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Cho MS, Lee JH, Nam GB, Hwang KW, Cha MJ, Kim J, Choi KJ. Comparison between catheter ablation versus permanent pacemaker implantation as an initial treatment for tachycardia-bradycardia syndrome patients: a prospective, randomized trial. BMC Cardiovasc Disord 2024; 24:246. [PMID: 38730404 PMCID: PMC11088091 DOI: 10.1186/s12872-024-03920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Clinical outcomes after catheter ablation (CA) or pacemaker (PM) implantation for the tachycardia-bradycardia syndrome (TBS) has not been evaluated adequately. We tried to compare the efficacy and safety outcomes of CA and PM implantation as an initial treatment option for TBS in paroxysmal atrial fibrillation (AF) patients. METHODS Sixty-eight patients with paroxysmal AF and TBS (mean 63.7 years, 63.2% male) were randomized, and received CA (n = 35) or PM (n = 33) as initial treatments. The primary outcomes were unexpected emergency room visits or hospitalizations attributed to cardiovascular causes. RESULTS In the intention-to-treatment analysis, the rates of primary outcomes were not significantly different between the two groups at the 2-year follow-up (19.8% vs. 25.9%; hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.25-2.20, P = 0.584), irrespective of whether the results were adjusted for age (HR 1.12, 95% CI 0.34-3.64, P = 0.852). The 2-year rate of recurrent AF was significantly lower in the CA group compared to the PM group (33.9% vs. 56.8%, P = 0.038). Four patients (11.4%) in the CA group finally received PMs after CA owing to recurrent syncope episodes. The rate of major or minor procedure related complications was not significantly different between the two groups. CONCLUSION CA had a similar efficacy and safety profile with that of PM and a higher sinus rhythm maintenance rate. CA could be considered as a preferable initial treatment option over PM implantation in patients with paroxysmal AF and TBS. TRIAL REGISTRATION KCT0000155.
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Affiliation(s)
- Min Soo Cho
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Hyun Lee
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Korea
| | - Myung-Jin Cha
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jun Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee-Joon Choi
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Morishima I, Kanzaki Y, Morita Y, Inoue K, Kobori A, Kaitani K, Kurotobi T, Yamaji H, Matsui Y, Nakazawa Y, Kusano K, Tomomatsu T, Ikai Y, Furui K, Yamauchi R, Miyazawa H, Tanaka N, Morimoto T, Kimura T, Shizuta S. Catheter Ablation for Paroxysmal Atrial Fibrillation With Sick Sinus Syndrome: Insights From the Kansai Plus Atrial Fibrillation Registry. Heart Lung Circ 2023; 32:205-214. [PMID: 36274004 DOI: 10.1016/j.hlc.2022.09.007] [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: 06/11/2022] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Coexisting sick sinus syndrome (SSS) is associated with both electrical and structural atrial remodelling in patients with atrial fibrillation (AF). Limited data are available concerning catheter ablation (CA) for AF in this condition. This study investigated the efficacy of CA as a curative therapy for AF and SSS in a large-scale prospective multicentre registry. METHODS The Kansai Plus Atrial Fibrillation (KPAF) registry enrolled 5,010 consecutive patients who underwent CA for AF; this included 3,133 patients with paroxysmal AF (mean age, 66 years; male, 69.3%; mean CHA2DS2-VASc score, 2.05±1.50; SSS, n=315 [tachy-brady syndrome, n=285]). The endpoints included the recurrence of AF with a blanking period of 90 days after CA, and de novo pacemaker implantation during the follow-up period (median duration, 2.93 years). RESULTS The AF-free survival did not significantly differ between patients with and those without SSS (n=2,818) after the initial (log-rank p=0.864) and final sessions (log-rank p=0.268). Pacemakers were implanted in 48 patients with SSS, and implantation in this group was significantly associated with AF recurrence, including early recurrence (adjusted odds ratio, 3.57; 95% confidence interval, 1.67-7.64; p=0.002). The remaining 85.3% of patients with SSS did not require pacemaker implantation at 3 years after CA. CONCLUSIONS Coexisting SSS did not adversely affect recurrence-free survival after CA for paroxysmal AF. Pacemaker implantation was not required in most patients with SSS, with AF recurrence serving as a strong predictor for this.
