1
|
Park J, Cha MJ, Kwon CH, Cho MS, Nam GB, Oh IY, Lee SR, Kim JY, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J, Lim HE. Long-term clinical impact of early recurrence of atrial tachyarrhythmia after cryoballoon ablation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:1614-1623. [PMID: 38890808 DOI: 10.1111/jce.16334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/16/2024] [Accepted: 05/25/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The impact of early recurrence of atrial tachyarrhythmia (ERAT) within the 90-day blanking period on long-term outcomes in atrial fibrillation (AF) patients undergoing cryoballoon ablation (CBA) is controversial. This study aimed to assess the relationship between ERAT and late recurrence of atrial tachyarrhythmia (LRAT) post-CBA. METHODS Utilizing data from a multicenter registry in Korea (May 2018 to June 2022), we analyzed the presence and timing of ERAT (<30, 30-60, and 60-90 days) and its association with LRAT risk after CBA. LRAT was defined as any recurrence of AF, atrial flutter, or atrial tachycardia lasting more than 30 s beyond the 90 days. RESULTS Out of 2636 patients, 745 (28.2%) experienced ERAT post-CBA. Over an average follow-up period of 21.2 ± 10.3 months, LRAT was observed in 874 (33.1%) patients. Patients with ERAT had significantly lower 1-year LRAT freedom compared to those without ERAT (42.6% vs. 85.5%, p < .001). Multivariate analysis identified ERAT as a potential predictor of LRAT, with a hazard ratio (HR) of 3.98 (95% confidence interval [CI], 3.47-4.57). Significant associations were noted across all examined time frames (HR, 3.84; 95% CI, 3.32-4.45 in <30 days, HR, 5.53; 95% CI, 4.13-7.42 in 30-60 days, and HR, 4.29; 95% CI, 3.12-5.89 in 60-90 days). This finding was consistently observed across all types of AF. CONCLUSION ERAT during the 90-day blanking period strongly predicts LRAT in AF patients undergoing CBA, indicating a need to reconsider the clinical significance of this period.
Collapse
Affiliation(s)
- Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jun Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| |
Collapse
|
2
|
Onishi N, Kaitani K, Nakagawa Y, Kobori A, Inoue K, Kurotobi T, Morishima I, Matsui Y, Yamaji H, Nakazawa Y, Kusano K, Shimizu Y, Hanazawa K, Tamura T, Izumi C, Morimoto T, Ono K, Kimura T, Shizuta S. Radiofrequency Catheter Ablation for Atrial Fibrillation Patients on Hemodialysis (From the Kansai Plus Atrial Fibrillation Registry) - Clinical Impact of Early Recurrence. Circ J 2024; 88:1057-1064. [PMID: 38199253 DOI: 10.1253/circj.cj-23-0671] [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] [Indexed: 01/12/2024]
Abstract
BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) in patients on hemodialysis (HD) is reported to have a high risk of late recurrence (LR). However, the relationship between early recurrence (ER) within a 90-day blanking period after CA in AF patients and LR in HD patients remains unclear. METHODS AND RESULTS Of the 5,010 patients in the Kansai Plus Atrial Fibrillation Registry, 5,009 were included in the present study. Of these patients, 4,942 were not on HD (non-HD group) and 67 were on HD (HD group). HD was an independent risk factor for LR after the initial CA (adjusted hazard ratio 1.6; 95% confidence interval 1.1-2.2; P=0.01). In patients with ER, the rate of sinus rhythm maintenance at 3 years after the initial CA was significantly lower in the HD than non-HD group (11.4% vs. 35.4%, respectively; log-rank P=0.004). However, in patients without ER, there was no significant difference in the rate of sinus rhythm maintenance at 3 years between the HD and non-HD groups (67.7% vs. 74.5%, respectively; log-rank P=0.62). CONCLUSIONS ER in HD patients was a strong risk factor for LR. However, even HD patients could expect a good outcome without ER after the initial CA.
Collapse
Affiliation(s)
- Naoaki Onishi
- Division of Cardiology, Japanese Red Cross Otsu Hospital
- Department of Cardiology, Tenri Hospital
| | - Kazuaki Kaitani
- Division of Cardiology, Japanese Red Cross Otsu Hospital
- Department of Cardiology, Tenri Hospital
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital
- Division of Cardiology, National Hospital Organization Osaka National Hospital
| | - Toshiya Kurotobi
- Cardiovascular Center, Shiroyama Hospital
- Cardiovascular Center, Namba Kurotobi Heart Clinic
| | | | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital
| | | | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yukiko Shimizu
- Department of Cardiology, Tenri Hospital
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Koji Hanazawa
- Department of Cardiology, Tenri Hospital
- Division of Arrhythmia and Electrophysiology, Nishinomiya Watanabe Cardiovascular Center
| | | | - Chisato Izumi
- Department of Cardiology, Tenri Hospital
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center
| | | | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
- Department of Cardiology, Hirakata Kosai Hospital
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| |
Collapse
|
3
|
Lurz J, Hengelhaupt L, Unterhuber M, Stenzel L, Hilbert S, Schöber AR, Dinov B, Darma A, Dagres N, Hindricks G, Lurz P, Bollmann A. App-Based Mental Training to Reduce Atrial Fibrillation-Related Symptoms After Pulmonary Vein Isolation: MENTAL AF Trial. J Am Heart Assoc 2024; 13:e033500. [PMID: 38780185 PMCID: PMC11255628 DOI: 10.1161/jaha.123.033500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Even after atrial fibrillation (AF) catheter ablation, many patients still experience relevant symptom burden. The objective of the MENTAL AF trial was to determine whether app-based mental training (MT) during the 3 months following pulmonary vein isolation reduces AF-related symptoms. METHODS AND RESULTS Patients scheduled for pulmonary vein isolation were enrolled and randomized 1:1 to either app-based MT or usual care. Of 174 patients, 76 in the MT and 75 in the usual care group were included in the final analysis. The intervention was delivered by a daily 10-minute app-based MT. The primary outcome was the intergroup difference of the mean AF6 sum score, an AF-specific questionnaire, during the 3-month study period. Secondary outcomes included quality-of-life measures such as the AFEQT (Atrial Fibrillation Effect on Quality of Life). Mean age (SD) was 61 (8.7) years and 61 (41%) were women. The mean AF6 sum score over the study period was 8.9 (6.9) points in the MT group and 12.5 (10.1) in the usual care group (P=0.011). This referred to a reduction in the AF6 sum score compared with baseline of 75% in MT and 52% for usual care (P<0.001). The change in the AFEQT Global Score was 22.6 (16.3) and 15.7 (22.1), respectively; P=0.026. CONCLUSIONS MENTAL AF showed that app-based MT as an adjunctive treatment tool following pulmonary vein isolation was feasible. App-based MT was found to be superior to standard care in reducing AF-related symptom burden and improving health-related quality of life. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04067427.
Collapse
Affiliation(s)
- Julia Lurz
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Laura Hengelhaupt
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Matthias Unterhuber
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
- Department of CardiologySan Maurizio HospitalBolzanoItaly
| | - Lukas Stenzel
- Institute of Sport Science, Martin Luther University Halle‐WittenbergHalle (Saale)Germany
| | - Sebastian Hilbert
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Anne Rebecca Schöber
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
- Department of CardiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | - Borislav Dinov
- Medical Clinic I, Cardiology and AngiologyMedical University of GiessenGiessenGermany
| | - Angeliki Darma
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| | | | | | - Philipp Lurz
- Department of CardiologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig at University LeipzigLeipzigGermany
| |
Collapse
|
4
|
De Becker B, El Haddad M, De Smet M, François C, Tavernier R, le Polain de Waroux JB, Duytschaever M, Knecht S. Early atrial fibrillation recurrence post catheter ablation: Analysis from insertable cardiac monitor in the era of optimized radiofrequency ablation. Heart Rhythm 2024; 21:521-529. [PMID: 38246570 DOI: 10.1016/j.hrthm.2024.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is associated with ablation-induced proarrhythmogenic inflammation; however, existing studies used intermittent monitoring or nonoptimized radiofrequency (RF) applications (noncontiguous or without ablation index target value). OBJECTIVE The purpose of this study was to investigate the relationship between ERAT and late recurrence based on insertable cardiac monitor (ICM) data. METHODS We compiled data from Close-To-Cure and Close Maze studies, which enrolled patients who underwent RF ablation for paroxysmal or persistent atrial fibrillation (AF). All patients were implanted with an ICM 2-3 months before ablation. RESULTS We studied 165 patients (104 with paroxysmal AF, 61 with persistent AF). Over the 1-year follow-up period, 41 of the patients experienced late recurrence. The risk of late recurrence was higher in patients experiencing ERAT (hazard ratio [HR] 6.2; 95% confidence interval [CI] 3.0-13.0), with negative and positive predictive values of 90.5% and 45.7%, respectively. Median burden of AF during the blanking period was significantly higher in patients with late recurrence (7.9% [0.0%-99.6%]) compared to those without recurrence (0.0% [0.0%-6.0]; P <.001). For each 1% increase in AF burden during the blanking period, late recurrence increased by 4.6% (HR 1.046; 95% CI 1.035-1.059). The best tradeoff for predicting AF from ERAT occurrence was AF burden of 0.6% and last ERAT at 64 days. CONCLUSION In patients ablated for paroxysmal and persistent AF with a durable RF lesion set and implanted with a continuous monitoring device, postablation early AF recurrence and burden significantly predict late recurrence. The post-AF ablation blanking period should be reduced to 2 months.
