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Basnet A, Naeem A, Sharma NR, Lamichhane S, Kansakar S, Gautam S, Tiwari K, Seitillari A, Thomas R, Janga K. Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature. Cureus 2023; 15:e46545. [PMID: 37927624 PMCID: PMC10625454 DOI: 10.7759/cureus.46545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia among patients with chronic kidney disease (CKD), which leads to increased cardiovascular complications. Catheter ablation (CA) has emerged as an effective and safe treatment for AF in CKD patients. CA offers tailored treatment strategies and presents a safer alternative with fewer adverse outcomes than anti-arrhythmic agents. Although CKD patients undergoing ablation have similar complication rates to non-CKD patients, they face a higher risk of hospitalization due to heart failure. Furthermore, CA shows promise in improving kidney function, particularly in individuals who maintain sinus rhythm. Future research should address limitations by including advanced CKD patients, conducting longer-term follow-ups, and developing individualized treatment approaches.
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Affiliation(s)
- Arjun Basnet
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Azka Naeem
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | - Nava R Sharma
- Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | - Sajog Kansakar
- Internal Medicine, Manipal College of Medical Sciences, Pokhara, NPL
| | | | - Kripa Tiwari
- Internal Medicine, Maimonides Medical Center, Brooklyn, USA
| | | | - Remil Thomas
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | - Kalyana Janga
- Nephrology, Maimonides Medical Center, Brooklyn, USA
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Sakamoto Y, Osanai H, Sakai Y, Sogo Y, Tanaka Y, Hiramatsu S, Matsumoto H, Tomooka K, Arai K, Watanabe T, Ohguchi S, Kanbara T, Nakashima Y, Asano H, Ajioka M. Efficacy and safety of atrial fibrillation ablation in heart failure patients with left ventricular ejection fraction less than 50. Indian Pacing Electrophysiol J 2023; 23:135-141. [PMID: 37385589 PMCID: PMC10491960 DOI: 10.1016/j.ipej.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION The efficacy of catheter ablation in patients with low cardiac function has been previously reported; however, only a few studies have included mid-range ejection fraction (mrEF). This study aimed to evaluate the efficacy and safety of atrial fibrillation (AF) ablation in patients with left ventricular ejection fraction (LVEF) < 50%. METHODS This study retrospectively analyzed 79 patients (reduced ejection fraction [rEF]/mrEF, 38/41; paroxysmal/persistent, 37/42; heart failure hospitalizations within one year before ablation, 36 [45.6%]) who underwent the first ablation procedure at our hospital from April 2017 to December 2021. Radiofrequency ablation and cryoablation were performed for 69 and 10 patients, respectively. RESULTS Complications included pacemaker implantation for postoperative sick sinus syndrome in one patient and inguinal hematoma in one patient. Regarding efficacy, there were significant postoperative improvements in echocardiographic data, blood test values, and diuretic use. After a mean follow-up of 60 months, 86.1% patients had no AF recurrence. There were 9 heart failure hospitalizations (11.4%) and 5 all-cause deaths (6.3%); no significant differences were found between the rEF and mrEF groups. No significant predictors of AF recurrence were found in preoperative patient characteristics. CONCLUSION AF ablation in patients with LVEF <50% significantly improved cardiac and renal functions with few complications, resulting in a high non-recurrence rate and reduced heart failure.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan.
| | - Hiroyuki Osanai
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Yuichiro Sakai
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshiki Sogo
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Yuki Tanaka
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Shotaro Hiramatsu
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Hikari Matsumoto
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Ken Tomooka
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Kenji Arai
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Takashi Watanabe
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Shioh Ohguchi
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Takahiro Kanbara
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Masayoshi Ajioka
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
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Kovačević V, Marinković MM, Kocijančić A, Isailović N, Simić J, Mihajlović M, Vučićević V, Potpara TS, Mujović NM. Long-Term Renal Function after Catheter Ablation of Atrial Fibrillation. J Cardiovasc Dev Dis 2023; 10:jcdd10040151. [PMID: 37103030 PMCID: PMC10142031 DOI: 10.3390/jcdd10040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Atrial fibrillation (AF) is associated with the development and progression of chronic kidney disease (CKD). This study evaluated the impact of long-term rhythm outcome after catheter ablation (CA) of AF on renal function. Methods and results: The study group included 169 consecutive patients (the mean age was 59.6 ± 10.1 years, 61.5% were males) who underwent their first CA of AF. Renal function was assessed by eGFR (using the CKD-EPI and MDRD formulas), and by creatinine clearance (using the Cockcroft–Gault formula) in each patient before and 5 years after index CA procedure. During the 5-year follow-up after CA, the late recurrence of atrial arrhythmia (LRAA) was documented in 62 patients (36.7%). The mean eGFR, regardless of which formula was used, significantly decreased at 5 years following CA in patients with LRAA (all p < 0.05). In the arrhythmia-free patients, the mean eGFR at 5 years post-CA remained stable (for the CKD-EPI formula: 78.7 ± 17.3 vs. 79.4 ± 17.4, p = 0.555) or even significantly improved (for the MDRD formula: 74.1 ± 17.0 vs. 77.4 ± 19.6, p = 0.029) compared with the baseline. In the multivariable analysis, the independent risk factors for rapid CKD progression (decline in eGFR > 5 mL/min/1.73 m2 per year) were the post-ablation LRAA occurrence (hazard ratio 3.36 [95% CI: 1.25–9.06], p = 0.016), female sex (3.05 [1.13–8.20], p = 0.027), vitamin K antagonists (3.32 [1.28–8.58], p = 0.013), or mineralocorticoid receptor antagonists’ use (3.28 [1.13–9.54], p = 0.029) after CA. Conclusions: LRAA after CA is associated with a significant decrease in eGFR, and it is an independent risk factor for rapid CKD progression. Conversely, eGFR in arrhythmia-free patients after CA remained stable or even improved significantly.