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Affiliation(s)
- Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Otsu Red Cross Hospital, Otsu, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Nanba Kurotobi Heart Clinic, Osaka, Japan
| | | | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Heart Rhythm Center, Shiga University of Medical Science, Shiga, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Yoshihiro Ikai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kataoka S, Ejima K, Yazaki K, Kanai M, Yagishita D, Shoda M, Hagiwara N. Impact of atrial fibrillation ablation on long-term outcomes in patients with tachycardia-bradycardia syndrome. J Arrhythm 2022; 38:598-607. [PMID: 35936036 PMCID: PMC9347207 DOI: 10.1002/joa3.12738] [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: 02/09/2022] [Revised: 04/23/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Reports of long-term outcomes after atrial fibrillation (AF) ablation for tachycardia-bradycardia syndrome (TBS) are limited. This study aimed to investigate the impact of radiofrequency catheter ablation (RFCA) on clinical outcomes in patients with TBS. Methods Among 1669 patients who underwent AF ablation between January 2010 and April 2020, we retrospectively enrolled 53 patients (62.3% males; age, 67.1 ± 7.0 years) who had been diagnosed with TBS before RFCA for paroxysmal AF (TBS group). After 1:2 propensity score-matching based on age, gender, AF type, and left atrial dimension, 106 patients were assigned to the control group (non-TBS group). The atrial tachyarrhythmia (ATA) recurrence rate and rate of avoidance of permanent pacemaker implantation (PMI) were examined. Results During a median follow-up period of 37.7 months, the ATA recurrence rate after a single ablation procedure was significantly higher in the TBS group than in the non-TBS group (51.0% vs. 38.5%; log-rank p = .008); however, the ATA recurrence rate after the final ablation procedure did not significantly differ between groups. In the TBS group, the rate of PMI avoidance after AF ablation was 92.5%. A Cox-regression multivariate analysis revealed that the presence of non-pulmonary vein/superior vena cava premature atrial contractions (odds ratio, 3.38; 95% confidence interval, 1.49-7.66; p = .004) was an independent predictor of ATA recurrence in the TBS group. Conclusions Patients with TBS had higher ATA recurrence rates after the first ablation procedure compared to those without TBS. However, ATA recurrence after AF ablation did not necessarily result in PMI for TBS patients.
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Affiliation(s)
- Shohei Kataoka
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Koichiro Ejima
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
- Clinical Research Division for Heart Rhythm Management, Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Kyoichiro Yazaki
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Miwa Kanai
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Daigo Yagishita
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
- Clinical Research Division for Heart Rhythm Management, Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
- Clinical Research Division for Heart Rhythm Management, Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Nobuhisa Hagiwara
- Department of CardiologyTokyo Women's Medical UniversityShinjuku‐kuJapan
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Koike H, Fujino T, Wada R, Yao S, Akitsu K, Shinohara M, Kinoshita T, Yuzawa H, Ikeda T. The Inducibility and Focus of Atrial Fibrillation after Ablation in Patients with Tachycardia‐Induced Heart Failure. Pacing Clin Electrophysiol 2022; 45:330-339. [DOI: 10.1111/pace.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/11/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Hideki Koike
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Ryo Wada
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Shintaro Yao
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Katsuya Akitsu
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Masaya Shinohara
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Hitomi Yuzawa
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine Toho University Faculty of Medicine Tokyo Japan