Collapse
Affiliation(s)
| | | | | | - Clara François
- Cardiology Department, AZ Sint Jan Bruges, Bruges, Belgium
| | - René Tavernier
- Cardiology Department, AZ Sint Jan Bruges, Bruges, Belgium
| | | | | | | |
Collapse
|
5
|
Musat DL, Milstein NS, Saberito M, Bhatt A, Habibi M, Sichrovsky TC, Preminger MW, Shaw RE, Mittal S. Defining the blanking period, using continuous ECG monitoring, after cryoballoon pulmonary vein isolation. Heart Rhythm 2024; 21:530-537. [PMID: 38350520 DOI: 10.1016/j.hrthm.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. A blanking period (BP) of 3 months is used in clinical trials and practice. However, the optimal BP duration after PVI remains undefined. OBJECTIVE The aim of this study was to objectively define, using continuous monitoring by an implantable loop recorder, the optimal BP duration after cryoballoon PVI. METHODS We enrolled consecutive patients who had cryoballoon PVI and an implantable loop recorder. We determined the time of the last confirmed episode of AF within the blanking period. This was then correlated with AF recurrence in the first year after ablation. RESULTS There were 210 patients (66 ± 9 years; 138 [66%] male; 116 [55%] paroxysmal AF; CHA2DS2-VASc score, 2.5 ± 1.6). We defined 4 distinct groups based on the last AF episode within the BP: no AF days 0-90 (n = 96 [46%]) and last AF 0-30 days (n = 46 [22%]), 31-60 days (n = 18 [9%]), and 61-90 days (n = 50 [24%]). After the 3-month BP, 101 (48%) patients had AF recurrence at 160 ± 86 days. Compared with patients with no AF in the BP, those with recurrent AF and AF burden >0% 30 days after ablation had a significantly greater AF recurrence during long-term follow-up (P = .001). CONCLUSION Our data show that the approximately one-third of patients in whom AF occurs and who have a burden of >0% after the first month that follows PVI are at significantly higher risk of long-term recurrent AF. We therefore suggest that the blanking period be limited to a month after cryoballoon PVI.
Collapse
Affiliation(s)
- Dan L Musat
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Nicolle S Milstein
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Matthew Saberito
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Advay Bhatt
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Mohammadali Habibi
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Tina C Sichrovsky
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Mark W Preminger
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Richard E Shaw
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Suneet Mittal
- Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey.
| |
Collapse
|
6
|
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
|
7
|
Schiavone M, Gasperetti A, Martignani C, Montemerlo E, Ciconte G, Ziacchi M, Arosio R, Piazzi E, Spadotto A, Ruggiero D, Angeletti A, Pozzi M, Biffi M, Rovaris G, Forleo GB. Atrial fibrillation recurrences during the blanking period after catheter ablation with the laser balloon technique. J Cardiovasc Electrophysiol 2023; 34:2443-2451. [PMID: 37767727 DOI: 10.1111/jce.16087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Regardless of the catheter ablation (CA) for atrial fibrillation (AF) strategy, the role of early recurrences during the blanking period (BP) is still unclear. Our aim was to evaluate atrial tachyarrhythmias (ATAs) recurrences during the BP after CA with the laser-balloon (LB) technique. METHODS Consecutive patients undergoing LBCA were enrolled. Primary outcome of the study was the overall crude ATA recurrence rate during the BP. ATA recurrences after the BP and in-hospital readmissions during the BP were deemed secondary outcomes. RESULTS Two hundred and twenty-four patients underwent CA with the LB. Median age was 63.0 (55.5-69.5) years and 74.1% were males. 28.6% were persistent AF patients, and 34.8% of patients were followed up with a loop recorder. 15.6% of patients experienced at least an ATA recurrence during the BP. Male sex, chronic heart failure, persistent AF, and recurrences during the BP were found to be associated with long-term ATA recurrences. Recurrences during the BP remained associated with the outcome of interest at multivariate analysis (hazard ratio [HR] = 12.393, 95% confidence interval [95% CI] = 3.699-41.865, p < .001). An association over time was found between early and late recurrences, with 73.7%, 45.5%, and 10.8% of patients presenting with recurrences at 1-, 2-, and 3-month follow-up being free from recurrences after the BP, respectively. 8.0% of patients were readmitted during the BP: 4.5% for AF electrical cardioversion, and 1.8% for CA of other atrial arrhythmias; no redo CA was performed. CONCLUSION After adjusting for confounders, ATA recurrences during the BP represent the most significant predictor of ATA recurrences after the BP, regardless of AF pattern.
Collapse
Affiliation(s)
- Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Department of Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cristian Martignani
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Roberto Arosio
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Elena Piazzi
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Spadotto
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Diego Ruggiero
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Andrea Angeletti
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mattia Pozzi
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | |
Collapse
|
8
|
Sørensen SK, Johannessen A, Worck R, Hansen ML, Ruwald MH, Hansen J. Early recurrence of atrial tachyarrhythmia indicates pulmonary vein reconduction independent of blanking period duration in the RACE-AF trial. J Cardiovasc Electrophysiol 2023; 34:2434-2442. [PMID: 37814483 DOI: 10.1111/jce.16098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/02/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Atrial tachyarrhythmia recurrence during the blanking period (early ATA) after pulmonary vein isolation (PVI) is associated with an increased risk of later recurrence, but its relationship with pulmonary vein reconduction (PVR) is poorly understood. The objective of the present study was to evaluate the relationship between early ATA and PVR. Second, to provide data on the optimal blanking period by (a) evaluating how the predictive values of ATA for PVR are affected by blanking period duration, and (b) assessing the temporal development in atrial fibrillation (AF) burden. METHODS In this RACE-AF substudy, 91 patients with paroxysmal AF undergoing PVI randomized to radiofrequency or cryoballoon ablation were included. All patients received an implantable cardiac monitor and underwent a protocol-mandated repeat procedure after 4-6 months for assessment of PVR. ATA ≥ 30 s. ≤ 90 days after PVI constituted early ATA. RESULTS PVR was found in 37/54 (69%) patients with early ATA and in 11/37 (30%) patients without (p < .001). The positive predictive value of ATA for PVR was independent of blanking period duration (range 0-90 days). In both patients with and without PVR, AF burden was higher in the first month after PVI, but AF burden from the second month was similar to AF burden after the conventional blanking period. CONCLUSION Early ATA indicates PVR, and the positive predictive value is independent of the blanking period duration. Altogether, the results of this study support substantially shortening the blanking period after PVI for paroxysmal AF.
Collapse
Affiliation(s)
- Samuel K Sørensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - René Worck
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Morten L Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| |
Collapse
|
9
|
Serban T, Mannhart D, Abid QUA, Höchli A, Lazar S, Krisai P, Bettelini AS, Knecht S, Kühne M, Sticherling C, du Fay de Lavallaz J, Badertscher P. Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review. Europace 2023; 25:euad335. [PMID: 37944133 PMCID: PMC10664405 DOI: 10.1093/europace/euad335] [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: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.
Collapse
Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | | | - Andres Höchli
- Department of Cardiology, Triemli Stadtspital, Zürich, Switzerland
| | - Sorin Lazar
- Department of Cardiology, Cook County Health, Chicago, IL, USA
| | - Philipp Krisai
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Arianna Sofia Bettelini
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| |
Collapse
|
10
|
Noujaim C, Lim C, Donnellan E, Mekhael M, Zhao C, Shan B, Hadi El Hajjar A, Chouman N, Assaf A, Feng H, Younes H, Kreidieh O, Berouti E, He H, Li D, Lanier B, Nelson D, Dhore-Patil A, Ayoub T, Huang C, Chelu MG, Marrouche NF. Smartphone AF Burden During the Blanking Period Predicts Catheter Ablation Outcomes: Insights From DECAAF II. JACC Clin Electrophysiol 2023; 9:2085-2095. [PMID: 37737774 DOI: 10.1016/j.jacep.2023.06.010] [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: 01/09/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) recurrence during the blanking period is under investigated. With the rise of smartphone-based electrocardiogram (ECG) monitoring, there's potential for better prediction and understanding of AF recurrence trends. OBJECTIVES In this study the authors hypothesize that AF burden derived from a single-lead Smartphone ECG during the blanking period predicts recurrence of atrial arrhythmias after ablation. METHODS 630 patients with persistent AF undergoing ablation were included from the DECAAF II (Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation) trial. Patients recorded daily ECG strips using a smartphone device. AF burden was defined as the ratio of ECG strips with AF to the total number of strips submitted. The primary outcome was the recurrence of atrial arrhythmia. RESULTS Recurrence occurred in 301 patients during the 18-month follow-up period. In patients who developed recurrent arrhythmia after 90 days of follow-up, AF burden during the blanking period was significantly higher when compared with patients who remained in sinus rhythm (31.3% vs 7.5%; P < 0.001). AF burden during the blanking period was an independent predictor of arrhythmia recurrence (HR: 1.41; 95% CI: 1.36-1.47; P < 0.001). Through grid searching, an AF burden of 18% best discriminates between recurrence and no-recurrence groups, yielding a C-index of 0.748. After a follow-up period of 18 months, recurrence occurred in 33.7% of patients (147 of 436) with an AF burden <18% and in 79.4% of patients (154 of 194) with an AF burden >18% (HR: 4.57; 95% CI: 3.63-5.75; P < 0.001). CONCLUSIONS A high AF burden derived from a smartphone ECG during the blanking period is a strong predictor of atrial arrhythmia recurrences after ablation.