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Yang SY, Cha MJ, Oh HJ, Cho MS, Kim J, Nam GB, Choi KJ. Role of non-pulmonary vein triggers in persistent atrial fibrillation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2023. [DOI: 10.1186/s42444-023-00088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
AbstractPulmonary vein isolation is an well-established treatment strategy for atrial fibrillation (AF), and it is especially effective for patients with paroxysmal AF. However, the success rate is limited for patients with persistent AF, because non-pulmonary vein triggers which increase AF recurrence are frequently found in these patients. The major non-pulmonary vein triggers are from the left atrial posterior wall, left atrial appendage, ligament of Marshall, coronary sinus, superior vena cava, and crista terminalis, but other atrial sites can also generate AF triggers. All these sites have been known to contain atrial myocytes with potential arrhythmogenic electrical activity. The prevalence and clinical characteristics of these non-pulmonary vein triggers are well studied; however, the clinical outcome of catheter ablation for persistent AF is still unclear. Here, we reviewed the current ablation strategies for persistent AF and the clinical implications of major non-pulmonary vein triggers.
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Koike T, Ejima K, Kataoka S, Yazaki K, Higuchi S, Kanai M, Yagishita D, Shoda M, Hagiwara N. Prognostic significance of cardiorenal dysfunction within 1 year after atrial fibrillation ablation in patients with systolic dysfunction. Heart Vessels 2023; 38:77-89. [PMID: 35879440 DOI: 10.1007/s00380-022-02124-w] [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: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 01/06/2023]
Abstract
Atrial fibrillation (AF) ablation can improve left ventricular ejection fraction (LVEF) and renal function and can even reduce mortality in patients with impaired LVEF. However, the effect of post-ablation cardiorenal dysfunction on the prognosis of patients with impaired LVEF who underwent AF ablation remains unclear. Of the 1243 consecutive patients undergoing AF ablation, the prognosis of 163 non-dialysis patients who underwent AF ablation with < 50% LVEF was evaluated. The primary outcome was a composite of all-cause mortality, heart failure hospitalization, and a need for modification of the treatment for heart failure. During the median follow-up of 4.2 years after the first AF ablation procedure, the primary outcome occurred in 30 of 163 patients (18%). The receiver operating characteristic curve analysis demonstrated that the post-LVEF (LVEF within 1 year after the procedure, and before the occurrence of primary outcome) had larger areas under the curve (0.70) than the pre-LVEF (LVEF before the procedure), and the most optimal cutoff value was LVEF ≤ 42%. Multivariate analysis demonstrated that patients with post-LVEF ≤ 42% and worsening renal function (WRF; an absolute increase in serum creatinine [SCr] ≥ 0.3 mg/dL compared with the SCr at baseline within 1 year after the procedure and before the occurrence of primary outcome) had a 3.4- to 4.3-fold and 3.4- to 3.7-fold higher risk of the primary outcome compared with those without these predictors, respectively. Patients were categorized using post-LVEF ≤ 42% and WRF as follows: group 1 (post-LVEF > 42% without WRF), group 2 (post-LVEF ≤ 42% without WRF), group 3 (post-LVEF > 42% with WRF), and group 4 (post-LVEF ≤ 42% with WRF). Group 4 had a 15.8-fold (P = 0.0001) higher risk of the primary outcome compared with group 1 after adjusting for pre-procedural factors. In patients with impaired LVEF undergoing AF ablation, post-LVEF ≤ 42% and WRF were independent predictors of poor prognosis. The combination of post-LVEF ≤ 42% and WRF is strongly associated with a poor prognosis in patients with AF undergoing ablation, who with these post-ablation cardiorenal dysfunction may have to be treated more intensively after AF ablation.
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Affiliation(s)
- Toshiharu Koike
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Mimuro R, Hayashi H, Iwasaki YK, Hachisuka M, Fujimoto Y, Oka E, Murata H, Yamamoto T, Yodogawa K, Shimizu W. Protective Effect of Catheter Ablation of Atrial Fibrillation on the Renal Function in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2022; 173:8-15. [PMID: 35397868 DOI: 10.1016/j.amjcard.2022.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia in patients with hypertrophic cardiomyopathy (HCM) and is associated with renal function deterioration. The protective effects of catheter ablation (CA) of AF on renal function in patients with HCM remain unsolved. From 2009 to 2020, a total of 169 consecutive patients with HCM and AF (age 70 ± 12, 87 males) were retrospectively evaluated. The estimated glomerular filtration rate (eGFR) was evaluated at the study enrollment or 1 month before the CA and reevaluated 3 and 12 months later. In the 169 patients, 63 underwent CA of AF (ablation group), and the remaining 106 did not (control group). After propensity score matching, 45 pairs were matched. The baseline eGFR was similar between the 2 groups (p = 0.83). During a mean follow-up period of 34 ± 27 months, sinus rhythm was maintained in 36 patients (80%) after 1.7 ± 0.8 ablation procedures. The eGFR significantly decreased from baseline to 3 months (p <0.01) and from baseline to 1 year (p <0.01) in the control group, whereas the eGFR in the ablation group was maintained both from baseline to 3 months (p = 0.94) and from baseline to 1 year (p = 1.00) after the CA. The change in the eGFR between baseline and 12 months was significantly smaller in the ablation group than in the control group (p <0.01). After logistic regression analysis, CA of AF was the independent predictor of an improvement of eGFR (odds ratio 2.81, 95% confidence interval 1.08 to 7.36, p = 0.04). In conclusion, CA of AF had a protective effect on renal function in patients with HCM.
