fully elucidated. This study aimed to determine the impact of RFCA on LA transport function in patients who maintained sinus rhythm (SR) after AF ablation. METHODS AND RESULTS A total of 96 patients (paroxysmal AF [PAF] = 52) who maintained SR during 1 year after AF ablation were enrolled. Multislice computed tomography was performed to determine LA volume (LAV) and LA emptying fraction (LAEF) at pre-RFCA and 1-year post-RFCA. Creatine kinase-MB (CK-MB) and troponin-T levels were analyzed 1-day post-RFCA. At 1-year post-RFCA, mean LAV and LAEF decreased in overall patients. Based on LAEF change (ΔLAEF) cutoff of 5.0%, LAEF reduced in 41 patients (worsened group) and improved or showed no change in 55 patients (preserved group). Compared with preserved group, worsened group had a higher proportion of PAF, higher levels of CK-MB and troponin-T, and additional LA ablation. ΔLAEF was inversely correlated with CK-MB and troponin-T levels. Subgroup analysis showed that LAEF significantly decreased in PAF patients who underwent additional LA ablation. Multivariate analysis revealed that high baseline LAEF and additional LA ablation were independent predictors for worsened LAEF. CONCLUSIONS Although SR was maintained for 1 year after AF ablation, LAEF as well as LAV decreased. The extent of LAEF deterioration was significantly associated with the amount of iatrogenic myocardial damage. Our data indicate that extensive atrial ablation may lead to LA functional deterioration, especially in patients with PAF.
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Affiliation(s)
- Jin-Seok Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Il Im
- Division of Cardiology, Kosin University Gospel Hospital, College of Medicine, Kosin University, Busan, Korea
| | - Seung Yong Shin
- Division of Cardiology, Heart Research Institute, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jun Hyuk Kang
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin Oh Na
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Ung Choi
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong Hwan Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Gyu Park
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Seog Seo
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Dong Joo Oh
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chun Hwang
- Division of Cardiology, Utah Valley Regional Medical Center, Provo, Utah, USA
| | - Young-Hoon Kim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Euy Lim
- Division of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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42
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Yang CH, Chou CC, Hung KC, Wen MS, Chang PC, Wo HT, Lee CH, Lin FC. Comparisons of the underlying mechanisms of left atrial remodeling after repeat circumferential pulmonary vein isolation with or without additional left atrial linear ablation in patients with recurrent atrial fibrillation. Int J Cardiol 2016; 228:449-455. [PMID: 27870975 DOI: 10.1016/j.ijcard.2016.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/31/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) is a potentially curative treatment for atrial fibrillation (AF), however, whether or not additional left atrial (LA) linear ablation for recurrent AF adversely affects LA remodeling is unknown. METHODS Thirty-eight patients experiencing AF recurrence after the 1st circumferential pulmonary vein isolation (CPVI) underwent a repeat RFCA, including 20 and 18 patients receiving a repeat CPVI (group I) or CPVI plus LA linear ablation (group II), respectively. 2-D echocardiography was performed during sinus rhythm within 24h, at 1-m and 6-m after RFCA. Longitudinal strains and strain rate were measured with speckle-tracking echocardiography. The standard deviation of contraction duration was defined as LA mechanical dispersion. RESULTS One and two patients experienced AF recurrence after the 2nd RFCA in group I and II, respectively (P=NS). The 1st CPVI with AF recurrence did not reduce LA size significantly in two groups. After a repeat CPVI, LA diameter but not LA maximal and minimal volume was significantly reduced in group I; additional LA linear ablation significantly decreased LA diameter, maximal and minimal volume in group II. However, there was no significant difference in LA emptying function, global and segmental LA strain and strain rate among the baseline, 1-m and 6-m follow-up in two groups. RFCA did not significantly increase LA mechanical dispersion regardless of the AF ablation strategies. CONCLUSIONS In patients with recurrent AF, a successful repeat CPVI with or without additional LA linear ablation reduced LA size without significant deleterious effects on LA function and mechanical dispersion.
