1
|
Wen S, Liao Y, Khurana TS, Bai R. Reconsideration of the definition of blanking period and significance of early recurrences after catheter ablation of atrial fibrillation. Curr Opin Cardiol 2024; 39:15-19. [PMID: 37751368 DOI: 10.1097/hco.0000000000001096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Early recurrence of atrial tachyarrhythmia (ERAT) during blanking period (BP) is not uncommon after catheter ablation of AF. Current guidelines and consensus statements recommend conservative treatment of ERAT. This review summarized recent studies, underlying mechanism and clinical managements of ERAT, and proposed a reconsideration of the definition and clinical significance of BP. RECENT FINDINGS Recent studies have shown that the entity of ERAT in the very early phase of BP (i.e., first 4 weeks of the 3-month period) is different from those ERATs occurring late which is strongly associated with the late recurrence of atrial tachyarrhythmia. The optimal BP duration suggested by clinical observation ranges from 21 to 58 days. Using antiarrhythmic drugs and early electrical cardioversion are the effective management for ERAT, whereas re-ablation is a reasonable strategy although remains controversial. SUMMARY The definition of BP with a shorter duration, that is, 1 month instead of 3 months post AF ablation, is supported by the observations of latest clinical studies. Recurrent atrial tachyarrhythmia beyond the 1-month time frame is associated with higher risk of late recurrence and may warrant repeat ablation. A revisit to the guideline recommendation on management of ERAT is needed to change clinical practice.
Collapse
Affiliation(s)
- Songnan Wen
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale
| | - Yu Liao
- Division of Cardiology, Banner University Medical Center-Phoenix, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Rong Bai
- Division of Cardiology, Banner University Medical Center-Phoenix, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| |
Collapse
|
2
|
Minami K, Kazawa M, Kakuta T, Fukushima S, Fujita T, Kabata D, Ohnishi Y. Early Atrial Tachyarrhythmia Recurrence Predicts Late Atrial Tachyarrhythmia Recurrence After the Cryo-Maze Procedure - An Observational Study. Circ J 2022; 87:76-83. [PMID: 35965068 DOI: 10.1253/circj.cj-22-0232] [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: 12/27/2022]
Abstract
BACKGROUND It is unknown whether early atrial tachyarrhythmia (ATA) recurrence occurring within 3 months after the Maze procedure predicts late ATA recurrence.Methods and Results: This study involved 610 patients who underwent the modified Cryo-Maze procedure in conjunction with other cardiac surgery. The primary outcomes were late ATA recurrence, defined as occurring ≥3 months after surgery. The effects of early ATA recurrence on late ATA recurrence were analyzed using a Cox proportional hazards model. The following 11 covariates were considered explanatory variables: early ATA recurrence, age, sex, body surface area, preoperative duration of atrial fibrillation, preoperative left atrial diameter, and concomitant surgery (mitral valve replacement, mitral valve repair, aortic valve replacement, tricuspid annuloplasty, and left atrial appendage closure). Statistical analyses were performed with a 2-sided 5% significance level. Early ATA recurrence occurred in 174 patients (28.5%). Late ATA recurrence occurred in 167 patients (27.5%), with 595 events identified in these patients. The Cox proportional hazards model showed that early ATA recurrence was an independent predictor of late ATA recurrence (hazard ratio, 4.14; 95% confidence interval, 3.00-5.70; P<0.001)Conclusions: Early ATA recurrence was an independent predictor of late ATA recurrence among patients undergoing the modified Cryo-Maze procedure. The blanking period might not be applied to patients undergoing the modified Cryo-Maze procedure.
Collapse
Affiliation(s)
- Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center
| | - Masahiro Kazawa
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center.,Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| |
Collapse
|
3
|
Bhatia NK, Shah RL, Deb B, Pong T, Kapoor R, Rogers A, Badhwar N, Brodt C, Wang PJ, Narayan SM, Lee AM. Mapping Atrial Fibrillation After Surgical Therapy to Guide Endocardial Ablation. Circ Arrhythm Electrophysiol 2022; 15:e010502. [PMID: 35622437 PMCID: PMC9839337 DOI: 10.1161/circep.121.010502] [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: 01/18/2023]
Abstract
BACKGROUND Surgical ablation for atrial fibrillation (AF) can be effective, yet has mixed results. It is unclear which endocardial lesions delivered as part of hybrid therapy' will best augment surgical lesion sets in individual patients. We addressed this question by systematically mapping AF endocardially after surgical ablation and relating findings to early recurrence, then performing tailored endocardial ablation as part of hybrid therapy. METHODS We studied 81 consecutive patients undergoing epicardial surgical ablation (stage 1 hybrid), of whom 64 proceeded to endocardial catheter mapping and ablation (stage 2). Stage 2 comprised high-density mapping of pulmonary vein (PV) or posterior wall (PW) reconnections, low-voltage zones (LVZs), and potential localized AF drivers. We related findings to postsurgical recurrence of AF. RESULTS Mapping at stage 2 revealed PW isolation reconnection in 59.4%, PV isolation reconnection in 28.1%, and LVZ in 42.2% of patients. Postsurgical recurrence of AF occurred in 36 patients (56.3%), particularly those with long-standing persistent AF (P=0.017), but had no relationship to reconnection of PVs (P=0.53) or PW isolation (P=0.75) when compared with those without postsurgical recurrence of AF. LVZs were more common in patients with postsurgical recurrence of AF (P=0.002), long-standing persistent AF (P=0.002), advanced age (P=0.03), and elevated CHA2DS2-VASc (P=0.046). AF mapping revealed 4.4±2.7 localized focal/rotational sites near and also remote from PV or PW reconnection. After ablation at patient-specific targets, arrhythmia freedom at 1 year was 81.0% including and 73.0% excluding previously ineffective antiarrhythmic medications. CONCLUSIONS After surgical ablation, AF may recur by several modes particularly related to localized mechanisms near low voltage zones, recovery of posterior wall or pulmonary vein isolation, or other sustaining mechanisms. LVZs are more common in patients at high clinical risk for recurrence. Patient-specific targeting of these mechanisms yields excellent long-term outcomes from hybrid ablation.
Collapse
Affiliation(s)
- Neal K. Bhatia
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA;,Department of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA
| | - Rajan L. Shah
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Brototo Deb
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Terrence Pong
- Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Ridhima Kapoor
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Albert Rogers
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nitish Badhwar
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA;,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Chad Brodt
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Paul J. Wang
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA;,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Sanjiv M. Narayan
- Departments of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA;,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Anson M. Lee
- Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA;,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
4
|
Churyla A. When should I worry? When should I be happy? J Cardiovasc Electrophysiol 2020; 31:2907-2908. [PMID: 32945046 DOI: 10.1111/jce.14747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrei Churyla
- Division of Cardiac Surgery, Feinberg School of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|