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Song ZQ, Lu XY, Xu YP, Lin H, Chen YH. The role of left atrium posterior wall isolation in patients undergoing catheter ablation for atrial fibrillation. J Cardiol 2025; 85:213-219. [PMID: 39341373 DOI: 10.1016/j.jjcc.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/17/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
The posterior left atrium (LAPW) is an important substrate for initiation and maintenance of atrial fibrillation (AF). While it has been proposed as a potential target for preventing recurrence of atrial tachyarrhythmias, it remains unclear whether electrical silence of LAPW offers additional benefits over pulmonary vein isolation (PVI) alone. We conducted a systematic review of PubMed, Medline, Embase, and Cochrane databases and identified 21 eligible studies, encompassing 1514 patients assigned to PVI + posterior wall isolation (PWI) group and 1629 patients assigned to PVI group. Over a median follow-up of 12 months, adjunctive PWI significantly improved the atrial tachyarrhythmia-free survival by 14 % in comparison to PVI alone [relative risk (RR): 1.14, 95 % confidence interval (CI): 1.04 to 1.25, p = 0.004]. This improvement was mainly attributed to a pronounced benefit for patients with persistent AF. In addition, patients undergoing PVI + PWI had a longer procedure time [weighted mean difference (WMD): 23.85, 95 % CI: 12.68 to 35.01, p < 0.001], ablation time (WMD: 9.27, 95 % CI: 5.19 to 13.54, p < 0.001), and a nearly negligible increase in fluoroscopic exposure (WMD: 2.69, 95 % CI: -0.23 to 5.62, p = 0.071). There was no increased risk of procedure-related complications between these approaches (RR: 1.06, 95 % CI: 0.71 to 1.57, p = 0.787). Compared with PVI alone, PWI adjunctive to PVI exhibited a higher procedure success of sinus rhythm maintenance in persistent AF during an index catheter ablation. Meanwhile, elongated procedure time and ablation time did not compromise the safety of extensive ablation strategy with additional PWI.
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Affiliation(s)
- Zheng-Qi Song
- The First Clinical Medical College, Wenzhou Medical University, Chashan, Wenzhou, Zhejiang, China
| | - Xin-Yu Lu
- The First Clinical Medical College, Wenzhou Medical University, Chashan, Wenzhou, Zhejiang, China
| | - Yu-Peng Xu
- The First Clinical Medical College, Wenzhou Medical University, Chashan, Wenzhou, Zhejiang, China
| | - Hui Lin
- Department of Respiratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Longwan, Wenzhou, Zhejiang, China
| | - Yi-He Chen
- Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, Zhejiang, China.
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Mumtaz M, Jabeen S, Danial A, Chaychi MTM, Zaheer MK, Mumtaz A, Mumtaz T, Herweg B. Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2023; 34:2043-2052. [PMID: 37526224 DOI: 10.1111/jce.16028] [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: 03/31/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. AIM The objective of this meta-analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA). METHODS We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager. RESULTS Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42-0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49-0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41-0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44-1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13-32.37, p < .0001). CONCLUSION Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.
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Affiliation(s)
- Mishal Mumtaz
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Sidra Jabeen
- Department of medicine, Liaquat National Hospital and Medical College, Affiliated with Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Ahmad Danial
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Muhammad Tayyab Muzaffar Chaychi
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Muhammad Kashan Zaheer
- Department of medicine, Liaquat National Hospital and Medical College, Affiliated with Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Aymen Mumtaz
- Department of medicine, CMH Lahore Medical and Dental College, Affiliated with National University of Medical Sciences, Pakistan
| | - Tayebah Mumtaz
- Department of Cardiovascular, St. Elizabeth's Medical Centre, Boston, Massachusetts, USA
| | - Bengt Herweg
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Heart & Vascular Institute, Tampa General Hospital, Tampa, Florida, USA
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Katrapati P, Bai R. Freezing the left atrial posterior wall to make real icing on the cake. J Cardiovasc Electrophysiol 2023; 34:2053-2054. [PMID: 37671690 DOI: 10.1111/jce.16049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Praneeth Katrapati
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Rong Bai
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Aryana A, Thiemann AM, Pujara DK, Cossette LL, Allen SL, Vierra EC, Bowers MR, Gandhavadi M, Heath R, Trivedi AD, O'Neill PG, Ellis ER, d'Avila A. Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices. Pacing Clin Electrophysiol 2023. [PMID: 37377391 DOI: 10.1111/pace.14767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI). METHODS This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF). RESULTS Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow-up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P = .007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P = .001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P = .003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P = .008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P < .001), need for cardioversion (5.2% vs. 23.6%, P < .001) and repeat catheter ablation (10.4% vs. 26.1%, P = .005), and a longer time-to-arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P < .001) in both PersAF and PAF patients. CONCLUSION In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long-term follow-up.