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Affiliation(s)
- Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Chuan Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Cheng Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-Ta Wo
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fen-Chiung Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Verma I, Tripathi H, Sikachi RR, Agrawal A. Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle? Heart Lung Circ 2016; 25:1177-1183. [PMID: 27475259 DOI: 10.1016/j.hlc.2016.05.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/21/2016] [Accepted: 05/31/2016] [Indexed: 01/19/2023]
Abstract
Atrial fibrillation is the most common heart rhythm disorder in United States, characterised by rapid and irregular beating of both the atria resulting in the similar ventricular response. While rate and rhythm control using pharmacological regimens remain the primary management strategies in these patients, radiofrequency catheter ablation (RFCA) is rapidly rising as an alternative modality of treatment. Increase in the incidence of RFCA has shed light on complications associated with this procedure. Pulmonary hypertension (PH) is one of the long-term complications that has been observed postcatheter ablation. There have been multiple mechanisms which have been proposed to explain these elevated pulmonary pressures. These include the involvement of the lungs due to pulmonary vein stenosis, pulmonary vein occlusion and, rarely, pulmonary embolism. Radiofrequency catheter ablation can also lead to scarring of the atrium which can cause left atrial diastolic dysfunction leading to elevated pulmonary pressures. Recently, it was also proposed that elevated pulmonary pressure was related to the unmasking of left ventricular diastolic dysfunction occurring after this procedure. In this article, we review all the mechanisms that are associated with the development of pulmonary hypertension in patients undergoing RCFA for atrial fibrillation and the approach to diagnosis and management of such patients.
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Affiliation(s)
- Isha Verma
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Hemantkumar Tripathi
- Alvin and Lois Lapidus Cancer Institute, Sinai Hospital of Baltimore, Maryland, USA
| | | | - Abhinav Agrawal
- Department of Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA; Northwell Health - Hofstra Northwell School of Medicine Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, New York, USA.
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45
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Mohty D, Boulogne C, Magne J, Varroud-Vial N, Martin S, Ettaif H, Fadel BM, Bridoux F, Aboyans V, Damy T, Jaccard A. Prognostic value of left atrial function in systemic light-chain amyloidosis: a cardiac magnetic resonance study. Eur Heart J Cardiovasc Imaging 2016; 17:961-9. [PMID: 27194782 DOI: 10.1093/ehjci/jew100] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/15/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cardiac involvement in systemic light-chain amyloidosis (AL) imparts an adverse impact on outcome. The left atrium (LA), by virtue of its anatomical location and muscular wall, is commonly affected by the amyloid process. Although LA infiltration by amyloid fibrils leads to a reduction in its pump function, the infiltration of the left ventricular (LV) myocardium results in diastolic dysfunction with subsequent increase in filling pressures and LA enlargement. Even though left atrial volume (LAV) is an independent prognostic marker in many cardiomyopathies, its value in amyloid heart disease remains to be determined. In addition, few data are available as to the prognostic value of LA function in systemic AL. Using cardiac magnetic resonance (CMR), the current study aims to assess the prognostic significance of the maximal LAV and total LA emptying fraction (LAEF) in patients with AL. METHODS AND RESULTS Fifty-four consecutive patients (age 66 ± 10 years, 59% males) with confirmed systemic AL and mean LV ejection fraction of 60 ± 12% underwent CMR. As compared with patients with no or minimal cardiac involvement (Mayo Clinic [MC] stage I), those at moderate and high risk (MC stages II and III) had significantly larger indexed maximal LAV (36 ± 15 vs. 46 ± 13 vs. 52 ± 19 mL/m(2), P = 0.03) and indexed minimal LAV (20 ± 6 vs. 34 ± 11 vs. 44 ± 17 mL/m(2), P < 0.001), lower LAEF (42 ± 9 vs. 26 ± 13 vs. 16 ± 9%, P < 0.0001) but similar LVEF. Furthermore, myocardial late gadolinium enhancement (LGE) was more frequent and significantly associated with lower LAEF. LAEF was also significantly lower in symptomatic (NHYA ≥ II, 22 ± 14%) as compared with asymptomatic patients (NYHA class I, 33 ± 13%, P = 0.006). Two-year survival rate was lower in patients with LAEF ≤ 16% as compared with those with LAEF > 16% (37 ± 11 vs. 94 ± 4%, P = 0.001). In multivariate analysis, lower LAEF remained independently associated with a higher risk of 2-year mortality (HR = 1.08 per 1% decrease, 95% CI: 1.02-1.15, P = 0.003). CONCLUSION In patients with systemic AL, LAEF as assessed by CMR is associated with NYHA functional class, MC stage, myocardial LGE and 2-year mortality.
