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Fei C, Zhao C, Ma Y, Liu Y, Chen R, Zhang H. Factors influencing early recurrence of atrial fibrillation among elderly patients following radiofrequency catheter ablation and the impact of different antiarrhythmic regimens. Front Med (Lausanne) 2024; 11:1393208. [PMID: 38994337 PMCID: PMC11236554 DOI: 10.3389/fmed.2024.1393208] [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: 02/28/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
Background Patients with atrial fibrillation (AF) who undergo radiofrequency catheter ablation (RFCA) necessitate the administration of antiarrhythmic drugs to prevent early recurrence. The clinical outcomes among these patients may be influenced by varying antiarrhythmic regimens. Objectives To identify the risk factors associated with early recurrence and compare the clinical outcomes among different antiarrhythmic regimens in elderly patients with AF following radiofrequency catheter ablation (RFCA) during a 3-month period. Methods A retrospective observational study encompassed 420 elderly patients with AF following RFCA. Baseline data were collected during the initial postoperative visit and clinical outcomes were carefully monitored over a 3-month follow-up period. Logistic regression and Cox-proportional hazard regression analyses were performed to investigate the relationship between various antiarrhythmic regimens and the clinical outcomes. Results Multivariate logistic regression analysis revealed that age (p = 0.001), left atrial diameter (p < 0.001), left ventricular diameter (p = 0.015), reactive hyperemia index (RHI) (p < 0.001), antiarrhythmic drug (p < 0.001) and hs-cTnI (p = 0.017) were independent risk factors of early recurrence. Furthermore, in cox survival regression analysis model, survival rate of early recurrence in the amiodarone group was higher than in the propafenone group (HR 2.30, 95%CI 1.17-4.53, p = 0.016) and in the sotalol group (HR 3.60, 95%CI 2.17-5.95, p < 0.001). Compared to the amiodarone group, the incidence of liver dysfunction was lower in the dronedarone group (p = 0.046) and the propafenone group (p = 0.021). The incidence of bradyarrhythmia (p = 0.003), QT interval prolongation (p = 0.035) and atrioventricular transmission block (p = 0.021) were higher in the sotalol group than in the amiodarone group. Conclusion RHI was identified as an independent risk factor for early recurrence among elderly AF patients after RFCA. Compared to amiodarone, propafenone and sotalol exhibited an elevated risk of early recurrence. Although there was no significant difference in early recurrence between amiodarone and dronedarone, dronedarone emerged as the preferred option due to its lower frequency of adverse drug reactions than amiodarone.
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Affiliation(s)
- Changdong Fei
- Department of Health Management Center, The 967th Hospital of Joint Logistics Support Force of Chinese PLA, Dalian, China
| | - Caitong Zhao
- Department of Quality Control, General Hospital of Northern Theater Command, Shenyang, China
| | - Yan Ma
- National Clinical Research Center of Geriatric Diseases, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yupeng Liu
- Department of Critical Care Medicine, The 967th Hospital of Joint Logistics Support Force of Chinese PLA, Dalian, China
| | - Renzheng Chen
- National Clinical Research Center of Geriatric Diseases, The Second Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Emergency, The 967th Hospital of Joint Logistics Support Force of Chinese PLA, Dalian, China
| | - Hualin Zhang
- Department of Emergency, The 967th Hospital of Joint Logistics Support Force of Chinese PLA, Dalian, China
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Krajčová A, Němcová V, Halačová M, Waldauf P, Balík M, Duška F. Amiodarone but not propafenone impairs bioenergetics and autophagy of human myocardial cells. Toxicol Appl Pharmacol 2023; 477:116676. [PMID: 37661063 DOI: 10.1016/j.taap.2023.116676] [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: 03/08/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Cardiac and extra-cardiac side effects of common antiarrhythmic agents might be related to drug-induced mitochondrial dysfunction. Supratherapeutic doses of amiodarone have been shown to impair mitochondria in animal studies, whilst influence of propafenone on cellular bioenergetics is unknown. We aimed to assess effects of protracted exposure to pharmacologically relevant doses of amiodarone and propafenone on cellular bioenergetics and mitochondrial biology of human and mouse cardiomyocytes. In this study, HL-1 mouse atrial cardiomyocytes and primary human cardiomyocytes derived from the ventricles of the adult heart were exposed to 2 and 7 μg/mL of either amiodarone or propafenone. After 24 h, extracellular flux analysis and confocal laser scanning microscopy were used to measure mitochondrial functions. Autophagy was assessed by western blots and live-cell imaging of lysosomes. In human cardiomyocytes, amiodarone significantly reduced mitochondrial membrane potential and ATP production, in association with an inhibition of fatty acid oxidation and impaired complex I- and II-linked respiration in the electron transport chain. Expectedly, this led to increased anaerobic glycolysis. Amiodarone increased the production of reactive oxygen species and autophagy was also markedly affected. In contrast, propafenone-exposed cardiomyocytes did not exert any impairment of cellular bioenergetics. Similar changes after amiodarone treatment were observed during identical experiments performed on HL-1 mouse cardiomyocytes, suggesting a comparable pharmacodynamics of amiodarone among mammalian species. In conclusion, amiodarone but not propafenone in near-therapeutic concentrations causes a pattern of mitochondrial dysfunction with affected autophagy and metabolic switch from oxidative metabolism to anaerobic glycolysis in human cardiomyocytes.
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Affiliation(s)
- Adéla Krajčová
- Department of Anaesthesia and Intensive Care of The Third Faculty of Medicine and Královské Vinohrady University Hospital, OXYLAB-Laboratory for Mitochondrial Physiology, Charles University, Prague, Czech Republic
| | - Vlasta Němcová
- Department of Biochemistry, Cell and Molecular Biology and Centre for Research on Nutrition, Metabolism and Diabetes, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milada Halačová
- Department of Anaesthesia and Intensive Care of The Third Faculty of Medicine and Královské Vinohrady University Hospital, OXYLAB-Laboratory for Mitochondrial Physiology, Charles University, Prague, Czech Republic; Department of Pharmacology of The Second Medical Faculty, Charles University, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care of The Third Faculty of Medicine and Královské Vinohrady University Hospital, OXYLAB-Laboratory for Mitochondrial Physiology, Charles University, Prague, Czech Republic
| | - Martin Balík
- Department of Anaesthesia and Intensive Care of The First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesia and Intensive Care of The Third Faculty of Medicine and Královské Vinohrady University Hospital, OXYLAB-Laboratory for Mitochondrial Physiology, Charles University, Prague, Czech Republic.
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Terata K, Abe Y, Tashiro H, Kato M, Sasaki F, Watanabe H. Comparison of Radiofrequency and Cryoballoon Pulmonary Vein Ablation for the Early and Late Recurrence of Atrial Fibrillation. Intern Med 2022; 61:3315-3322. [PMID: 35400703 PMCID: PMC9751734 DOI: 10.2169/internalmedicine.9367-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Early recurrence (ER) after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is expected to resolve within the recommended 3-month blanking period, irrespective of the ablation device used. To compare the occurrence and relationship of AF within the blanking period and subsequent late recurrence (LR) with radiofrequency (RF) and cryoballoon (CB) ablation. Methods A retrospective analysis of 294 patients (mean age=62±9, 70.0% male) undergoing PVI for drug-refractory paroxysmal AF was done. After categorizing the patients into the RF group (n=152) and the CB group (n=142), a group-wise comparison was done to investigate the impact of ER on LR throughout a 2-year follow-up. Results The groups were similar regarding the occurrence of ER (RF=22.4%, CB=24.6%, p=0.62), while LR was significantly higher in the RF group (p=0.003). ER was associated with LR in the RF group (p<0.01) but not in the CB group (p=0.08), while a significant independent association with an increased LR risk was observed [hazard ratio (HR) 6.12; 95% confidence interval (CI) 3.56-10.51, p<0.01]. RF ablation also significantly increased the risk of LR (HR=2.93; 95% CI=1.64-5.23, p<0.01). Conclusion A recurrence of atrial arrhythmia is more frequent with RF-PVI than with CB-PVI for patients with paroxysmal AF. ER and RF-ablation are strong predictors for LR after the 3-month blanking period.