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Watanabe K, Nagata Y, Nitta G, Okata S, Nagase M, Miyazaki R, Nagamine S, Kaneko M, Lee T, Nozato T, Ashikaga T, Goya M, Sasano T. Impact of the sinus node recovery time after termination of atrial fibrillation during catheter ablation on clinical outcomes in patients with persistent atrial fibrillation. PLoS One 2021; 16:e0259750. [PMID: 34739524 PMCID: PMC8570470 DOI: 10.1371/journal.pone.0259750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although long sinus arrest is occasionally observed during atrial fibrillation (AF) catheter ablation when the fibrillation was terminated, its meaning and prognosis have not yet been clearly elucidated. We hypothesized that sinus node recovery time (SNRT) after termination of AF (time from termination of AF to the earliest sinus node activation) could reflect the extent of atrial remodeling, influencing the formation of non-pulmonary vein (non-PV) triggers and post-ablation outcomes. METHOD The participants were 157 consecutive patients with persistent AF (male: 77.1%, age: 63.3±11.2 years) who underwent catheter ablation. We recorded SNRT after terminating AF by radiofrequency delivery or electrical cardioversion during the first ablation and evaluated the relationships between SNRT and atrial tachyarrhythmia recurrence and between SNRT and non-PV triggers after repeat ablation. RESULTS Forty-five patients (28.7%) experienced recurrence of atrial tachyarrhythmias. Patients with recurrence had longer SNRTs (1738 ms vs. 1394 ms, p = 0.012). In the multivariate logistic regression analysis, only SNRT ≥2128ms was a significant independent predictor of clinical AF recurrence (hazard ratio 7.48; 95% confidence interval 2.94-19.00; P<0.001). Kaplan-Meier estimator showed that the recurrence-free rate was significantly lower if ≥ 2128ms (log-rank, p<0.001). Thirty-five patients (77.8%) underwent a second ablation. Although there was no difference in the rate of pulmonary vein reconnections (78.6% vs. 71.4%, p = 0.712), non-PV triggers were observed more frequently in the longer SNRT group (57.1% vs. 14.3%, p = 0.012). CONCLUSIONS Patients with a prolonged SNRT had a higher prevalence of AF recurrence after the first ablation and higher inducibility of non-PV triggers. Measuring SNRT might be used for the stratification of patients with persistent AF.
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Affiliation(s)
- Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Kyonancho, Musashino city, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiology, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan
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Morita N, Iida T, Nanao T, Ushijima A, Ueno A, Ikari Y, Kobayashi Y. Effect of ganglionated plexi ablation by high-density mapping on long-term suppression of paroxysmal atrial fibrillation - The first clinical survey on ablation of the dorsal right plexusus. Heart Rhythm O2 2021; 2:480-488. [PMID: 34667963 PMCID: PMC8505203 DOI: 10.1016/j.hroo.2021.07.002] [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] [Indexed: 10/25/2022] Open
Abstract
Background Long-term outcomes of suppressing paroxysmal atrial fibrillation (PAF) with additive ganglionated plexus (GP) ablation (GPA) remains unknown. Objectives The aim of the study is to assess potential role of additional GPA for PAF suppression. Methods This study consisted of 225 patients; 68 (group A: 58 male, aged 60 ± 11 years) underwent pulmonary vein isolation (PVI) alone and 157 (group B: 137 male, aged 61 ± 11 years) GPA followed by PVI. GPA was performed based on the high-density mapping with high-frequency stimulation (HFS) delivered to left atrial (LA) major GP. The latter 85 group B patients (54%) underwent ablation to a posteromedial area within superior vena cava as a part of dorsal right atrial GP (SVC-Ao GP). Results In group B, HFS was applied to 126 ± 32 sites, with a median of 47 GP sites (40.0%) being ablated. In patients undergoing an SVC-Ao GPA, HFS and the SVC-Ao GPA were applied at a median of 15 and 4 sites (29.4%), respectively. The PVI with a GPA provided higher PAF suppression than a PVI alone during more than 4 years of follow-up (56.7% vs 38.2%, odds ratio: 0.42, 95% confidence interval: 0.23-0.76, P < .05), but the SVC-Ao GPA did not provide further suppressive effects. Multivariate analyses revealed that tachycardia-bradycardia syndrome and non-PV foci were independent predictors of PAF recurrence after PVI with a GPA (P < .01). Conclusion GPA to LA major GP by high-density mapping provides long-term benefits for PAF suppression over 4 years of follow-up, but the effect of an empiric SVC-Ao GPA could not be appreciated, suggesting little effect on suppressing non-PV foci.
