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Sunaga A, Matsuoka Y, Nakatani D, Okada K, Kida H, Sakamoto D, Kitamura T, Tanaka N, Masuda M, Watanabe T, Minamiguchi H, Egami Y, Oka T, Miyoshi M, Okada M, Matsuda Y, Kawasaki M, Inoue K, Hikoso S, Sotomi Y, Sakata Y. Extensive ablation for persistent atrial fibrillation patients with mitral regurgitation: Insights from the EARNEST-PVI prospective randomized trial. Int J Cardiol 2024; 410:132231. [PMID: 38838745 DOI: 10.1016/j.ijcard.2024.132231] [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: 03/31/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Extensive ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not yielded consistent results, indicating diversity in their efficacy. Mitral regurgitation (MR) associated with AF may indicate a higher prevalence of arrhythmogenic substrate, suggesting potential benefits of extensive ablation for these patients. METHODS This post-hoc analysis of the EARNEST-PVI trial compared PVI alone versus an extensive ablation strategy (PVI-plus) in persistent AF patients, stratified by MR presence. The primary endpoint of the study was the recurrence of AF. The secondary endpoints included death, cerebral infarction, and procedure-related complications. RESULTS The trial included 495 eligible patients divided into MR and non-MR groups. The MR group consisted of 192 patients (89 in the PVI-alone arm and 103 in the PVI-plus arm), while the non-MR group had 303 patients (158 in the PVI-alone arm and 145 in the PVI-plus arm). In the non-MR group, recurrence rates were similar between PVI-alone and PVI-plus arms (Log-rank P = 0.47, Hazard ratio = 0.85 [95%CI: 0.54-1.33], P = 0.472). However, in the MR group, PVI-plus was significantly more effective in preventing AF recurrence (Log-rank P = 0.0014, Hazard ratio = 0.40 [95%CI: 0.22-0.72], P = 0.0021). No significant differences were observed in secondary endpoints between the two arms. CONCLUSIONS For persistent AF patients with mild or greater MR, receiving PVI-plus was superior to PVI-alone in preventing AF recurrence. Conversely, for patients without MR, the effectiveness of extensive ablation was not demonstrated. These findings suggest tailoring ablation strategies based on MR presence can lead to better outcomes in AF management.
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Affiliation(s)
- Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Matsuoka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Sakamoto
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Masaharu Masuda
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | | | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Takafumi Oka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miwa Miyoshi
- Department of Cardiology, Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | - Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Koichi Inoue
- Cardiovascular Division, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Martins N, Landmesser U, Attanasio P, Huemer M. Bipolar catheter ablation of a left atrial anteroseptal line in a patient with peri-mitral atrial flutter: a case report. Eur Heart J Case Rep 2024; 8:ytae455. [PMID: 39286728 PMCID: PMC11404515 DOI: 10.1093/ehjcr/ytae455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/14/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024]
Abstract
Background Treatment of recurring atrial flutter can be challenging due to anatomical obstacles preventing complete conduction block of linear ablation lesions. Epicardial or bipolar ablation can be used as an alternative to create deeper ablation lesions but is still limitedly used in patients with atrial flutter. Case summary We describe a case of a 54-year-old patient with recurring peri-mitral flutter treated with ablation of an anteroseptal line using bipolar ablation to achieve a complete conduction block. Discussion As conventional ablation cannot always achieve, complete conduction block in linear ablation lesions alternatives may be used to create deeper lesions. In this, case bipolar ablation was used successfully for an anteroseptal line in a patient with recurring peri-mitral flutter.
