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Mohanty S, Mohanty P, Kessler D, Gianni C, Baho KK, Morris T, Yildiz T, Quintero Mayedo A, MacDonald B, Della Rocca DG, Al-Ahmad A, Bassiouny M, Gallinghouse GJ, Horton R, Burkhardt JD, di Biase L, Natale A. Impact of Colchicine Monotherapy on the Risk of Acute Pericarditis Following Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2023:S2405-500X(23)00118-4. [PMID: 37086226 DOI: 10.1016/j.jacep.2023.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Acute pericarditis is a known complication of ablation procedures for atrial fibrillation (AF). OBJECTIVES This study aimed to evaluate the benefits of colchicine monotherapy in terms of reducing the risk of pericarditis and related hospitalization rate in AF patients undergoing catheter ablation. METHODS Consecutive AF patients undergoing first catheter ablation were classified into 3 groups based on their colchicine use: Group 1: no colchicine; group 2: colchicine from 7 days before to 1 month after ablation; and group 3: colchicine from the day of the procedure to 1 month after. Standard institutional protocol was used to follow all patients for 1 year. RESULTS A total of 1,075 patients were classified into groups 1 (n = 607), 2 (n = 213), and 3 (n = 255). Symptoms of acute pericarditis were reported in 129 patients (12%): group 1: n = 106 (17.5%); group 2: n = 4 (1.9%); and group 3: n = 19 (7.5%); P < 0.001. Rate of mild-moderate as well as severe pericarditis were significantly lower in group 2. In the multivariable regression analysis, pre- and post-ablation colchicine use was seen to be associated with significantly lower risk of acute pericarditis and related hospitalization compared with the other 2 groups. In addition, at 1-year follow-up, arrhythmia-free survival rate was significantly higher in paroxysmal AF patients receiving colchicine compared with the no-colchicine population. CONCLUSIONS Colchicine therapy starting 7 days before to 1 month after the ablation procedure was associated with significantly lower risk of acute pericarditis and related hospitalization. In addition, paroxysmal AF patients receiving colchicine had a higher arrhythmia-free survival rate compared with those not receiving colchicine.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Danielle Kessler
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Karim K Baho
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Trevor Morris
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Tuna Yildiz
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | | | - Bryan MacDonald
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | | | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Mohamed Bassiouny
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - John D Burkhardt
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Luigi di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA; Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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Rosca CI, Sharma A, Nisulescu DD, Otiman G, Duda-Seiman DM, Morariu SI, Lighezan DF, Kundnani NR. Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients. Healthcare (Basel) 2023; 11. [PMID: 36673543 DOI: 10.3390/healthcare11020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients.
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Cappato R, Ali H. Ablation Indexing for Pulmonary Vein Ablation: A Promising Step in the Struggle Against Atrial Fibrillation. JACC Clin Electrophysiol 2022; 8:1090-2. [PMID: 36137712 DOI: 10.1016/j.jacep.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/20/2022]
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Yang L, Zhang X, Jin Q, Kong D, Zhang Y, Li M, Zhang L, Chen S, Pan W, Zhou D, Ge J. Pericardial Effusion During the Perioperative Period for Left Atrial Appendage Closure. Front Cardiovasc Med 2021; 8:678460. [PMID: 34409074 PMCID: PMC8365031 DOI: 10.3389/fcvm.2021.678460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To analyze the predictors of pericardial effusion (PE) during the perioperative period of the left atrial appendage closure procedure in our center. Methods: A total of 624 consecutive patients with non-valvular AF undergoing LAAC from May 2014 to October 2019 were involved in this study. Patients were divided into groups depending on whether they showed no PE, intraoperative PE or postoperative PE. We analyzed the predictors of PE during the perioperative period of the LAAC procedure. Results: (1) Of the 624 patients in our population (age 68.2 ± 9.1 years, 63% male, CHA2DS2-VASc score 3.4 ± 1.6), 30 patients experienced PE in the perioperative period, including 10 intraoperative PE and 20 postoperative PE. (2) A total of 26 (86.6%) patients had mild PE. 4 (13.4%) patients had pericardial tamponade, 2 (6.7%) of which were intraoperative, and the other 2 (6.7%) postoperative. (3) Significant differences were measured in relation to female sex, intraoperative time, combined procedures, changes in sinus rhythm, device retrieval times and duration of hospitalization between 2 groups (no PE occurred, intraoperative PE), P values were 0.039, 0.024, 0.004, 0.015, 0.003 and 0.039. Conclusions: Female sex, paroxysmal AF, changing in sinus rhythm, device retrieval times and intraoperative time all had a positive association with PE during the perioperative period.