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Affiliation(s)
- Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takayuki Iida
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomihisa Nanao
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akiko Ushijima
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Akira Ueno
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Medicine, Tokai University Hospital, Kanagawa, Japan
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Tokyo, Japan
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Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome. IJC HEART & VASCULATURE 2021; 32:100717. [PMID: 33532545 PMCID: PMC7822950 DOI: 10.1016/j.ijcha.2021.100717] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/21/2022]
Abstract
Background The clinical characteristics of atrial fibrillation (AF) resulting from non-pulmonary vein (PV) triggers remain unknown. This study aimed to evaluate the clinical characteristics of patients with AF caused by non-PV triggers, localization of non-PV foci, clinical differences, and clinical outcomes after catheter ablation in each AF focus. Methods A total of 2967 patients who underwent initial catheter ablation for paroxysmal or persistent AF were examined. After PV isolation, all patients underwent high-dose isoproterenol infusion to assess the existence of non-PV foci. Results Non-PV foci were identified in 564 patients (19.2%). The localization of successfully ablated non-PV foci in 514 patients were the superior vena cava (SVC: 213 cases), interatrial septum (IAS: 125 cases), coronary sinus (CS: 98 cases), right atrium (RA: 125 cases), left atrium (LA: 114 cases), and unmappable (50 cases). Multivariate analysis revealed that female gender, low body mass index (BMI), non-paroxysmal AF (PAF), and sick sinus syndrome were independent and significant indicators of non-PV foci. In the multivariate analysis of each AF focus, female gender, low BMI, and non-PAF were significant predictors of IAS and CS foci, RA and IAS foci, and CS foci, respectively. In addition, dilatation of the LA was significantly associated with LA foci, whereas RA, LA, IAS, and CS foci were associated with AF recurrence. Conclusion These findings could help to identify patients at a higher risk of AF caused by non-PV triggers and clarify the clinical difference according to the localization of non-PV foci.
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8
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Wagner L, Darche FF, Thomas D, Lugenbiel P, Xynogalos P, Seide S, Scholz EP, Katus HA, Schweizer PA. Cryoballoon pulmonary vein isolation-mediated rise of sinus rate in patients with paroxysmal atrial fibrillation. Clin Res Cardiol 2020; 110:124-135. [PMID: 32405738 PMCID: PMC7806555 DOI: 10.1007/s00392-020-01659-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/27/2020] [Indexed: 02/05/2023]
Abstract
Background Modulation of the cardiac autonomic nervous system by pulmonary vein isolation (PVI) influences the sinoatrial nodal rate. Little is known about the causes, maintenance and prognostic value of this phenomenon. We set out to explore the effects of cryoballoon PVI (cryo-PVI) on sinus rate and its significance for clinical outcome. Methods and results We evaluated 110 patients with paroxysmal atrial fibrillation (AF), who underwent PVI using a second-generation 28 mm cryoballoon by pre-, peri- and postprocedural heart rate acquisition and analysis of clinical outcome. Ninety-one patients could be included in postinterventional follow-up, indicating that cryo-PVI resulted in a significant rise of sinus rate by 16.5% (+ 9.8 ± 0.9 beats/min, p < 0.001) 1 day post procedure compared to preprocedural acquisition. This effect was more pronounced in patients with initial sinus bradycardia (< 60 beats/min.) compared to patients with faster heart rate. Increase of rate was primarily driven by ablation of the right superior pulmonary vein and for a subset of patients, in whom this could be assessed, persisted ≥ 1 year after the procedure. AF recurrence was neither predicted by the magnitude of the initial rate, nor by the extent of rate change, but postprocedural sinus bradycardia was associated with higher recurrence of AF in the year post PVI. Conclusions Cryo-PVI causes a significant rise of sinus rate that is more pronounced in subjects with previous sinus bradycardia. Patient follow-up indicates persistence of this effect and suggests an increased risk of AF recurrence in patients with postprocedural bradycardia. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01659-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lara Wagner
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Fabrice F Darche
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
| | - Panagiotis Xynogalos
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany
| | - Svenja Seide
- Institute of Medical Biometry and Informatics, University of Heidelberg, INF 130.3, 69120, Heidelberg, Germany
| | - Eberhard P Scholz
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany. .,Heidelberg Center for Heart Rhythm Disorders (HCR), University Hospital Heidelberg, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany.