Collapse
Affiliation(s)
- Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chanho Lim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Eoin Donnellan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Cong Zhao
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Botao Shan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Abdel Hadi El Hajjar
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Nour Chouman
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ala Assaf
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Han Feng
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Omar Kreidieh
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Emilia Berouti
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Hua He
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dan Li
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Brennan Lanier
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Daniel Nelson
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aneesh Dhore-Patil
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Tarek Ayoub
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Chao Huang
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mihail G Chelu
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA; Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA; Baylor St. Luke's Medical Center, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Nassir F Marrouche
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| |
Collapse
|
11
|
Junarta J, O'Neill P, Dikdan SJ, Pang Z, Fradin JJ, Frisch DR. Mobile electrocardiographic devices and healthcare utilization in post-atrial fibrillation ablation patients. J Electrocardiol 2023; 80:139-142. [PMID: 37390585 DOI: 10.1016/j.jelectrocard.2023.06.004] [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: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The use of mobile electrocardiogram (mECG) devices is becoming more prevalent. mECG devices allow instant access to recording arrhythmias and enable automatic rhythm interpretation. Providers can remotely evaluate patients and this may reduce in-person healthcare utilization. We sought to evaluate the utility of mECG devices in reducing healthcare utilization among patients who underwent atrial fibrillation (AF) ablation. METHODS We identified a population of patients with paroxysmal or persistent AF presenting for their first AF ablation. Patients were divided into two groups: KardiaMobile (AliveCor, Mountain View, CA) mECG users and non-KardiaMobile users. Healthcare utilization was compared between the two groups for one year post-ablation. RESULTS 184 patients were studied (76 KardiaMobile users, 108 non-KardiaMobile users). There was no difference in the number of office visits (p = 0.59), cardiac-specific emergency department visits (p = 0.26), cardiac-specific hospital admissions (p = 0.13), ablations or cardioversions completed (p = 0.24), telephone encounters (p = 0.05), patient electronic health record messages (p = 0.40), or cardiac imaging (transthoracic or transesophageal echocardiograms) tests ordered (p = 0.36). Exposure to the device was associated with a reduction in ambulatory cardiac monitor use (p = 0.04). There was no difference in sinus rhythm maintenance over 12 months by Kaplan-Meier survival analysis (log rank test p = 0.05) between groups. CONCLUSION Mobile technology is available for heart rhythm monitoring and can give instant feedback to the user. mECG use is associated with a significant reduction in ambulatory cardiac monitor use in the post-ablation period. There was no difference in other AF-related healthcare utilization.
Collapse
Affiliation(s)
- Joey Junarta
- Department of Medicine, Thomas Jefferson University Hospital, USA
| | - Parker O'Neill
- Department of Medicine, Thomas Jefferson University Hospital, USA
| | - Sean J Dikdan
- Jefferson Heart Institute, Thomas Jefferson University Hospital, USA
| | - Zachary Pang
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - James J Fradin
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Daniel R Frisch
- Sidney Kimmel Medical College, Thomas Jefferson University, USA.
| |
Collapse
|
12
|
Wang Z, Lai Y, Wang Y, Wang J, Jiang C, He L, Guo X, Li S, Wang W, Jiang C, Liu N, Tang R, Long D, Sang C, Du X, Dong J, Ma C. Very-early symptomatic recurrence is associated with late recurrence after radiofrequency ablation of atrial fibrillation. Europace 2023; 25:euad189. [PMID: 37417712 PMCID: PMC10337823 DOI: 10.1093/europace/euad189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023] Open
Abstract
AIMS After radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF), the effect of very-early (within 48 h) symptomatic recurrence (VESR) on late (after 3 months of RFCA) recurrence (LR) has been seldomly reported. We aimed to explore the relationship between VESR and LR among post-RFCA patients. METHODS AND RESULTS This was a single-centre prospective cohort study that enrolled 6887 AF patients who received the first RFCA procedure from June 2018 to December 2021 at Beijing Anzhen Hospital. Patients were divided into four groups based on VESR and early (from 48 h to 3 months after RFCA) recurrence (ER): Group A (no VESR, no ER); Group B (VESR but no ER); Group C (ER but no VESR); and Group D (both VESR and ER). Three hundred and thirty (4.79%) patients experienced VESR (Groups B and D). With an average follow-up of 14.7 months after grouping, the Kaplan-Meier curve showed that LR risk in VESR patients was higher than in other patients (log-rank, P < 0.001), and the difference was significant in both paroxysmal (log-rank, P < 0.001) and persistent (log-rank, P < 0.001) AF patients (P for interaction = 0.118). In multivariate analysis, Groups B, C, and D were associated with a 2.161-, 5.409-, and 7.401-fold increase in the risk of LR, respectively. What is more, compared with Group A, VESR-atrial tachycardia and VESR-AF were related to a 3.467- and 5.564-fold LR risk, respectively. In VESR patients, classification based on ER and VESR modes improved the prediction potential of LR risk. CONCLUSION Very-early symptomatic recurrence is associated with an increased risk of LR.
Collapse
Affiliation(s)
- Zhen Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Jue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Xueyan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Wei Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, No. 2, Anzhen Road, Chao Yang District, Beijing 100029, China
| |
Collapse
|
13
|
Noujaim C, Lim C, Mekhael M, Feng H, Chouman N, Younes H, Assaf A, Shan B, Shamaileh G, Dhore-Patil A, Nelson D, Lanier B, Makan N, Marrouche N, Donnellan E. Identifying the prognostic significance of early arrhythmia recurrence during the blanking period and the optimal blanking period duration: insights from the DECAAF II study. Europace 2023; 25:euad173. [PMID: 37337683 PMCID: PMC10292951 DOI: 10.1093/europace/euad173] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Early atrial arrhythmia recurrence following atrial fibrillation (AF) ablation is common. Current guidelines promulgate a 3-month blanking period. We hypothesize that early atrial arrhythmia recurrence during the blanking period may predict longer-term ablation outcomes. METHODS AND RESULTS A total of 688 patients with persistent AF undergoing catheter ablation were included in the DECAAF II trial database. The primary endpoint of the study was the first confirmed recurrence of atrial arrhythmia. Recurrence was also monitored during the 90-day blanking period. A total of 287 patients experienced recurrent atrial arrhythmia during the blanking period, while 401 remained in sinus rhythm. Rates of longer-term arrhythmia recurrence were substantially higher among those who developed recurrence during the blanking period compared to those who remained in sinus rhythm throughout the blanking period (68% vs. 32%, P < 0.001). The study cohort was divided into three groups according to the timing of arrhythmia recurrence during the blanking period. Of those who had recurrent arrhythmia during the first month of the blanking period (Group 1), 43.9% experienced longer-term recurrence, compared to 61.6% who recurred during the second month of the blanking period (Group 2), and 93.3% of those who had arrhythmia recurrence during the third month (Group 3, P < 0.001). The risk of recurrent arrhythmia was highest in Group 3 (HR = 10.15), followed by Group 2 (HR = 2.35) and Group 1 (HR = 1.5). Receiver operating characteristic analysis was performed to assess the relationship between the timing of arrhythmia recurrence and the primary outcome (AUC = 0.746, P < 0.001). The optimal blanking period duration was identified as 34 days. Atrial fibrillation burden determined by smartphone electrocardiogram technology over the 18 months follow-up period was significantly higher in Group 3 (29%) compared to Groups 1 (6%) and 2 (7%) and in patients who stayed in sinus rhythm during the blanking period (5%) (P < 0.0001). CONCLUSION Early atrial arrhythmia recurrence during the blanking period, particularly during the third month, is significantly associated with later recurrence. Although a blanking period is warranted, it should be abbreviated.
Collapse
Affiliation(s)
- Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Chanho Lim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Han Feng
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Nour Chouman
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Ala Assaf
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Botao Shan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Ghaith Shamaileh
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Aneesh Dhore-Patil
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Daniel Nelson
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Brennan Lanier
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Noor Makan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Eoin Donnellan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| |
Collapse
|
14
|
Saglietto A, Ballatore A, Xhakupi H, Rubat Baleuri F, Magnano M, Gaita F, De Ferrari GM, Anselmino M. Evidence-based insights on ideal blanking period duration following atrial fibrillation catheter ablation. Europace 2022; 24:1899-1908. [PMID: 35917218 DOI: 10.1093/europace/euac098] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA. METHODS AND RESULTS PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic 'test', whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4-45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56-0.75]. Specificity (95% CI: 63-85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8-51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0-63.4 days, AUC-SROC: 0.76) after cryoballoon ablation. CONCLUSION The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration.
Collapse
Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | - Andrea Ballatore
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | - Henri Xhakupi
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | - Federico Rubat Baleuri
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | - Massimo Magnano
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| | - Matteo Anselmino
- Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy
| |
Collapse
|
15
|
Silva Cunha P, Portugal G, Laranjo S, Alves M, Luísa Papoila A, Valente B, Sofia Delgado A, Lousinha A, Paulo M, Brás M, Guerra C, Cruz Ferreira R, Martins Oliveira M. The atrial fibrillation burden during the blanking period is predictive of time to recurrence after catheter ablation. IJC HEART & VASCULATURE 2022; 43:101138. [PMID: 36275421 PMCID: PMC9579489 DOI: 10.1016/j.ijcha.2022.101138] [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: 07/31/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
Objective This study aimed to assess whether atrial fibrillation (AF) occurrence or its corresponding daily mean burden (in minutes/day) during the mid to late blanking period after pulmonary vein isolation (PVI), predicts AF recurrence. Methods Analysis of consecutive first PVI ablation patients undergoing prolonged electrocardiogram (ECG) monitoring during the second and third months after PVI. The clinical variables, total AF burden, and their relationship with time to recurrence were studied. Results 477 patients with a mean age of 56.9 (SD = 12.3) years (63.7 % male; 71.7 % paroxysmal AF), from which 317 (66.5 %) had an external event recorder between 30 and 90 days after ablation. Median follow-up of 16.0 (P 25:12.0: P 75:33.0) months, 177 (37 %) patients had an AF recurrence, with 106 (22.2 %) having the first episode after 12 months of follow-up. In the group of patients with an event recorder, 80 (25.2 %) had AF documented during the blanking period. Multivariable analysis showed that AF during the blanking period was associated with a 4-fold higher risk of recurrence (HR: 3.98; 95 %CI: 2.95–5.37), and, compared to patients in sinus rhythm, those with an AF burden ≥ 23 min/day had an approximately 7-fold higher risk of recurrence (HR estimate: 6.79; 95 %CI: 4.56–10.10). Conclusions The probability of experiencing AF recurrence can be predicted by atrial tachyarrhythmia episodes during the second and third months after PVI. Atrial arrhythmias burden > 23 min/day has a high predictive ability for recurrence.
