1
|
Zhao D, Zhang F, Liu X, Li M, Zhang L, Hu J, Li F, Wu J. Efficacy of catheter ablation for atrial fibrillation in patients with significant functional mitral regurgitation. Medicine (Baltimore) 2023; 102:e33231. [PMID: 36897680 PMCID: PMC9997827 DOI: 10.1097/md.0000000000033231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Catheter ablation has been established to be an effective therapy for paroxysmal atrial fibrillation (AF) and is recommended as the treatment of choice for many patients, including those with clinically significant functional mitral regurgitation (MR). However, there is little information available about the clinical efficacy of catheter ablation for paroxysmal AF in patients with significant functional MR. METHODS We performed a retrospective study of 247 patients with paroxysmal AF who underwent AF ablation. The study included 28 (11.3%) patients with significant functional MR and 219 (88.7%) without significant functional MR. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting >30 seconds beyond 3 months after catheter ablation. RESULTS During a mean follow-up of 20.1 ± 7.4 months (range, 3-36 months), 45 (18.2%) patients developed recurrence of AF. The recurrence rate of AF was higher in patients with significant functional MR than in those without significant functional MR (42.9% vs 15.1%; P < .001). Univariable Cox proportional hazards regression analysis showed that significant functional MR (hazard ratio [HR], 3.46; 95% confidence interval [CI], 1.78-6.72; P < .001), age (HR, 1.04; 95% CI, 1.01-1.08; P = .009), the CHA2DS2-VASc score (HR, 1.28; 95% CI, 1.05-1.56; P = .017), and heart failure (HR, 4.71; 95% CI, 1.85-11.96; P = .001) were associated with the risk of recurrence. Multivariable analysis showed that significant functional MR (HR, 2.48; 95% CI, 1.21-5.05; P = .013), age (HR, 1.04; 95% CI, 1.00-1.07; P = .031), and heart failure (HR, 3.39; 95% CI, 1.27-9.03; P = .015) were independent predictors of AF recurrence. CONCLUSION Patients with significant functional MR have an increased risk of AF recurrence after catheter ablation.
Collapse
Affiliation(s)
- Danqing Zhao
- Department of Cardiology, Anyang People’s Hospital, Anyang, China
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Futao Zhang
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Xiaojie Liu
- Department of Cardiology, Henan University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Muzhang Li
- Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Central China Fuwai Hospital, Zhengzhou, China
| | - Leiming Zhang
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Hu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jintao Wu
- Heart Centre of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Long-term safety and effectiveness of paroxysmal atrial fibrillation ablation using a porous tip contact force-sensing catheter from the SMART SF trial. J Interv Card Electrophysiol 2020; 61:63-69. [PMID: 32462550 PMCID: PMC8195769 DOI: 10.1007/s10840-020-00780-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
Purpose The prospective, multicenter SMART SF trial demonstrated the acute safety and effectiveness of the 56-hole porous tip irrigated contact force (CF) catheter for drug-refractory paroxysmal atrial fibrillation (PAF) ablation with a low primary adverse event rate (2.5%), leading to FDA approval of the catheter. Here, we are reporting the long-term effectiveness and safety results that have not yet been reported. Methods Ablations were performed using the 56-hole porous tip irrigated CF catheter guided by the 3D mapping system stability module. The primary effectiveness endpoint was freedom from atrial tachyarrhythmia (including atrial fibrillation, atrial tachycardia, and/or atrial flutter), based on electrocardiographic data at 12 months. Atrial tachyarrhythmia recurrence occurring 3 months post procedure, acute procedural failures such as lack of entrance block confirmation of all PVs, and undergoing repeat procedure for atrial fibrillation in the evaluation period (91 to 365 days post the initial ablation procedure) were considered to be effectiveness failures. Results Seventy-eight patients (age 64.8 ± 9.7 years; male 52.6%; Caucasian 96.2%) participated in the 12-month effectiveness evaluation. Mean follow-up time was 373.5 ± 45.4 days. The Kaplan-Meier estimate of freedom from 12-month atrial tachyarrhythmia was 74.9%. Two procedure-related pericardial effusion events were reported at 92 and 180 days post procedure. There were no pulmonary vein stenosis complications or deaths reported through the 12-month follow-up period. Conclusions The SMART SF 12-month follow-up evaluation corroborates the early safety and effectiveness success previously reported for PAF ablation with STSF.