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9
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Utility of a 64-pole basket catheter to detect non–pulmonary vein trigger in patients with paroxysmal atrial fibrillation. HeartRhythm Case Rep 2020; 6:98-101. [PMID: 32099799 PMCID: PMC7026565 DOI: 10.1016/j.hrcr.2019.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Hwang TH, Yu HT, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Permanent Pacemaker Implantations after Catheter Ablation in Patients with Atrial Fibrillation Associated with Underlying Sinus Node Dysfunction. Korean Circ J 2019; 50:346-357. [PMID: 31960638 PMCID: PMC7067613 DOI: 10.4070/kcj.2019.0268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND). METHODS Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate. RESULTS During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03-28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02-1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND. CONCLUSIONS After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.
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Affiliation(s)
- Tae Hyun Hwang
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hee Tae Yu
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Tae Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jong Youn Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Moon Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea.
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11
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Amioka M, Nakano Y, Ochi H, Onohara Y, Sairaku A, Tokuyama T, Motoda C, Matsumura H, Tomomori S, Hironobe N, Okubo Y, Okamura S, Chayama K, Kihara Y. Ser96Ala genetic variant of the human histidine-rich calcium-binding protein is a genetic predictor of recurrence after catheter ablation in patients with paroxysmal atrial fibrillation. PLoS One 2019; 14:e0213208. [PMID: 30840693 PMCID: PMC6402671 DOI: 10.1371/journal.pone.0213208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) still remains a serious issue. Ca2+ handling has a considerable effect on AF recurrence. The histidine-rich calcium-binding protein (HRC) genetic single nucleotide polymorphism (SNP), rs3745297 (T>G, Ser96Ala), is known to cause a sarcoplasmic reticulum Ca2+ leak. We investigated the association between HRC Ser96Ala and AF recurrence after RFCA in paroxysmal AF (PAF) patients. METHODS AND RESULTS We enrolled PAF patients who underwent RFCA (N = 334 for screening and N = 245 for replication) and were genotyped for HRC SNP (rs3745297). The patient age was younger and rate of diabetes and hypertension lower in the PAF patients with Ser96Ala than in those without (TT/TG/GG, 179/120/35; 64±10/60±12/59±13 y, P = 0.001; 18.5/ 9.2/8.6%, P = 0.04 and 66.1/50.0/37.1%, P = 0.001, respectively). During a mean 19 month follow-up, 57 (17.1%) patients suffered from AF recurrences. The rate of an Ser96Ala was significantly higher in patients with AF recurrence than in those without in the screening set (allele frequency model: odds ratio [OR], 1.80; P = 0.006). We also confirmed this significant association in the replication set (OR 1.74; P = 0.03) and combination (P = 0.0008). A multivariate analysis revealed that the AF duration, sinus node dysfunction, and HRC Ser96Ala were independent predictors of an AF recurrence (hazard ratio [HR], 1.04, P = 0.037; HR 2.42, P = 0.018; and HR 2.66, P = 0.007, respectively). CONCLUSION HRC SNP Ser96Ala is important as a new genetic marker of AF recurrence after RFCA.
