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Boersma LVA, Natale A, Haines D, DeLurgio D, Sood N, Marchlinski F, Calkins H, Hoyt RH, Sanders P, Irwin J, Packer D, Mittal S, Durrani S, Di Biase L, Sangrigoli R, Tada H, Sasano T, Tomita H, Yamane T, Kuck KH, Wazni O, Tarakji K, Cerkvenik J, van Bragt KA, Abeln BGS, Verma A. Prevalence, timing, and impact of early recurrence of atrial tachyarrhythmias after pulsed field ablation: A secondary analysis of the PULSED AF trial. Heart Rhythm 2024:S1547-5271(24)02810-8. [PMID: 38925335 DOI: 10.1016/j.hrthm.2024.06.036] [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: 04/16/2024] [Revised: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Early recurrence of atrial tachyarrhythmias (ERAT) within 3 months of thermal ablation for atrial fibrillation (AF) is common and often considered transient. Pulsed field ablation (PFA) is a nonthermal energy source in which ERAT is not well described. OBJECTIVE The purpose of this study was to analyze ERAT in patients with AF undergoing PFA in the Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF (PULSED AF) trial. METHODS This analysis included 294 patients (154 paroxysmal AF and 140 persistent AF) who had ≥10 rhythm assessments during the 90-day blanking period. ERAT was defined as any instance of ≥30 seconds of AF, atrial flutter, or atrial tachycardia on transtelephonic monitoring (weekly and symptomatic) or ≥10 seconds on electrocardiography (at 3 months), both within 90 days. Late recurrence of atrial tachyarrhythmias (LRAT) was defined as observed atrial tachyarrhythmias between 90 days and 12 months. RESULTS The overall prevalence of ERAT was 27.1% in patients with paroxysmal AF and 31.6% in patients with persistent AF. In patients with ERAT, 73% had ERAT onset within the first month of the procedure. The presence of ERAT was associated with LRAT in patients with paroxysmal AF (hazard ratio 6.4; 95% confidence interval 3.6-11.3) and patients with persistent AF (hazard ratio 3.8; 95% confidence interval 2.2-6.6). Yet, in 29.4% of patients with paroxysmal AF and 34.3% of patients with persistent AF with ERAT, LRAT was not observed. LRAT was positively correlated with the number of ERAT observations. CONCLUSION ERAT after PFA predicted LRAT in patients with paroxysmal and persistent AF. However, the concept of a blanking period after PFA is still valid, as approximately one-third of patients with ERAT did not continue to have LRAT during follow-up and may not need reablation.
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Affiliation(s)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin, Texas; University of Tor Vergata, Rome, Italy; MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - David DeLurgio
- Emory Heart & Vascular Center at St. Joseph's, Atlanta, Georgia
| | - Nitesh Sood
- Southcoast Health Center, Fall River, Massachusetts; Brown Alpert School of Medicine, Brown University, Providence, Rhode Island
| | | | | | | | | | - James Irwin
- BayCare St. Joseph's Hospital, Tampa, Florida
| | | | - Suneet Mittal
- The Valley Hospital and the Snyder Center for Comprehensive Atrial Fibrillation, Ridgewood, New Jersey
| | - Sarfraz Durrani
- MedStar Heart and Vascular Institute, Washington, District of Columbia
| | | | | | | | | | - Hirofumi Tomita
- Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | | | | | | | | | | | | | - Bob G S Abeln
- St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Atul Verma
- McGill University Health Centre, Montreal, Quebec, Canada
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Matei LL, Siliște C, Stoica S, Bejan GC, Ghilencea LN, Vinereanu D. Predictors of Atrial Fibrillation Recurrences after a First Radiofrequency Catheter Ablation Intervention for Paroxysmal Atrial Fibrillation—Experience of a Low Volume Ablation Centre. Medicina (B Aires) 2021; 57:medicina57111139. [PMID: 34833357 PMCID: PMC8618952 DOI: 10.3390/medicina57111139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Atrial fibrillation recurrences (AFR) after radiofrequency catheter ablation (RFCA) are not uncommon, up to 65% of patients having relapses in the first year. However, current data are based mainly on studies from centres with a large volume of ablations, as they include technically inhomogeneous interventions, and populations with different types of AF. The aim of our study was to assess and stratify the risk at 6 and 12 months for AFR after a single RFCA, in patients with paroxysmal AF, in a centre with low volume activity. Materials and Methods: We enrolled 40 patients who underwent an initial RFCA, followed by continuous 48 h ECG monitoring at 1, 3, 6, and 12 months. Patients self-monitored their cardiac activity by random daily radial pulse palpation or in the presence of palpitations. Results: Ten independent predictors for late AFR were identified, and a 6-month risk score was computed using three of them: AFR duration in the first month, number of AFR between 1 and 3 months, and supraventricular ectopics per 24 h at 6 months. The score can explain 59% of the AFR (p = 0.001). A further 12-month assessment identified three independent predictors. The presence of AFR between 6–12 months is the most important of them (OR = 23.11, 95% CI = 3.87–137.83, p = 0.001), explaining 45% of AFR over 1 year. The risk scores at 6 and 12 months were internally validated. Conclusions: The 6-month score proved to be a useful tool in guiding further strategy for patients with a low risk, while a longer follow-up to 12 months may avoid unnecessary early reinterventions.
