1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01771-5. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)00261-3. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [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: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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4
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Fei X, Wang B, Chu H, Fu G, Yu Y, Feng M, Du X, Liu J. Clinical outcomes of combined catheter ablation and left atrial appendage closure in elderly patients with nonvalvular atrial fibrillation. Clin Cardiol 2024; 47:e24169. [PMID: 37804320 PMCID: PMC10766124 DOI: 10.1002/clc.24169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Catheter ablation (CA) combined with left atrial appendage closure (LAAC) has emerged as a promising method to relieve symptoms while reducing the incidence of stroke in selected high-risk patients with atrial fibrillation (AF). HYPOTHESIS We aimed to investigate the clinical outcomes of combined CA and LAAC in elderly patients. METHODS A total of 316 patients with symptomatic drug-refractory AF who underwent combined CA and LAAC between January 2016 and December 2020 were retrospectively included. Baseline characteristics, periprocedural complications, and clinical events during follow-up were recorded and compared between patients aged ≥ 75 years (n = 66) and <75 years (n = 250). RESULTS Pulmonary vein isolation and satisfactory LAAC were achieved in all patients. No patients experienced death or stroke/transient ischemic stroke periprocedurally. After a median follow-up of 12.2 (6.7-24.4) months and 11.9 (5.5-23.6) months, the rate of sinus rhythm maintenance was comparable between the two groups (≥75 years: 78.8% vs. <75 years: 80.8%; log-rank test, p = 0.674). The median follow-up periods for clinical outcomes were 27.9 (9.3-44.8) months and 25.2 (10.8-45.7) months, respectively. In patients aged ≥ 75 years, one suffered ischemic stroke, and one experienced major bleeding event. In patients aged < 75 years, four had ischemic stroke, and eight had major bleeding events. Two patients aged < 75 years died during follow-up, while none of the patients aged ≥ 75 years died. CONCLUSIONS Combining CA and LAAC was feasible, safe and effective in elderly patients with AF.
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Affiliation(s)
- Xiaohong Fei
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Binhao Wang
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Huimin Chu
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Guohua Fu
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Yibo Yu
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Mingjun Feng
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Xianfeng Du
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
| | - Jing Liu
- Arrhythmia Center, the First Affiliated Hospital of Ningbo UniversityNingboChina
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang ProvinceNingboZhejiang ProvinceChina
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5
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Fong KY, Zhao JJ, Chan YH, Wang Y, Yeo C, Tan VH. Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023. [DOI: 10.47102/annals-acadmedsg.2022326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction: Despite promising trials, catheter ablation is still regarded as an adjunct to antiarrhythmic drugs (AADs) in the treatment of paroxysmal atrial fibrillation (PAF). This study aimed to compare the effectiveness of various ablation therapies and AAD.
Method: Randomised controlled trials or propensity score-matched studies comparing atrial tachyarrhythmia recurrence among any combination of ablation modalities or AAD were retrieved. Kaplan-Meier curves and risk tables for this outcome were graphically reconstructed to extract patient-level data. Frequentist network meta-analysis (NMA) using derived hazard ratios (HRs), as well as 2 restricted mean survival time (RMST) NMAs, were conducted. Treatment strategies were ranked using P-scores.
Results: Across 24 studies comparing 6 ablation therapies (5,132 patients), Frequentist NMA-derived HRs of atrial fibrillation recurrence compared to AAD were 0.35 (95% confidence interval [CI]=0.25–0.48) for cryoballoon ablation (CBA), 0.34 (95% CI=0.25–0.47) for radiofrequency ablation (RFA), 0.14 (95% CI=0.07–0.30) for combined CBA and RFA, 0.20 (95% CI=0.10–0.41) for hot-balloon ablation, 0.43 (95% CI=0.15–1.26) for laser-balloon ablation (LBA), and 0.33 (95% CI=0.18–0.62) for pulmonary vein ablation catheter. RMST-based NMAs similarly showed significant benefit of all ablation therapies over AAD. The combination of CBA + RFA showed promising long-term superiority over CBA and RFA, while LBA showed favourable short-term efficacy.