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Affiliation(s)
- Ken Terata
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Yoshihisa Abe
- Department of Cardiovascular Medicine, Akita City Hospital, Japan
| | - Haruwo Tashiro
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
| | - Mamoru Kato
- Department of Radiology, Research Institute for Brain and Blood Vessels-Akita, Japan
| | - Fumiaki Sasaki
- Department of Radiology, Research Institute for Brain and Blood Vessels-Akita, Japan
| | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Japan
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Wei Y, Bao Y, Lin C, Xie Y, Luo Q, Zhang N, Wu L. Early recurrence after cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: mechanism and implication in long-term outcome. BMC Cardiovasc Disord 2022; 22:400. [PMID: 36071377 PMCID: PMC9450458 DOI: 10.1186/s12872-022-02816-1] [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: 03/28/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early recurrence (ER) after catheter ablation for atrial fibrillation (AF) has been considered as a common phenomenon but its mechanism and implication in long-term outcome has not been fully elucidated. We aimed to clarify the relation between post-ablation inflammation and ER after cryoballoon ablation (CBA) or radio-frequency ablation (RFA) and evaluate the clinical significance of ER. Methods A total of 154 patients with paroxysmal AF undergoing ablation were consecutively recruited, including 90 patients undergoing RFA (RF group) and 64 patients undergoing CBA (CB group). Myocardial injury and inflammation biomarkers were analyzed before and 6 h, 24 h and 48 h after ablation. Acute early recurrence (AER), non-acute early recurrence (NAER) and late recurrence (LR) was defined as recurrence of atrial tachyarrhythmia during 0–3, 4–90 days and beyond a 90-day blanking period after ablation. Results Cardiac troponin I was significantly higher in CB group while C reactive protein (CRP) and Ratio Neutrophil/Lymphocyte were more elevated in RF group. Higher CRP level after RFA was significantly associated with AER in RF group and lower CRP level after CBA was predictive of AER in CB group. In addition, average cryoablation duration was positively correlated with CRP level after CB group. Cox regression revealed that NAER and left atrial diameter were associated with LR in RF group, while AER and NAER were predictive of LR after CBA. Conclusions Post-ablation inflammation was greater in RFA than in CBA. Excessive inflammatory response may be an important factor of AER after RFA. AER after CBA was related with lower inflammation and predictive of LR. Further investigations are still warranted to address on these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02816-1.
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Affiliation(s)
- Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China.
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin No.2 Road, Shanghai, 201204, China.
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Wei Y, Chen L, Cao J, Liu S, Ling T, Huang X, Zhou G, Lin C, Xie Y, Bao Y, Luo Q, Ye J, Zhang N, Jin Q, Wu L. Long-term outcomes of a time to isolation - based strategy for cryoballoon ablation compared to radiofrequency ablation in patients with symptomatic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:1015-1023. [PMID: 35767472 DOI: 10.1111/pace.14556] [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: 01/03/2022] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is one of the most commonly used technologies designed for pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF), although the dosing of CBA remains controversial. We evaluated the long-term efficacy and safety of a novel individualized strategy of CBA compared to radiofrequency ablation (RFA) for patients with PAF. METHODS In this observational study, symptomatic patients with drug-refractory paroxysmal AF were prospectively consented and enrolled in four centers, being assigned either to the CBA or RFA arm for ablation. In the CBA group, we used a time to isolation (TTI) - based dosing protocol. The primary endpoint was the recurrence of atrial arrhythmia >30 s following a 90-day blanking period. The secondary endpoint was procedure-related complications and procedure parameters. RESULTS A total of 500 patients were recruited in either the CBA group (n = 247) or the RFA group (n = 253) between January 2017 and July 2018. After a median follow-up of 778 days, the atrial tachyarrhythmia-free survival was 71.7% in the CBA group and 67.0% in the RFA group. CBA and RFA displayed similar major or minor complication occurrence, while the former had a significantly shorter procedure duration (82.5 min vs. 141.1 min, p < .001) and left atrial dwell time (60.1 min vs. 109.9 min, p < .001) but longer fluoroscopy exposure (13.8 min vs. 8.1 min, p < .001). CONCLUSION Compared to RFA, our TTI-based CBA dosing protocol showed comparable efficacy and safety, with a significantly reduced procedure duration in patients with PAF.
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Affiliation(s)
- Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lin Chen
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Jiang Cao
- Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai, People's Republic of China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xinmiao Huang
- Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai, People's Republic of China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiawen Ye
- Department of Cardiology, Shanghai No. 9 People's Hospital, Shanghai, People's Republic of China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Vrachatis DA, Papathanasiou KA, Kossyvakis C, Kazantzis D, Giotaki SG, Deftereos G, Sanz-Sánchez J, Raisakis K, Kaoukis A, Avramides D, Lambadiari V, Siasos G, Giannopoulos G, Deftereos S. Early arrhythmia recurrence after cryoballoon ablation in atrial fibrillation: a systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021; 33:527-539. [PMID: 34951496 DOI: 10.1111/jce.15337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early arrhythmia recurrence within the three-month blanking period is a common event that historically has been attributed to reversible phenomena. While its' mechanistic links remain obscure, accumulating evidence support the argument of shortening the blanking period. We aimed to elucidate the association between early and late arrhythmia recurrence after atrial fibrillation cryoablation. METHODS The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating early and late arrhythmia recurrence rates in patients undergoing cryoablation for AF. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was late arrhythmia recurrence. RESULTS Early arrhythmia recurrence was found predictive of decreased arrhythmia-free survival after evaluating 3975 patients with paroxysmal or persistent atrial fibrillation who underwent cryoablation (OR: 5.31; 95% CI: 3.75-7.51). This pattern remained unchanged after sub-analyzing atrial fibrillation type (paroxysmal; OR: 7.16; 95% CI: 4.40-11.65 and persistent; OR: 7.63; 95% CI: 3.62-16.07) as well as cryoablation catheter generation (first generation; OR: 5.15, 95% CI: 2.39-11.11 and advanced generation; OR: 5.83, 95% CI: 3.68-9.23). Studies permitting anti-arrhythmic drug utilization during blanking period or examining early recurrence as a secondary outcome were found to be a significant source of statistical heterogeneity. CONCLUSION Our findings suggest that early arrhythmia recurrence is predictive of late outcomes after cryoablation for atrial fibrillation. Identifying which patients deserve earlier re-intervention is an open research avenue. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | | | - Dimitrios Kazantzis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotiria G Giotaki
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Greece
| | - Jorge Sanz-Sánchez
- Division of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigacion Biomédica en Red (CIBERCV), Madrid, Spain
| | | | - Andreas Kaoukis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Greece
| | - Dimitrios Avramides
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Greece
| | - Vaia Lambadiari
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Siasos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Spyridon Deftereos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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You L, Zhang X, Yang J, Wang L, Zhang Y, Xie R. The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study. Front Cardiovasc Med 2021; 8:719452. [PMID: 34722655 PMCID: PMC8551484 DOI: 10.3389/fcvm.2021.719452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10 and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by these three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence following catheter ablation. Methods: There were 238 patients involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group), and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated. Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs. no recurrence, 56.58 ± 18.37 vs. 65.59 ± 18.83, respectively, p = 0.003), left atrial (LA) anteroposterior dimension (recurrence vs. no recurrence, 36.56 ± 4.65 vs. 35.00 ± 4.37, respectively; p = 0.028), and LA vertical dimension (recurrence vs. no recurrence, 56.31 ± 6.96 vs. 53.72 ± 6.52, respectively; p = 0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961-0.997). Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze, and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.