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Affiliation(s)
- Lifan Yang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qinchun Jin
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mingfei Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China
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Geng M, Lin A, Nguyen TP. Revisiting Antiarrhythmic Drug Therapy for Atrial Fibrillation: Reviewing Lessons Learned and Redefining Therapeutic Paradigms. Front Pharmacol 2020; 11:581837. [PMID: 33240090 PMCID: PMC7680856 DOI: 10.3389/fphar.2020.581837] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Since the clinical use of digitalis as the first pharmacological therapy for atrial fibrillation (AF) 235 years ago in 1785, antiarrhythmic drug therapy has advanced considerably and become a cornerstone of AF clinical management. Yet, a preventive or curative panacea for sustained AF does not exist despite the rise of AF global prevalence to epidemiological proportions. While multiple elevated risk factors for AF have been established, the natural history and etiology of AF remain incompletely understood. In the present article, the first section selectively highlights some disappointing shortcomings and current efforts in antiarrhythmic drug therapy to uncover reasons why AF is such a clinical challenge. The second section discusses some modern takes on the natural history of AF as a relentless, progressive fibro-inflammatory "atriomyopathy." The final section emphasizes the need to redefine therapeutic strategies on par with new insights of AF pathophysiology.
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Affiliation(s)
| | | | - Thao P. Nguyen
- Division of Cardiology, Department of Medicine, The Cardiovascular Research Laboratory, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Chen Q, Mohanty S, Trivedi C, Gianni C, Della Rocca DG, Canpolat U, Burkhardt JD, Sanchez JE, Hranitzky P, Gallinghouse GJ, Al-Ahmad A, Horton R, Di Biase L, Natale A. Association between prolonged P wave duration and left atrial scarring in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:1811-1818. [PMID: 31310407 DOI: 10.1111/jce.14070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND We evaluated the association of P wave duration (PWD) with left atrial scar (LAS) in patients with paroxysmal atrial fibrillation (PAF). METHODS Consecutive patients with PAF undergoing their first catheter ablation were screened and only those in sinus rhythm at baseline were included in the analysis. A standard 12-lead electrocardiogram (ECG) was performed in all and three-dimensional voltage mapping of the left atrium was generated for identification of low-voltage areas (≤0.2 mV) before the procedure. RESULTS In total, 411 patients with PAF were included in this study of which 181 had LASs (scar group), while 230 had no scar (nonscar group). In the scar group, patients were older (65.5 ± 8.8 vs 59.7 ± 11.7 years; P < .001), the proportion of female was higher (47.5% vs 37.4%; P = .04) and left atrial (LA) diameter (4.1 ± 0.6 vs 3.9 ± 0.6 cm; P < .001) was larger compared with the nonscar group. There was no significant difference in terms of hypertension, sleep apnea, and diabetes between the two groups. When comparing ECG characteristics between the two groups, PWD was significantly longer in the scar group (122.9 ± 18.5 and 116.9 ± 28.0 ms; P = .01). A multivariate analysis was performed, after adjustment of age, sex, LA diameter, PWD ≥ 120 ms was found to be an independent predictor of LA scarring (OR: 1.69, p-value: 0.02). CONCLUSION In the current series, prolonged PWD was found to be independently associated with LA scarring in PAF, even after adjustment for age, sex, and LA diameter.
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Affiliation(s)
- Qiong Chen
- Department of Cardiopulmonary Function Test, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.,Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Sanghamitra Mohanty
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Internal Medicine, Dell Medical School, Austin, Texas
| | - Chintan Trivedi
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Carola Gianni
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Domenico G Della Rocca
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Ugur Canpolat
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - John David Burkhardt
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Javier E Sanchez
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Patrick Hranitzky
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Gerald Joseph Gallinghouse
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Amin Al-Ahmad
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Medicine (Cardiology), Albert Einstein College of Medicine, Montefiore Hospital, New York City, New York
| | - Andrea Natale
- Division of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.,Department of Internal Medicine, Dell Medical School, Austin, Texas.,Division of Interventional Electrophysiology, Interventional Electrophysiology, Scripps Clinic, San Diego, California.,Department of Electrophysiology, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Division of Cardiology, Stanford University, Stanford, California
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7
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Gökoğlan Y, Mohanty S, Güneş MF, Trivedi C, Santangeli P, Gianni C, Asfour IK, Bai R, Burkhardt JD, Horton R, Sanchez J, Hao S, Hongo R, Beheiry S, Di Biase L, Natale A. Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation: More Than a Decade of Follow-Up. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003660. [PMID: 27162030 DOI: 10.1161/circep.115.003660] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/01/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. METHODS AND RESULTS A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. CONCLUSIONS In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers.
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Affiliation(s)
- Yalçin Gökoğlan
- For the author affiliations, please see the Appendix section
| | | | - Mahmut F Güneş
- For the author affiliations, please see the Appendix section
| | - Chintan Trivedi
- For the author affiliations, please see the Appendix section
| | | | - Carola Gianni
- For the author affiliations, please see the Appendix section
| | - Issa K Asfour
- For the author affiliations, please see the Appendix section
| | - Rong Bai
- For the author affiliations, please see the Appendix section
| | | | - Rodney Horton
- For the author affiliations, please see the Appendix section
| | - Javier Sanchez
- For the author affiliations, please see the Appendix section
| | - Steven Hao
- For the author affiliations, please see the Appendix section
| | - Richard Hongo
- For the author affiliations, please see the Appendix section
| | - Salwa Beheiry
- For the author affiliations, please see the Appendix section
| | - Luigi Di Biase
- For the author affiliations, please see the Appendix section
| | - Andrea Natale
- For the author affiliations, please see the Appendix section.
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