Collapse
Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal,Corresponding author at: Santa Marta Hospital, Cardiology Service, Arrhythmology, Pacing, and Electrophysiology Unit, R. de Santa Marta 50, 1169-024 Lisboa, Portugal.
| | - Guilherme Portugal
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,ComprehensiveHealth Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Marta Alves
- NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Bruno Valente
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Sofia Delgado
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Lousinha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Paulo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Manuel Brás
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Guerra
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
16
|
Bordignon S, Barra S, Providencia R, de Asmundis C, Marijon E, Farkowski MM, Anic A, Guerra JM, Kosiuk J, Iliodromitis K, Schmidt B, Conte G, Chun JKR, Boveda S. The blanking period after atrial fibrillation ablation: an European Heart Rhythm Association survey on contemporary definition and management. Europace 2022; 24:1684-1690. [PMID: 35942585 DOI: 10.1093/europace/euac131] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/07/2022] [Indexed: 01/25/2023] Open
Abstract
The use of a blanking period (BP) after an atrial fibrillation (AF) ablation procedure is a common practice, but recent data questions the benign nature of early recurrences of atrial tachyarrhythmias (ERATs). A physician-based survey was carried out by the European Heart Rhythm Association (EHRA) to investigate the current definition and applicability of BP and ERAT management. An online questionnaire was sent to clinical and interventional electrophysiologists. A total of 436 respondents (88% interventional electrophysiologists) reported observing ERATs in 25% (interquartile range 15-35) of patients, less commonly in paroxysmal AF (PAF) compared with persistent AF (persAF). The median reported duration of BP used by respondents was 90 days, with 22% preferring a shorter BP duration for PAF patients compared with persAF. Half of the patients with ERATs are expected to also experience late recurrences (LR). Isolated episodes of ERATs are treated conservatively by 99% of the respondents, but repeat ablation during the BP is preferred by 20% of electrophysiologists for multiple ERATs and by 16% in patients with organized atrial tachyarrhythmias. In conclusion, ERATs are commonly observed after AF ablation, particularly in persAF patients, and are perceived as predictors of LR by half of the respondents. A general adherence to a 90-day BP duration was observed. During this time period, ERAT is mainly treated conservatively, but repeat ablation during the BP is occasionally offered to patients with multiple ERATs and those with organized atrial tachyarrhythmias.
Collapse
Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia 4400, Portugal.,Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB20AY, UK
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London EC1A 7BE, UK.,Institute of Health Informatics, University College of London, London NW1 2DA, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium
| | - Eloi Marijon
- University of Paris, Paris 75006, France.,Cardiology Department & Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris 75015, France
| | - Michal M Farkowski
- II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Center Split, Split 21000, Croatia
| | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona 08025, Spain
| | - Jedrzej Kosiuk
- Department of Rhythmology, Helios Clinic Köthen, Köthen 06366, Germany
| | - Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Hagen 58135, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Giulio Conte
- Cardiology Department, Fondazione Cardiocentro Ticino, Lugano 6900, Switzerland
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Med. Klinik III, Markuskrankenhaus, Frankfurt 60431, Germany
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels 1090, Belgium.,Clinique Pasteur, Heart Rhythm Department, 31076 Toulouse, France.,INSERM U970 75908, Paris, France
| |
Collapse
|
17
|
Groen MHA, van Driel VJHM, Neven K, van Wessel H, de Bakker JMT, Doevendans PAF, Wittkampf FHM, Loh P, van Es R. Multielectrode Contact Measurement Can Improve Long-Term Outcome of Pulmonary Vein Isolation Using Circular Single-Pulse Electroporation Ablation. Circ Arrhythm Electrophysiol 2022; 15:e010835. [PMID: 35917465 PMCID: PMC9384826 DOI: 10.1161/circep.121.010835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) ablation is generally performed with multielectrode catheters. Electrode-tissue contact is an important predictor for the success of pulmonary vein (PV) isolation; however, contact force is difficult to measure with multielectrode ablation catheters. In a preclinical study, we assessed the feasibility of a multielectrode impedance system (MEIS) as a predictor of long-term success of PV isolation. In addition, we present the first-in-human clinical experience with MEIS. METHODS In 10 pigs, one PV was ablated based on impedance (MEIS group), and the other PV was solely based on local electrogram information (electrophysiological group). IRE ablations were performed at 200 J. After 3 months, recurrence of conduction was assessed. Subsequently, in 30 patients undergoing PV isolation with IRE, MEIS was evaluated and MEIS contact values were compared to local electrograms. RESULTS In the porcine study, 43 IRE applications were delivered in 19 PVs. Acutely, no reconnections were observed in either group. After 3 months, 0 versus 3 (P=0.21) PVs showed conduction recurrence in the MEIS and electrophysiological groups, respectively. Results from the clinical study showed a significant linear relation was found between mean MEIS value and bipolar dV/dt (r2=0.49, P<0.001), with a slope of 20.6 mV/s per Ohm. CONCLUSIONS Data from the animal study suggest that MEIS values predict effective IRE applications. For the long-term success of electrical PV isolation with circular IRE applications, no significant difference in efficacy was found between ablation based on the measurement of electrode interface impedance and ablation using the classical electrophysiological approach for determining electrode-tissue contact. Experiences of the first clinical use of MEIS were promising and serve as an important basis for future research.
Collapse
Affiliation(s)
- Marijn H A Groen
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Netherlands Heart Institute, Utrecht (M.H.A.G., P.A.F.D.)
| | - Vincent J H M van Driel
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands (V.J.H.M.v.D.)
| | - Kars Neven
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen (K.N.).,Department of Medicine, Witten/Herdecke University, Witten, Germany (K.N.)
| | - Harry van Wessel
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Abbott Medical Nederland B.V., Veenendaal (H.v.W.)
| | - J M T de Bakker
- Heart Center, Department of Experimental Cardiology, Academic Medical Center Amsterdam, the Netherlands (J.M.T.d.B.)
| | - Pieter A F Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.).,Netherlands Heart Institute, Utrecht (M.H.A.G., P.A.F.D.)
| | - Fred H M Wittkampf
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
| | - Peter Loh
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
| | - René van Es
- Division Heart and Lungs, Department of Cardiology, University Medical Center (M.H.A.G., V.J.H.M.v.D., K.N., H.v.W., P.A.F.D., F.H.M.W., P.L., R.v.E.)
| |
Collapse
|
18
|
Li Z, Wang S, Hidru TH, Sun Y, Gao L, Yang X, Xia Y. Long Atrial Fibrillation Duration and Early Recurrence Are Reliable Predictors of Late Recurrence After Radiofrequency Catheter Ablation. Front Cardiovasc Med 2022; 9:864417. [PMID: 35402564 PMCID: PMC8990906 DOI: 10.3389/fcvm.2022.864417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Recurrence after atrial fibrillation (AF) ablation is still common. Objective This study aimed to evaluate the predictive abilities of AF duration and early recurrence (ER) to discriminate high-risk patients for recurrence. Methods We enrolled 1,763 consecutive patients with AF who were scheduled to receive the index radiofrequency catheter ablation (RFCA) from January 2016 to August 2021 in Dalian, China. Long AF duration (LAFD) was considered if the course of AF lasted for ≥ 12 months. ER was defined as any atrial tachycardia (AT) or AF event longer than 30 s occurring within a 3-month post-RFCA. Results Late recurrence occurred in 643 (36.5%) of the 1,763 patients at a median of 35 months after RFCA. Multivariate analysis identified LAFD (hazard ratio (HR): 1.80, 95% confidence interval (CI): 1.38–2.35, p < 0.001) and ER (HR: 2.34, 95% CI: 1.82–3.01, p < 0.001) as strong independent predictors of late recurrence in non-paroxysmal AF. Similarly, LAFD (HR: 1.48, 95% CI: 1.20–1.84, p < 0.001) and ER (HR: 3.40, 95% CI: 2.68–4.30, p < 0.001) were significantly associated with late recurrence in paroxysmal AF. Receiver operating curve analyses revealed that the CAAP-AF (CAD, Atrial diameter, Age, Persistent or longstanding AF, Antiarrhythmic drugs failed, Female) had the highest predict power [area under ROC curve (AUC) 0.586]. The addition of ER and LAFD to the CAAP-AF score significantly improved risk discrimination for late recurrence after AF ablation from 0.586 to 0.686. Conclusion Long AF duration and ER were independently associated with late recurrence. The prediction performance of the CAAP-AF model for recurrence was improved by the addition of LAFD and ER.
Collapse
|
19
|
Moore BM, Kistler PM. To blank or not to blank - that is the question: Time to shorten the blanking period after AF ablation. Int J Cardiol 2021; 343:53-54. [PMID: 34537307 DOI: 10.1016/j.ijcard.2021.09.025] [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: 09/05/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Benjamin M Moore
- Baker Heart and Diabetes Research Institute, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Peter M Kistler
- Baker Heart and Diabetes Research Institute, Melbourne, Australia; Alfred Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Monash Health, Melbourne, Australia.
| |
Collapse
|
20
|
Yasumoto K, Egami Y, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Tsuda M, Okamoto N, Tanaka A, Matsunaga-Lee Y, Yano M, Shutta R, Sakata Y, Nishino M, Tanouchi J. Ablation index-guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score-matched analysis. J Interv Card Electrophysiol 2021; 64:479-487. [PMID: 34674119 DOI: 10.1007/s10840-021-01059-y] [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: 06/16/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)-guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)-guided PVI. METHODS Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period. RESULTS A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269-0.639, P < 0.001). CONCLUSIONS AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.
Collapse
Affiliation(s)
- Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasuyuki Egami
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Kohei Ukita
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Akito Kawamura
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Hitoshi Nakamura
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yutaka Matsuhiro
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Masaki Tsuda
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Naotaka Okamoto
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Akihiro Tanaka
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasuharu Matsunaga-Lee
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Masamichi Yano
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Ryu Shutta
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masami Nishino
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan.
| | - Jun Tanouchi
- Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan
| |
Collapse
|
21
|
Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence? Clin Res Cardiol 2021; 111:85-95. [PMID: 34519875 PMCID: PMC8766394 DOI: 10.1007/s00392-021-01934-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/30/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. METHODS The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. RESULTS ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184-45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003-0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. CONCLUSION ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies.