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Affiliation(s)
| | | | | | | | | | - Ruiqin Xie
- Second Hospital of Hebei Medical University, Shijiazhuang, China
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8
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Budzianowski J, Hiczkiewicz J, Łojewska K, Kawka E, Rutkowski R, Korybalska K. Predictors of Early-Recurrence Atrial Fibrillation after Catheter Ablation in Women and Men with Abnormal Body Weight. J Clin Med 2021; 10:jcm10122694. [PMID: 34207297 PMCID: PMC8235463 DOI: 10.3390/jcm10122694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022] Open
Abstract
Our study aimed to select factors that affect the rate of early recurrence (up to 3 months) of atrial fibrillation (AF) (ERAF) following pulmonary veins isolation (PVI) in obese women and men. The study comprised 114 patients: 54 women (age: 63.8 ± 6.3, BMI 31 ± 4 kg/m2), and 60 men (age: 60.7 ± 6.7; BMI 31 ± 3 kg/m2) with paroxysmal, persistent and long-standing persistent AF. They had been scheduled to undergo cryoballoon (men n = 30; women n = 30) and radiofrequency (RF) ablation (men n = 30; women n = 24) using the CARTO-mapping. The blood was collected at baseline and 24 h after ablation. The rate of ERAF was comparable after cryoballoon and RF ablation and constituted 18% in women and 22% in men. Almost 70 parameters were selected to perform univariate and multivariate analysis and to create a multivariate logistic regression (MLR) model of ERAF in the obese men and women. The MLR analysis was performed by forward stepwise logistic regression with three variables. It was only possible to create the MLR model for the group of obese men. It revealed a poor predictive value with an unsatisfactory sensitivity of 31%. Men with ERAF: smokers (OR 39.25, 95% CI 1.050-1467.8, p = 0.0021), with a higher ST2 elevation (OR 1.68, 95% CI 1.115-2.536, p = 0.0021) who received dihydropyridine calcium channel blockers (OR 0.042, 95% CI 0.002-1.071, p = 0.0021) less frequently. Our results indicate a complex pathogenesis of ERAF dependent on the patients' gender.
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Affiliation(s)
- Jan Budzianowski
- Department of Cardiology, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sól, Poland; (J.H.); (K.Ł.)
- Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland
- Correspondence:
| | - Jarosław Hiczkiewicz
- Department of Cardiology, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sól, Poland; (J.H.); (K.Ł.)
- Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Katarzyna Łojewska
- Department of Cardiology, Nowa Sól Multidisciplinary Hospital, 67-100 Nowa Sól, Poland; (J.H.); (K.Ł.)
| | - Edyta Kawka
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (E.K.); (R.R.); (K.K.)
| | - Rafał Rutkowski
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (E.K.); (R.R.); (K.K.)
| | - Katarzyna Korybalska
- Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznań, Poland; (E.K.); (R.R.); (K.K.)
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9
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Egami Y, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Tanaka A, Matsunaga-Lee Y, Yano M, Shutta R, Sakata Y, Nishino M, Tanouchi J. Novel Score to Predict Very Late Recurrences After Catheter Ablation of Atrial Fibrillation. Am J Cardiol 2021; 141:49-55. [PMID: 33217347 DOI: 10.1016/j.amjcard.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/29/2022]
Abstract
Various predictors of atrial fibrillation (AF) recurrence have been shown based on the baseline characteristics before catheter ablation (CA). This study aimed to develop a novel scoring system for predicting very late recurrences of AF (VLRAFs) after an initial CA, taking the postprocedural clinical data into account and reassessing VLRAFs in 12-month patients' condition using previously known preprocedural predictors of AF recurrences. We retrospectively studied 327 patients who underwent an initial CA with freedom from AF for over 12 months. We elucidated the predictors of VLRAFs and created a new score to predict VLRAFs in the discovery AF cohort (n = 181). Thereafter, we investigated whether the new scoring system could accurately predict VLRAFs in the validation AF cohort (n = 146). In the discovery AF cohort, VLRAFs were observed in 53 patients (29%) during the follow-up period (mean follow-up duration: 55 months). The univariate and multivariate Cox proportional-hazards model demonstrated that non-pulmonary vein foci, early recurrences of AF (ERAFs), atrial premature contraction (APC) burden ≥ 142/24 hours, and minimum prematurity index of the APCs ≤ 48% were associated with VLRAFs after CA. We created a new scoring system to predict VLRAFs, the n-PReDCt score (non-pulmonary vein: 1 point, early recurrences of AFs (Recurrences of AF in early phase after CA): 1 point, APC burden ≥ 142/24 hours: 1 point, and minimum prematurity index (= Coupling interval) of the APCs of ≤ 48%: 1 point). The n-PReDCt score was significantly associated with VLRAFs by a Kaplan-Meier analysis in the discovery AF and validation AF cohorts (p < 0.0001 and p < 0.0001, respectively).
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Affiliation(s)
- Yasuyuki Egami
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Kohei Ukita
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akito Kawamura
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hitoshi Nakamura
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yutaka Matsuhiro
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Koji Yasumoto
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Masaki Tsuda
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Naotaka Okamoto
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Akihiro Tanaka
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | | | - Masamichi Yano
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Ryu Shutta
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masami Nishino
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
| | - Jun Tanouchi
- Department of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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10
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Calkins H, Gache L, Frame D, Boo LM, Ghaly N, Schilling R, Deering T, Duytschaever M, Packer DL. Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period. Heart Rhythm 2020; 18:366-373. [PMID: 33242668 DOI: 10.1016/j.hrthm.2020.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recurrent arrhythmia following catheter ablation of atrial fibrillation (AF) may present early, during a standard 3-month blanking period. Early recurrence has been correlated to late recurrence, but the degree to which its absence predicts longer-term success has not been quantified. OBJECTIVE The purpose of this study was to explore and quantify the relationship between early and late arrhythmia recurrence, specifically the negative predictive value, that is, the degree to which absence of blanking period recurrence predicts absence of late recurrence. METHODS A systematic literature review and meta-analysis were conducted using statistical methods of a diagnostic test accuracy review. Studies of AF ablation using point-by-point radiofrequency, with repeated monitoring of arrhythmia recurrence including asymptomatic recurrence, and with separate data by AF type, were eligible. RESULTS Nine studies met the prespecified eligibility criteria. For paroxysmal AF, 89% (confidence interval [CI] 82%-94%) of patients free from early recurrence remained free from late recurrence. The estimate for persistent AF was similar (91%; CI 75%-97%). This finding was robust in sensitivity analyses. Patients with early recurrence had a wider range of likely outcomes with longer-term follow-up. CONCLUSION Freedom from AF recurrence during the blanking period is highly predictive of longer-term success in catheter ablation. Clinical trials in this area may be able to leverage these findings to more quickly assess the potential utility of new ablation technologies and methods, for example, by using early surrogate measures of success.