Conclusion: The advantage of ablation therapies over AAD in preventing atrial tachyarrhythmia recurrence suggests that ablation should be considered as the first-line treatment for PAF in patients fit for the procedure. The promising nature of several specific therapies warrants further trials to elicit their long-term efficacy and perform a cost-benefit analysis.
Keywords: Atrial fibrillation, catheter ablation, network meta-analysis
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong Huak Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yue Wang
- Changi General Hospital, Singapore
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6
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Boehmer AA, Rothe M, Zezyk C, Soether CM, Dobre BC, Kaess BM, Ehrlich JR. Persistent Atrial Fibrillation in Elderly Patients: Limited Efficacy of Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11206070. [PMID: 36294392 PMCID: PMC9604667 DOI: 10.3390/jcm11206070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/02/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cryoballoon pulmonary vein isolation (cryoPVI) is established for symptomatic paroxysmal atrial fibrillation (AF) treatment, but its value in persistent AF is less clear. In particular, limited data are available on its efficacy in elderly patients (≥75 years) with persistent AF. Age is an important modifier of AF progression and represents a risk-factor for AF recurrence. (2) Methods: Prospective, single-center observational study to evaluate the impact of age on efficacy and safety of cryoPVI in elderly patients. Primary efficacy endpoint was symptomatic AF recurrence after 90-day blanking period. Primary safety endpoints were death from any cause, procedure-associated complications or stroke/transient ischemic attack. Median follow-up was 17 months (range 3−24). (3) Results: We included 268 patients with persistent AF (94 ≥ 75 years of age). Multivariate Cox regression analysis identified age as the only independent factor influencing AF recurrence in the overall cohort (p = 0.006). To minimize confounding bias in efficacy and safety analysis of cryoPVI, we matched younger and elderly patients with respect to baseline characteristics. At 24 months, primary efficacy endpoint occurred in 13/69 patients <75 years and 31/69 patients ≥75 years of age (24 months Kaplan−Meier event-rate estimates, HR 0.34; 95% CI, 0.19 to 0.62; log-rank p = 0.0004). No differences were observed in the occurrence of safety end points. (4) Conclusions: Elderly (≥75 years) patients with persistent AF undergoing cryoPVI had an approximately threefold higher risk of symptomatic AF recurrence than matched younger patients. Accordingly, other treatment modalities may be evaluated in this population.
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7
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Cecchini F, Mugnai G, Iacopino S, Abugattas JP, Adriaenssens B, Al-Housari M, Almorad A, Bala G, Bisignani A, de Asmundis C, De Greef Y, Maj R, Osòrio TG, Pannone L, Schwagten B, Sieira J, Sorgente A, Stroker E, Wolf M, Chierchia GB. Safety and long-term efficacy of cryoballoon ablation for atrial fibrillation in octogenarians: a multicenter experience. J Interv Card Electrophysiol 2022; 65:559-571. [DOI: 10.1007/s10840-022-01313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022]
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8
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Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation. IJC HEART & VASCULATURE 2022; 40:101021. [PMID: 35399609 PMCID: PMC8987379 DOI: 10.1016/j.ijcha.2022.101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
Background Limited data exist on pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) ablation and additional non-pulmonary vein trigger ablation for non-paroxysmal atrial fibrillation (non-PAF). We aimed to assess the outcomes of first-stage catheter ablation for non-PAF patients. Methods Initial PVI was performed on 734 non-PAF patients (age: 64 ± 10 years; male: 584 (80%)) between September 2014 and June 2018 [315 (43%), CB ablation; 419 (57%), RF catheter]. A logistic regression model was used to match 257 pairs (514 patients) according to the propensity scores (CB or RF group). After PVI, additional non-PV trigger ablation was performed if induced by isoproterenol. We analysed the clinical outcomes of both groups. Results The mean procedural time was significantly shorter in the CB group (125 [range, 89–165] min) than in the RF group (190 [160–224] min; P < 0.001). The 1-year Kaplan-Meier event rate revealed similar atrial fibrillation-free survival rates between the two groups (CB: 77.9%, RF: 82.3%; log-rank P = 0.111). The additional ablation percentage for non-PV foci (CB: 39%, RF: 41%; P = 0.653) and complication incidence (CB: 5%, RF: 4%; P = 0.670) were also similar. Conclusions In non-PAF patients, the combination strategy of PVI using CB or RF ablation and non-PV trigger ablation achieved comparable outcomes.