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Affiliation(s)
- Nadja Martins
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Philipp Attanasio
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité-Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
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Mohanty S, Torlapati PG, Casella M, Della Rocca DG, Schiavone M, Doty B, La Fazia VM, Pahi S, Pierucci N, Valeri Y, Gianni C, Al-Ahmad A, Burkhardt JD, Gallinghouse JG, Di Biase L, Chierchia GB, Nair DG, Dello Russo A, Tondo C, Natale A. Redefining the blanking period after pulsed-field ablation in patients with atrial fibrillation. Heart Rhythm 2024:S1547-5271(24)03117-5. [PMID: 39117003 DOI: 10.1016/j.hrthm.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Recurrence during the 3-month blanking period after radiofrequency ablation of atrial fibrillation (AF) is typically not considered as a predictor for late recurrence. OBJECTIVE We investigated the significance of early recurrence as a risk factor for late recurrence in patients with AF receiving pulsed-field ablation (PFA). METHODS Consecutive patients undergoing PFA were prospectively followed up for 1 year. All patients received isolation of pulmonary veins. Additional ablation procedures were performed per operator's discretion. After the procedure, all remained on their previously ineffective antiarrhythmic drugs (AADs) during the 2-month blanking period after which the AADs were discontinued. Early recurrence was defined as atrial arrhythmia of >30-second duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence. RESULTS A total of 337 patients undergoing PFA for AF were included. Early recurrence was recorded in 53 patients (15.7%): 10 in the first month, 12 in the second month, and 31 in the third month. Of the 10 patients having recurrence during the first month, 7 (70%) remained in sinus rhythm after cardioversion whereas 3 (30%) underwent a redo procedure because of late recurrence. At 1 year, all patients with recurrence in the second and third months experienced late recurrence; among these patients, 10 (83.3%) of 12 and 27 (87%) of 31 underwent a redo procedure and the remaining 6 patients were in sinus rhythm on AADs. CONCLUSION In this consecutive series of patients with AF, early recurrence in the second or third month after the PFA procedure was associated with a high risk of late recurrence. Thus, blanking period could be redefined as 1 month after PFA.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | | | - Michela Casella
- Department of Electrophysiology, Ospedali Riuniti Hospital, Ancona, Italy
| | | | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Brandon Doty
- Department of Electrophysiology, St. Bernard's Heart & Vascular Center, Jonesboro, Arkansas
| | | | - Shubham Pahi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Yari Valeri
- Department of Electrophysiology, Ospedali Riuniti Hospital, Ancona, Italy
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - John D Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - J G Gallinghouse
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Department of Electrophysiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, New York
| | | | - Devi G Nair
- Department of Electrophysiology, St. Bernard's Heart & Vascular Center, Jonesboro, Arkansas
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Interventional Electrophysiology, Scripps Clinic, San Diego, California; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy.
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4
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Zaman JAB, Khan A, Nielsen J, Kristiansen SB, Kronborg MB, Witt CT, Gerdes C, Kristensen J, Jensen HK, Lukac P, Agarwal SC. Repeat ablation of atrial fibrillation using electrogram dispersion to identify additional areas of mechanistic significance. Heart Rhythm O2 2024; 5:543-550. [PMID: 39263613 PMCID: PMC11385402 DOI: 10.1016/j.hroo.2024.07.007] [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] [Indexed: 09/13/2024] Open
Abstract
Background Electrogram dispersion identifies putative atrial fibrillation (AF) drivers in first time ablation procedures, with high acute termination rates and long-term outcomes akin to extensive ablation approaches. Its use in a population that had undergone repeat ablation is unknown, particularly where the pulmonary veins are already isolated. Objective This purpose of this study was to assess electrogram dispersion mapping during repeat ablation procedures for persistent AF. Methods One hundred sixty-seven patients from the United Kingdom and Denmark, all with persistent AF recurrence after prior ablation procedure(s), were mapped using a five splined catheter for electrogram dispersion before ablation. Areas were manually tagged on biatrial electroanatomic maps and ablated once pulmonary vein isolation was confirmed or reisolated if required. All patients had 12-month continuous monitoring, with most of the cohort having follow-up beyond 24 months. Results Of the 167 patients [53 (32%) female; mean age 66 ± 8 years; mean left atrial (LA) diameter 4.8 cm; mean ejection fraction 53%], 108 had pulmonary veins already isolated. Dispersion sites occurred in both atria (3.2 LA, 1.4 right atrium). Acute termination to sinus rhythm occurred in 71 (42%) of the cohort patients, with a further 73 (44%) terminating to atrial tachycardia/flutter. At 12-month follow-up, 95% of patients were free of AF, with 74% overall freedom from all atrial arrhythmias. Heart failure and severely enlarged LA predicted recurrence, and termination to sinus improved freedom from all atrial arrhythmias. Conclusion Dispersion mapping is a promising approach at repeat ablation procedures for persistent AF, with high acute termination rates and good clinical outcomes. Further prospective randomized trials are needed to evaluate this approach in a population that had undergone repeat ablation.