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Affiliation(s)
- Hugh Calkins
- Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Larry Gache
- Real World Evidence, CTI Clinical Trial and Consulting Services, Covington, Kentucky
| | - Diana Frame
- Real World Evidence, CTI Clinical Trial and Consulting Services, Covington, Kentucky
| | - Lee Ming Boo
- Clinical Science and External Research, Biosense Webster, Inc, Irvine, California
| | - Nader Ghaly
- Medical Affairs, Biosense Webster, Inc, Irvine, California
| | - Richard Schilling
- Department of Cardiology, St Bartholomew's Hospital, London, United Kingdom
| | - Thomas Deering
- Department of Cardiology, Piedmont Heart Institute, Atlanta, Georgia
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11
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Comparison of Amiodarone and Propafenone in Blanking Period after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation: A Propensity Score-Matched Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1835181. [PMID: 32685445 PMCID: PMC7335385 DOI: 10.1155/2020/1835181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/19/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022]
Abstract
Background Amiodarone and propafenone are commonly used to maintain sinus rhythm in patients with atrial fibrillation (AF). However, it is not known which one is better in reducing early recurrence (ER) during the blanking period (the first three months after catheter ablation). Objective To compare the efficacy and safety of amiodarone and propafenone in reducing ER during the blanking period after radiofrequency catheter ablation (RFCA) in AF patients. Materials and Methods A total of 694 patients who underwent their first RFCA between May 2014 and May 2018 were enrolled in this retrospective study. Subsequently, 202 patients were excluded according to the exclusion criteria. The remaining 492 patients were divided into two groups based on the choice of antiarrhythmic drugs (AADs) (amiodarone or propafenone) in the blanking period. The primary outcomes were incidence of ER and AAD-associated adverse effects during the blanking period after RFCA. Propensity score matching (PSM) analyses were used to compare the outcomes of the two groups while controlling for confounders. Results Among the 492 patients who took AADs in the blanking period (187 amiodarone and 305 propafenone), PSM selected 135 unique pairs of patients with similar characteristics. Amiodarone was associated with a lower ER incidence rate (23.7% versus 48.9%, p < 0.001) and a similar rate of AAD-associated adverse effects (2.1% versus 1.5%, p = 0.652). Treatment with amiodarone in the blanking period was significantly associated with a lower ER incidence rate compared to treatment with propafenone (HR = 0.416, 95% CI 0.272–0.637, p < 0.001). Conclusions Compared with propafenone, amiodarone was associated with a lower ER incidence rate, and they had similar rates of AAD-associated adverse effects. Treatment with amiodarone in the blanking period was shown to be more effective in reducing ER than propafenone.
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12
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Yang DY, Cheng ZW, Liu YT, Gao P, Chen TB, Deng H, Cheng KA, Fan JB, Fang Q. Noninvasive electrocardiography monitoring for very early recurrence predicts long-term outcome in patients after atrial fibrillation ablation. Ann Noninvasive Electrocardiol 2020; 25:e12785. [PMID: 32588512 PMCID: PMC7679836 DOI: 10.1111/anec.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia, and catheter ablation has been shown to be a highly effective treatment for patients with symptomatic AF. Very early recurrence (VER) of AF within 7 days after catheter ablation is common, but the clinical significance of VER remains unclear. We have examined the usefulness of the noninvasive electrocardiography monitor for the detection of VER and the relationship between VER and late recurrence (LR). Methods Eighty‐eight patients with paroxysmal or persistent atrial fibrillation were retrospectively included. All patients underwent primary catheter ablation at a large general hospital between March 2016 and August 2018. All patients were followed up in atrial fibrillation clinic at an interval of every 3 months for late recurrence of AF. VER was evaluated by one‐lead continuous noninvasive electrocardiography monitoring device for 7 days after ablation. The association between VER and LR was analyzed by univariate and multivariate Cox regression model. Results Mean age was 62.9 ± 9.7 years, and 39.8% were female. Thirty‐two patients (36.4%) experienced VER. After a mean follow‐up of 539.36 ± 211.66 days, 17 patients (19.3%) experienced LR. Multivariate Cox regression analysis revealed VER was an independent predictor of LR: HR 3.6 (95% CI, 1.2–10.8), p = .020. In addition, diabetes was also associated with LR of atrial fibrillation. Conclusions Noninvasive electrocardiography monitoring was a useful tool for detecting VER and VER after catheter ablation was associated with LR.
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Affiliation(s)
- De-Yan Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhong-Wei Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong-Tai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tai-Bo Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hua Deng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kang-An Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing-Bo Fan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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13
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Efremidis M, Letsas KP, Georgopoulos S, Karamichalakis N, Vlachos K, Lioni L, Bazoukis G, Saplaouras A, Sakellaropoulou A, Kolokathis AM, Rokiza A, Anagnostou A, Valkanas K, Sideris A. Safety, long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation. Acta Cardiol 2019; 74:319-324. [PMID: 30303043 DOI: 10.1080/00015385.2018.1494114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Data regarding long-term outcomes of atrial fibrillation (AF) catheter ablation are limited. This study evaluated the safety, long-term efficacy and predictors of recurrence after a single left atrial ablation procedure in patients with paroxysmal (PAF) and non-paroxysmal AF (NPAF). Methods: Data from 520 patients (354 males, mean age 57.08 ± 11.33 years) with PAF (n = 356, 68.5%) or NPAF (n = 164, 31.5%) who underwent a single radiofrequency ablation procedure were analysed. Across the NPAF group, there were 143 (27.5%) patients with persistent AF and 21 (4%) with long-standing persistent AF. The mean follow-up period was 39.05 ± 20.83 months (range 19-60 months). Results: Arrhythmia recurrence was observed in 102/356 (28.7%) of PAF patients and in 63/164 (38.4%) of NPAF patients. In patient with PAF, sinus rhythm maintenance was observed in 76.9%, 73% and 71.3% of patients at 1, 2 and 5 years of follow-up, respectively. In patients with NPAF, sinus rhythm was maintained in 68.7%, 63.4% and 61.6% of patients at 1, 2 and 5 years of follow-up, respectively. Independent predictors of AF recurrence were left atrial diameter (OR 1.15, 95% CI 1.10-1.21, p < 0.01) as well as early arrhythmia recurrence during the blanking period of 3 months after the procedure (OR 8.13, 95% CI 5.10-12.82, p < 0.01). Major complications were observed in 11 patients (2.1%). Conclusions: Long-term arrhythmia-free survival rates remain high among PAF and NPAF patients after a single catheter ablation procedure. Left atrial diameter and early arrhythmia recurrence were independent predictors of late arrhythmia recurrence in both PAF and NPAF patients.
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Affiliation(s)
- Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Stamatis Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Nikolaos Karamichalakis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Louiza Lioni
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Antigoni Sakellaropoulou
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Angelos Michael Kolokathis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Aikaterini Rokiza
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Aikaterini Anagnostou
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Kosmas Valkanas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Antonios Sideris
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
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14
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Tokuda M, Yamashita S, Matsuo S, Kato M, Sato H, Oseto H, Okajima E, Ikewaki H, Yokoyama M, Isogai R, Tokutake K, Yokoyama K, Narui R, Tanigawa SI, Yoshimura M, Yamane T. Clinical significance of early recurrence of atrial fibrillation after cryoballoon vs. radiofrequency ablation-A propensity score matched analysis. PLoS One 2019; 14:e0219269. [PMID: 31265482 PMCID: PMC6605651 DOI: 10.1371/journal.pone.0219269] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives One of the mechanisms of early recurrence of atrial fibrillation (ERAF) after AF ablation is considered to be the inflammatory reaction of the atrial tissue. The aim of this study is to compare the clinical significance of ERAF at each stage for true AF recurrence between cryoballoon (CB) and radiofrequency (RF) ablation. Methods Among 798 paroxysmal AF patients who underwent an initial ablation, 460 patients (CB, n = 230; RF, n = 230) were selected by propensity score matching. Very ERAF (VERAF), ERAF-1M, ERAF-3M and true AF recurrence were defined as AF recurrence at 0–2, 3–30, 31–90 days and more than 90 days after the procedure, respectively. Results The patient characteristics of the two groups were similar. ERAF was observed 21% and 27% in the CB and RF groups, respectively. In both the CB and RF group, VERAF, ERAF-1M and ERAF-3M were more frequently observed in patients with true AF recurrence than in those without. In a multivariable analysis, ERAF-1M and ERAF-3M were found to be independent predictors of true AF recurrence in both the CB (P = 0.04 and P<0.001, respectively) and RF groups (P = 0.02 and P = 0.001, respectively). However, while VERAF was associated with true AF recurrence after RF ablation (P = 0.03), it was not associated with true AF recurrence after CB ablation (P = 0.19). Conclusion The relationship between ERAF and true AF recurrence differed between the RF and CB ablation groups. While VERAF was associated with true AF recurrence after RF ablation, it was not a predictor of true AF recurrence after CB ablation.