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9
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Volgman AS, Nair G, Lyubarova R, Merchant FM, Mason P, Curtis AB, Wenger NK, Aggarwal NT, Kirkpatrick JN, Benjamin EJ. Management of Atrial Fibrillation in Patients 75 Years and Older: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:166-179. [PMID: 35027110 DOI: 10.1016/j.jacc.2021.10.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of atrial fibrillation (AF) is increasing as the population ages. AF treatment-related complications also increase markedly in older adults (defined as ≥75 years of age for this review). The older AF population has a high risk of stroke, bleeding, and death. Syncope and fall-related injuries are the most common reasons for nonprescription of oral anticoagulation (OAC), and are more common in older adults when OACs are used with antiarrhythmic drugs. Digoxin may be useful for rate control, but associations with increased mortality limit its use. Beyond rate and rhythm control considerations, stroke prophylaxis is critical to AF management, and the benefits of direct OACs, compared with warfarin, extend to older adults. Invasive procedures such as AF catheter ablation, pacemaker implantation/atrioventricular junction ablation, and left atrial appendage occlusion may be useful in appropriately selected cases. However, older adults have generally been under-represented in clinical trials.
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Affiliation(s)
| | - Gatha Nair
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| | - Radmila Lyubarova
- Division of Cardiology, Albany Medical Center, Albany, New York, USA
| | - Faisal M Merchant
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pamela Mason
- Department of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Anne B Curtis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Nanette K Wenger
- Department of Medicine, Section of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neelum T Aggarwal
- Departments of Neurological Sciences, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Emelia J Benjamin
- Boston Medical Center, and Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
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10
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Akhtar T, Wallace R, Daimee UA, Sivasambu B, Hart E, Yang E, Marine JE, Berger R, Calkins H, Spragg D. Safety and efficacy of cryoballoon versus radiofrequency ablation for atrial fibrillation in elderly patients: A real-world evidence. Indian Pacing Electrophysiol J 2021; 22:24-29. [PMID: 34838748 PMCID: PMC8811282 DOI: 10.1016/j.ipej.2021.11.006] [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: 09/25/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are limited data describing the experience of radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial fibrillation (AF) among elderly patients in the United States. METHODS We conducted a retrospective analysis of patients ≥75 years of age undergoing index RF vs. CB ablation between January 2014 and May 2020 at our center. The choice of ablation technique was left to the operator's discretion. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 s after one year of follow-up, were assessed in patients with index RF vs. CB ablation. RESULTS In our cohort of 186 patients, the median age was 78 (76-81) years, 54.8% were men, and 39.2% had persistent AF. The median CHA2DS2-VASc score was 4 (3-4), while the median duration of AF was 3 (1-7) years. The majority (n = 112, 60.2%) underwent RF ablation. The median procedure time was significantly lower in CB group (197 vs 226.5 min, p=<0.01). The incidence of complications was similar in the two sub-groups (RF: 1.8% vs. CB: 2.7%, p = 0.67). Similarly, arrhythmia-free survival rate on antiarrhythmic drugs at 1-year follow-up remained statistically comparable (63.4% vs. 68.9%, p = 0.33) between patients receiving RF vs. CB ablation. CONCLUSION The safety and efficacy of RF vs. CB ablation for AF remained comparable in our cohort of patients older than 75 years. CB ablation was associated with a shorter procedure time.
