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Wu JT, Zhao DQ, Li FF, Zhang LM, Hu J, Fan XW, Hu GL, Yang HT, Yan LJ, Liu JJ, Xu XJ, Wang SL, Chu YJ. Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome. Clin Cardiol 2020; 43:1511-1516. [PMID: 33002216 PMCID: PMC7724218 DOI: 10.1002/clc.23470] [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: 07/07/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background Although successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff‐Parkinson‐White (WPW) syndrome and paroxysmal AF, in other patients it can recur. Hypothesis Whether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown. Methods We retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P‐wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12‐lead electrocardiography (ECG). Results During the mean follow‐up period of 30.9 ± 9.2 months (range, 3‐36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26‐1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032). Conclusions PVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12‐lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.
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Affiliation(s)
- Jin-Tao Wu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Dan-Qing Zhao
- Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Fei-Fei Li
- Human Resource Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei-Ming 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
| | - Xian-Wei Fan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Guang-Ling Hu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Hai-Tao Yang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Li-Jie Yan
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing-Jing Liu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xian-Jing Xu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Shan-Ling Wang
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying-Jie Chu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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Chen M, Wang Q, Sun J, Zhang PP, Li W, Mo BF, Li YG. Early repolarization in the inferior leads after accessory pathway ablation is highly correlated with atrial fibrillation in Wolff-Parkinson-White syndrome. J Cardiol 2019; 75:323-329. [PMID: 31445855 DOI: 10.1016/j.jjcc.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/29/2019] [Accepted: 07/22/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Both atrial fibrillation (AF) and early repolarization (ER) are highly prevalent in patients with Wolff-Parkinson-White (WPW) syndrome. METHODS We retrospectively identified 123 WPW patients with manifest accessory pathway (mAP) and 105 patients with concealed accessory pathways (cAP) who underwent successful ablation of the APs. AF history prior to the ablation was investigated. The presence of ER was evaluated from the 12-lead electrocardiograms performed both before and immediately after the ablation. Patients were further followed up for AF occurrence after the AP ablation. RESULTS Compared with cAP patients, WPW patients presented with higher incidence of previous AF, as well as ER after the AP ablation. Compared with those without AF history, WPW patients with comorbid AF were more prone to presenting ER, especially in the inferior leads, after the mAP ablation. Regression analysis suggested that the post-ablation ER in the inferior leads was strongly associated with AF in WPW patients [OR = 5.85; 95% confidence interval (CI): 2.29-14.96], even after adjusting for age and left atrial diameter (OR = 5.14; 95% CI: 1.80-14.74). Moreover, post-ablation inferior-lead ER was predictive of AF recurrence after mAP ablation during the follow-up of 22.6 ± 11.1 months. In comparison, ER was correlated with neither AF history nor AF recurrence in patients undergoing cAP ablation. CONCLUSIONS ER in the inferior leads after the mAP ablation is highly correlated with AF history and recurrence in WPW patients.
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Affiliation(s)
- Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng-Pai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bin-Feng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Wu J, Zhao D, Li F, Wu R, Fan X, Hu G, Bai M, Yang H, Yan L, Liu J, Xu X, Wang S, Chu Y. Advanced interatrial block predicts recurrence of atrial fibrillation after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome. Clin Cardiol 2019; 42:806-811. [PMID: 31243791 PMCID: PMC6727880 DOI: 10.1002/clc.23222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Paroxysmal atrial fibrillation (AF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome. Although successful ablation of the accessory pathway (AP) eliminates paroxysmal AF in some patients, in other patients it can recur. HYPOTHESIS We investigated the clinical utility of advanced interatrial block (IAB) for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation. METHODS This retrospective study included 103 patients (70 men, 33 women; mean age, 44 ± 16 years) with WPW syndrome who had paroxysmal AF. A resting 12-lead electrocardiogram was performed immediately after successful AP ablation to evaluate the presence of advanced IAB, which was defined as a P-wave duration of >120 ms and biphasic [±] morphology in the inferior leads. RESULTS During the mean follow-up period of 30.9 ± 20.0 months (range, 2-71 months), 16 patients (15.5%) developed AF recurrence. Patients with advanced IAB had significantly reduced event-free survival from AF (P < .001). Cox regression analysis with adjustment for the left atrial diameter and CHA2 DS2 -VASc score identified advanced IAB (hazard ratio, 9.18; 95% confidence interval [CI], 2.30-36.72; P = .002) and age > 50 years (hazard ratio, 12.64; 95% CI, 1.33-119.75; P = .027) as independent predictors of AF recurrence. CONCLUSIONS Advanced IAB was an independent predictor of AF recurrence after successful AP ablation in patients with WPW syndrome.
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Affiliation(s)
- Jin‐Tao Wu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Dan‐Qing Zhao
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Fei‐Fei Li
- Department of Internal MedicineThe Third Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Rui Wu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Xian‐Wei Fan
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Guang‐Ling Hu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Min‐Fu Bai
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Hai‐Tao Yang
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Li‐Jie Yan
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Jing‐Jing Liu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Xian‐Jing Xu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Shan‐Ling Wang
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
| | - Ying‐Jie Chu
- Department of Cardiology, Henan Provincial People's HospitalHenan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai HospitalZhengzhouChina
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Ichijo S, Miyazaki S, Kusa S, Nakamura H, Hachiya H, Kajiyama T, Iesaka Y. Impact of catheter ablation of atrial fibrillation on long-term clinical outcomes in patients with heart failure. J Cardiol 2018; 72:240-246. [PMID: 29609877 DOI: 10.1016/j.jjcc.2018.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/20/2018] [Accepted: 02/12/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heart failure (HF) promotes atrial fibrillation (AF) and AF worsens HF. This study aimed to investigate the long-term clinical outcomes after AF ablation in patients with HF. METHODS AND RESULTS A total of 106 consecutive HF patients, including 51 (48.1%) with a reduced left ventricular ejection fraction (LVEF) (HFrEF) and 55 (51.9%) with a preserved LVEF (HFpEF), underwent AF ablation. All patients underwent successful pulmonary vein antrum isolation, and substrate modification was added in 38 (35.8%). The mean follow-up period was 32.4±18.6 months, and mean number of procedures was 1.4±0.5 per patient. Low-dose antiarrhythmic drugs were combined in 29 (27.3%) patients. Freedom from recurrent atrial arrhythmias (ATa), HF-related hospitalizations, and the composite endpoint (all-cause death, stroke, HF-related hospitalizations) at 3 years was 88.7%, 97.6%, and 97.6% in HFrEF patients, and 79.3%, 96.2%, and 91.8% in HFpEF patients, respectively. LVEF normalization (≥50%) was observed in 37 (72.5%) HFrEF patients post-ablation, and a smaller LV diastolic diameter (LVDd) was the sole predictor [odds ratio (OR)=0.863; 95% confidence interval (CI)=0.779-0.955, p=0.005]. Shortening of the LVDd (≥5mm) was observed in 16 (29.1%) HFpEF patients post-ablation, and no recurrence after the initial procedure was the sole predictor (OR=6.229; 95% CI=1.524-25.469, p=0.011). CONCLUSIONS Catheter ablation of AF could be one of the important therapeutic options in the management of patients with HF combined with AF regardless of the type of HF.
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Affiliation(s)
- Sadamitsu Ichijo
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Fukui University, Fukui, Japan.
| | - Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Takatsugu Kajiyama
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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