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Affiliation(s)
- Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidenori Sato
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotsuna Oseto
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Eri Okajima
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidetsugu Ikewaki
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masaaki Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin-ichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, Tokyo, Japan
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15
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Lee WC, Lee YW, Fang HY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC. Common pulmonary vein on the recurrence of atrial tachyarrhythmia after pulmonary vein isolation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:882-889. [PMID: 31049997 DOI: 10.1111/pace.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023]
Abstract
AIMS Catheter ablation has become an effective treatment modality for atrial fibrillation (AF). However, the relationship between common pulmonary vein (PV) and recurrent atrial tachyarrhythmia (ATA) after PV isolation (PVI) remains controversial. This study aimed to explore the function of common PV on the risk of recurrent ATA after PVI. METHODS We identified a total of 191 patients who received radiofrequency catheter ablation for paroxysmal AF at our hospital between July 2010 and December 2017 for retrospective chart review. We collected the following data for analysis: results of preprocedural computed tomography, including the anatomy of PV and left atrial (LA) volume; the incidence of early- and late-onset recurrence of ATA. We compared these characteristics between the two groups defined by the presence or absence of the late-onset recurrence of ATA. RESULTS Compared to the no ATA recurrence group, the ATA recurrence group had larger LA size, larger LA end-diastolic and systolic volumes, larger maximal diameter of PV, higher prevalence of common PV, and higher incidence of early-onset recurrence of ATA. In multivariate logistic regression analyses, presence of common PV and early-onset recurrence were independently associated with late-onset recurrence of ATA. Compared to patients without common PV, patients with common PV had larger diameter of PV and higher incidence of late-onset recurrent ATA. CONCLUSION In patients with paroxysmal AF, early-onset recurrence of ATA and the presence of common PV were independently associated with late-onset recurrent ATA after radiofrequency catheter ablation.
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Affiliation(s)
- Wei-Chieh Lee
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Wei Lee
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mien-Cheng Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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16
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Yin J, Yang M, Yu S, Fu H, Huang H, Yang B, Liu Y, He B, Bao M, Wu G, Lu Z, Liu H, Liu X, Dong L, Huang C, Zhao Q. Effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after pulmonary vein electrical isolation in patients with persistent atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:910-917. [PMID: 30907035 DOI: 10.1111/jce.13924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Early atrial fibrillation (AF) recurrences are common and have been shown to predict AF recurrences late after AF ablation during follow-up. Neiguan point acupuncture has been recognized to be therapeutic in treating AF in clinical practice. METHODS AND RESULTS Eighty-five patients were enrolled in succession due to persistent AF. All patients were randomized divided into control group and acupuncture group. In the control group (n = 45), amiodarone was orally taken from the first day after pulmonary vein isolation (PVI). In the acupuncture group (n = 40), patients were treated with Neiguan point acupuncture for 7 days and amiodarone was prescribed as same as the control group after PVI. The levels of inflammatory factors were analyzed before operation, 1 week after the operation and 3 months later. After 3 months, the acupuncture group had a lower rate of early recurrences than the control group (5/40 [12.5%] vs 15/45 [33.3%], P = 0.039). The inflammatory factors level in the two groups were significantly increased after ablation. However, compared with the control group, the levels of TNF-α, IL-6, CRP, TGF-β1, MMP2 in the acupuncture group significantly lower (P < 0.05). In a multivariate analysis, acupuncture was an independent factor associated with a lower rate of early recurrences during the blanking period (odds ratio, 0.17; 95% confidence interval, 0.05-0.63; P = 0.008). CONCLUSION Neiguan point acupuncture combined with amiodarone is superior to amiodarone alone in reducing early recurrences of patients with persistent AF after PVI. The efficacy of Neiguan acupuncture therapy on the early recurrence is associated with the decreased inflammation factors.
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Affiliation(s)
- Junkui Yin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Mei Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Shengbo Yu
- Department of Cardiology, Weihai Municipal Hospital, Weihai, Henan
| | - Haixia Fu
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Henan Provincial Peoples Hospital, Zhengzhou, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Yu Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Mingwei Bao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Gang Wu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Huangfen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Libin Dong
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
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17
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Wang Y, Xu Y, Ling Z, Chen W, Su L, Du H, Xiao P, Liu Z, Yin Y. Radiofrequency catheter ablation for paroxysmal atrial fibrillation: outcomes during a 3-year follow-up period. J Int Med Res 2019; 47:1636-1648. [PMID: 30803295 PMCID: PMC6460609 DOI: 10.1177/0300060519828522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective This study was performed to observe the effect of radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and to explore the risk factors for late recurrence of atrial fibrillation (LRAF) after a single RFCA session. Methods In this retrospective study, 243 patients with PAF underwent RFCA and were followed up regularly. Results At a median follow-up of 37 months after a single procedure, 60.5% of patients maintained sinus rhythm (SR), and at a median follow-up of 42 months after multiple procedures, 74.9% of patients maintained SR. The statistically significant risk factors for LRAF after a single RFCA session were the left atrial diameter (LAD), left inferior pulmonary vein superior–inferior diameter (LIPV SID), PV number variation, circumferential pulmonary vein isolation (CPVI) combined with additional ablation, and early recurrence of atrial fibrillation (ERAF). The best cut-off value for LAD was 35.5 mm. Conclusions During a 3-year follow-up, about 70% of the patients with PAF maintained SR. LRAF after a single procedure was associated with the LAD, LIPV SID, PV number variation, CPVI combined with additional ablation, and ERAF.
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Affiliation(s)
- Yubing Wang
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China.,2 Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Yanping Xu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zhiyu Ling
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Weijie Chen
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Li Su
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Huaan Du
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Peilin Xiao
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zengzhang Liu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Yuehui Yin
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
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Allam LE, Moteleb AMAE, Ghanem MT. Predictors of Short and Long Term Recurrences of Paroxysmal AF after Radiofrequency Ablation. Is Blanking Period Really Benign? J Atr Fibrillation 2018; 11:2012. [PMID: 31139279 DOI: 10.4022/jafib.2012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/19/2017] [Accepted: 09/12/2018] [Indexed: 11/10/2022]
Abstract
Background Following pulmonary vein isolation for paroxysmal atrial fibrillation (PAF), early recurrences of atrial arrhythmias (ERAA) are frequent, classified benign as a part of a blanking period. But recently it seems that there is increased incidence of late recurrences in patients with ERAA but mechanism is still unknown. Purpose To assess the incidence and risk factors for early and late AF recurrences post AF ablation and the impact of these ERAA on long-term success. Methods Thirty-six consecutive patients (age 45 ± 11 years, 72% males) undergoing RF ablation for PAF. They were followed up in hospital for 2 days post ablation then every week for one month. Subsequent follow-up visits consisted of clinical interview, ECGs, and 24h Holter monitoring every 3 months were done for one year. Extended Holter monitoring was done for patients with palpitations. Any episode of symptomatic or asymptomatic documented atrial tachyarrhythmia > 30 seconds was considered recurrence. Results Prevalence of ERAA during first 3 months was 47.2%, while late AF recurrence was 25%. 35% of patients with ERAA had late AF recurrence. ≥ 2 attacks of ERAA during the blanking period had significant diagnostic performance in prediction of late AF with sensitivity 44% and specificity 100% (p value=0.05) and also long procedural time ( with sensitivity 89% and specificity 63% (p value=0.049). Multivariate logistic regression showed that frequent ERAA attacks was the only significant factor that increases the risk of late AF recurrence (p value =0.008, OR= 4.39, 95% CI=1.48-12.99). Conclusion ERAA in blanking period may be associated with increased risk for late AF recurrence. Frequent episodes of early recurrences (≥ 2 attacks) is a strong predictor for late AF recurrence. These data should be considered during follow up of the patients with paroxysmal AF after ablation.