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Affiliation(s)
- Dania Mohty
- CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France
| | | | | | | | | | | | - Bahaa M Fadel
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | | | | | - Arnaud Jaccard
- CHU Dupuytren, Limoges, France French National Reference Center for Light chains Amyloidosis and Other Diseases by Monoclonal Immunoglobulin Deposits, Limoges University, Limoges, France
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46
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Sanchis L, Prat S, Sitges M. Cardiovascular Imaging in the Electrophysiology Laboratory. ACTA ACUST UNITED AC 2016; 69:595-605. [PMID: 27107802 DOI: 10.1016/j.rec.2016.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/09/2016] [Indexed: 10/21/2022]
Abstract
In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.
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Affiliation(s)
- Laura Sanchis
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Susanna Prat
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Marta Sitges
- Instituto Cardiovascular, Hospital Clínic, IDIBAPS, Universidad de Barcelona, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
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47
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Yang Y, Liu Q, Wu Z, Li X, Xiao Y, Tu T, Zhou S. Stiff Left Atrial Syndrome: A Complication Undergoing Radiofrequency Catheter Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2016; 27:884-9. [PMID: 26920815 DOI: 10.1111/jce.12966] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/28/2016] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
Radiofrequency catheter ablation for atrial fibrillation is an effective approach for treating atrial fibrillation. Its complications have attracted much attention, of which the stiff left atrial syndrome is a recently discovered complication that has not been completely understood. This study aims to investigate the concept, pathologic basis, clinical characteristics, predictors, and treatment protocols of the stiff left atrial syndrome after radiofrequency ablation for atrial fibrillation.
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Affiliation(s)
- Yufan Yang
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qiming Liu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Zhihong Wu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xuping Li
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yichao Xiao
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Tao Tu
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shenghua Zhou
- Cardiac Catheterization Lab of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Department of Cardiology of Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Pre-Procedural Serum Atrial Natriuretic Peptide Levels Predict Left Atrial Reverse Remodeling After Catheter Ablation in Patients With Atrial Fibrillation. JACC Clin Electrophysiol 2016; 2:151-158. [PMID: 29766864 DOI: 10.1016/j.jacep.2015.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/07/2015] [Accepted: 12/27/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study aimed to investigate the role of atrial natriuretic peptide (ANP) levels to predict left atrial (LA) reverse remodeling in atrial fibrillation (AF) patients. BACKGROUND Although LA reverse remodeling after radiofrequency catheter ablation (RFCA) for AF was reported to be associated with favorable outcomes and improvement of LA and left ventricular function, the predictor has not been extensively evaluated. METHODS This study included 104 consecutive patients who underwent RFCA for AF. All patients underwent multidetector computed tomography examination and laboratory tests, including measurement of ANP, plasma B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (hs-CRP) levels before and 6 months after RFCA. The study population was divided according to the extent of the decrease in the LA volume index at follow-up; responders were defined as patients who exhibited a ≥15% decrease in the LA volume index. RESULTS At follow-up, 49 patients (47%) were classified as responders. Pre-procedural serum ANP and BNP levels were significantly higher in the responders than in the nonresponders (both p < 0.01). In the responders, a significant decrease was observed in the log ANP, log BNP, and log hs-CRP levels from baseline to follow-up (all p < 0.01). Multivariate linear regression analysis revealed that log ANP levels before RFCA and maintenance of sinus rhythm during follow-up were independent predictors of LA reverse remodeling (both p < 0.01). CONCLUSIONS In this study, 47% of the patients exhibited LA reverse remodeling after RFCA for AF, with a concomitant improvement in serum ANP, BNP, and hs-CRP levels. The pre-procedural ANP level and maintenance of sinus rhythm were independently associated with LA reverse remodeling.