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Affiliation(s)
- Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Ryan Wallace
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Usama A Daimee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Bhradeev Sivasambu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Erica Hart
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eunice Yang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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11
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Kawamura I, Aikawa T, Yokoyama Y, Takagi H, Kuno T. Catheter ablation for atrial fibrillation in elderly patients: Systematic review and a meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:59-71. [PMID: 34816458 DOI: 10.1111/pace.14413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/01/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
AIMS Catheter ablation (CA) is established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of CA in elderly patients. We studied the long-term efficacy and periprocedural safety of radiofrequency and cryoballoon CA for elderly patients with AF. METHODS PubMed and Embase were searched through April 2021 to investigate the comparative outcomes between elderly and non-elderly patients who underwent CA for AF. The primary efficacy and safety endpoints were AF recurrence and procedure-related complications, respectively. Subgroup analyses were performed by procedure type of CA. RESULTS The search identified 20 observational studies with 110,606 patients, including 8009 elderly patients (7.2%). The risk of AF recurrence was not significantly different between elderly and non-elderly patients (hazard ratio, 1.37; 95% confidence interval [CI], 0.94-2.00; p = .10, I2 = 70%). However, relative to the non-elderly, elderly patients had significantly higher major complications (risk ratio [RR], 1.32; 95% CI, 1.14-1.54], p < .01, I2 = 0%) and overall complications (RR, 1.26; 95% CI, 1.00-1.57; p = .05, I2 = 56%) with higher cerebrovascular events (RR, 1.68; 95% CI, 1.25-2.25; p = < .01, I2 = 0%). Subgroup analysis with cryoballoon CA showed that procedure-related complications in elderly patients were similar to those in non-elderly patients but not with radiofrequency CA. CONCLUSIONS CA for AF in elderly patients has comparable long-term efficacy compared to that in non-elderly patients; however, the incidence of procedure-related complications were higher in elderly patients. Cryoballoon CA did not confer a higher procedure-related risk in elderly patients.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA
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12
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Watanabe K, Nagata Y, Nitta G, Okata S, Nagase M, Miyazaki R, Nagamine S, Kaneko M, Lee T, Nozato T, Ashikaga T, Goya M, Sasano T. Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation. PLoS One 2021; 16:e0259750. [PMID: 34739524 PMCID: PMC8570470 DOI: 10.1371/journal.pone.0259750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termination of AF (time from termination of AF to the earliest sinus node activation) could reflect the extent of atrial remodeling, influencing the formation of non-pulmonary vein (non-PV) triggers and post-ablation outcomes. Method The participants were 157 consecutive patients with persistent AF (male: 77.1%, age: 63.3±11.2 years) who underwent catheter ablation. We recorded SNRT after terminating AF by radiofrequency delivery or electrical cardioversion during the first ablation and evaluated the relationships between SNRT and atrial tachyarrhythmia recurrence and between SNRT and non-PV triggers after repeat ablation. Results Forty-five patients (28.7%) experienced recurrence of atrial tachyarrhythmias. Patients with recurrence had longer SNRTs (1738 ms vs. 1394 ms, p = 0.012). In the multivariate logistic regression analysis, only SNRT ≥2128ms was a significant independent predictor of clinical AF recurrence (hazard ratio 7.48; 95% confidence interval 2.94–19.00; P<0.001). Kaplan–Meier estimator showed that the recurrence-free rate was significantly lower if ≥ 2128ms (log-rank, p<0.001). Thirty-five patients (77.8%) underwent a second ablation. Although there was no difference in the rate of pulmonary vein reconnections (78.6% vs. 71.4%, p = 0.712), non-PV triggers were observed more frequently in the longer SNRT group (57.1% vs. 14.3%, p = 0.012). Conclusions Patients with a prolonged SNRT had a higher prevalence of AF recurrence after the first ablation and higher inducibility of non-PV triggers. Measuring SNRT might be used for the stratification of patients with persistent AF.