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Affiliation(s)
- Junaid A B Zaman
- Keck School of Medicine, University of Southern California, Los Angeles, California
- Royal Papworth Hospital, Cambridge, United Kingdom
| | - Abdulhaseeb Khan
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jan Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mads B Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sharad C Agarwal
- Royal Papworth Hospital, Cambridge, United Kingdom
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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5
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Matsunaga-Lee Y, Inoue K, Tanaka N, Masuda M, Watanabe T, Makino N, Egami Y, Oka T, Minamiguchi H, Miyoshi M, Okada M, Kanda T, Matsuda Y, Kawasaki M, Kawanami S, Sugae H, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Yano M, Nishino M, Sunaga A, Sotomi Y, Dohi T, Nakatani D, Hikoso S, Sakata Y. Appropriate Selection of Substrate Ablation for Persistent Atrial Fibrillation Using Intraprocedural Assessment. Circ J 2024; 88:1068-1077. [PMID: 38811199 DOI: 10.1253/circj.cj-23-0936] [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] [Indexed: 05/31/2024]
Abstract
BACKGROUND It has not been fully elucidated which patients with persistent atrial fibrillation (PerAF) should undergo substrate ablation plus pulmonary vein isolation (PVI). This study aimed to identify PerAF patients who required substrate ablation using intraprocedural assessment of the baseline rhythm and the origin of atrial fibrillation (AF) triggers. METHODS AND RESULTS This was a post hoc subanalysis using extended data of the EARNEST-PVI trial, a prospective multicenter randomized trial comparing PVI-alone and PVI-plus (i.e., PVI with added catheter ablation) arms. We divided 492 patients into 4 groups according to baseline rhythm and the location of AF triggers before PVI: Group A (n=22), sinus rhythm with pulmonary vein (PV)-specific AF triggers (defined as reproducible AF initiation from PVs only); Group B (n=211), AF with PV-specific AF triggers; Group C (n=94), sinus rhythm with no PV-specific AF trigger; Group D (n=165), AF with no PV-specific AF trigger. Among the 4 groups, only in Group D (AF at baseline and no PV-specific AF triggers) was arrhythmia-free survival significantly lower in the PVI-alone than PVI-plus arm (P=0.032; hazard ratio 1.68; 95% confidence interval 1.04-2.70). CONCLUSIONS Patients with sinus rhythm or PV-specific AF triggers did not receive any benefit from substrate ablation, whereas patients with AF and no PV-specific AF trigger benefited from substrate ablation.
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Affiliation(s)
| | - Koichi Inoue
- National Hospital Organization Osaka National Hospital
| | | | | | | | | | | | | | | | - Miwa Miyoshi
- Osaka Hospital, Japan Community Healthcare Organization
| | | | | | | | | | | | | | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital
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6
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Miyazaki S. Optimal Ablation Strategy for Non-Paroxysmal Atrial Fibrillation During the Index Procedure. Circ J 2024; 88:1078-1080. [PMID: 38839378 DOI: 10.1253/circj.cj-24-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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7
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Matsunaga-Lee Y, Inoue K, Tanaka N, Masuda M, Watanabe T, Makino N, Egami Y, Oka T, Minamiguchi H, Miyoshi M, Okada M, Kanda T, Matsuda Y, Kawasaki M, Kawanami S, Ukita K, Kawamura A, Yasumoto K, Tsuda M, Okamoto N, Yano M, Nishino M, Sunaga A, Sotomi Y, Dohi T, Nakatani D, Hikoso S, Sakata Y. Duration of atrial fibrillation persistence: Implications for recurrence risk after catheter ablation and efficacy of additional substrate ablation. Heart Rhythm 2024; 21:733-740. [PMID: 38307310 DOI: 10.1016/j.hrthm.2024.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The optimal duration of atrial fibrillation (AF) persistence for predicting poor outcomes after catheter ablation of long-standing AF (LsAF) and the best ablation strategy for these patients remain unclear. OBJECTIVE We aimed to assess the impact of the duration of AF persistence on outcomes after catheter ablation of AF. METHODS We analyzed the Efficacy of Pulmonary Vein Isolation Alone in Patients with Persistent Atrial Fibrillation (EARNEST-PVI) trial data comparing pulmonary vein isolation (PVI) alone (PVI-alone) with additional linear ablation or defragmentation (PVI-plus) in persistent AF (PerAF). Patients who received catheter ablation by contact force-sensing catheter were enrolled in the study. In patients with LsAF, the optimal cutoff duration of AF persistence was evaluated. With use of the threshold, patients with LsAF were divided into 2 groups and compared with PerAF <1 year for arrhythmia-free survival after a 3-month blanking period. RESULTS The optimal cutoff duration was 2.4 years. Of 458 patients, arrhythmia-free survival rates for LsAF 1-2.4 years were comparable to those of PerAF (hazard ratio [HR], 1.01; 95% CI, 0.67-1.52). However, LsAF >2.4 years had a higher recurrence risk than PerAF (HR, 2.22; 95% CI, 1.42-3.47). In LsAF >2.4 years, the PVI-plus strategy showed advantages over the PVI-alone strategy (HR, 0.36; 95% CI, 0.14-0.89). However, the interaction effect between LsAF 1-2.4 years and LsAF >2.4 years did not reach statistical significance (P = .116). CONCLUSION Whereas LsAF 1-2.4 years has similar outcomes to those of PerAF, LsAF >2.4 years was linked to higher arrhythmia recurrence risks. For LsAF >2.4 years, the PVI-plus strategy showed a potential to be superior to the PVI-alone strategy.