Collapse
|
3
|
Gourraud JB, Khairy P, Abadir S, Tadros R, Cadrin-Tourigny J, Macle L, Dyrda K, Mondesert B, Dubuc M, Guerra PG, Thibault B, Roy D, Talajic M, Rivard L. Atrial fibrillation in young patients. Expert Rev Cardiovasc Ther 2018; 16:489-500. [DOI: 10.1080/14779072.2018.1490644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Sylvia Abadir
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Rafik Tadros
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Blandine Mondesert
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Peter G. Guerra
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Lena Rivard
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| |
Collapse
|
4
|
Seo GH, Jang SW, Oh YS, Lee MY, Rho TH. Efficacy and Safety Outcomes of Catheter Ablation of Non-valvular Atrial Fibrillation in Korean Practice: Analysis of Nationwide Claims Data. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Wu JT, Long DY, Dong JZ, Wang SL, Fan XW, Yang HT, Duan HY, Yan LJ, Qian P, Yang CK. Advanced interatrial block predicts clinical recurrence of atrial fibrillation after catheter ablation. J Cardiol 2015; 68:352-6. [PMID: 26611936 DOI: 10.1016/j.jjcc.2015.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been demonstrated that advanced interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF); however, the impact of advanced IAB on recurrence of paroxysmal AF after catheter ablation is not clear. METHODS 204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment. RESULTS During the mean follow-up period of 13.9±6.2 months (range, 3-27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p=0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034-4.308; p=0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004-1.100; p=0.034) as two independent predictors of recurrence of AF. CONCLUSIONS Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.
Collapse
Affiliation(s)
- Jin-Tao Wu
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - De-Yong Long
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shan-Ling Wang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Xian-Wei Fan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hai-Tao Yang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hong-Yan Duan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Li-Jie Yan
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Peng Qian
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Chao-Kuan Yang
- Department of Cardiology, Henan Medical College, Zhengzhou, China.
| |
Collapse
|
6
|
BUNCH TJARED, MAY HEIDIT, BAIR TAMIL, JACOBS VICTORIA, CRANDALL BRIANG, CUTLER MICHAEL, WEISS JPETER, MALLENDER CHARLES, OSBORN JEFFREYS, ANDERSON JEFFREYL, DAY JOHND. The Impact of Age on 5-Year Outcomes After Atrial Fibrillation Catheter Ablation. J Cardiovasc Electrophysiol 2015; 27:141-6. [DOI: 10.1111/jce.12849] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022]
Affiliation(s)
- T. JARED BUNCH
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
- Stanford University; Palo Alto; California USA
| | - HEIDI T. MAY
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - TAMI L. BAIR
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - VICTORIA JACOBS
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - BRIAN G. CRANDALL
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - MICHAEL CUTLER
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - J. PETER WEISS
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - CHARLES MALLENDER
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - JEFFREY S. OSBORN
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - JEFFREY L. ANDERSON
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| | - JOHN D. DAY
- Intermountain Medical Center Heart Institute; Intermountain Medical Center; Salt Lake City Utah
| |
Collapse
|
7
|
Wernhart S, Halle M. Atrial fibrillation and long-term sports practice: epidemiology and mechanisms. Clin Res Cardiol 2014; 104:369-79. [DOI: 10.1007/s00392-014-0805-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/16/2014] [Indexed: 12/19/2022]
|
8
|
Wasmer K, Köbe J, Eckardt L. Antiarrhythmic therapy of atrial fibrillation: are we treating too late? Herzschrittmacherther Elektrophysiol 2014; 25:210-213. [PMID: 25143226 DOI: 10.1007/s00399-014-0331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
Atrial fibrillation (AF) is associated with increased risk for stroke, heart failure and mortality. The causality between worse prognosis and AF is not clear at this time and AF may just be expression of underlying heart disease that by itself is associated with increased morbidity and mortality. AF is characterized by progression from rare paroxysmal episodes to permanent AF. It has been well recognized that maintenance of sinus rhythm with either antiarrhythmic drugs or catheter ablation is easier to achieve if treatment is established early on. In addition to the established indication of symptomatic improvement, the focus of AF management is shifting to earlier intervention to prevent cardiovascular complications. This concept is currently under investigation in the ongoing EAST trial. Early treatment initiation is desirable from a pathophysiologic perspective. This includes consequent prevention and treatment of AF risk factors, efforts for early diagnosis, and stroke prevention according to the CHA2DS2-VASc score. As long as no data support prognostic advantages with "aggressive" rhythm control therapy it remains reserved for symptomatic patients, since both, medication and catheter ablation, convey a significant risk for complications.