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Murase Y, Inden Y, Imai H, Kyo S, Yanagisawa S, Fujii A, Sakamoto Y, Tomomatsu T, Murohara T. Clinical significance of the timing of early recurrence of atrial arrhythmia after pulmonary vein isolation: a two-institution clinical study. Heart Vessels 2018; 34:842-850. [PMID: 30390124 DOI: 10.1007/s00380-018-1295-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/26/2018] [Indexed: 11/28/2022]
Abstract
Early recurrence of atrial arrhythmia (ERAA) after ablation frequently occurs, but there is limited evidence about ERAA-timing. This study aimed to investigate the association between ERAA-timing and late recurrence. We retrospectively investigated 332 patients who underwent PVI for paroxysmal atrial fibrillation at Nagoya University Hospital and Komaki City Hospital. Seventy-six patients (23%) had ERAA. The cutoff value of the first ERAA for late recurrence was set as 3 days, with a specificity of 77% and sensitivity of 43%. On multivariate analysis, first ERAA beyond 3 days (hazard ratio, 2.477; 95% confidence interval, 1.168-5.25; p = 0.018) and large left atrial diameter (LAD) (hazard ratio, 1.101; 95% confidence interval, 1.024-1.184; p = 0.009) were independent predictors for late recurrence. Patients who had first ERAA within 3 days and no ERAA beyond 3 days showed a significantly higher recurrence-free rate than those who had first ERAA beyond 3 days and those who had ERAA both within 3 days and beyond 3 days (89% versus 39%, 44%; p < 0.001). Moreover, the patients with ERAA within 3 days and LAD ≤ 37.7 mm showed a significantly higher recurrence-free rate than those with ERAA beyond 3 days and LAD > 37.7 mm, and as compared with the other patients (100% versus 26% and 60%, respectively; p < 0.001). ERAA beyond 3 days after ablation was a predictor for late recurrence. Among patients with ERAA, those with ERAA within 3 days and smaller LAD showed favorable prognosis after ablation.
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Affiliation(s)
- Yosuke Murase
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Hajime Imai
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Seifuku Kyo
- Department of Cardiology, Komaki City Hospital, 1-20 Joubushi, Komaki, Aichi, 485-8520, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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20
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Deng H, Shantsila A, Xue Y, Potpara TS, Bai Y, Zhan X, Fang X, Liao H, Wei W, Wu S, Lip GYH. Using the MB-LATER score for predicting arrhythmia outcome after catheter ablation for atrial fibrillation: The Guangzhou atrial fibrillation project. Int J Clin Pract 2018; 72:e13247. [PMID: 30144238 DOI: 10.1111/ijcp.13247] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Several clinical scoring systems have been derived to predict the arrhythmia outcome of catheter ablation (CA) for atrial fibrillation (AF) but which is better is not clear. Simple clinical risk scores (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following CA and the simple MB-LATER score has recently been described. We compare the predictive ability of seven existing clinical scoring systems (HATCH, CHADS2 , CHA2 DS2 -VASc, BASE-AF2 , APPLE, CAAP-AF, and MB-LATER) in a Chinese cohort of AF patients undergoing CA. METHODS AND RESULTS 1410 patients (mean age 57.2 ± 11.6 years; 68% male) with AF undergoing CA during 2011-2015 were enrolled in final analysis. Symptoms, 12 lead ECG and Holter ECGs were recorded before discharge, and at 1, 3, 6 months, and every 6 months thereafter to detect the arrhythmia relapse. During a mean 20.7 ± 8.8-month follow-up, recurrence occurred in 365 patients(25.9%). All tested scores were predictors of AF recurrence with areas under the curve (AUCs) of 0.58, 0.57, 0.57, 0.75, 0.74, 0.71, and 0.73 respectively (all P < 0.01). Compared to all other scores, the MB-LATER score showed improved reclassification (NRI range 30%-82.6%, P < 0.01) and discrimination indexes (IDI range 2.6%-18.6%, all P < 0.01) in predicting AF recurrence. CONCLUSION Based on net reclassification and discrimination analysis, the MB-LATER score performed best for predicting AF recurrent postablation, in a large "all comers" Chinese cohort. This simple clinical risk score (that any clinician can use in the everyday clinic) can help assess the likelihood of recurrence of AF following catheter ablation.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Alena Shantsila
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ying Bai
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianhong Fang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Wei
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gregory Y H Lip
- Institute of Cardiovascular Science, University of Birmingham, Birmingham, UK
- 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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21
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Yubing W, Yanping X, Zhiyu L, Weijie C, Li S, Huaan D, Peilin X, Zengzhang L, Yuehui Y. Long-term outcome of radiofrequency catheter ablation for persistent atrial fibrillation. Medicine (Baltimore) 2018; 97:e11520. [PMID: 30024535 PMCID: PMC6086529 DOI: 10.1097/md.0000000000011520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Catheter ablation has been wildly used to treat atrial fibrillation (AF) and has achieved a better efficacy for paroxysmal AF (PAF) but not for persistent AF (PerAF). Furthermore, a few data on the efficacy and safety of catheter ablation for PerAF were reported. This study aimed to investigate long-term efficacy of radiofrequency catheter ablation (RFCA) for PerAF and explore predictors of late recurrence of atrial fibrillation (LRAF).A total of 92 consecutive patients with PerAF (64 males, aged 56.42 ± 11.24 years) were enrolled in this study and accepted circumferential pulmonary vein isolation (CPVI) alone or CPVI combined additional ablation.Maintenance rate of sinus rhythm (SR) was 40.2% after a single procedure with median follow-up of 15 months and 52.2% after mean 1.3 ± 0.6 procedures with median follow-up of 26 months. Long-term SR maintenance rate was no statistical difference between patients with CPVI alone and with CPVI combined additional ablation (48.6% vs 35.1%, log rank test, P = .152). Patients with AF duration < 24 months had a higher long-term SR maintenance rate than those with AF duration ≥ 24 months (55.6% vs 30.4%, log rank test, P = .022). AF duration (OR = 1.015, 95%CI 1.001-1.030, P = .015), and early recurrence of AF (ERAF) (OR = 10.654, 95%CI 3.853-29.460, P < .001) were predictors of LRAF after a single procedure.In conclusion, long-term maintenance SR rate was 52.2% in patients with PerAF after multiple procedures with a median over 2-year follow-up. Patients with AF duration < 24 months had better outcome. AF duration and ERAF were predictors of LRAF after a single procedure.