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49
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Lee A, See VA, Lim TW, Descallar J, Chik W, Ross DL, Thomas SP, Thomas L. Atrial fibrillation ablation by single ring isolation versus wide antral isolation: Effects on left atrial size and function. Int J Cardiol 2015; 206:1-6. [PMID: 26761395 DOI: 10.1016/j.ijcard.2015.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/06/2015] [Accepted: 12/12/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) by single ring isolation (SRI) has been demonstrated to reduce recurrence of atrial fibrillation (AF) compared to the standard technique of wide antral isolation (WAI). In this study, we examine the differential effect of these techniques on left atrial size and function. METHODS We examined left atrial (LA) size (LA maximum and LA minimum volumes) and function (LA emptying fraction and LA expansion index) over a period of 6 months following PVI as measured by transthoracic echocardiography in 187 patients that were enrolled in a randomised controlled trial of SRI vs WAI. RESULTS Compared to pre-ablation, at 6 months post-PVI, there was a small decrease in the LA maximum volume in the WAI group (67.3 vs 62.7 mL, p=0.02). The LA size did not change significantly over 6 months in the SRI group. Patients who underwent SRI had a small reduction in the LA expansion index at 6 months post-PVI compared to baseline (80.6 vs 66.6%, p=0.02). LA function did not change significantly over 6 months in the WAI group. However, at 6 months, there was no difference in any measure of LA size or function between the SRI and WAI groups. CONCLUSIONS SRI, whilst previously demonstrated to be more effective than WAI in preventing AF recurrence, is associated with minimal adverse effects on left atrial function at medium term follow-up despite the isolation of a larger region of LA myocardium.
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Affiliation(s)
- Adam Lee
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - Valerie A See
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - Toon Wei Lim
- Department of Cardiology, Westmead Hospital, Sydney, Australia; Cardiac Department, National University Heart Centre, Singapore
| | - Joseph Descallar
- Ingham Institute, Sydney, Australia; The University of New South Wales, Sydney, Australia
| | - William Chik
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - David L Ross
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Liza Thomas
- Department of Cardiology, Liverpool Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia; The University of Sydney, Sydney, Australia.
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50
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Phillips KP, Walker DT, Humphries JA. Combined catheter ablation for atrial fibrillation and Watchman® left atrial appendage occlusion procedures: Five-year experience. J Arrhythm 2015; 32:119-26. [PMID: 27092193 PMCID: PMC4823577 DOI: 10.1016/j.joa.2015.11.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/16/2015] [Accepted: 11/04/2015] [Indexed: 11/25/2022] Open
Abstract
Background Patients with atrial fibrillation (AF) may benefit from undergoing concomitant interventions of left atrial catheter ablation and device occlusion of the left atrial appendage (LAA) as a two-pronged strategy for rhythm control and stroke prevention. We report on the outcome of combined procedures in a single center case series over a 5-year timeframe. Methods Ninety-eight patients with non-valvular AF and a mean CHA2DS2-VASc score 2.6±1.0 underwent either first time, or redo pulmonary vein isolation (PVI) procedures, followed by successful implant of a Watchman® device. Results All procedures were generally uncomplicated with a mean case time of 213±40 min. Complete LAA occlusion was achieved at initial implant in 92 (94%) patients. Satisfactory LAA occlusion was achieved in 100% of patients at 12 months, with a complete LAA occlusion rate of 86%. All patients discontinued oral anticoagulation. Persistent late peri-device leaks were more frequently associated with device angulation or shoulder protrusion, and were associated with a significantly lower achieved device compression of 12±3% vs. 15±5% (p<0.01) than complete occlusion. One ischemic stroke was recorded over a mean follow-up time of 802±439 days. Twelve months׳ freedom from detectable AF was achieved in 77% of patients. Conclusions Combined procedures of catheter ablation for AF and Watchman® LAA implant appear to be feasible and safe, with excellent rates of LAA occlusion achieved and an observed stroke rate of 0.5% per year during mid-term follow-up. Incomplete occlusion was associated with lower achieved device compression and was more frequently associated with suboptimal device position.
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Affiliation(s)
- Karen P Phillips
- HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia
| | - Daniel T Walker
- HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia
| | - Julie A Humphries
- HeartCare Partners, GenesisCare, Greenslopes Private Hospital, Newdegate St, Greenslopes, Brisbane, QLD 4120, Australia
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