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Affiliation(s)
- Michitaka Amioka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Yuko Onohara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akinori Sairaku
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takehito Tokuyama
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Chikaaki Motoda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroya Matsumura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shunsuke Tomomori
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Naoya Hironobe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yousaku Okubo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Sho Okamura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Cellular and Molecular Biology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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12
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Higa S, Lo LW, Chen SA. Catheter Ablation of Paroxysmal Atrial Fibrillation Originating from Non-pulmonary Vein Areas. Arrhythm Electrophysiol Rev 2018; 7:273-281. [PMID: 30588316 DOI: 10.15420/aer.2018.50.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/16/2018] [Indexed: 02/04/2023] Open
Abstract
Pulmonary veins (PVs) are a major source of ectopic beats that initiate AF. PV isolation from the left atrium is an effective therapy for the majority of paroxysmal AF. However, investigators have reported that ectopy originating from non-PV areas can also initiate AF. Patients with recurrent AF after persistent PV isolation highlight the need to identify non-PV ectopy. Furthermore, adding non-PV ablation after multiple AF ablation procedures leads to lower AF recurrence and a higher AF cure rate. These findings suggest that non-PV ectopy is important in both the initiation and recurrence of AF. This article summarises current knowledge about the electrophysiological characteristics of non-PV AF, suitable mapping and ablation strategies, and the safety and efficacy of catheter ablation of AF initiated by ectopic foci originating from non-PV areas.
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Affiliation(s)
- Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital Okinawa, Japan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Taipei, Taiwan.,Institute of Clinical Medicine, Department of Medicine, School of Medicine, National Yang-Ming University Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital Taipei, Taiwan.,Institute of Clinical Medicine, Department of Medicine, School of Medicine, National Yang-Ming University Taipei, Taiwan
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13
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Kawaji T, Shizuta S, Yamagami S, Aizawa T, Yoshizawa T, Kato M, Yokomatsu T, Miki S, Ono K, Kimura T. Impact of Pre-Existing Bradycardia on Subsequent Need for Pacemaker Implantation After Radiofrequency Catheter Ablation for Atrial Fibrillation. Circ J 2018; 82:2493-2499. [DOI: 10.1253/circj.cj-18-0214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Shintaro Yamagami
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takashi Yoshizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masashi Kato
- Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital
| | | | - Shinji Miki
- Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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14
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Hada M, Miyazaki S, Kajiyama T, Yamaguchi M, Kusa S, Nakamura H, Hachiya H, Tada H, Hirao K, Iesaka Y. Catheter ablation of paroxysmal atrial fibrillation in patients with sick sinus syndrome. Heart Vessels 2018; 34:503-508. [PMID: 30178186 DOI: 10.1007/s00380-018-1256-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022]
Abstract
Sick sinus syndrome (SSS) frequently coexists with atrial fibrillation (AF). The results of AF ablation in patients with SSS have not been fully evaluated. We retrospectively investigated 65 patients with paroxysmal AF (PAF) and SSS who underwent AF ablation using either radiofrequency (n = 50) or cryoballoon ablation (n = 15) in our institute. Forty-nine (75.4%) patients had a median of 5.6 (4.8-6.0) s of documented sinus pauses prior to the procedure (42 patients on antiarrhythmic drugs), and were observed when AF terminated in 47 patients. Successful pulmonary vein isolation was achieved in all, and substrate modification was added in 3 patients. Freedom from recurrent atrial arrhythmias after single procedures was 58.7, 45.2, and 38.9% at 1, 2, and 3 years after the initial procedure. During a 23.4 (11.1-40.7) month median follow-up and after 1.4 ± 0.6 sessions, 80.6% of patients were free from arrhythmia recurrence; however, permanent pacemaker implantations were required in 9 (13.8%) patients at a median of 5.3 (2.9-21.0) months after initial procedures. The average heart rate did not significantly differ before or a median of 2.5 (1.2-5.3) months post-procedure (76.7 ± 17.4 vs. 73.5 ± 14.6 bpm, p = 0.90). Multivariate analyses revealed that larger left atrial diameters [odds ratio (OR) 1.21, 95% confidential interval (CI) 1.01-1.45, p = 0.042] were independent predictor of AF recurrence, and SSS type 1 was the sole predictor of pacemaker implantations (OR 10.30, 95% CI 1.38-76.7, p = 0.023), respectively. AF ablation obviated permanent pacemaker implantations in the majority of the patients with SSS and PAF, and SSS type 1 was a sole factor predicting pacemaker implantations.