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Affiliation(s)
- Wang Yubing
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
- Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Xu Yanping
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Ling Zhiyu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Chen Weijie
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Su Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Du Huaan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Xiao Peilin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Liu Zengzhang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Yin Yuehui
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
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Jin X, Pan J, Wu H, Xu D. Are left ventricular ejection fraction and left atrial diameter related to atrial fibrillation recurrence after catheter ablation?: A meta-analysis. Medicine (Baltimore) 2018; 97:e10822. [PMID: 29768386 PMCID: PMC5976293 DOI: 10.1097/md.0000000000010822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/28/2018] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF), the most common form of arrhythmia, is associated with the prevalence of many common cardiovascular and cerebrovascular diseases. Catheter ablation is considered the first-line therapy for AF; however, AF recurrence is very common after catheter ablation. Studies have been performed to analyze the factors associated with AF recurrence, but none have reached a consistent conclusion on whether left ventricular ejection fraction (LVEF) and left atrial diameter (LA diameter) affect AF recurrence after catheter ablation.The databases PubMed, Embase, and the Cochrane Library were used to search for relevant studies up to September 2017. RevMan 5.3.5 software provided by the Cochrane Collaboration Network was used to conduct this meta-analysis.Thirteen studies involving 2825 patients were included in this meta-analysis. Overall, the results revealed that elevated LA diameter values were significantly associated with AF recurrence in patients after catheter ablation (MD = 2.19, 95% CI: 1.63-2.75, P < .001), while baseline LVEF levels were not significantly positively associated with AF recurrence in patients after catheter ablation (MD = -0.91, 95% CI: -1.18 to 1.67, P = .14).Overall, elevated LA diameter may be associated with AF recurrence after catheter ablation; however, there was no direct relationship between LVEF values and AF recurrence after catheter ablation when baseline LVEF values are normal or mildly decreased. Besides, because of publication bias, further studies should be performed to explore the mechanisms underlying AF recurrence.
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Affiliation(s)
- Xiao Jin
- Second School of Clinical Medicine, Guangzhou Univ Chinese Med
| | - Jianke Pan
- Department of Orthopedics, Second Affiliated Hospital of Guangzhou Univ Chinese Med (Guangdong Provincial Hospital of Chinese Medicine)
| | - Huanlin Wu
- Second School of Clinical Medicine, Guangzhou Univ Chinese Med
- Beijing University of Chinese Medicine, Beijing, China
| | - Danping Xu
- Department of Cardiology, Second Affiliated Hospital of Guangzhou Univ Chinese Med (Guangdong Provincial Hospital of Chinese Medicine)
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23
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Bazoukis G, Letsas KP, Tse G, Naka KK, Korantzopoulos P, Ntzani E, Vlachos K, Saplaouras A, Pagkalidou E, Michalis LK, Sideris A, Efremidis M. Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation. Clin Cardiol 2018; 41:63-67. [PMID: 29356016 PMCID: PMC6489697 DOI: 10.1002/clc.22850] [Citation(s) in RCA: 8] [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: 09/08/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long-term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF. HYPOTHESIS We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure. METHODS Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow-up post-ablation. RESULTS The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow-up period of 38.2 months (range, 5-92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence. CONCLUSIONS The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow-up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.
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Affiliation(s)
- George Bazoukis
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Konstantinos P. Letsas
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongSARP.R. China
| | - Katerina K. Naka
- Second Department of CardiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | | | - Evangelia Ntzani
- Department of Hygiene and EpidemiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | - Konstantinos Vlachos
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Athanasios Saplaouras
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Eirini Pagkalidou
- Department of Hygiene and Epidemiology, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Lampros K. Michalis
- Director of the Second Department of CardiologyUniversity of Ioannina, School of MedicineIoanninaGreece
| | - Antonios Sideris
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
| | - Michael Efremidis
- Department of Cardiology, Electrophysiology LaboratoryEvangelismos General Hospital of AthensAthensGreece
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24
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Deng H, Bai Y, Shantsila A, Fauchier L, Potpara TS, Lip GYH. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clin Res Cardiol 2017; 106:813-823. [PMID: 28560516 PMCID: PMC5613037 DOI: 10.1007/s00392-017-1123-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 11/01/2022]
Abstract
Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation. Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Ying Bai
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Beijing Tongren Hospital, Capital University, Beijing, China
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK.
- School of Medicine, Belgrade University, Belgrade, Serbia.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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25
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FUJIMOTO YUHI, HAYASHI MEISO, IWASAKI YUKI, YODOGAWA KENJI, YAMAMOTO TEPPEI, TSUBOI IPPEI, TAKAHASHI KENTA, IZUMI YUKI, OKA EIICHIRO, HAGIWARA KANAKO, MIYAUCHI YASUSHI, SHIMIZU WATARU. Blanking Period Phenomenon After a Second Atrial Fibrillation Ablation Session: The Application and Factors Related to It. J Cardiovasc Electrophysiol 2016; 28:159-166. [DOI: 10.1111/jce.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/28/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- YUHI FUJIMOTO
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - MEISO HAYASHI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - YU-KI IWASAKI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - KENJI YODOGAWA
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - TEPPEI YAMAMOTO
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - IPPEI TSUBOI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - KENTA TAKAHASHI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - YUKI IZUMI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - EIICHIRO OKA
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - KANAKO HAGIWARA
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - YASUSHI MIYAUCHI
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
| | - WATARU SHIMIZU
- Department of Cardiovascular Medicine; Nippon Medical School; Tokyo Japan
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26
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Yanagisawa S, Inden Y, Kato H, Fujii A, Mizutani Y, Ito T, Kamikubo Y, Kanzaki Y, Ando M, Hirai M, Shibata R, Murohara T. Effect and Significance of Early Reablation for the Treatment of Early Recurrence of Atrial Fibrillation After Catheter Ablation. Am J Cardiol 2016; 118:833-841. [PMID: 27453516 DOI: 10.1016/j.amjcard.2016.06.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 01/07/2023]
Abstract
There are few reports on early reablation (ER) for early recurrence of atrial fibrillation (AF) after catheter ablation. The present study evaluated the efficacy and significance of ER for early recurrence within a blanking period of 3 months after ablation of both paroxysmal and persistent AF, using a propensity-matched analysis. Of 874 patients who underwent catheter ablation of AF, 389 (45%) had early recurrence. Of these, 78 patients underwent an ER procedure. A total of 132 matched patients (66 in the ER and 66 in the non-ER groups, 82 patients with paroxysmal AF) were included in the analysis. During a mean follow-up of 15.4 months, the patients who underwent ER had a significantly lower recurrence rate than those who did not (29 [44%] vs 42 patients [64%], p = 0.023). The benefit of ER was especially apparent in patients with paroxysmal AF (p = 0.008) but not in those with persistent AF (p = 0.774). However, 24 patients (36%) in the non-ER group did not experience recurrence after a blanking period without any reablation procedure. The total number of reablation sessions was higher in the ER group than in the non-ER group (1.2 ± 0.5 vs 0.4 ± 0.6, p <0.001). Nonetheless, mean number of arrhythmia outpatient clinic visits at follow-up was significantly fewer in the ER group than in the late reablation group. In conclusion, ER for early recurrence of AF after catheter ablation might be effective for preventing recurrence during follow-up, especially for paroxysmal AF.
