1
|
Benali K, Barré V, Hermida A, Galand V, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jésel-Morel L, Sagnard A, Champ-Rigot L, Dang D, Guy-Moyat B, Abbey S, Garcia R, Césari O, Badenco N, Lepillier A, Ninni S, Boulé S, Maury P, Algalarrondo V, Bakouboula B, Mansourati J, Lesaffre F, Lagrange P, Bouzeman A, Muresan L, Bacquelin R, Bortone A, Bun SS, Pavin D, Macle L, Martins RP. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circ Arrhythm Electrophysiol 2023; 16:e011354. [PMID: 36802906 DOI: 10.1161/circep.122.011354] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
Collapse
Affiliation(s)
- Karim Benali
- CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.)
| | - Valentin Barré
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | | | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse (S.B.)
| | | | | | | | | | | | | | | | | | | | | | - Frédéric Sebag
- Rythmologie, Institut Mutualiste Montsouris, Paris (F.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Babé Bakouboula
- Institut Cardiovasculaire de Strasbourg, Clinique RHENA (B.B.)
| | | | | | | | | | | | | | | | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Canada (L.M.)
| | - Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| |
Collapse
|
3
|
Mohanty S, Della Rocca DG, Gianni C, Trivedi C, Mayedo AQ, MacDonald B, Natale A. Predictors of recurrent atrial fibrillation following catheter ablation. Expert Rev Cardiovasc Ther 2021; 19:237-246. [PMID: 33678103 DOI: 10.1080/14779072.2021.1892490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a complex and multi-factorial rhythm disorder. Catheter ablation is widely used for the management of AF. However, it is limited by relapse of the arrhythmia necessitating repeat procedures. AREAS COVERED This review aims to discuss the predictors of post-ablation recurrent AF including age, gender, genetic predisposition, AF type and duration, comorbidities, lifestyle factors, echocardiographic parameters of heart chambers, left atrial fibrosis and ablation strategies and targets. An extensive literature search was undertaken on PubMed and Google Scholar to obtain full texts of relevant AF-related articles. EXPERT OPINION Maintenance of stable sinus rhythm is the main intended outcome of AF ablation. Therefore, it is very crucial to identify the risk factors that may influence the ablation success. Most of these predictors such as comorbidities, ablation strategy and targets and lifestyle factors are either reversible or modifiable. Thus, not only the awareness of these known risk factors by both patients and their physicians but also future research to identify the unknown predictors are critical to optimize care in this multi-faceted morbidity.
Collapse
Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | | | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.,Department of electrophysiology, Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA.,Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
5
|
Tison GH, Sanchez JM, Ballinger B, Singh A, Olgin JE, Pletcher MJ, Vittinghoff E, Lee ES, Fan SM, Gladstone RA, Mikell C, Sohoni N, Hsieh J, Marcus GM. Passive Detection of Atrial Fibrillation Using a Commercially Available Smartwatch. JAMA Cardiol 2019; 3:409-416. [PMID: 29562087 DOI: 10.1001/jamacardio.2018.0136] [Citation(s) in RCA: 257] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Atrial fibrillation (AF) affects 34 million people worldwide and is a leading cause of stroke. A readily accessible means to continuously monitor for AF could prevent large numbers of strokes and death. Objective To develop and validate a deep neural network to detect AF using smartwatch data. Design, Setting, and Participants In this multinational cardiovascular remote cohort study coordinated at the University of California, San Francisco, smartwatches were used to obtain heart rate and step count data for algorithm development. A total of 9750 participants enrolled in the Health eHeart Study and 51 patients undergoing cardioversion at the University of California, San Francisco, were enrolled between February 2016 and March 2017. A deep neural network was trained using a method called heuristic pretraining in which the network approximated representations of the R-R interval (ie, time between heartbeats) without manual labeling of training data. Validation was performed against the reference standard 12-lead electrocardiography (ECG) in a separate cohort of patients undergoing cardioversion. A second exploratory validation was performed using smartwatch data from ambulatory individuals against the reference standard of self-reported history of persistent AF. Data were analyzed from March 2017 to September 2017. Main Outcomes and Measures The sensitivity, specificity, and receiver operating characteristic C statistic for the algorithm to detect AF were generated based on the reference standard of 12-lead ECG-diagnosed AF. Results Of the 9750 participants enrolled in the remote cohort, including 347 participants with AF, 6143 (63.0%) were male, and the mean (SD) age was 42 (12) years. There were more than 139 million heart rate measurements on which the deep neural network was trained. The deep neural network exhibited a C statistic of 0.97 (95% CI, 0.94-1.00; P < .001) to detect AF against the reference standard 12-lead ECG-diagnosed AF in the external validation cohort of 51 patients undergoing cardioversion; sensitivity was 98.0% and specificity was 90.2%. In an exploratory analysis relying on self-report of persistent AF in ambulatory participants, the C statistic was 0.72 (95% CI, 0.64-0.78); sensitivity was 67.7% and specificity was 67.6%. Conclusions and Relevance This proof-of-concept study found that smartwatch photoplethysmography coupled with a deep neural network can passively detect AF but with some loss of sensitivity and specificity against a criterion-standard ECG. Further studies will help identify the optimal role for smartwatch-guided rhythm assessment.