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Affiliation(s)
- Rei Mimuro
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Masato Hachisuka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Eiichiro Oka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study. Front Physiol 2022; 13:846620. [PMID: 35370797 PMCID: PMC8968313 DOI: 10.3389/fphys.2022.846620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps). Methods We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps. Results Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010). Conclusion CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hui-Nam Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Dilk P, Wachter R, Hindricks G. Catheter ablation for atrial fibrillation: impact on mortality, morbidity, quality of life, and implications for the future. Herz 2022; 47:118-122. [PMID: 35258637 PMCID: PMC8902845 DOI: 10.1007/s00059-022-05101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/05/2022]
Abstract
Despite the advances in technologies and techniques in the field of catheter ablation for cardiac arrhythmias, it is estimated that the prevalence of atrial fibrillation (AF) will further increase in the nearest future. The latest trials have proven the beneficial effect on mortality after pulmonary vein isolation in patients with impaired left ventricular function, while no such effect has been seen in patients without left ventricular dysfunction. This raises the question of whether catheter ablation for AF is still suited for the latter patient cohort or whether the endpoint of mortality is not adequate enough. Not only does pulmonary vein isolation reduce the burden of atrial fibrillation, but it also somehow alters the patients’ perception of it in the case of recurrence. Independent of the presence of ventricular dysfunction, patients experience a relief of AF-related symptoms, which is accompanied by an increase in quality of life based on the available patient-reported outcome measures, despite AF recurrence. Trials that are currently recruiting patients seek to unveil the accountable circumstances for these remaining uncertainties and help expand our understanding of a procedure that has been routinely performed for two decades.
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Affiliation(s)
- Patrick Dilk
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. .,Department of Electrophysiology, Heart Centre Leipzig, Leipzig, Germany.
| | - Rolf Wachter
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Centre Leipzig, Leipzig, Germany
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Park JW, Kwon OS, Shim J, Hwang I, Kim YG, Yu HT, Kim TH, Uhm JS, Kim JY, Choi JI, Joung B, Lee MH, Kim YH, Pak HN. Machine Learning-Predicted Progression to Permanent Atrial Fibrillation After Catheter Ablation. Front Cardiovasc Med 2022; 9:813914. [PMID: 35252393 PMCID: PMC8890475 DOI: 10.3389/fcvm.2022.813914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We developed a prediction model for atrial fibrillation (AF) progression and tested whether machine learning (ML) could reproduce the prediction power in an independent cohort using pre-procedural non-invasive variables alone. Methods Cohort 1 included 1,214 patients and cohort 2, 658, and all underwent AF catheter ablation (AFCA). AF progression to permanent AF was defined as sustained AF despite repeat AFCA or cardioversion under antiarrhythmic drugs. We developed a risk stratification model for AF progression (STAAR score) and stratified cohort 1 into three groups. We also developed an ML-prediction model to classify three STAAR risk groups without invasive parameters and validated the risk score in cohort 2. Results The STAAR score consisted of a stroke (2 points, p = 0.003), persistent AF (1 point, p = 0.049), left atrial (LA) dimension ≥43 mm (1 point, p = 0.010), LA voltage <1.109 mV (2 points, p = 0.004), and PR interval ≥196 ms (1 point, p = 0.001), based on multivariate Cox analyses, and it had a good discriminative power for progression to permanent AF [area under curve (AUC) 0.796, 95% confidence interval (CI): 0.753–0.838]. The ML prediction model calculated the risk for AF progression without invasive variables and achieved excellent risk stratification: AUC 0.935 for low-risk groups (score = 0), AUC 0.855 for intermediate-risk groups (score 1–3), and AUC 0.965 for high-risk groups (score ≥ 4) in cohort 1. The ML model successfully predicted the high-risk group for AF progression in cohort 2 (log-rank p < 0.001). Conclusions The ML-prediction model successfully classified the high-risk patients who will progress to permanent AF after AFCA without invasive variables but has a limited discrimination power for the intermediate-risk group.
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Affiliation(s)
- Je-Wook Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jaemin Shim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
- *Correspondence: Jaemin Shim
| | - Inseok Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Yun Gi Kim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jong-Youn Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jong Il Choi
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Young-Hoon Kim
- Department of Internal Medicine, Korea University Cardiovascular Center, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
- Hui-Nam Pak
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10
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Liu CF. Atrial Fibrillation Ablation in Chronic Kidney Disease - Lessons from Large Datasets. J Cardiovasc Electrophysiol 2022; 33:412-413. [PMID: 35020245 DOI: 10.1111/jce.15355] [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: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022]
Abstract
Outcomes data regarding atrial fibrillation (AF) treatment in chronic kidney disease (CKD) are lacking. Available data and unanswered questions in this realm will be discussed, along with how the present manuscript fits into the overall literature of this field. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Christopher F Liu
- From the Division of Cardiology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, 10021
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11
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Shen Y, Chen H, Yang G, Ju W, Zhang F, Gu K, Cui C, Li M, Chen M. Changes in Renal Function in Patients with Recurrence of Atrial Arrhythmia after an Initial Catheter Ablation. Int J Clin Pract 2022; 2022:6923377. [PMID: 35685553 PMCID: PMC9159111 DOI: 10.1155/2022/6923377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Impaired renal function and atrial fibrillation (AF) can form a vicious cycle. Although there have been reports on improved renal function in patients who undergo successful AF ablation, renal function in patients with recurrence of AF has not been studied separately. We explored the changes in renal function in recurrent AF patients after catheter ablation with mild renal dysfunction and the influencing factors. METHODS We retrospectively recruited nonvalvular AF (NVAF) patients with mildly impaired renal function admitted for catheter ablation and readmitted due to recurrence of AF. The estimated glomerular filtration rate (eGFR) was calculated before the index procedure and during readmission. △eGFR was defined as the difference between eGFR readmission and eGFR baseline. The same calculation applied for △CHA2DS2-VASc score. The primary endpoint was improved renal function (△eGFR >0) after AF catheter ablation in patients with atrial arrhythmia recurrence. RESULTS A total of 132 NVAF patients were included in this study. The mean eGFR at readmission was significantly increased compared with the eGFR at baseline before the index ablation procedure (81.5 ± 1.1 vs. 78.0 ± 0.7 ml/min/1.73 m2, P < 0.001). The multivariable Cox regression analysis showed that a lower △CHA2DS2-VASc score (HR: 0.42, P=0.003) and paroxysmal recurrent atrial arrhythmia (HR: 2.97, P=0.001) were associated with better renal function. CONCLUSION In NVAF patients with mildly impaired renal function, even those with recurrence after the initial catheter ablation, we observed improvements in renal function, which was associated with a lower △CHA2DS2-VASc score and paroxysmal recurrent arrhythmia.