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27
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MIYAZAKI SHINSUKE, HACHIYA HITOSHI, NAKAMURA HIROAKI, TANIGUCHI HIROSHI, TAKAGI TAKAMITSU, HIRAO KENZO, IESAKA YOSHITO. Pulmonary Vein Isolation Using a Second-Generation Cryoballoon in Patients With Paroxysmal Atrial Fibrillation: One-Year Outcome Using a Single Big-Balloon 3-Minute Freeze Technique. J Cardiovasc Electrophysiol 2016; 27:1375-1380. [DOI: 10.1111/jce.13078] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/08/2016] [Accepted: 08/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- SHINSUKE MIYAZAKI
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - HITOSHI HACHIYA
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - HIROAKI NAKAMURA
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - HIROSHI TANIGUCHI
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - TAKAMITSU TAKAGI
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - KENZO HIRAO
- Heart Rhythm Center; Tokyo Medical and Dental University; Tokyo Japan
| | - YOSHITO IESAKA
- Cardiology Division, Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
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Yao Y, Yao W, Bai R, Lu ZH, Tang RB, Long DY, Jiang CX, Sang CH, Zhang JQ, Yu RH, Du X, Liu XH, Dong JZ, Ma CS. Plasma homocysteine levels predict early recurrence after catheter ablation of persistent atrial fibrillation. Europace 2016; 19:66-71. [PMID: 27194539 DOI: 10.1093/europace/euw081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/26/2016] [Indexed: 12/24/2022] Open
Abstract
AIMS To assess the association and the predictive value of plasma homocysteine (Hcy) with early recurrence in persistent atrial fibrillation patients after a single ablation procedure. METHODS AND RESULTS Two hundred and fifty-seven consecutive patients with persistent atrial fibrillation who underwent successful catheter ablation were enrolled. Early recurrence of atrial tachyarrhythmia was documented within 3 months after ablation. The logistic regression analysis and Kaplan-Meier curve analysis were used to evaluate the association of Hcy with early recurrence. During the 3-month follow-up, 75 (29.2%) patients experienced recurrence. Patients with early recurrence were older, more likely to have larger left atrial diameter and higher CHA2DS2-VASc score (all P< 0.001). Plasma Hcy levels were significantly elevated in patients with early recurrence compared with those without early recurrence (15.1 ± 4.1 vs. 12.4 ± 3.7 µmol/L, P< 0.001). In multivariate analysis, Hcy was significantly associated with early recurrence (OR 1.188, 95% CI 1.097-1.286, P< 0.001). Hcy demonstrated a predictive value with AUC of 0.688 (95% CI 0.623-0.753, P< 0.001). The optimal cut-off value was 14 µmol/L for Hcy (sensitivity 69%, specificity 59%). Patients with Hcy ≥14 µmol/L had higher early recurrence rate compared with those with Hcy <14 µmol/L (41 vs. 22%, P= 0.006). CONCLUSION Plasma Hcy levels are associated with early recurrence of atrial tachyarrhythmia after catheter ablation in persistent atrial fibrillation patients, thus it should be taken into account in prediction of early recurrence.
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Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Wei Yao
- Department of Cardiology, Suizhou Hospital, Hubei University of Medicine, Hubei, P.R. China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhen-Hua Lu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Jian-Qiang Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Xiao-Hui Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China
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Hayashi K, Fukunaga M, Yamaji K, An Y, Nagashima M, Hiroshima K, Ohe M, Makihara Y, Yamashita K, Ando K, Iwabuchi M, Goya M. Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome - Important Role of Non-Pulmonary Vein Foci. Circ J 2016; 80:887-94. [PMID: 26936115 DOI: 10.1253/circj.cj-15-1384] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical efficacy of catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) and the mechanism and predictors of recurrence are not yet completely elucidated. METHODS AND RESULTS Of 963 consecutive patients who underwent PAF ablation during the study period, a total of 108 patients with SSS (SSS group) and 108 matched controls without SSS (non-SSS group) were followed up. During the follow-up period (mean, 32.8±17.5 months), the SSS group had significantly higher AF recurrence rate since the last procedure than the non-SSS group (26.9% vs. 12.0%; P=0.02). The SSS group had significantly higher prevalence of non-pulmonary vein (non-PV) foci than the non-SSS group (25.9% vs. 13.9%; P=0.027). On multivariate analysis congestive heart failure (HR, 13.7; 95% CI: 1.57-119; P=0.02) and non-PV foci (HR, 5.75; 95% CI: 1.69-19.6; P=0.005) were independent predictors of recurrence following CA in the SSS group. In the SSS group, 88 patients had bradycardia-tachycardia syndrome without prior permanent pacemaker implantation. Of these, 6 required pacemaker implantation because of AF and sinus pause recurrence. CONCLUSIONS Patients with SSS are at higher risk of AF recurrence after CA. Non-PV foci are associated with AF recurrence following PAF with SSS.
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Yanagisawa S, Inden Y, Kato H, Miyoshi A, Mizutani Y, Ito T, Kamikubo Y, Kanzaki Y, Hirai M, Murohara T. Elevated Red Blood Cell Distribution Width Predicts Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Heart Failure - Comparison With Non-Heart Failure Patients. Circ J 2016; 80:627-38. [PMID: 26823143 DOI: 10.1253/circj.cj-15-1152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Elevated red blood cell distribution width (RDW) predicts poor prognosis in patients with cardiovascular diseases. However, little is known about the association between RDW and outcomes after catheter ablation of atrial fibrillation (AF). METHODS AND RESULTS A total of 757 patients who underwent radiofrequency catheter ablation of AF were divided into heart failure (HF, n=79) and non-HF (n=678) groups; RDW was assessed as a predictor after catheter ablation in each. During a 22.3-month follow-up period, the baseline RDW in the HF group was greater in the recurrence group than in the non-recurrence group (14.5±2.0% vs. 13.5±0.9%, P=0.013). In contrast, no significant difference in RDW at baseline was found in the non-HF group between the recurrence and non-recurrence groups (13.3±0.8% vs. 13.2±0.8%, P=0.332, respectively). Multivariate analysis demonstrated that RDW (hazard ratio 1.20, 95% confidence interval 1.01-1.40, P=0.034) was an independent predictor of AF recurrence in the HF group. The cut-off values of RDW for the recurrence of AF and major adverse events in the HF group were 13.9% and 14.8%, respectively. CONCLUSIONS High RDW is an independent predictor for the recurrence of AF and major adverse events in patients with HF after catheter ablation. RDW is a potential noninvasive marker in AF patients complicated with HF. (Circ J 2016; 80: 627-638).
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Miyazaki S, Kuroi A, Hachiya H, Nakamura H, Taniguchi H, Ichihara N, Takagi T, Iwasawa J, Iesaka Y. Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies - Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation. Circ J 2015; 80:346-53. [PMID: 26638872 DOI: 10.1253/circj.cj-15-1051] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammation plays a prominent role in the etiology of the early recurrence of atrial fibrillation (ERAF). We prospectively compared the proportion of ERAF and time-course patterns of biomarkers between radiofrequency (RF) and cryoballoon (CB) ablation. METHODS AND RESULTS We enrolled 82 consecutive paroxysmal AF patients undergoing pulmonary vein (PV) isolation, performed with either a 28-mm 2nd-generation CB and 3-min freeze technique or point-by-point RF ablation. Each group had 41 patients. In the RF group, all PVs were successfully isolated with 28.9 ± 6.5 min of RF delivery. In the CB group, a mean of 5.3 ± 1.4 applications/patient was delivered. The proportion of ERAF was similar between the groups. The time-course patterns significantly differed between the groups for high-sensitivity C-reactive protein (hs-CRP) value (P=0.006) and myocardial injury markers (P<0.0001). Greater myocardial injury was observed in the CB than in the RF group (P<0.0001), whereas the peak hs-CRP value was comparable between the groups. The 2-day post-procedure hs-CRP value was the sole factor correlating with ERAF as identified by the multivariable analysis (hazard ratio 1.697; 95% confidence interval, 1.005-2.865; P=0.048) in the RF, but not the CB group. CONCLUSIONS The proportion of ERAF was comparable after RF and 2nd-generation CB ablation. Despite CB ablation exhibiting greater myocardial injury than RF ablation, the inflammatory responses were comparable between the groups. The inflammatory response extent predicted ERAF post-RF ablation but not post-CB ablation.
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Affiliation(s)
- Shinsuke Miyazaki
- Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital
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