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Aguiar-Neves I, Sá Carvalho A, Diaz SO, Ribeiro Silva M, Santos Silva G, Teixeira R, Lopes Fernandes S, Cruz I, Almeida JG, Fonseca P, Oliveira M, Gonçalves H, Saraiva F, Barros AS, Dias Ferreira N, Sampaio F, Primo J, Fontes-Carvalho R. Sex-based differences and risk of recurrence in patients with atrial fibrillation undergoing pulmonary vein isolation. Int J Cardiol 2024; 409:132161. [PMID: 38744339 DOI: 10.1016/j.ijcard.2024.132161] [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: 02/29/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Studies suggest increased likelihood of atrial fibrillation (AF) recurrence after catheter ablation (CA) in women than in men, indicating that sex may be an independent risk factor for recurrence. Nevertheless, the influence of sex on AF recurrence and underlying mechanisms remains unclear. METHODS Retrospective, single-centre study including patients undergoing AF CA between 2017 and 2021. Late recurrence (LR) was defined as AF recurrence ≥90 days after ablation, whereas early recurrence (ER) occurred within 90 days. RESULTS 656 patients (32% women) were included, with a median follow-up period of 26 months. Compared to men, women undergoing CA were older, had higher body mass indexes, and had higher rates of hypertension, thyroid dysfunction, and valvular disease. Women also had increased LR risk after CA (HR 1.76, 95% CI [1.19, 2.59]). A time-split multivariable analysis at one year of follow-up showed no difference in LR risk during the first 12 months after CA (HR 1.19, 95% CI [0.73, 1.94]); however, LR risk increased in women (HR 2.90, 95% CI [1.68, 5.01]) after 12 months. In a sex-stratified analysis, coronary calcium score (CCS) >100 was associated with increased LR risk in men (HR 1.81, 95% CI [1.06, 3.08]), but not in women. Cardiac adipose tissue volume was not associated with increased LR risk. CONCLUSIONS Fewer women underwent CA than men and LR was more frequent in women, particularly one year after the procedure. CCS was associated with increased LR risk in men.
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Affiliation(s)
- Inês Aguiar-Neves
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal.
| | - Augusto Sá Carvalho
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sílvia O Diaz
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mariana Ribeiro Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Gualter Santos Silva
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Rafael Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | | | - Inês Cruz
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João G Almeida
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Helena Gonçalves
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Francisca Saraiva
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - António S Barros
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Nuno Dias Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - João Primo
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Rua Conceição Fernandes, 4434-532, Vila Nova de Gaia, Portugal; Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
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Kanda T, Masuda M, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Matsuda Y, Hata Y, Uematsu H, Toyoshima T, Higashino N, Mano T. Impact of left atrial low-voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1697-1704. [PMID: 35748348 DOI: 10.1111/jce.15607] [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: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Very late recurrence of atrial fibrillation (VLRAF) occurring >1 year after catheter ablation may influence long-term follow-up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation. The purpose of this study was to investigate the impact of LVAs on VLRAF. METHODS This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1-year follow-up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3 to 12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year. RESULTS A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow-up of 25 (19, 37) months, VLRAF more than one year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan-Meier analysis showed that the AF-free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1 year follow-up. (P<0.001) An additional Kaplan-Meier analysis of the incidence of VLRAF in propensity score-matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs. (P=0.003) CONCLUSIONS: LVAs during the initial AF ablation procedures have an impact on VLRAF occurrence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Takashi Kanda
- Department of Cardiology, Osaka Police Hospital, Osaka, Japan.,Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Hiroyuki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, Amagasaki, Hyogo, Japan
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Solimene F, Giannotti Santoro M, Stabile G, Malacrida M, De Simone A, Pandozi C, Pelargonio G, Rossi P, Battaglia A, Pecora D, Bongiorni MG, Zucchelli G, Stocco C, Arestia A, Iuliano S, Russo M, Narducci ML, Segreti L. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:2031-2040. [PMID: 34606098 DOI: 10.1111/pace.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/03/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND An early, comprehensive rhythm-control therapy is needed in order to treat atrial fibrillation (AF) effectively and to improve ablation outcomes. METHODS A total of 153 consecutive patients from the CHARISMA registry undergoing AF ablation at eight centers were included. Patients with de novo PVI were classified as having undergone early treatment (ET) if the procedure was performed within 6 months after the first AF episode, and as having undergone delayed treatment (DT) if ablation was performed over 6 months after the first AF episode. RESULTS One-hundred fifty-three patients were enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF). The time from the first AF episode to the ablation procedure was 1034 ± 1483 days. The ET group comprised 36 patients (25.3%), the DT group 60 (39.2%) and Redo cases were 57 (37.3%). During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/AT recurrence. More DT patients than ET patients suffered recurrences (15.7% vs. 2.2%, p = 0.0452) and the time to AT/AF recurrence was shorter in the group of patients who received an ablation treatment after 6 months (HR = 6.19, 95% CI: 1.7 to 21.9; p = 0.0474). On multivariate Cox analysis, only hypertension (HR = 4.86, 95% CI: 1.6 to 14.98, p = 0.0062) was independently associated with recurrences. Beyond the hypertension risk factor, ET was associated with a low risk of recurrence; recurrence rate ranged from 0% (ET patients without hypertension) to 25.0% (DT patients with hypertension). CONCLUSIONS An early rhythm-control ablation therapy in the absence of common risk factors was associated with the lowest rate of recurrences.
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Affiliation(s)
| | - Mario Giannotti Santoro
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Stabile
- Clinica Montevergine, Mercogliano, Avellino, Italy.,Anthea Hospital, Bari, Italy
| | | | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy
| | | | - Domenico Pecora
- Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Sara Iuliano
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Maurizio Russo
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Mittal S. Implantable Loop Recorders-Syncope, Cryptogenic Stroke, Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:439-447. [PMID: 34330371 DOI: 10.1016/j.ccep.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The implantable loop recorder (ILR) is a subcutaneous, single-lead, electrocardiographic (ECG) monitoring device used for diagnosis in patients with recurrent, unexplained episodes of palpitations or syncope, for long-term monitoring in patients at risk for atrial fibrillation (AF), and to guide clinical management in patients with known AF. These devices are capable of storing and transmitting ECG data automatically in response to a significant bradyarrhythmia or tachyarrhythmia or in response to patient activation. This document aims to review the clinical utility of ILRs for arrhythmia monitoring in common clinical situations such as syncope, cryptogenic stroke, and management of patients with known AF.
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Affiliation(s)
- Suneet Mittal
- Department of Cardiology, Snyder Center for Comprehensive Atrial Fibrillation, Valley Health System, Ridgewood, NJ, USA; Electrophysiology, Valley Health System, 970 Linwood Avenue, Paramus, NJ 07652, USA.
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