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Affiliation(s)
- Masahiro Hada
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinsuke Miyazaki
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan. .,Department of Cardiovascular Medicine, Fukui University, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida, Fukui, 910-1193, Japan.
| | - Takatsugu Kajiyama
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Masao Yamaguchi
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Shigeki Kusa
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Tada
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.,Department of Cardiovascular Medicine, Fukui University, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida, Fukui, 910-1193, Japan
| | - Kenzo Hirao
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.,Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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15
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Wu J, Fan X, Yang H, Yan L, Xu X, Duan H, Wang S, Chu Y. Usefulness of a Low Resting Heart Rate to Predict Recurrence of Atrial Fibrillation After Catheter Ablation in People ≥65 Years of Age. Am J Cardiol 2018; 122:97-101. [PMID: 29685573 DOI: 10.1016/j.amjcard.2018.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
A low resting heart rate (RHR) is associated with an increased risk of atrial fibrillation (AF), and this is common in older people. Whether a low RHR in older people can predict recurrence of AF after catheter ablation is unclear. A total of 329 consecutive patients ≥65 years of age with paroxysmal AF who underwent index circumferential pulmonary vein isolation were prospectively enrolled. A 10-second standard resting 12-lead electrocardiogram in sinus rhythm was recorded to measure the RR interval, P-wave duration, and PR interval. The RHR was calculated based on the mean RR interval. During a mean follow-up period of 17.0 ± 8.3 months (range, 3 to 32 months), 96 (29.2%) patients developed recurrence of AF. The AF recurrence rate was 46.2%, 32.3%, and 25.4% in patients with an RHR <50, 50 to 59, and ≥60 beats/min, respectively (log-rank test, p = 0.009). Cox regression analysis with adjustment for P-wave duration and the CHADS2 score showed that an RHR <50 beats/min (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.12 to 3.28, p = 0.017), advanced interatrial block (HR 1.82, 95% CI 1.09 to 3.04, p = 0.022), and left atrial diameter (HR 1.05, 95% CI 1.00 to 1.09, p = 0.029) were independent predictors of recurrence of AF after catheter ablation. In conclusion, in people ≥65 years of age, an RHR <50 beats/min is an independent predictor of AF recurrence in patients who have undergone catheter ablation for paroxysmal AF.