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Affiliation(s)
- Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
- * E-mail:
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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13
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Catheter ablation for atrial fibrillation in patients with congestive heart failure. Int J Cardiol 2021; 333:98-104. [PMID: 33647363 DOI: 10.1016/j.ijcard.2021.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/31/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We evaluated the 1-year success rate of maintaining sinus rhythm after catheter ablation (CA) for atrial fibrillation (AF) in patients with or without congestive heart failure (CHF). METHODS In this single-centre retrospective matched-pair cohort study of 3,018 AF patients who underwent initial CA between January 2012 and June 2018, 227 pairs with (CHF group) or without CHF (control group) were matched using propensity scores. In the CHF group, 108 patients were assigned to the arrhythmia-induced cardiomyopathy (AIC) group whose left ventricular systolic dysfunction was explained only by lasting AF or atrial tachycardia; the remaining 119 had organic heart diseases (non-AIC group). We evaluated the 1-year AF-free survival and changes in clinical findings before and after CA. RESULTS The CHF and control groups showed similar AF-free survival; however, AIC patients had significantly better survival than non-AIC patients. AF recurrence was significantly related to CHF re-hospitalisation, which was significantly more frequent in the non-AIC group than in the AIC group. The clinical outcomes of left atrial dilation, brain natriuretic peptide level, and left ventricular ejection function improved significantly before and after CA in both groups. The degree of improvement was significantly better in the AIC group than in the non-AIC group. CONCLUSIONS The 1-year success rate was not significantly different between the CHF and control groups. The 1-year success rate in the AIC group was similar to that in the AIC-control group and was better than that in the non-AIC group. CHF clinical outcomes were improved significantly.
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14
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Ikenouchi T, Inaba O, Takamiya T, Inamura Y, Sato A, Matsumura Y, Sato H, Hirakawa A, Takahashi Y, Goya M, Sasano T, Nitta J. The impact of left atrium size on selection of the pulmonary vein isolation method for atrial fibrillation: Cryoballoon or radiofrequency catheter ablation. Am Heart J 2021; 231:82-92. [PMID: 33098808 DOI: 10.1016/j.ahj.2020.10.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is the cornerstone of ablation strategies for atrial fibrillation (AF), and noninferiority of cryoballoon (CB) over radiofrequency (RF) ablation has been previously reported. One of the risk factors of recurrence is left atrium (LA) enlargement. This study aimed to analyze the impact of LA enlargement on the selection of CB or RF ablation for AF patients. METHODS A total of 2,224 AF patients (64.4 ± 10.7 years, 65.5% male) who underwent PVI were analyzed retrospectively. Left atrial diameter (LAD) and volume (LAV) were measured using echocardiography before the procedures. LA enlargement was defined as LAD ≥40 mm and LAV index (LAVI) ≥35 mL/m2. Patients undergoing CB and RF ablation were propensity score matched, and 376 matched pairs were evaluated. RESULTS Cox proportional hazard analysis revealed that LAD (95% CI, 1.01-1.05), LAV (95% CI, 1.01-1.02), and LAVI (95% CI, 1.01-1.03) were independent predictors of recurrence. CB showed equivalent clinical outcomes to those of RF with shorter procedure time required for patients without LA enlargement. CB was inferior to RF in patients with LA enlargement (LAD, 74.5% vs 84.6%, P = .028; LAVI, 74.7% vs 83.4%, P = .015), and large LAVI was associated with a higher prevalence of non-PV foci (35% vs 29%, P = .008). CONCLUSIONS CB ablation may be recommended for patients without enlarged LA based on the short procedure time and efficacy, whereas RF would be more appropriate in large LAs. LAVI may be a valuable reference to predict PVI outcomes and in selecting the ablation method.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan.