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Affiliation(s)
- Youmei Shen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Gang Yang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Fengxiang Zhang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Kai Gu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chang Cui
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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12
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Baek YS, Kwon OS, Lim B, Yang SY, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Kim DH, Lee MH, Park J, Pak HN. Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial. Front Cardiovasc Med 2021; 8:772665. [PMID: 34957255 PMCID: PMC8692944 DOI: 10.3389/fcvm.2021.772665] [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] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF. Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group. Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016]. Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF. Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.
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Affiliation(s)
- Yong-Soo Baek
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Dae-Hyeok Kim
- Inha University College of Medicine and Inha University Hospital, Incheon, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea
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13
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Kwon OS, Hwang I, Pak HN. Computational modeling of atrial fibrillation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00051-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractWith the aging society, the prevalence of atrial fibrillation (AF) continues to increase. Nevertheless, there are still limitations in antiarrhythmic drugs (AAD) or catheter interventions for AF. If it is possible to predict the outcome of AF management according to various AADs or ablation lesion sets through computational modeling, it will be of great clinical help. AF computational modeling has been utilized for in-silico arrhythmia research and enabled high-density entire chamber mapping, reproducible condition control, virtual intervention, not possible clinically or experimentally, in-depth mechanistic research. With the recent development of computer science and technology, more sophisticated and faster computational modeling has become available for clinical application. In particular, it can be applied to determine the extra-PV target of persistent AF catheter ablation or to select the AAD with the best effect. AF computational modeling combined with artificial intelligence is expected to contribute to precision medicine for more diverse uses in the future. Therefore, in this review, we will deal with the history, development, and various applications of computation modeling.
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14
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Ciccarelli M, Dawson D, Falcao-Pires I, Giacca M, Hamdani N, Heymans S, Hooghiemstra A, Leeuwis A, Hermkens D, Tocchetti CG, van der Velden J, Zacchigna S, Thum T. Reciprocal organ interactions during heart failure: a position paper from the ESC Working Group on Myocardial Function. Cardiovasc Res 2021; 117:2416-2433. [PMID: 33483724 PMCID: PMC8562335 DOI: 10.1093/cvr/cvab009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2021] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
Heart failure-either with reduced or preserved ejection fraction (HFrEF/HFpEF)-is a clinical syndrome of multifactorial and gender-dependent aetiology, indicating the insufficiency of the heart to pump blood adequately to maintain blood flow to meet the body's needs. Typical symptoms commonly include shortness of breath, excessive fatigue with impaired exercise capacity, and peripheral oedema, thereby alluding to the fact that heart failure is a syndrome that affects multiple organ systems. Patients suffering from progressed heart failure have a very limited life expectancy, lower than that of numerous cancer types. In this position paper, we provide an overview regarding interactions between the heart and other organ systems, the clinical evidence, underlying mechanisms, potential available or yet-to-establish animal models to study such interactions and finally discuss potential new drug interventions to be developed in the future. Our working group suggests that more experimental research is required to understand the individual molecular mechanisms underlying heart failure and reinforces the urgency for tailored therapeutic interventions that target not only the heart but also other related affected organ systems to effectively treat heart failure as a clinical syndrome that affects and involves multiple organs.
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Affiliation(s)
- Michele Ciccarelli
- University of Salerno, Department of Medicine, Surgery and Dentistry, Via S. Allende 1, 84081, Baronissi(Salerno), Italy
| | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen AB25 2DZ, UK
| | - Inês Falcao-Pires
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Mauro Giacca
- King’s College London, Molecular Medicine Laboratory, 125 Caldharbour Lane, London WC2R2LS, United Kingdom
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, 99, 34149 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34129 Trieste, Italy
| | - Nazha Hamdani
- Department of Clinical Pharmacology and Molecular Cardiology, Institute of Physiology, Ruhr University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital, Ruhr University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
| | - Stéphane Heymans
- Centre for Molecular and Vascular Biology, KU Leuven, Herestraat 49, Bus 911, 3000 Leuven, Belgium
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
- ICIN-Netherlands Heart Institute, Holland Heart House, Moreelsepark 1, 3511 EP Utrecht, the Netherlands
| | - Astrid Hooghiemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081HZ, Amsterdam, The Netherlands
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - Annebet Leeuwis
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081HZ, Amsterdam, The Netherlands
| | - Dorien Hermkens
- Department of Pathology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences and Interdepartmental Center of Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Jolanda van der Velden
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Physiology, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081HZ Amsterdam, the Netherlands
| | - Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34129 Trieste, Italy
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Padriciano, 99, 34149 Trieste, Italy
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
- REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Nicolai-Fuchs-Str. 1, D-30625 Hannover, Germany
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15
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Park JW, Yang SY, Kim M, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation. Front Cardiovasc Med 2021; 8:709585. [PMID: 34692779 PMCID: PMC8530188 DOI: 10.3389/fcvm.2021.709585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Whereas, high-power short-duration (HPSD) radiofrequency (RF) ablation is generally used in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and influence on autonomic function have not been well established in a large population. This study compared HPSD-AFCA and conventional power (ConvP)-AFCA in propensity score matched-population. Methods: In 3,045 consecutive patients who underwent AFCA, this study included 1,260 patients (73.9% male, 59 ± 10 years old, 58.2% paroxysmal type) after propensity score matching: 315 in 50~60W HPSD group vs. 945 in the ConvP group. This study investigated the procedural factors, complication rate, rhythm status, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results: Procedure time was considerably short in the HPSD group (135 min in HPSD vs. 181 min in ConvP, p < 0.001) compared to ConvP group, but there was no significant difference in the complication rate (2.9% in HPSD vs. 3.7% in ConvP, p = 0.477) and the 3-month HRV between the two groups. At the one-year follow-up, there was no significant difference in rhythm outcomes between the two groups (Overall, Log-rank p = 0.885; anti-arrhythmic drug free, Log-rank p = 0.673). These efficacy and safety outcomes were consistently similar irrespective of the AF type or ablation lesion set. The Cox regression analysis showed that the left atrium volume index estimated by computed tomography (HR 1.01 [1.00–1.02]), p = 0.003) and extra-pulmonary vein triggers (HR 1.59 [1.03–2.44], p = 0.036) were independently associated with one-year clinical recurrence, whereas the HPSD ablation was not (HR 1.03 [0.73–1.44], p = 0.887). Conclusion: HPSD-AFCA notably reduced the procedure time with similar rhythm outcomes, complication rate, and influence on autonomic function as ConvP-AFCA, irrespective of the AF type or ablation lesion set.