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16
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Yamaguchi N, Okumura Y, Watanabe I, Nagashima K, Takahashi K, Iso K, Watanabe R, Arai M, Mano H, Kogawa R, Kurokawa S, Ohkubo K, Nakai T, Hirayama A, Sonoda K, Tosaka T. Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation. Int Heart J 2018; 59:497-502. [PMID: 29743409 DOI: 10.1536/ihj.17-097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atrial electrical and structural remodeling is related to the perpetuation of atrial fibrillation (AF) subsequent to sinus node dysfunction. We investigated the relationship between AF recurrence after catheter ablation and sinus node dysfunction in long-standing persistent AF patients using the sinus node recovery time (SNRT) after defibrillation.Fifty-one consecutive patients who underwent a first ablation for long-standing persistent AF were enrolled. Intracardiac cardioversion was applied before ablation in the absence of any antiarrhythmic drugs, and the power required to defibrillate, number, and SNRT after defibrillation were measured. All patients underwent the same designed radiofrequency catheter ablation procedure.No patient required permanent pacemaker implantation due to sinus dysfunction after the ablation. During the follow-up period of 28.4 months (3.6-43.7), 35 out of 51 patients (69%) experienced an AF recurrence. The AF recurrence was significantly associated with an older age (60 ± 11 versus 52 ± 12 years in the non-recurrence group, P = 0.0196), longer SNRT after defibrillation (1722 [1410-2656] versus 1295 [676-1651] msec, P = 0.0125), and larger left atrial (LA) volume (59 ± 25 versus 41 ± 15 mL, P = 0.0119). There were no significant differences in the AF duration, AF cycle length, and right and total atrial conduction times between the 2 groups. A longer SNRT after defibrillation (adjusted HR 2.13, 95%CI 1.16-3.71, P = 0.0152) and larger LA volume (adjusted HR 1.03, 95%CI 1.01-1.04, P = 0.0054) were independent predictors of AF recurrence after ablation.Assessment of the SNRT after defibrillation may help to predict a successful ablation in patients with long-standing persistent AF.
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Affiliation(s)
- Naoko Yamaguchi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Keiko Takahashi
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Hiroaki Mano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Rikitake Kogawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kazumasa Sonoda
- Division of Cardiology, Department of Medicine, Tokyo Rinkai Hospital
| | - Toshimasa Tosaka
- Division of Cardiology, Department of Medicine, Tokyo Rinkai Hospital
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17
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Srivatsa U, Danielsen B, Amsterdam E, Yang Y, Fan D, Pezeshkian N, White RH. California study of Ablation (CAABL):early utilization after index hospitalization for non-valvular atrial fibrillation. J Atr Fibrillation 2017; 10:1599. [PMID: 29250223 DOI: 10.4022/jafib.1599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/12/2017] [Accepted: 05/20/2017] [Indexed: 11/10/2022]
Abstract
Background Catheter ablation (ABL) for non-valvular AF (NVAF) is recommended for symptomatic patients refractory to medical therapy and its success is related to the duration of the arrhythmia prior to intervention.Our aim was to assess the early utilization and the factors that prompted ABL in patients hospitalized for new onset NVAF. Methods Using de-identified administrative discharge records for hospitalizations and emergency department (ED) visits, we determined the patients who had a first-time (since 1991) health record diagnosis of AF between2005 - 2011. We linked ambulatory surgery encounters for ABL based on ICD 9 code occurring within two years of initial hospitalization. After excluding other cardiac arrhythmias, atrio-ventricular nodal ablation or pacemaker/defibrillator placement and cardiac valve disease, bivariate comparisons were made with those who did not undergo ABL. Results During the study period,3,440 of 424,592 patients (0.81%) hospitalized for new onset NVAF underwent ABL. Parameters significantly (p<0.001) associated with ABL compared tonon-ABL patientsincluded: principal diagnosis of AF (55% vs 25%), age 35-64 yrs (46.1% vs. 22.4%), male (58.9% vs. 48.2%), private insurance (46.6% vs. 21.1%), Caucasian (81.0% vs.71.6%), lower frequency of ED visit < 6 months before index AF hospitalization (10.7% vs. 15.9%), lower severityofillness at time of AF diagnosis (16.5% vs. 35.6%) anda lower prevalence ofmajor comorbidities (p< 0.001). Conclusions Ablation has low utilization for treatment of new onset NVAF within two years of diagnosis. Earlier utilization of ABL may reduce health care burden related to NVAF and requires further evaluation.
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Affiliation(s)
| | | | | | - Yingbo Yang
- Division of Cardiovascular Medicine, UC Davis
| | - Dali Fan
- Division of Cardiovascular Medicine, UC Davis
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