Collapse
|
22
|
Onishi N, Kaitani K, Nakagawa Y, Inoue K, Kobori A, Nakazawa Y, Ozawa T, Kurotobi T, Morishima I, Miura F, Watanabe T, Masuda M, Naito M, Fujimoto H, Nishida T, Furukawa Y, Shirayama T, Tanaka M, Okajima K, Yao T, Egami Y, Satomi K, Noda T, Miyamoto K, Haruna T, Higashi Y, Ito M, Horie M, Kusano KF, Shimizu W, Kamakura S, Shimizu Y, Hanazawa K, Tamura T, Izumi C, Morimoto T, Kimura T, Shizuta S. The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study. Int J Cardiol 2021; 341:39-45. [PMID: 34343532 DOI: 10.1016/j.ijcard.2021.07.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between the timing of the first early recurrence and late recurrence after a single catheter ablation procedure for atrial fibrillation is controversial. METHODS The Efficacy of Short-Term Use of Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation trial followed 2038 patients who underwent radiofrequency catheter ablation for atrial fibrillation. RESULTS Of the patients, 907 (45%) had early recurrences within 90 days after the initial ablation. We divided these patients into two groups according to the timing of the first early recurrence episode, namely the ER1 group (early recurrence during the early phase; 0-30 days, n = 814) and ER2 group (early recurrence during the late phase; 31-90 days, n = 93). Three years after ablation, patients with early recurrences had a significantly lower event-free rate from late recurrences after a 90-day blanking period than patients without early recurrences (36.2% and 74.2%, respectively; log-rank, P < 0.0001). Three years after ablation, the event-free rate was significantly higher in the ER1 than the ER2 group (38.3% and 17.1%, respectively; log-rank, P < 0.0001). Moreover, the event-free rate at 3 years in the ER2 group was extremely low (5.6%) in patient with non-paroxysmal atrial fibrillation. CONCLUSION Early recurrences were strongly associated with late recurrences, especially in patients with the first recurrence episode at >1 month within the blanking period after a single ablation procedure. Therefore, these patients should undergo close observation during follow-up, when they had especially with non-paroxysmal atrial fibrillation.
Collapse
Affiliation(s)
- Naoaki Onishi
- Division of Cardiology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Japan; Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Japanese Red Cross Otsu Hospital, Otsu 520-8511, Japan; Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan.
| | - Yoshihisa Nakagawa
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka 530-0001, Japan; Division of Cardiology, National Hospital Organization Osaka Medical Center, Osaka 540-0006, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Tomoya Ozawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Namba Kurotobi Heart Clinic, Osaka 542-0076, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki 503-8502, Japan
| | - Fumiharu Miura
- Department of Cardiology, Hiroshima Prefectural Hospital, Hiroshima 734-8530, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki 660-8511, Japan
| | - Masaki Naito
- Cardiovascular Center, Naito Hospital, Osaka 537-0002, Japan
| | - Hajime Fujimoto
- Department of Cardiovascular Medicine, Nara Prefecture Western Medical Center, Nara 636-0802, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara 634-8522, Japan
| | - Yoshio Furukawa
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya 494-0001, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Omihachiman 523-0082, Japan
| | - Mariko Tanaka
- Department of Cardiology, JCHO Kobe Central Hospital, Kobe 651-1145, Japan
| | - Katsunori Okajima
- Department of Cardiology, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Takenori Yao
- Faculty of Human Sciences, Osaka University of Economics, Osaka 533-8533, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Osaka 591-8025, Japan
| | - Kazuhiro Satomi
- Department of Cardiology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Tetsuya Haruna
- Cardiovascular Center, Tazuke Medical Research Institute Kitano Hospital, Osaka 530-8480, Japan
| | - Yukei Higashi
- Department of Cardiovascular Medicine, Okamura Memorial Hospital, Shizuoka 411-0904, Japan
| | - Makoto Ito
- Cardiovascular Center, Ito Medical Clinic, Kusatsu 525-0037, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Kengo F Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo 113-8603, Japan
| | - Shiro Kamakura
- Department of Cardiology, Mahoshi Hospital, Kobe 651-1242, Japan
| | - Yukiko Shimizu
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki 660-8550, Japan
| | - Koji Hanazawa
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Department of Cardiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama 640-8558, Japan
| | | | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri 632-0015, Japan; Division of Heart Failure, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita 564-8565, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya 663-8501, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | | |
Collapse
|
23
|
Steinberg C, Champagne J, Deyell MW, Dubuc M, Leong-Sit P, Calkins H, Sterns L, Badra-Verdu M, Sapp J, Macle L, Khairy P, Andrade JG. Prevalence and outcome of early recurrence of atrial tachyarrhythmias in the Cryoballoon vs Irrigated Radiofrequency Catheter Ablation (CIRCA-DOSE) study. Heart Rhythm 2021; 18:1463-1470. [PMID: 34126269 DOI: 10.1016/j.hrthm.2021.06.1172] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is common after pulmonary vein isolation (PVI) and has been associated with an increased risk of late atrial fibrillation (AF) recurrence. OBJECTIVE The purpose of this study was to determine the incidence and outcomes of patients experiencing ERAT after PVI using advanced-generation ablation technologies. METHODS This is a prespecified substudy of the CIRCA-DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation: Double-Short vs Standard Exposure Duration) trial, a prospective, randomized, multicenter study comparing PVI with contact force-guided radiofrequency ablation to secondary-generation cryoballoon ablation for paroxysmal AF. All study patients received an implantable cardiac monitor to allow continuous rhythm monitoring. ERAT was defined as any recurrent atrial tachyarrhythmia within the first 90 days after AF ablation. RESULTS ERAT occurred in 61% of the 346 patients at a median of 12 days (range 1-90 days) after ablation. ERAF was a significant predictor of late recurrence (60.1% with ER vs 25.9% without ER; P <.001) and symptomatic atrial tachyarrhythmia (31.6% with ERAF vs 6.7% without ERAF; P <.001). Receiver operating curve analyses revealed a strong correlation between ERAT timing and burden and late recurrence. Multivariate analysis identified ER timing (hazard ratio [HR] 2.90; 95% confidence interval [CI] 1.41-5.95; P = .004) and burden (HR 1.05 per 1% ER burden; 95% CI 1.04-1.07; P <.001) as strong independent predictors of late recurrence. Incidence rate, timing, burden, and prognostic significance of ER did not differ between the study groups. CONCLUSION ERAT remains common after PVI despite use of advanced-generation ablation technologies. Early AF recurrence beyond 3 weeks after ablation is associated with increased risk of late recurrence.
Collapse
Affiliation(s)
- Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ-UL), Quebec, Canada
| | - Jean Champagne
- Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ-UL), Quebec, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Marc Dubuc
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | | | - Hugh Calkins
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | | | | | - John Sapp
- Queen Elizabeth-II Health Sciences Centre, Dalhousie University, Halifax, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada; Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada.
| |
Collapse
|
24
|
Darden D, Aldaas O, Malladi CL, Mylavarapu PS, Munir MB, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:323-331. [PMID: 33826085 PMCID: PMC9399025 DOI: 10.1007/s10840-021-00987-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation. Methods A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively. Results ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523–1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57–3.74, p < 0.001; month 2: HR 2.01, CI 1.13–3.83, p = 0.02; month 3: HR 1.46, CI 0.5–3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64). Conclusion Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.
Collapse
Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Omar Aldaas
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Chaitanya L Malladi
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Praneet S Mylavarapu
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, CA, 92037, USA.
| |
Collapse
|
25
|
Bohm A, Urban L, Tothova L, Bacharova L, Musil P, Kyselovic J, Michalek P, Uher T, Bezak B, Olejnik P, Hatala R. Advanced glycation end products predict long-term outcome of catheter ablation in paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2021; 64:17-25. [PMID: 33694091 DOI: 10.1007/s10840-021-00972-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Oxidative stress is an important contributor to the etiology of atrial fibrillation (AF). Our aim was to study oxidative stress biomarkers in patients undergoing pulmonary vein isolation (PVI) for paroxysmal AF with radiofrequency catheter ablation and to assess its prognostic value in predicting long-term PVI outcome. METHODS In this prospective cohort study, we included 62 patients (mean age 55±8 years, 12 females and 50 males) with paroxysmal AF and implanted ECG loop recorders who underwent PVI. Plasmatic concentrations of advanced glycation end-products (AGEs), fructosamine, advanced oxidation protein products, and thiobarbituric-acid reacting substances were measured before PVI. AF burden (percentage of time spent in AF) was continually assessed during the follow-up period (1063±271 days). RESULTS Nineteen patients (31%) were defined as optimal responders (oR) with AF burden < 0.5% after PVI. Remaining 43 patients (69%) were defined as sub-optimal responders. Concentration of AGEs was significantly lower in oR by 3.7 g/g (CI: -6.5 to -1.7; P=0.0003). After adjustment for age, sex, BMI, left atrial size, arterial hypertension, and AF burden before PVI, only low concentration of AGEs remained significantly associated with oR (odds ratio: 1.3; P=0.04). AGEs concentration achieved area under the curve of 0.78 for predicting optimal long-term PVI response. CONCLUSIONS AGEs concentration before PVI was associated with long-term PVI outcome in patients with paroxysmal AF. Further research will show if this biomarker could contribute to optimal patient selection for catheter ablation.
Collapse
Affiliation(s)
- Allan Bohm
- National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, SK-83348, Bratislava, Slovakia.
- 3rd Department of Internal Medicine, University Hospital Bratislava, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.