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Affiliation(s)
- Je-Wook Park
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Song-Yi Yang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Min Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
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16
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Pak HN, Park JW, Yang SY, Kim TH, Uhm JS, Joung B, Lee MH, Yu HT. Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation: A Single-Center, Prospective, Randomized Study. Circ Arrhythm Electrophysiol 2021; 14:e010040. [PMID: 34465132 DOI: 10.1161/circep.121.010040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
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17
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Affiliation(s)
- Marianne Benn
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Park S, Lee S, Kim Y, Lee Y, Kang MW, Kim K, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Atrial fibrillation and kidney function: a bidirectional Mendelian randomization study. Eur Heart J 2021; 42:2816-2823. [PMID: 34023889 DOI: 10.1093/eurheartj/ehab291] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/11/2020] [Accepted: 04/27/2021] [Indexed: 01/06/2023] Open
Abstract
AIMS The aim of this study was to investigate the causal effects between atrial fibrillation (AF) and kidney function. METHODS AND RESULTS We performed a bidirectional summary-level Mendelian randomization (MR) analysis implementing the results from a large-scale genome-wide association study for estimated glomerular filtration rate (eGFR) by the CKDGen (N = 765 348) and AF (N = 588 190) to identify genetic instruments. The inverse variance weighted method was the main MR method used. For replication, an allele score-based MR was performed by individual-level data within a UK Biobank cohort of white British ancestry individuals (N = 337 138). A genetic predisposition to AF was significantly associated with decreased eGFR [for log-eGFR, beta -0.003 (standard error, 0.0005), P < 0.001] and increased risk of chronic kidney disease [beta 0.059 (0.0126), P < 0.001]. The significance remained in MR sensitivity analyses and the causal estimates were consistent when we limited the analysis to individuals of European ancestry. Genetically predicted eGFR did not show a significant association with the risk of AF [beta -0.366 (0.275), P = 0.183]. The results were similar in allele score-based MR, as allele score for AF was significantly associated with reduced eGFR [for continuous eGFR, beta -0.079 (0.021), P < 0.001], but allele score for eGFR did not show a significant association with risk of AF [beta -0.005 (0.008), P = 0.530]. CONCLUSIONS Our study supports that AF is a causal risk factor for kidney function impairment. However, an effect of kidney function on AF was not identified in this study.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do 13574, Korea
| | - Soojin Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Gyeonggi-do 11759, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Gyeonggi-do 11759, Korea
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul 03080, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Jung Pyo Lee
- Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Chun Soo Lim
- Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
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19
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Kim M, Yu HT, Kim J, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Atrial fibrillation and the risk of ischaemic strokes or intracranial haemorrhages: comparisons of the catheter ablation, medical therapy, and non-atrial fibrillation population. Europace 2021; 23:529-538. [PMID: 33045047 DOI: 10.1093/europace/euaa235] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/14/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Although atrial fibrillation (AF) catheter ablation (AFCA) is an effective rhythm control strategy, there is limited data on whether ischaemic stroke (IS) or intracranial haemorrhage (ICH) decreases after AFCA compared with medical therapy or non-AF population. We explored the IS and ICH risk after AFCA or medical therapy in the AF population and matched non-AF population. METHODS AND RESULTS We compared 1629 patients with AFCA (Yonsei AF ablation cohort), 3258 with medical therapy [Korean National Health Insurance (NHIS) database], and 3258 non-AF subjects (NHIS database) following a 1:2:2 propensity score matching. All AFCA patients underwent regular rhythm follow-ups for 51 ± 29 months. Among the AFCA group, the incidence rate ratio (IRR) of ISs was significantly higher in patients with sustained AF recurrences after the last ablation (0.87%) than in those remaining in sinus rhythm (0.24%, P = 0.017; log rank P = 0.003). The IRR of ISs was significantly higher in the medical therapy (1.09%) than AFCA (0.30%, P < 0.001, log rank P < 0.001 vs. medical therapy) or non-AF groups (0.34%, P < 0.001, log rank P < 0.001 vs. medical therapy; P = 0.673, log rank P = 0.874 vs. AFCA). The IRR of ICHs was 0.17% in the medical therapy, 0.06% in the AFCA (P = 0.023, log rank P = 0.042 vs. medical therapy), and 0.12% in the non-AF group (P = 0.226, log rank P = 0.241 vs. medical therapy; P = 0.172, log rank P = 0.193 vs. AFCA). CONCLUSION Post-procedural AF control influences the risk of ISs. Atrial fibrillation catheter ablation significantly reduces the risk of both ISs and ICHs to the extent of the non-AF population compared to the medical therapy.