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Tomomasa Takamiya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Yutaka Matsumura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Hiroyuki Sato
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Hirakawa
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu-shi, Tokyo, Japan
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15
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Akhtar T, Berger R, Marine JE, Daimee UA, Calkins H, Spragg D. Cryoballoon Ablation of Atrial Fibrillation in Octogenarians. Arrhythm Electrophysiol Rev 2020; 9:104-107. [PMID: 32983532 PMCID: PMC7491081 DOI: 10.15420/aer.2020.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A significant proportion of AF patients with advanced age are being treated in clinical practice. Cryoballoon ablation of AF, given its shorter procedure time and comparable efficacy to radiofrequency ablation, has rapidly become a commonly used tool for AF ablation. Data regarding the outcomes of cryoballoon ablation of AF in octogenarians are limited because of the exclusion of this age group in the previous studies. The authors report outcomes of 15 octogenarian AF patients undergoing index cryoballoon ablation at a single centre. The mean age of the included patients was 83 ± 3 years. In total, 13 patients (87%) presented with paroxysmal AF, and two (13%) had long-standing persistent AF. At 6 and 12 months of follow-up, freedom from AF was 80% and 70%, respectively. None of the patients suffered any procedure-related complications. Cryoballoon ablation appears to be a safe and effective approach for treating symptomatic AF refractory to antiarrhythmic drug therapy in octogenarian patients, based on outcomes in this cohort. These findings require further validation in prospective randomised studies with larger sample sizes.
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Affiliation(s)
- Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Usama A Daimee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
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16
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Fortuni F, Casula M, Sanzo A, Angelini F, Cornara S, Somaschini A, Mugnai G, Rordorf R, De Ferrari GM. Meta-Analysis Comparing Cryoballoon Versus Radiofrequency as First Ablation Procedure for Atrial Fibrillation. Am J Cardiol 2020; 125:1170-1179. [PMID: 32087997 DOI: 10.1016/j.amjcard.2020.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. Radiofrequency (RF) represents a standard of care for pulmonary vein isolation, whereas cryoballoon (CB) ablation has emerged as a valid alternative. The aim of our meta-analysis was to explore the efficacy and safety of CB compared with RF as first ablation procedure for AF. We searched the literature for studies that investigated this issue. The primary efficacy outcome was AF recurrence. The safety outcomes were: pericardial effusion, cardiac tamponade, phrenic nerve palsy, vascular complications, and major bleedings. Fourteen randomized controlled studies and 34 observational studies were included in the analysis. A total of 7,951 patients underwent CB ablation, whereas 9,641 received RF ablation. Mean follow-up was 14 ± 7 months. Overall, CB reduced the incidence of AF recurrence compared with RF ablation (relative risk [RR] 0.86; 95% confidence interval [CI] 0.78 to 0.94; p = 0.001), and this result was consistent across different study design and AF type. CB had a significantly higher rate of phrenic nerve palsy, whereas it was related to a lower incidence of pericardial effusion, cardiac tamponade (RR 0.58; 95% CI 0.38 to 0.88; p = 0.011) and vascular complications (RR 0.61; 95% CI 0.48 to 0.77; p <0.001) compared with RF. There was no significant difference in major bleedings between the 2 strategies. CB ablation had a shorter procedural time compared with RF (mean difference -20.76 minutes; p <0.001). In conclusion, considered its efficacy/safety profile and short procedural time, CB ablation represents the preferable option for first AF ablation procedure.
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17
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Chen CF, Zhong YG, Jin CL, Gao XF, Liu XH, Xu YZ. Comparing between second-generation cryoballoon vs open-irrigated radiofrequency ablation in elderly patients: Acute and long-term outcomes. Clin Cardiol 2020; 43:500-507. [PMID: 31943264 PMCID: PMC7244300 DOI: 10.1002/clc.23335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second‐generation cryoballoon (CB‐2) vs radiofrequency (RF) ablation in elderly patients (>75‐year‐old). Hypothesis CB‐2 ablation may demonstrate different outcomes compared with that using RF ablation for elderly patients with AF. Method Elderly patients with symptomatic drug‐refractory AF were included in the study. Pulmonary vein isolation was performed in all patients. Results A total of 324 elderly patients were included (RF: 176, CB‐2:148) from September 2016 to April 2019. The CB‐2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs 135.1 ± 9.9 minutes, P < .001; 53.7 ± 8.9 vs 65.1.9 ± 9.0 minutes, P < .001), but marked fluoroscopy utilization (22.1 ± 3.3 vs 18.5 ± 3.6 minutes, P < .001). Complications occurred in 3.3% (CB‐2) and 6.2% (RF) of patients with no significant different (P = .307). The length of stay after ablation was shorter, but the costs were higher in the CB‐2 group (1.94 vs 2.53 days, P < .001 and 91 132.6 ± 3723.5 vs 81 149.4 ± 6824.1 CNY, P < .001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia was lower in the CB‐2 group (14.2 vs 23.3%, P = .047), but the long‐term success rate was similar between two groups. Conclusions CB‐2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long‐term success are similar between the two groups.