- Premedix Academy, Bratislava, Slovakia.
| | - Lubos Urban
- National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, SK-83348, Bratislava, Slovakia
| | - Lubomira Tothova
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ljuba Bacharova
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
- International Laser Center, Bratislava, Slovakia
| | - Peter Musil
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jan Kyselovic
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Michalek
- Premedix Academy, Bratislava, Slovakia
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Branislav Bezak
- National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, SK-83348, Bratislava, Slovakia
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Olejnik
- National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, SK-83348, Bratislava, Slovakia
- Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Robert Hatala
- National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, SK-83348, Bratislava, Slovakia
- Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| |
Collapse
|
26
|
Choi JH, Hwang KW, Jung SM, Lee SY, Lee SH, Chon MK, Kim JS, Je HG, Park YH, Kim JH, Lee SK, Chun KJ. Incidence and clinical impact of early recurrence of atrial tachyarrhythmia after surgical ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2898-2906. [PMID: 32945008 DOI: 10.1111/jce.14749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial tachyarrhythmias (ATAs) are common within the 3-month blanking period after catheter ablation of atrial fibrillation (AF). However, little evidence is available regarding the current guidelines on the blanking period after surgical AF ablation. We investigate the incidence and significance of early recurrence of atrial tachyarrhythmia (ERAT) and evaluate the optimal blanking period after surgical AF ablation. METHODS Data from 259 patients who underwent surgical AF ablation from 2009 to 2016 were collected. ERAT was defined as documented ATA episodes lasting for 30 s. A multivariate Cox proportional hazard model was constructed to evaluate the role of ERAT as a predictor of late recurrences (LR) for AF. RESULTS In total, 127 patients (49.0%) experienced their last episodes of ERAT during the first (n = 65), second (n = 14), or third (n = 48) month of the 3-month blanking period (p < .001). One year freedom from ATAs was 97.8% in patients without ERAT compared with 95.4%, 64.3%, and 8.3% in patients with ERAT in the first, second, and third months after the index procedure, respectively (p < .001). Hazard ratios of LR according to the timing of the last episode of ERAT first, second, and third months after the procedure were 2.84, 16.70, and 119.75, respectively. CONCLUSIONS The ERAT occurred in 49.0% of patients within the first 3 months after surgical ablation. The occurrence of ERAT within 3 months after surgical AF ablation was a significant independent predictor of LR. Hence, the currently accepted 3-month blanking period may be considered for redefining in patients with AF surgical ablation.
Collapse
Affiliation(s)
- Jin Hee Choi
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soon Myung Jung
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soo Yong Lee
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Hyun Lee
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min-Ku Chon
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeong-Su Kim
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyung Gon Je
- Department of Cardiovascular and Thoracic Surgery, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Hyun Park
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June Hong Kim
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Kwon Lee
- Department of Cardiovascular and Thoracic Surgery, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kook Jin Chun
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| |
Collapse
|
27
|
Xia Y, Liu J, Jia Y, Zhang H, Yu M, Li X, Fang P. Redefining the Blanking Period by a Long-Term Follow-Up after Atrial Fibrillation Ablation Using Second-Generation Cryoballoon. Int Heart J 2020; 61:936-943. [PMID: 32879265 DOI: 10.1536/ihj.20-234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
On the basis of radiofrequency ablation of atrial fibrillation (AF), some studies suggested that early recurrences of atrial tachyarrhythmia (ERATs) were associated with late AF recurrence (LAFR), and some also suspected and challenged the current recommended 90 day blanking period. We aim to evaluate the impact of ERAT on long-term success and to determine the optimum blanking period after AF ablation using second-generation cryoballoon (sg-CB). From August 2016 to October 2018, 369 consecutive patients who successfully underwent initial AF ablation using sg-CB at the Fuwai Hospital were finally enrolled. All patients were followed up no less than 12 months. Receiver operating characteristic curve analysis was used to determine the optimum blanking period after AF ablation. There were 62 (16.8%) who experienced ERAT. After a median follow-up of 615 days, 74.5% were free of LAFR after the 90 day blanking period. Incidence of freedom from LAFR during the long-term follow-up was markedly lower in patients with ERAT than in those without ERAT (27.4% versus 84.0%; log-rank P < 0.001). Furthermore, only ERAT (HR 8.579; 95% CI 5.604-13.133; P < 0.001) was significantly associated with an increased risk of LAFR after adjusting for other factors. The optimum cut-off time point for the blanking period was 21.5 days (sensitivity: 71.1%, specificity: 94.1%). In conclusion, ERAT was an independent predictor of LAFR after AF ablation using sg-CB. Based on our findings, blanking period was advised to be shorten to 21.5 days or about 3 weeks instead of 90 days after CB ablation.
Collapse
Affiliation(s)
- Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jun Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yuhe Jia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hao Zhang
- Department of Cardiology, Chongqing General Hospital
| | - Miao Yu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| |
Collapse
|
28
|
Kalinsek TP, Kottmaier M, Telishevska M, Berger F, Semmler V, Popa M, Brkic A, Lengauer S, Otgonbayar U, Koch-Büttner K, Bartowiak M, Kornmayer M, Brooks S, Risse E, Kathan S, Hofmann M, Grebmer C, Reents T, Hessling G, Deisenhofer I, Bourier F. Early recurrence after pulmonary vein isolation is associated with inferior long-term outcomes: Insights from a retrospective cohort study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1156-1164. [PMID: 32895960 DOI: 10.1111/pace.14060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long-term outcomes and to identify clinical variables associated with ER. METHODS We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan-Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long-term outcomes. RESULTS ER was observed in 13% of patients. Kaplan-Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14-day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30-day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. CONCLUSIONS ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long-term outcomes.
Collapse
Affiliation(s)
- Tine Prolic Kalinsek
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Florian Berger
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Verena Semmler
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Amir Brkic
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Ulamnemekh Otgonbayar
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Katharina Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marcin Bartowiak
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Marielouise Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Stephanie Brooks
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Susanne Kathan
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Monika Hofmann
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Christian Grebmer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University Munich, Lazarettstrasse 36, Munich, 80636, Germany
| |
Collapse
|
29
|
Oka T, Koyama Y, Tanaka K, Hirao Y, Tanaka N, Okada M, Yoshimoto I, Kitagaki R, Okamura A, Iwakura K, Sakata Y, Fujii K, Inoue K. Early recurrence during the blanking period and left atrial reverse remodeling after catheter ablation for non-paroxysmal atrial fibrillation. IJC HEART & VASCULATURE 2020; 30:100588. [PMID: 32743045 PMCID: PMC7385444 DOI: 10.1016/j.ijcha.2020.100588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/20/2020] [Accepted: 07/07/2020] [Indexed: 01/14/2023]
Abstract
Background Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation. Methods We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0–7 days after ablation), Intermediate (N = 67, 8–30), and Late-ERAT (N = 70, 31–90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR. Results Late-ERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21–9.47, p = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups (p < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; p = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06–0.27; p < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation. Conclusions Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.
Collapse
Affiliation(s)
- Takafumi Oka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Koyama
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yuko Hirao
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Issei Yoshimoto
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Ryo Kitagaki
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Atsunori Okamura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Katsuomi Iwakura
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenshi Fujii
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| |
Collapse
|
30
|
Mulder MJ, Kemme MJB, Hagen AMD, Hopman LHGA, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation. IJC HEART & VASCULATURE 2020; 29:100574. [PMID: 32642554 PMCID: PMC7334811 DOI: 10.1016/j.ijcha.2020.100574] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
Ablation Index-guided ablation allows for ablation lesions of consistent depth. Ablation Index-guided ablation is limited by ignoring local wall thickness. Local atrial wall thickness is associated with acute pulmonary vein reconnection. Wall thickness adjusted Ablation Index targets may improve ablation outcomes.
Background Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI.
Collapse
Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| |
Collapse
|
31
|
Uetake S, Miyauchi Y, Mitsuishi T, Maruyama M, Seino Y, Shimizu W. Re-definition of blanking period in radiofrequency catheter ablation of atrial fibrillation in the contact force era. J Cardiovasc Electrophysiol 2020; 31:2363-2370. [PMID: 32608072 DOI: 10.1111/jce.14643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Early recurrence (ER) of atrial fibrillation (AF) is defined as the recurrence of atrial tachyarrhythmias within 3 months after AF ablation, however, this definition is based on data from the era of radiofrequency catheter ablation (RFCA), without contact force (CF) technology. We investigated the significance of ER as a risk factor for late recurrence (LR) in paroxysmal AF (PAF) patients treated with CF and non-CF-guided ablation. METHODS AND RESULTS We studied 395 patients with PAF who underwent RFCA. Of these, 97 patients underwent RFCA without-CF technology (non-CF group) and 298 underwent with CF technology (CF group). Over a 2-year postablation follow-up period, LR occurred in 54 (55.7%) patients in the non-CF group, and in 105 (35.2%) patients in the CF group. ER had a more significant relationship with LR in the CF group, and all patients in the CF group with ER in the third month developed LR. CONCLUSION PAF patients with ER who have undergone CF-guided ablation have a greater risk of LR than those who have undergone non-CF-guided ablation. ER in the third month after CF-guided ablation may indicate an absolute risk of LR. Blanking period could be defined as 2 months in the CF era.
Collapse
Affiliation(s)
- Shunsuke Uetake
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Tatsuya Mitsuishi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Yoshihiko Seino
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital, Inzai, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
32
|
Yang DY, Cheng ZW, Liu YT, Gao P, Chen TB, Deng H, Cheng KA, Fan JB, Fang Q. Noninvasive electrocardiography monitoring for very early recurrence predicts long-term outcome in patients after atrial fibrillation ablation. Ann Noninvasive Electrocardiol 2020; 25:e12785. [PMID: 32588512 PMCID: PMC7679836 DOI: 10.1111/anec.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia, and catheter ablation has been shown to be a highly effective treatment for patients with symptomatic AF. Very early recurrence (VER) of AF within 7 days after catheter ablation is common, but the clinical significance of VER remains unclear. We have examined the usefulness of the noninvasive electrocardiography monitor for the detection of VER and the relationship between VER and late recurrence (LR). Methods Eighty‐eight patients with paroxysmal or persistent atrial fibrillation were retrospectively included. All patients underwent primary catheter ablation at a large general hospital between March 2016 and August 2018. All patients were followed up in atrial fibrillation clinic at an interval of every 3 months for late recurrence of AF. VER was evaluated by one‐lead continuous noninvasive electrocardiography monitoring device for 7 days after ablation. The association between VER and LR was analyzed by univariate and multivariate Cox regression model. Results Mean age was 62.9 ± 9.7 years, and 39.8% were female. Thirty‐two patients (36.4%) experienced VER. After a mean follow‐up of 539.36 ± 211.66 days, 17 patients (19.3%) experienced LR. Multivariate Cox regression analysis revealed VER was an independent predictor of LR: HR 3.6 (95% CI, 1.2–10.8), p = .020. In addition, diabetes was also associated with LR of atrial fibrillation. Conclusions Noninvasive electrocardiography monitoring was a useful tool for detecting VER and VER after catheter ablation was associated with LR.