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Affiliation(s)
- Lavinia-Lucia Matei
- Cardiothoracic Pathology Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (L.-L.M.); (C.S.); (G.-C.B.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Călin Siliște
- Cardiothoracic Pathology Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (L.-L.M.); (C.S.); (G.-C.B.)
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, 050098 Bucharest, Romania;
| | - Sebastian Stoica
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, 050098 Bucharest, Romania;
| | - Gabriel-Cristian Bejan
- Cardiothoracic Pathology Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (L.-L.M.); (C.S.); (G.-C.B.)
| | - Liviu-Nicolae Ghilencea
- Cardiothoracic Pathology Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (L.-L.M.); (C.S.); (G.-C.B.)
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: (L.-N.G.); (D.V.); Tel.: +44-7535-043647 (L.-N.G.); +40-21-316-16-00 (D.V.)
| | - Dragoș Vinereanu
- Cardiothoracic Pathology Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (L.-L.M.); (C.S.); (G.-C.B.)
- Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, 050098 Bucharest, Romania;
- Correspondence: (L.-N.G.); (D.V.); Tel.: +44-7535-043647 (L.-N.G.); +40-21-316-16-00 (D.V.)
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Numminen A, Penttilä T, Arola O, Inkovaara J, Oksala N, Mäkynen H, Hernesniemi J. Treatment success and its predictors as well as the complications of catheter ablation for atrial fibrillation in a high-volume centre. J Interv Card Electrophysiol 2021; 63:357-367. [PMID: 34060008 PMCID: PMC8983498 DOI: 10.1007/s10840-021-01011-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose Catheter ablation for atrial fibrillation (AF) is a standard procedure for maintaining sinus rhythm. The aim of this study was to evaluate treatment success and its predictors and to provide quality control data on complications and redo operations in a centre with an initially a low but currently high annual volume. Methods Data on patients (n = 1,253) treated with catheter ablation for AF in Tays Heart Hospital between January 2010 and May 2018 was evaluated (n = 1178 ablation-naïve patients and n = 1514 AF ablations). Comprehensive data on patient characteristics, treatment results, redo operations and complications were collected. Treatment success (maintenance of sinus rhythm at 1 year) was evaluated among patients residing within the hospital district (45% of the entire study population). Results Treatment success was observed in approximately 62.9% of the ablation-naïve patients. Preoperative predictors of treatment success were paroxysmal AF type, previous use of antiarrhythmic drugs, left atrium diameter and age. The experience at the centre did not associate with the 1-year outcome. A relapse during the first 3-month blanking period was associated with a nine-fold risk of failure at 1 year (unadjusted OR 9.1, 95% CI 5.5–15.1, p < 0.001). The major complication rate was 4.5% (68/1514) with no deaths. Ten percent of the patients needed a redo procedure within the first year. Conclusions Patient-related factors are the most significant predictors of treatment success. A relapse during a 3-month blanking period is associated with a very high risk of failure at 1 year.
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Affiliation(s)
- Anna Numminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Tero Penttilä
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Olli Arola
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jaakko Inkovaara
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Heikki Mäkynen
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
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Glowniak A, Tarkowski A, Wojewoda K, Wysokinska K, Kozak M, Wacinski P, Wysokinski A. Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome. J Clin Med 2019; 8:E1589. [PMID: 31581683 PMCID: PMC6832435 DOI: 10.3390/jcm8101589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is a routine treatment in atrial fibrillation (AF). Single-shot techniques were introduced to simplify the procedure. We analyzed time-dependent changes in procedural parameters, acute success, complication rates, and long-term outcomes during our initial experience with multipolar phased-radiofrequency (RF) ablation. Methods and Results: The first 126 consecutive patients (98 male; age: 58.8 ± 8.7 years) who underwent PVI with phased-RF ablation at our center were included in the study. Procedural parameters, complication rate, acute success and 12-month efficacy were compared in the first, second and third group of 42 consecutive patients. In all patients, 516/526 PVs were effectively isolated (98.1%), with no differences between the tierces (p = 0.67). Procedure (169.8 vs. 132.9 vs. 105.8 min, p < 0.0001), fluoroscopy (32.9 vs. 24.3 vs. 14.1 min, p < 0.0001) and left atrial dwell (83.0 vs. 61.9 vs. 51.4 min, p < 0.0001) times were significantly reduced with experience in tierces 1-3, respectively. In the 12-month follow-up, 60.3% of patients were arrhythmia-free with no differences between the tierces (p = 0.88). In multivariate analysis, the relapse in the blanking period (p < 0.0001), time from AF diagnosis (p = 0.004) and left atrial diameter (p = 0.012) were the only independent predictors of AF recurrence. CONCLUSIONS The learning curve effect was demonstrated in procedural parameters, but not in the complication rate nor the long-term success of PVI with phased-RF technique. The relapse in the blanking period was the strongest predictor of treatment failure in long-time observation.
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Affiliation(s)
- Andrzej Glowniak
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland.
| | - Adam Tarkowski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Katarzyna Wojewoda
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Katarzyna Wysokinska
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Mariusz Kozak
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Piotr Wacinski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
| | - Andrzej Wysokinski
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland
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