Collapse
Affiliation(s)
- Kristina Wasmer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany,
| | | | | |
Collapse
|
9
|
Wasmer K, Breithardt G, Eckardt L. The young patient with asymptomatic atrial fibrillation: what is the evidence to leave the arrhythmia untreated? Eur Heart J 2014; 35:1439-47. [DOI: 10.1093/eurheartj/ehu113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
10
|
Zhang XD, Gu J, Jiang WF, Zhao L, Zhou L, Wang YL, Liu YG, Liu X. Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial. Eur Heart J 2014; 35:1327-34. [PMID: 24497338 DOI: 10.1093/eurheartj/ehu017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM Although catheter ablation (CA) has replaced antiarrhythmic drugs (AAD) as first-line treatment in selected patients with atrial fibrillation (AF), optimal treatment of recurrent atrial tachycardia (AT) after AF ablation remains unclear. This parallel randomized controlled study compared CA vs. AAD for recurrent AT after persistent AF ablation. METHODS AND RESULTS Two-hundred and one patients (aged 59.1 ± 10.9 years, 68.7% male) with recurrent AT after persistent AF ablation were enrolled and randomized to either CA (n = 101) or AAD (n = 100) treatment. Primary endpoint was freedom from recurrent atrial tachyarrhythmia (ATa, including AT and AF) at 24-month follow-up. Composite secondary endpoints comprised procedural complications, long-term morbidity and improvement in quality of life (QoL). On an intention-to-treat basis, the CA group had a higher rate of freedom from recurrent ATa (56.4 vs. 34.0%; P = 0.001). Adjusted Cox regression analysis showed a significant treatment effect with a hazard ratio of 0.538 (95% CI: 0.355-0.816) in favour of CA. There was a higher proportion of periprocedural complications in the CA group (7.9 vs. 0; P = 0.012), and of long-term adverse events in the AAD group (10.9 vs. 24.0%; P = 0.014). Quality of life was significantly higher for CA. CONCLUSIONS This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.
Collapse
Affiliation(s)
- Xiao-Dong Zhang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Jun Gu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Wei-Feng Jiang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Liang Zhao
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Li Zhou
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Yuan-Long Wang
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Yu-Gang Liu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| | - Xu Liu
- Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai 200030, China
| |
Collapse
|
11
|
Osmancik P, Budera P, Straka Z, Widimsky P. Predictors of complete arrhythmia free survival in patients undergoing surgical ablation for atrial fibrillation. PRAGUE-12 randomized study sub-analysis. Int J Cardiol 2014; 172:419-22. [PMID: 24507744 DOI: 10.1016/j.ijcard.2014.01.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 01/05/2014] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical ablation (SA) is commonly used in atrial fibrillation (AF) patients undergoing cardiac surgery. However, its effect has been established in few randomized studies. To assess the complete atrial fibrillation free (AF-free) survival in randomized study assessing the effects of additional concomitant SA of AF in patients primarily indicated for other cardiac surgery. METHODS The PRAGUE-12 study was a prospective randomized study comparing the effect of adding SA to other cardiac surgery. We examined the data from the PRAGUE-12 trial and grouped patients according to complete AF-free survival. All patients had regular check-ups at 3, 6, 9 months, some of them with Holter recordings, and a final check-up at 12 months with Holter recording. RESULTS One hundred ninety-four patients were analyzed; 104 originally randomized to surgery with adding SA (SA group) and 90 without it (non-SA group). Complete AF-free status was found in 46 patients from the SA group (44.2%) and 25 patients (27.8%) from the non-SA group (p<0.05). In a multivariate logistic regression, the SA group was associated with a greater chance for complete AF-free survival (OR 1.87, p<0.05). In the multivariate analysis of the SA group, history of myocardial infarction (OR 0.2, p<0.05) and a higher EuroSCORE (OR 0.9, p 0.05) were independently associated with a lower probability of AF-free survival. CONCLUSION Complete AF-free survival following SA was present in almost one half of patients. Patients with a history of myocardial infarction and higher EuroSCOREs were less likely to benefit from an add-on SA procedure.
Collapse
Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic.
| | - Petr Budera
- Cardiocenter, Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic
| | - Zbynek Straka
- Cardiocenter, Department of Cardiac Surgery, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady Prague, Czech Republic
| |
Collapse
|