Collapse
Affiliation(s)
- De-Yan Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhong-Wei Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong-Tai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tai-Bo Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hua Deng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kang-An Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing-Bo Fan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
33
|
Cherian TS, Callans DJ. Recurrent Atrial Fibrillation After Radiofrequency Ablation: What to Expect. Card Electrophysiol Clin 2020; 12:187-197. [PMID: 32451103 DOI: 10.1016/j.ccep.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recurrent atrial fibrillation after radiofrequency ablation is observed in up to 50% of patients within 3 months. Early and multiple recurrences predict late recurrences within 1 year, which occurs in 20% to 50% of patients. Although no consensus exists regarding patient selection and timing of redo ablation, we refer symptomatic patients with multiple recurrences and persistent atrial fibrillation for ablation. Reisolation of reconnected pulmonary veins and ablation of nonpulmonary vein triggers is the primary ablation strategy. In addition to repeat ablation, we recommend weight loss, treatment of sleep-disordered breathing, and management of comorbid conditions for durable maintenance of sinus rhythm.
Collapse
Affiliation(s)
- Tharian S Cherian
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9.129 Founders Pavilion, 3400 Spruce Street, Philadelphia PA 19104, USA. https://twitter.com/tscherian
| | - David J Callans
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9.129 Founders Pavilion, 3400 Spruce Street, Philadelphia PA 19104, USA.
| |
Collapse
|
34
|
Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study. J Interv Card Electrophysiol 2020; 60:271-278. [PMID: 32253599 DOI: 10.1007/s10840-020-00741-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/26/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recurrence of atrial tachyarrhythmias after ablation of atrial fibrillation (AF) is common, although consensus guidelines advise against immediate re-ablation of "early recurrences" (occurring ≤ 90 days after ablation). However, recent studies show early recurrence is associated with "late recurrence" (occurring > 90 days) and question the duration of this "blanking period." We investigated incidence and timing of early recurrence in relation to late recurrence in a large nationwide cohort. METHODS From Danish nationwide registers, we included all patients aged 18 and older who underwent first-time ablation for AF between January 2005 and April 2017 and followed them for up to 2 years. RESULTS Of the total 7339 patients included (72% male; median age 62 years), 2801 (38%) experienced early recurrence. The odds of late recurrence were 2.34 times higher (95% confidence interval, 2.09-2.63; P < 0.001) given early recurrence, compared with those without early recurrence. In particular, both timing and frequency of early recurrences were associated with a significantly higher odds of late recurrence in a graded relationship: odds ratio (OR) 2.08/4.96/6.25 for early recurrences in the first/second/third month respectively (all P < 0.001); and OR 1.64/2.83/5.14 for those experiencing one/two/more than two episodes respectively (all P < 0.001); compared with those without early recurrence. CONCLUSION In patients undergoing first-time ablation for AF, both the frequency and later onset of early recurrence are significantly associated with higher odds of late recurrence. This suggests the arbitrary blanking period should be abandoned in favor of a case-by-case assessment when evaluating candidates for re-ablation.
Collapse
|
35
|
Olshausen G, Uijl A, Jensen‐Urstad M, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Bourke T, Kennebäck G, Insulander P, Deisenhofer I, Braunschweig F. Early recurrences of atrial tachyarrhythmias post pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:674-681. [DOI: 10.1111/jce.14368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Gesa Olshausen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Alicia Uijl
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholm Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht University The Netherlands
- Health Data Research UK London, Institute for Health InformaticsUniversity College London London United Kingdom
| | - Mats Jensen‐Urstad
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jonas Schwieler
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Nikola Drca
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Hamid Bastani
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jari Tapanainen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Ott Saluveer
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Tara Bourke
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Göran Kennebäck
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Per Insulander
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz‐ und KreislauferkrankungenTechnische Universität MünchenMunich Germany
| | | |
Collapse
|
36
|
Aljuaid M, Marashly Q, AlDanaf J, Tawhari I, Barakat M, Barakat R, Zobell B, Cho W, Chelu MG, Marrouche NF. Smartphone ECG Monitoring System Helps Lower Emergency Room and Clinic Visits in Post-Atrial Fibrillation Ablation Patients. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820901508. [PMID: 32009826 PMCID: PMC6974745 DOI: 10.1177/1179546820901508] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023]
Abstract
Aim: To evaluate the effectiveness of using a smartphone-based electrocardiography
(ECG) monitoring device (ECG Check) on the frequency of clinic or emergency
room visits in patients who underwent ablation of atrial fibrillation
(AF). Methods: Two groups of patients were identified and compared: The conventional
monitoring group (CM group) included patients who were prescribed
conventional event monitoring or Holter monitoring systems. The ECG Check
group (EC group) included patients who were prescribed the ECG Check device
for continuous monitoring in addition to conventional event monitoring. The
primary outcome was the number of patient visits to clinic or emergency
room. The feasibility, accuracy, and detection rate of mobile ECG Check were
also evaluated. Results: Ninety patients were studied (mean age: 66.2 ± 11 years, 64 males, mean
CHA2DS2-VASc score: 2.6 ± 2). In the EC group,
forty-five patients sent an average of 52.8 ± 6 ECG records for either
routine monitoring or symptoms of potential AF during the follow-up period.
The rhythm strips identified sinus rhythm (84.7%), sinus tachycardia (8.4%),
AF (4.2%), and atrial flutter (0.9%). Forty-two EC transmissions (1.8%) were
uninterpretable. Six patients (13%) in the EC group were seen in the clinic
or emergency room over a 100-day study period versus 16 (33%) in the
standard care arm (P value < 0.001). Conclusions: Use of smartphone-based ECG monitoring led to a significant reduction in
AF-related visits to clinic or emergency department in the postablation
period.
Collapse
Affiliation(s)
- Mossab Aljuaid
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Qussay Marashly
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jad AlDanaf
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ibrahim Tawhari
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michel Barakat
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Section of Cardiac Electrophysiology, Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, USA
| | - Rody Barakat
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA
| | - Brittany Zobell
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William Cho
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mihail G Chelu
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Section of Cardiac Electrophysiology, Cardiovascular Medicine Division, University of Utah School of Medicine, Salt Lake City, USA
| | - Nassir F Marrouche
- Comprehensive Arrhythmia and Research Management (CARMA) Center, Salt Lake City, UT, USA.,Section of Cardiac Electrophysiology, Tulane University Heart & Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
37
|
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.
Collapse
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
| |
Collapse
|
38
|
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.
Collapse
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.
| |
Collapse
|
39
|
Forkmann M, Schwab C, Edler D, Vevecka A, Butz S, Haller B, Brachmann J, Busch S. Characteristics of early recurrences detected by continuous cardiac monitoring influencing the long-term outcome after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2019; 30:1886-1893. [PMID: 31397518 DOI: 10.1111/jce.14109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 01/23/2023]
Abstract
AIMS Early recurrences (ER) of atrial arrhythmias are common after catheter ablation of atrial fibrillation (AF). The significance of these ER is controversial. Based on data of continuous cardiac monitoring, we sought to investigate the characteristics of ER and their impact on late recurrences (LR) during follow-up. METHODS One hundred twenty-six patients with paroxysmal (49%) or persistent (51%) AF underwent an AF ablation with subsequent implantation of implantable loop recorder. Follow up was 12 months using remote monitoring. All atrial arrhythmia (AF or atrial tachycardia-AT-) episodes >30 seconds. within the 3-month blanking period were considered and the AF burden evaluated every 3 months. RESULTS Within the 3-months blanking period, 72 patients (57%) experienced an AF/AT recurrence. Survival free from any arrhythmia recurrence during follow-up was 40% in patients with ER vs 69% in those without ER. AF burden during the blanking period and timing of ER correlated significantly with LR at 12 months (area under curve = 0.74, P < .0001 and .831, P < .0001). An AF burden ≥0.5% and ER after 74 days predicted LR (sensitivity 60%, specificity 84.4%; sensitivity 75.6%, specificity 90.3%). In cox regression analysis, AF burden ≥0.5% and ER after 74 days were independently associated with LR. CONCLUSION Continuous cardiac monitoring after AF ablation provides important information regarding early recurrence episodes and their prognostic impact. A cut-off of 74 days for the blanking period seems to better differentiate patients with a good or a poor long-term outcome. An AF burden ≥0.5% during the 3 months postablation is predictive for late arrhythmia recurrences.
Collapse
Affiliation(s)
| | | | - Daniela Edler
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Aneida Vevecka
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Steffi Butz
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar der TU München, München, Germany
| | | | - Sonia Busch
- II, Medizinische Klinik, Klinikum Coburg, Coburg, Germany
| |
Collapse
|
40
|
An ablation index operator-independent approach to improve efficacy in atrial fibrillation ablation at 24-month follow-up: a single center experience. J Interv Card Electrophysiol 2019; 57:241-249. [DOI: 10.1007/s10840-019-00587-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
|
41
|
Kawai S, Mukai Y, Inoue S, Yakabe D, Nagaoka K, Sakamoto K, Takase S, Chishaki A, Tsutsui H. Predictive value of the induction test with atrial burst pacing with regard to long-term recurrence after ablation in persistent atrial fibrillation. J Arrhythm 2019; 35:223-229. [PMID: 31007786 PMCID: PMC6457478 DOI: 10.1002/joa3.12150] [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] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Induction test of atrial fibrillation (AF) is one of endpoint measures in catheter ablation (CA). However, its predictive value in long-term outcome remains controversial. METHODS Ninety-eight patients (61 years, 77 males) with persistent AF who underwent pulmonary vein antrum isolation-based CA were retrospectively analyzed. We determined whether inducibility of AF/atrial tachyarrhythmias (AT) by atrial burst pacing at the end of CA and other characteristics were associated with the recurrence of AF/AT. Atrial burst pacing was performed with 30-beat from the coronary sinus; increasing from 240 to 320 ppm. Inducibility was defined as AF/AT lasting ≥5 minutes following atrial burst pacing. RESULTS AF/AT was induced in 50 patients (51%). During 1 year of follow-up, 71 patients (72.4%) had no recurrence of AF/AT. A logistic regression analysis showed that female gender (OR 3.8; P = 0.02), multiple sessions (OR 3.5; P = 0.02), and early recurrence of AF/AT (OR 5.3; P = 0.004) were associated with clinical recurrence. AF/AT Inducibility was not associated with clinical recurrence (P = 0.65). A subanalysis in patients with enlarged LA (LA diameter ≥45 mm, n = 40) showed that AF/AT inducibility was associated with recurrence (OR 8.1; P = 0.04). The positive and negative predictive values of AF/AT inducibility for AF/AT recurrence were 41 and 89%, respectively. Negative predictive value was increased to 92.3% when the inducibility was defined as AF/AT of ≥30 seconds following atrial burst pacing. CONCLUSIONS AF/AT inducibility cannot predict long-term clinical recurrence in patients with persistent AF. However, it may have a prognostic value especially in patients with enlarged LA.