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Affiliation(s)
- Min Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - JongYoun Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Moon-Hyoung Lee
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, 50 Yonseiro, Seodaemun-gu, Seoul 120-752, Republic of Korea
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20
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Hwang I, Jin Z, Park JW, Kwon OS, Lim B, Hong M, Kim M, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Computational Modeling for Antiarrhythmic Drugs for Atrial Fibrillation According to Genotype. Front Physiol 2021; 12:650449. [PMID: 34054570 PMCID: PMC8155488 DOI: 10.3389/fphys.2021.650449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/22/2021] [Indexed: 01/11/2023] Open
Abstract
Background: The efficacy of antiarrhythmic drugs (AAD) can vary in patients with atrial fibrillation (AF), and the PITX2 gene affects the responsiveness of AADs. We explored the virtual AAD (V-AAD) responses between wild-type and PITX2 +/--deficient AF conditions by realistic in silico AF modeling. Methods: We tested the V-AADs in AF modeling integrated with patients' 3D-computed tomography and 3D-electroanatomical mapping, acquired in 25 patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal type). The ion currents for the PITX2 +/- deficiency and each AAD (amiodarone, sotalol, dronedarone, flecainide, and propafenone) were defined based on previous publications. Results: We compared the wild-type and PITX2 +/- deficiency in terms of the action potential duration (APD90), conduction velocity (CV), maximal slope of restitution (Smax), and wave-dynamic parameters, such as the dominant frequency (DF), phase singularities (PS), and AF termination rates according to the V-AADs. The PITX2 +/--deficient model exhibited a shorter APD90 (p < 0.001), a lower Smax (p < 0.001), mean DF (p = 0.012), PS number (p < 0.001), and a longer AF cycle length (AFCL, p = 0.011). Five V-AADs changed the electrophysiology in a dose-dependent manner. AAD-induced AFCL lengthening (p < 0.001) and reductions in the CV (p = 0.033), peak DF (p < 0.001), and PS number (p < 0.001) were more significant in PITX2 +/--deficient than wild-type AF. PITX2 +/--deficient AF was easier to terminate with class IC AADs than the wild-type AF (p = 0.018). Conclusions: The computational modeling-guided AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF. AF wave-dynamic and electrophysiological characteristics are different among the PITX2-deficient and the wild-type genotype models.
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21
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Gomez-Fernández P, Martín Santana A, Arjona Barrionuevo JDD. Oral anticoagulation in chronic kidney disease with atrial fibrillation. Nefrologia 2021; 41:137-153. [PMID: 36165375 DOI: 10.1016/j.nefroe.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/11/2020] [Indexed: 06/16/2023] Open
Abstract
Chronic kidney disease (CKD) and atrial fibrillation (AF) frequently coexist, amplifying the risk of cardiovascular events and mortality. In patients with CKD stage 3 and non-valvular AF, direct oral anticoagulants (DOACs) have shown, compared to vitamin K antagonists (VKA), equal or greater efficacy in the prevention of stroke and systemic embolism, and greater safety. There are no randomizedtrials of the efficacy and safety of DOACs and VKA in advanced CKD. On the other hand, observational studies suggest that DOACs, compared to warfarin, are associated with a lower risk of acute kidney damage and generation/progression of CKD. This paper reviews the epidemiological and pathophysiological aspects of the CKD and AF association, the evidence of the efficacy and safety of warfarin and ACODs in various stages of CKD with AF as well as the comparison between warfarin and ACODs in efficacy and anticoagulant safety, and in its renal effects.
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Affiliation(s)
- Pablo Gomez-Fernández
- Unidad de Factores de Riesgo Vascular, Servicio de Nefrología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain.
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Pak HN, Park JW, Yang SY, Kim M, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH. Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation. Heart 2021; 107:1862-1867. [PMID: 33483352 DOI: 10.1136/heartjnl-2020-318282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures. METHODS Among 3282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5±10.3 years old, 61.5% with paroxysmal atrial fibrillation) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications and long-term clinical recurrences after propensity score matching. RESULTS LA volume index (43.1±18.6 vs 35.8±11.6 mL/m2, p<0.001) was higher, but LA dimension (40.0±6.8 vs 41.6±6.3 mm, p=0.018), LA voltage (0.94±0.55 vs 1.20±0.68 mV, p=0.002) and pericardial fat volume (89.5±43.1 vs 122.1±53.9 cm3, p<0.001) were lower in women with repeat ablation than in their male counterparts. Pulmonary vein (PV) reconnections were lower (58.7% vs 74.9%, p=0.001), but the proportion of extra-PV triggers (27.5% vs 17.0%, p=0.026) and elevated LA pulse pressures (79.7% vs 63.7%, p=0.019) was significantly higher in women than in men. There was no significant sex difference in the rate of procedure-related complications (4.6% vs 4.2%, p=0.791). During a 31-month (8-60) median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log-rank p=0.039, antiarrhythmic drug (AAD)-free log-rank p<0.001) and the second procedure (log-rank p=0.006, AAD-free log-rank p=0.093). Female sex (HR 1.51, 95% CI 1.06 to 2.15, p=0.023), non-paroxysmal atrial fibrillation (HR 1.78, 95% CI 1.30 to 2.34, p<0.010) and extra-PV triggers (HR 1.88, 95% CI 1.28 to 2.75, p=0.001) were independently associated with clinical recurrences after repeat procedures. CONCLUSIONS During repeat AFCA procedures, PV reconnections were lower in women than in men, and the existence of extra-PV triggers and an LA pressure elevation were more significant, which resulted in poor rhythm outcomes. TRIAL REGISTRATION NUMBER NCT02138695.
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Affiliation(s)
- Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea (the Republic of)
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Wan H, Wang J, Yang Y, Fan X, Chen D, Bian N. Impact of estimated glomerular filtration rate on long-term clinical outcomes among Chinese patients with atrial fibrillation. BMC Cardiovasc Disord 2020; 20:490. [PMID: 33213382 PMCID: PMC7678047 DOI: 10.1186/s12872-020-01786-6] [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: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Estimated glomerular filtration rate (eGFR) is a widely accepted indicator of renal function. The aim of this study was to evaluate the relationship between eGFR and 3-year clinical outcomes among Chinese patients with atrial fibrillation (AF). METHODS We retrospectively studied 433 consecutive Chinese patients with AF (51.0% males, mean age 65.6 ± 13.2 years) between February 2013 and December 2017. Baseline clinical data were collected according to medical records. eGFR was calculated by MDRD equation for Chinese patients according to baseline age, sex and serum creatinine. The primary clinical outcome of interest was all-cause mortality. RESULTS During a median follow-up period of 3.1 (0.5-4.5) years, 73 deaths (16.9%) were recorded. Multivariate Cox regression analyses indicated that eGFR was independently associated with all-cause death in total population [hazard ratio (HR) 0.984; 95% confidence interval (CI) 0.972-0.995, P = 0.006] and patients free of valvular heart diseases (VHDs) (HR 0.975; 95% CI 0.959-0.992, P = 0.003), but not with VHDs. A receiver operating characteristic (ROC) analysis revealed that reduced eGFR predicted all-cause mortality with areas under the ROC curve of 0.637 (95% CI 0.539-0.735, P = 0.004) in AF patients free of VHDs. CONCLUSIONS eGFR is an independent predictor of 3-year all-cause mortality among Chinese patients with AF, especially among those patients free of VHDs.