Collapse
Affiliation(s)
- Geoffrey H Tison
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - José M Sanchez
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | | | - Avesh Singh
- Cardiogram Incorporated, San Francisco, California
| | - Jeffrey E Olgin
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Emily S Lee
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Shannon M Fan
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Rachel A Gladstone
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Carlos Mikell
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Nimit Sohoni
- Cardiogram Incorporated, San Francisco, California
| | | | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| |
Collapse
|
6
|
Piorkowski C, Kronborg M, Hourdain J, Piorkowski J, Kirstein B, Neudeck S, Wechselberger S, Päßler E, Löwen A, El-Armouche A, Mayer J, Ulbrich S, Pu L, Richter U, Gaspar T, Huo Y. Endo-/Epicardial Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e005748. [DOI: 10.1161/circep.117.005748] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Mads Kronborg
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Jerome Hourdain
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Judith Piorkowski
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Bettina Kirstein
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Sebastian Neudeck
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Simon Wechselberger
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ellen Päßler
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Anastasia Löwen
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Ali El-Armouche
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Julia Mayer
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Stefan Ulbrich
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Liying Pu
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Utz Richter
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Thomas Gaspar
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| | - Yan Huo
- From the Department of Electrophysiology, Heart Center (C.P., J.H., J.P., B.K., S.N., S.W., J.M., S.U., L.P.,U.R., T.G., Y.H.) and Department of Pharmacology and Toxicology (A.E.-A.), University of Technology Dresden, Germany; Department of Cardiology, Aarhus University Hospital, Denmark (M.K.); and Steinbeis Research Institute-Electrophysiology and Cardiac Devices, Dresden, Germany (E.P., A.L.)
| |
Collapse
|
7
|
Sanchez JM, Al-Dosari G, Chu S, Beygui R, Deuse T, Badhwar N, Lee RJ. Hybrid and surgical procedures for the treatment of persistent and longstanding persistent atrial fibrillation. Expert Rev Cardiovasc Ther 2018; 16:91-97. [PMID: 29327638 DOI: 10.1080/14779072.2018.1425140] [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] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia. The incidence of AF increases with age and is associated with increased stroke, heart failure and mortality. Persistent and long standing persistent AF is difficult to treat and often refractory to medical therapy and catheter ablation. Areas covered: This article reviews the historical development of the surgical Cox-MAZE procedure and current hybrid and minimally invasive surgical approaches for the treatment of persistent and long standing persistent AF. The role of concomitant pulmonary vein isolation and left atrial appendage (LAA) exclusion will also be reviewed. Expert commentary: An ablation pattern emulating the Cox-Maze surgical procedure is commonly needed to obtain maintenance of sinus rhythm in patients with persistent and long standing persistent atrial fibrillation. Minimally invasive bilateral thorascopic surgical procedures can achieve a similar Cox-Maze lesion set, but are associated with increased adverse events compared to catheter ablation. Future prospective randomized studies are required to confirm whether the recently developed hybrid subxyphoid epicardial/endocardial procedure and percutaneous LAA ligation and catheter ablation are indeed as effective as surgical options with less adverse events.
Collapse
Affiliation(s)
- Jose M Sanchez
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Ghannam Al-Dosari
- b Cardiovascular Surgery Division, Department of Surgery , University of Texas , Galvaston , TX , USA
| | - Sherman Chu
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Ramin Beygui
- c Cardiovascular Surgery Division, Department of Surgery , University of California , San Francisco , CA , USA
| | - Tobias Deuse
- c Cardiovascular Surgery Division, Department of Surgery , University of California , San Francisco , CA , USA
| | - Nitish Badhwar
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| | - Randall J Lee
- a Division of Cardiology, Section of Cardiac Electrophysiology, Department of Medicine , University of California , San Francisco , CA , USA
| |
Collapse
|