Collapse
Affiliation(s)
- Shunsuke Kawai
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasushi Mukai
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shujiro Inoue
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Daisuke Yakabe
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Kazuhiro Nagaoka
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Kazuo Sakamoto
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Susumu Takase
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Akiko Chishaki
- Department of Health SciencesGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| |
Collapse
|
42
|
Nakamaru R, Tanaka N, Okada M, Tanaka K, Ninomiya Y, Hirao Y, Oka T, Inoue H, Koyama Y, Okamura A, Iwakura K, Rakugi H, Sakata Y, Fujii K, Inoue K. Usefulness of Failed Electrical Cardioversion for Early Recurrence After Catheter Ablation for Atrial Fibrillation as a Predictor of Future Recurrence. Am J Cardiol 2019; 123:794-800. [PMID: 30558757 DOI: 10.1016/j.amjcard.2018.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
Early recurrence of atrial arrhythmia (ERAA) during a blanking period after catheter ablation (CA) for atrial fibrillation (AF) does not always result in subsequent AF recurrence. We investigated whether failed electrical cardioversion (ECV) during the blanking period was associated with recurrence. A total of 1,240 consecutive patients who underwent first-time CA for AF at our institution between March 2012 and March 2016 were investigated. Among the 517 patients (42%) who experienced ERAA, 262 underwent ECV. Failure or success of ECV was defined according to the current expert consensus statement. Failed ECV was defined as failure to terminate AF and/or relapse into AF within 30 seconds after transient sinus rhythm conversion by ECV with a shock energy of 270 J in this study. Of the patients, 254 (97%) with restored sinus rhythm were included, and 8 who experienced sustained AF afterward and discontinued the rhythm-control strategy were excluded. We divided the 254 patients into the following 2 groups on the basis of failed or successful ECV: failed-ECV (n = 105; at least 1 failed ECV but experienced successful ECV at a later date nevertheless) and successful-ECV (n = 149, no failed ECV) groups. At the median follow-up period of 610 days after CA, the recurrence rate was higher in the failed-ECV group than in the successful-ECV group (76.2% vs 45.6%, log-rank p < 0.001). After adjustment for baseline differences, failed ECV was found to be a significant predictor of recurrence in the multivariate model (p < 0.001). In conclusion, failed ECV for ERAA was an independent predictor of future recurrence.
Collapse
|
43
|
Abugattas JP, Schwagten B, De Cocker J, Coutiño HE, Salghetti F, Varnavas V, Ströker E, Sieira J, Wolf M, Brugada P, de Asmundis C, Chierchia GB, Greef YD. Predictors of long-term outcome in patients undergoing a first repeat ablation consisting solely of re-isolation of reconnected pulmonary veins. J Atr Fibrillation 2019; 11:2114. [PMID: 31139297 PMCID: PMC6533818 DOI: 10.4022/jafib.2114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/22/2018] [Accepted: 12/06/2018] [Indexed: 01/26/2023]
Abstract
AIMS To define predictors of long-term outcome of a first repeat ablation solely consisting of re-isolation of reconnected pulmonary veins (PVs). METHODS Three hundred seven patients (age 59 ± 9%, 77% males, non-paroxysmal AF 43%) with recurrent AF after first PVI were studied. Re-isolation of reconnected PVs was guided by a circular mapping catheter and 3D mapping system using RF ablations. A PV was defined as "triggering" in case of spontaneous ectopy or AF paroxysms originating from the PV. RESULTS After a mean follow-up of 5.05 ± 2.21 years, 194 (63.2%) patients (73.0% in PAF vs 50.4% in non-PAF, log Rank <0.001) were free from AF. A "triggering" PV was present in 48 (15.6%) during the first PVI and in 52 (16.9%) at repeat. Independent predictors of recurrence were a non-PAF type (HR: 1.814, 95%CI: 1.090 - 3.018, p=0.022) and early recurrence (≤ 3 months) after first PVI (HR: 1.632, 95%CI: 1.091 - 2.443, p=0.017) while a "triggering" PV at first or repeat was a predictor of good outcome (HR: 0.574; 95%CI: 0.344 - 0.959; p=0.034) in the multivariable analysis. CONCLUSIONS A repeat ablation solely consisting of re-isolation of reconnected PVs results in a high degree of long-term AF freedom, especially in PAF and in case of a PV trigger at index or repeat. Patients with non-PAF or experiencing early AF recurrence after first PVI are less responsive.
Collapse
Affiliation(s)
| | - Bruno Schwagten
- Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| | - Jeroen De Cocker
- Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Francesca Salghetti
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Varnavas Varnavas
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael Wolf
- Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Lindendreef 1, 2020 Antwerp, Belgium
| |
Collapse
|
44
|
Lee JM, Jeong DS, Yu HT, Park HS, Shim J, Kim JY, Kim J, Yoon NS, Oh S, Roh SY, Cho YJ, Kim KH. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part III. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
45
|
Murase Y, Inden Y, Imai H, Kyo S, Yanagisawa S, Fujii A, Sakamoto Y, Tomomatsu T, Murohara T. Clinical significance of the timing of early recurrence of atrial arrhythmia after pulmonary vein isolation: a two-institution clinical study. Heart Vessels 2018; 34:842-850. [PMID: 30390124 DOI: 10.1007/s00380-018-1295-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
Early recurrence of atrial arrhythmia (ERAA) after ablation frequently occurs, but there is limited evidence about ERAA-timing. This study aimed to investigate the association between ERAA-timing and late recurrence. We retrospectively investigated 332 patients who underwent PVI for paroxysmal atrial fibrillation at Nagoya University Hospital and Komaki City Hospital. Seventy-six patients (23%) had ERAA. The cutoff value of the first ERAA for late recurrence was set as 3 days, with a specificity of 77% and sensitivity of 43%. On multivariate analysis, first ERAA beyond 3 days (hazard ratio, 2.477; 95% confidence interval, 1.168-5.25; p = 0.018) and large left atrial diameter (LAD) (hazard ratio, 1.101; 95% confidence interval, 1.024-1.184; p = 0.009) were independent predictors for late recurrence. Patients who had first ERAA within 3 days and no ERAA beyond 3 days showed a significantly higher recurrence-free rate than those who had first ERAA beyond 3 days and those who had ERAA both within 3 days and beyond 3 days (89% versus 39%, 44%; p < 0.001). Moreover, the patients with ERAA within 3 days and LAD ≤ 37.7 mm showed a significantly higher recurrence-free rate than those with ERAA beyond 3 days and LAD > 37.7 mm, and as compared with the other patients (100% versus 26% and 60%, respectively; p < 0.001). ERAA beyond 3 days after ablation was a predictor for late recurrence. Among patients with ERAA, those with ERAA within 3 days and smaller LAD showed favorable prognosis after ablation.
Collapse
Affiliation(s)
- Yosuke Murase
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hajime Imai
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Seifuku Kyo
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| |
Collapse
|
46
|
The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set. Sci Rep 2018; 8:9875. [PMID: 29959347 PMCID: PMC6026210 DOI: 10.1038/s41598-018-28072-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023] Open
Abstract
Early recurrence of atrial fibrillation (ERAF) after catheter-ablation (CA) can be a transient phenomenon due to inflammation, or a harbinger of late AF recurrence due to CA lesion (re)conduction. We studied the relationship between ERAF and the 3-month CA lesions integrity. Forty one consecutive AF patients who underwent a pulmonary vein isolation (PVI), roof line (RL) and mitral isthmus line (MIL) CA were enrolled. At 3 months all patients underwent invasive assessment of the lesion set integrity irrespective of ERAF. The PVI, RL and MIL ablation was successful in 100.0%, 95.1% and 82.9% patients, respectively. At the 3-month remapping, a gap in PVI-lesion(s), RL or MIL was identified in 61.0%, 31.7% and 36.6% patients, respectively. Patients with (n = 17, 41.5%) compared to those without ERAF (n = 24) had a significantly higher rate of any PV-reconnection (88.2% vs. 41.7%), the right PV(s)-reconnection (82.5% vs. 29.2%) and the RL gap (52.9% vs. 16.7%), as well as a higher number of reconnected right PVI-segments, all p < 0.05. On multivariate analysis, only the number of reconnected right PVI-segments was associated with ERAF (OR 4.26, p = 0.004). The ERAF following PVI + RL + MIL ablation was significantly related to 3-month PV-reconnections and the presence of RL gaps.
Collapse
|
47
|
Liang JJ, Dixit S. Early Recurrences During the Blanking Period after Atrial Fibrillation Ablation. J Atr Fibrillation 2018; 10:1726. [PMID: 29988237 DOI: 10.4022/jafib.1726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022]
Abstract
Early recurrences of atrial arrhythmias (ERAA) after ablation are common and predict late recurrences and ablation failure.However,becausea proportion of patients with ERAA will have no subsequent arrhythmias after the blanking period, consensus guidelines recommend against immediate repeat ablation for ERAA episodes occurring during the first 3 months post-ablation. In this review, we summarize the predictors, significance, and treatment of ERAA after AF ablation.
Collapse
Affiliation(s)
- Jackson J Liang
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dixit
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
48
|
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 715] [Impact Index Per Article: 119.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
49
|
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1391] [Impact Index Per Article: 198.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
50
|
WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|