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Affiliation(s)
- Huaibin Wan
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Guangdong, China.
| | - Juan Wang
- Emergency and Intensive Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanmin Yang
- Emergency and Intensive Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Fan
- Department of Cardiology, Dongguan People's Hospital, Southern Medical University, Guangdong, China
| | - Dongdong Chen
- Department of Cardiology, First Affiliated Hospital, Jinan University, Guangdong, China
| | - Ning Bian
- Department of Cardiology, First Affiliated Hospital, Jinan University, Guangdong, China
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Renal function and outcomes in atrial fibrillation patients after catheter ablation. PLoS One 2020; 15:e0241449. [PMID: 33166317 PMCID: PMC7652258 DOI: 10.1371/journal.pone.0241449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and renal failure coexist and interact. However, scarce data about association between renal function and clinical outcomes in patients undergoing catheter ablation for AF are available. We sought to evaluate long-term renal function and clinical outcomes after AF ablation. METHODS We enrolled 791 non-dialysis patients undergoing catheter ablation for AF, and evaluated the incidence of worsening renal function (WRF) after the procedure, defined as >30% decline in estimate glomerular filtration rate. RESULTS Mean follow-up duration was 5.1±2.5 years. Five hundreds and twenty-six patients (66.5%) were free from recurrent atrial arrhythmias without any antiarrhythmic drugs at the time of final follow-up. Cumulative incidence of WRF was 13.2% at 5-year after procedure, which was significantly higher in patients with recurrent AF compared to those without (21.6% versus 8.7%, P<0.001). In the multivariable analysis, recurrent AF was an independent risk factor for WRF (adjusted hazard ratio [HR] 1.89, 95% confidence interval 1.27-2.81, P = 0.002), along with congestive heart failure, diabetes, and eGFR <60 ml/min/1.73m2 at baseline. Patients with WRF had significantly higher 5-year incidences of all-cause death, cardiovascular death, heart failure hospitalization, ischemic stroke, and major bleeding compared to those without WRF. After adjustment of baseline differences in the multivariate Cox model, the excessive risks of WRF for all-cause death and heart failure hospitalization remained significant (adjusted HR 3.46, P = 0.002; adjusted HR 3.67, P<0.001). CONCLUSIONS In AF patients undergoing catheter ablation for AF, arrhythmia recurrence was associated with WRF during follow-up, which was a strong predictor of adverse clinical outcomes.
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25
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Ding WY, Gupta D, Wong CF, Lip GYH. Pathophysiology of atrial fibrillation and chronic kidney disease. Cardiovasc Res 2020; 117:1046-1059. [PMID: 32871005 DOI: 10.1093/cvr/cvaa258] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/28/2020] [Accepted: 08/25/2020] [Indexed: 01/06/2023] Open
Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely related conditions with shared risk factors. The growing prevalence of both AF and CKD indicates that more patients will suffer from concurrent conditions. There are various complex interlinking mechanisms with important implications for the management of these patients. Furthermore, there is uncertainty regarding the use of oral anticoagulation (OAC) in AF and CKD that is reflected by a lack of consensus between international guidelines. Therefore, the importance of understanding the implications of co-existing AF and CKD should not be underestimated. In this review, we discuss the pathophysiology and association between AF and CKD, including the underlying mechanisms, risk of thrombo-embolic and bleeding complications, influence on stroke management, and evidence surrounding the use of OAC for stroke prevention.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Christopher F Wong
- Department of Renal Medicine, Liverpool University Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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26
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Pak HN, Park J, Park JW, Yang SY, Yu HT, Kim TH, Uhm JS, Choi JI, Joung B, Lee MH, Kim YH, Shim J. Electrical Posterior Box Isolation in Persistent Atrial Fibrillation Changed to Paroxysmal Atrial Fibrillation: A Multicenter, Prospective, Randomized Study. Circ Arrhythm Electrophysiol 2020; 13:e008531. [PMID: 32755396 DOI: 10.1161/circep.120.008531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persistent atrial fibrillation (AF) can change to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient groups. METHODS We prospectively randomized 114 patients with persistent AF to paroxysmal AF (men, 75%; 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). Primary end point was AF recurrence after a single procedure, and secondary end points were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs. RESULTS After a mean follow-up of 23.8±10.2 months, the clinical recurrence rate did not significantly differ between the CPVI alone and additional POBI group (31.6% versus 28.1%; P=0.682; log-rank P=0.729). The recurrences as atrial tachycardias (5.3% versus 12.3%; P=0.134) and cardioversion rates (5.3% versus 10.5%; P=0.250) were not significantly different between the CPVI and POBI groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% of CPVI group and 59.6% of POBI group (P=0.450). No significant difference was found in major complication rates between the two groups (5.3% versus 1.8%; P=0.618), but the total ablation time was significantly longer in the POBI group (4187±952 versus 5337±1517 s; P<0.001). CONCLUSIONS In patients with persistent AF converted to paroxysmal AF by antiarrhythmic drug, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation or influence overall safety, while leading to longer ablation time. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02176616.
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Affiliation(s)
- Hui-Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Junbeom Park
- Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea (J.P.)
| | - Je-Wook Park
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Song-Yi Yang
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Hee Tae Yu
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Tae-Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Jae-Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Jong-Il Choi
- Department of Cardiology, Korea University Medical Center, Seoul, Republic of Korea (J.I.C., Y.-H.K., J.S.)