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Affiliation(s)
| | - Koichi Inoue
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | | | | | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Takafumi Oka
- Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Miwa Miyoshi
- Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | | | | | | | | | | | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
| | - Akihiro Sunaga
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Yohei Sotomi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoharu Dohi
- Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Shungo Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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8
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Kinjo T, Kimura M, Horiuchi D, Itoh T, Ishida Y, Nishizaki K, Toyama Y, Hamaura S, Sasaki S, Tomita H. Comparing cryoballoon and contact-force guided radiofrequency ablation in pulmonary vein isolation for atrial fibrillation in patients with hypertrophic cardiomyopathy. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01822-x. [PMID: 38743142 DOI: 10.1007/s10840-024-01822-x] [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: 02/24/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) employing cryoballoon (CB) or contact force-guided radiofrequency (CF-RF) catheter ablation has been established as an effective strategy for managing atrial fibrillation (AF). However, its efficacy in hypertrophic cardiomyopathy (HCM) remains to be further explored. METHODS This retrospective study analyzed 60 consecutive AF patients with HCM (average age 67 ± 10 years; 41 men) who were consecutively admitted to our hospital from January 2014 to December 2022 and underwent initial PVI. RESULTS The patients were treated with CB (26 patients) or CF-RF (34 patients). Successful PVI was achieved in both groups without significant complications. In the CF-RF group, additional ablations were performed on the cavotricuspid isthmus (14.7% of patients) and the anterior line (2.9%). The CB group benefited from reduced procedural times (93 ± 31 vs. 165 ± 60 min, p < 0.05) and decreased saline irrigation requirements (77.5 ± 31.4 vs. 870 ± 281.9 mL, p < 0.0001). Using a contrast medium was exclusive to the CB group (33.8 ± 4.2 mL). In a 12-month follow-up, the atrial tachyarrhythmia recurrence-free rates in the CB and CF-RF groups were comparable (77% and 76%, respectively; p = 0.63 according to the log-rank test). Notably, pulmonary vein reconnection was prevalent in most (7 out of 8) patients requiring a secondary ablation procedure. CONCLUSION PVI is feasible as a strategy for AF in patients with HCM employing either CB or CF-RF techniques. While the recurrence-free rates were comparable in both groups, differences were noted in procedure duration, saline usage, and the need for a contrast medium.
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Affiliation(s)
- Takahiko Kinjo
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Daisuke Horiuchi
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Yuji Ishida
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Toyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shogo Hamaura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Department of the Advanced Therapeutics for Cardiovascular Diseases, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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9
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Guo X, Li J. Risk and Protective Factors of Recurrence after Catheter Ablation for Atrial Fibrillation. Rev Cardiovasc Med 2024; 25:81. [PMID: 39076956 PMCID: PMC11263837 DOI: 10.31083/j.rcm2503081] [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] [Received: 08/29/2023] [Revised: 10/04/2023] [Accepted: 10/27/2023] [Indexed: 07/31/2024] Open
Abstract
Atrial fibrillation (AF) is a common disease and is effectively managed through catheter ablation (CA). However, post-ablation AF recurrence can compromise patient outcomes, making the identification of associated risk factors crucially important. Factors influencing poor clinical outcomes include age, female sex, body mass index (BMI), non-paroxysmal AF, and comorbidities including diabetes mellitus (DM) and obstructive sleep apnea (OSA). Furthermore, the selected ablation strategy and employed technology are pivotal to long-term success in maintaining sinus rhythm control. The mechanisms of AF recurrence are complex and multifactorial; no single predictor is definitive. Thus, a personalized assessment of each patient should be tailored to the individual situation. A high risk of relapse does not preclude the option of ablation therapy, but rather underscores the necessity to address and manage underlying conditions contributing to AF pathogenesis, aiming to mitigate the risk of recurrence.
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Affiliation(s)
- Xinwei Guo
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
| | - Jingbo Li
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 200233 Shanghai, China
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10
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Homoud M. Ablation for Persistent Atrial Fibrillation: Is There a Light at the End of the Tunnel? J Am Heart Assoc 2023; 12:e031258. [PMID: 37642025 PMCID: PMC10547349 DOI: 10.1161/jaha.123.031258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Munther Homoud
- Section of Pacing and ElectrophysiologyTufts Medical CenterBostonMAUSA
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