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Affiliation(s)
- Chao-Feng Chen
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Gang Zhong
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chao-Lun Jin
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Fei Gao
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Hua Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi-Zhou Xu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Chen CF, Liu MJ, Jin CL, Gao XF, Liu XH, Xu YZ. Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China. J Interv Card Electrophysiol 2020; 59:557-564. [PMID: 31893337 PMCID: PMC7679317 DOI: 10.1007/s10840-019-00697-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/23/2019] [Indexed: 12/21/2022]
Abstract
Purpose Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies. Methods Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients. Results A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups. Conclusions CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.
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Affiliation(s)
- Chao-Feng Chen
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China
| | - Mei-Jun Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China
| | - Chao-Lun Jin
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China
| | - Xiao-Fei Gao
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China
| | - Xiao-Hua Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China
| | - Yi-Zhou Xu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, #261 Huansha Road, Hangzhou, 310000, Zhejiang Province, China.
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Kato N, Nitta J, Sato A, Inamura Y, Takamiya T, Inaba O, Negi K, Takahashi Y, Goya M, Sasano T. Characteristics of the nonpulmonary vein foci induced after second‐generation cryoballoon ablation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:174-184. [DOI: 10.1111/jce.14314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nobutaka Kato
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Junichi Nitta
- Department of CardiologySakakibara Heart Institute Fuchu Japan
| | - Akira Sato
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Yukihiro Inamura
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Tomomasa Takamiya
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Osamu Inaba
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Ken Negi
- Department of CardiologyJapanese Red Cross Saitama Hospital Saitama Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
| | - Tetuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental University Tokyo Japan
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Kanda T, Masuda M, Kurata N, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Okuno S, Matsuda Y, Hata Y, Mano T. Efficacy and safety of the cryoballoon-based atrial fibrillation ablation in patients aged ≥80 years. J Cardiovasc Electrophysiol 2019; 30:2242-2247. [PMID: 31507014 DOI: 10.1111/jce.14166] [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: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/25/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The prevalence of atrial fibrillation (AF) increases with age. Although the efficacy of cryoballoon ablation (CB-A) in patients with AF has been demonstrated, data on the efficacy of this CB-A in elderly patients are limited. The aim of this study was to evaluate the 1-year efficacy and safety of CB-A in patients aged ≥80 years compared with those less than 80 years. METHODS A total of 49 consecutive patients ≥80 years with paroxysmal AF (PAF) who underwent CB-A were compared with 241 patients aged <80 years. AF-free survival rate at 1 year and procedural data were compared between the groups. RESULTS Median (25th, 75th quartile) age was 83 (82, 85) years in the older group and 68 (61, 73) years in the younger group. At 1-year follow-up, the success rate did not significantly differ between the groups. In Cox regression analysis, age ≥80 years was not significantly related to AF recurrence. Low-voltage areas were more frequently observed in the elderly group than the control group (39% vs 17%; P = .01). Fluoroscopy time and procedure time did not differ significantly. There was no significant difference in the occurrence rate of transient phrenic nerve palsy. No severe complications occurred in either group, including procedure-related deaths, atrioesophageal fistula, cardiac tamponade, and cerebrovascular embolic events. CONCLUSION The results of our study showed that CB-A for PAF is a feasible and safe procedure even in elderly patients, with similar success and complication rates when compared with a younger population.
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Affiliation(s)
- Takashi Kanda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Naoya Kurata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Shota Okuno
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Yosuke Hata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
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