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Moon-Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, Republic of Korea (H.-N.P., J.-W.P., S.-Y.Y., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L.)
| | - Young-Hoon Kim
- Department of Cardiology, Korea University Medical Center, Seoul, Republic of Korea (J.I.C., Y.-H.K., J.S.)
| | - Jaemin Shim
- Department of Cardiology, Korea University Medical Center, Seoul, Republic of Korea (J.I.C., Y.-H.K., J.S.)
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Pak HN, Park JW, Yang SY, Yu HT, Uhm JS, Joung B, Lee MH, Kim TH. A mesh-type flexible tip catheter vs a contact force catheter for catheter ablation of atrial fibrillation: A prospective nonrandomized 1:1 matched study. J Cardiovasc Electrophysiol 2020; 31:1279-1288. [PMID: 32270578 DOI: 10.1111/jce.14484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mesh-type flexible tip (MFT) catheters allow clinicians to safely generate large radiofrequency lesions during catheter ablation of atrial fibrillation (AF), while contact force (CF) catheters provide better catheter-tissue contact. We compared the clinical outcomes of catheter ablation of AF using MFT and CF catheters in a prospective, nonrandomized manner. METHODS We prospectively assigned 217 patients with AF (paroxysmal AF 73.5%; male 69.1%; 59.9 ± 10.7 years old) at a 1:1 ratio to ablation with MFT catheters (FlexAbility) or CF catheters (TactiCath). The primary endpoint was AF recurrence after a single procedure; the secondary endpoint was a response to antiarrhythmic drugs. RESULTS After a mean follow-up of 22.3 ± 4.4 months, the clinical recurrence rate did not significantly differ between the two study groups (29.7% vs 30.2%; P = .941) (log-rank P = .838). The recurrence rate for atrial tachycardias (30.3% vs 9.7%; P = .035) and cardioversion rates (8.1% vs 1.9%; P = .024) were higher in the MFT group than CF group. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 57.7% of the MFT group and 40.6% of the CF group (P = .010). No significant difference was found in the major complication rates between the two groups (0.9% vs 5.7%), although the ablation time was significantly longer in the MFT group (4192.1 ± 1080.2 vs 3583.8 ± 977.2 seconds; P < .001). CONCLUSION MFT and CF catheters had similar effectiveness in achieving AF rhythm control during catheter ablation, and there was no significant difference between the two catheters with regard to overall safety.
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Affiliation(s)
- Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song-Yi Yang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jin MN, Kim TH, Kang KW, Yu HT, Uhm JS, Joung B, Lee MH, Kim E, Pak HN. Response by Jin et al to Letter Regarding Article, "Atrial Fibrillation Catheter Ablation Improves 1-Year Follow-Up Cognitive Function, Especially in Patients With Impaired Cognitive Function". Circ Arrhythm Electrophysiol 2019; 12:e007880. [PMID: 31597478 DOI: 10.1161/circep.119.007880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Moo-Nyun Jin
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Ki-Woon Kang
- Division of Cardiology, Eulji University Hospital, Daejeon (K.-W.K.)
| | - Hee Tae Yu
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
| | - Eosu Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea (E.K.)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul (M.-N.J., T.-H.K., H.T.Y., J.-S.U., B.J., M.-H.L., H.-N.P.)
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29
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Abstract
See Editorial Park et al
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Affiliation(s)
- Paulette Wehner
- Marshall University Joan C. Edwards School of Medicine Huntington WV
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30
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Park JW, Yang PS, Bae HJ, Yang SY, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Five-Year Change in the Renal Function After Catheter Ablation of Atrial Fibrillation. J Am Heart Assoc 2019; 8:e013204. [PMID: 31474174 PMCID: PMC6755838 DOI: 10.1161/jaha.119.013204] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Although it has been reported that renal function can improve after catheter ablation of atrial fibrillation (AF), long‐term changes in renal function and its relationship to rhythm outcomes have not yet been evaluated. We explored the 5‐year change in estimated glomerular filtration rate (eGFR) in AF patients depending on medical therapy and catheter ablation. Methods and Results Among 1963 patients who underwent AF catheter ablation and 14 056 with AF under medical therapy in the National Health Insurance Service database, we compared 571 with AF catheter ablation (59±10 years old, 72.3% male, and 66.5% paroxysmal AF) and 1713 with medical therapy after 1:3 propensity‐score matching. All participants had 5 years of serial eGFR data (Chronic Kidney Disease‐Epidemiology Collaboration [CKD‐EPI] method). Catheter ablation improved eGFR5 yrs (P<0.001), but medical therapy did not. In 2284 matched patients, age (adjusted odds ratio [OR], 0.98 [0.97–0.99]; P<0.001) and AF catheter ablation (adjusted OR, 2.02 [1.67–2.46]; P<0.001) were independently associated with an improved eGFR5 yrs. Among 571 patients who underwent AF ablation, freedom from AF/atrial tachycardia recurrence after the last AF ablation procedure was independently associated with an improved eGFR5 yrs (adjusted OR, 1.44 [1.01–2.04]; P=0.043), especially in patients without diabetes mellitus (adjusted OR, 1.78 [1.21–2.63]; P=0.003, P for interaction=0.012). Although underlying renal dysfunction (<60 mL/min/1.73m2) was associated with atrial structural remodeling (adjusted OR, 1.05 [1.00–1.11]; P=0.046), it did not affect the AF ablation rhythm outcome. Conclusions AF catheter ablation significantly improved renal function over a 5‐year follow‐up, especially in patients maintaining sinus rhythm without preexisting diabetes mellitus. See Editorial Wehner
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Affiliation(s)
- Je-Wook Park
- Yonsei University Health System Seoul Republic of Korea
| | - Pil-Sung Yang
- Division of Cardiology CHA University Seongnam Republic of Korea
| | - Han-Joon Bae
- Daegu Catholic University Medical Center Daegu Republic of Korea
| | - Song-Yi Yang
- Yonsei University Health System Seoul Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System Seoul Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System Seoul Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System Seoul Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System Seoul Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System Seoul Republic of Korea
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