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Affiliation(s)
- Arash Aryana
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Anna M Thiemann
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Deep K Pujara
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Laura L Cossette
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Shelley L Allen
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Eleanor C Vierra
- Sutter Heart and Vascular Institute, Sacramento, California, USA
| | - Mark R Bowers
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Russell Heath
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - Amar D Trivedi
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - Padraig Gearoid O'Neill
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Ethan R Ellis
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - André d'Avila
- The Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Aryana A, Thiemann AM, Pujara DK, Cossette LL, Allen SL, Bowers MR, Gandhavadi M, Heath R, Trivedi AD, O'Neill PG, Ellis ER, d'Avila A. Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial. JACC Clin Electrophysiol 2023; 9:628-637. [PMID: 37225309 DOI: 10.1016/j.jacep.2023.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. OBJECTIVES This study investigated the acute and long-term outcomes of PVI vs PVI+PWI using cryoballoon in patients with symptomatic PAF. METHODS This retrospective study (NCT05296824) examined the outcomes of cryoballoon PVI (n = 1,342) vs cryoballoon PVI+PWI (n = 442) in patients with symptomatic PAF during long-term follow-up. Using the nearest-neighbor method, a 1:1 matched sample of patients receiving PVI alone and PVI+PWI was created. RESULTS The matched cohort consisted of 320 patients (PVI: n = 160; PVI+PWI: n = 160). PVI+PWI was associated with longer cryoablation (23 ± 10 minutes vs 42 ± 11 minutes; P < 0.001) and procedure times (103 ± 24 minutes vs 127 ± 14 minutes; P < 0.001). In 39 (24.4%) of 160 patients, adjunct radiofrequency ablation was required for PVI+PWI. Adverse event rates were similar (PVI 3.8% vs PVI+PWI 1.9%; P = 0.31). Though there were no differences at 12 months, freedom from all atrial arrhythmias (67.5% vs 45.0%; P < 0.001) and AF (75.6% vs 55.0%; P < 0.001) were significantly greater with PVI+PWI vs PVI alone at 39 ± 9 months of follow-up. PVI+PWI was also associated with reduced long-term need for cardioversion (16.9% vs 27.5%; P = 0.02) and repeat catheter ablation (11.9% vs 26.3%; P = 0.001), and emerged as the only significant predictor of freedom from recurrent AF (HR: 2.79; 95% CI: 1.64-4.74; P < 0.001). CONCLUSIONS Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
| | - Anna M Thiemann
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Deep K Pujara
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura L Cossette
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Shelley L Allen
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Russell Heath
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Amar D Trivedi
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Ethan R Ellis
- University of Colorado Health, Fort Collins, Colorado, USA
| | - André d'Avila
- Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Bisignani A, Conte G, Pannone L, Sieira J, Del Monte A, Lipartiti F, Bala G, Miraglia V, Monaco C, Ströker E, Overeinder I, Almorad A, Gauthey A, Franchetti Pardo L, Raes M, Detriche O, Brugada P, Auricchio A, Chierchia GB, de Asmundis C. Long-Term Outcomes of Pulmonary Vein Isolation in Patients With Brugada Syndrome and Paroxysmal Atrial Fibrillation. J Am Heart Assoc 2022; 11:e026290. [PMID: 35862178 PMCID: PMC9375506 DOI: 10.1161/jaha.122.026290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacological treatment of atrial fibrillation (AF) in the setting of Brugada syndrome (BrS) is challenging. In addition, patients with BrS with an implantable cardioverter-defibrillator (ICD) might experience inappropriate shocks for fast AF. Long-term outcome of pulmonary vein isolation in BrS has not been well established yet, and it is still unclear whether pulmonary vein triggers are the only pathophysiological mechanism of AF in BrS. The aim of the study is to assess the long-term outcomes in patients with BrS undergoing pulmonary vein isolation for paroxysmal AF compared with a matched cohort of patients without BrS. Methods and Results Sixty patients with BrS undergoing pulmonary vein isolation with cryoballoon catheter ablation for paroxysmal AF were matched with 60 patients without BrS, who underwent the same procedure. After a mean follow-up of 58.2±31.7 months, freedom from atrial tachyarrhythmias was achieved in 61.7% in the BrS group and in 78.3% in the non-BrS group (log-rank P=0.047). In particular, freedom from AF was 76.7% in the first group and in 83.3% in the second (P=0.27), while freedom from atrial tachycardia/atrial flutter was 85% and 95% (P=0.057). In the BrS group, 29 patients (48.3%) had an ICD and 8 (27.6%) had a previous ICD-inappropriate shock for fast AF. In the BrS cohort, ICD-inappropriate interventions for AF were significantly reduced after ablation (3.4% versus 27.6%; P=0.01). Conclusions Pulmonary vein isolation in patients with BrS was associated with higher rate of arrhythmic recurrence. Despite this, catheter ablation significantly reduced inappropriate ICD interventions in BrS patients and can be considered a therapeutic strategy to prevent inappropriate device therapies.
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Affiliation(s)
- Antonio Bisignani
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium.,Institute of Cardiology Università Cattolica del Sacro Cuore Rome Italy
| | - Giulio Conte
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Luigi Pannone
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alvise Del Monte
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Anaïs Gauthey
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Livia Franchetti Pardo
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Matthias Raes
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Olivier Detriche
- Anaesthesiology Department Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Angelo Auricchio
- Division of Cardiology Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale Lugano Switzerland
| | - Gian-Battista Chierchia
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Postgraduate Program in Cardiac Electrophysiology and Pacing, Heart Rhythm Management Centre, European Reference Networks Guard-Heart Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels Belgium
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Shao Y, Chen L, Chen W, Sang C, Xu C, Zhang C. Left atrial epicardial adipose tissue is associated with low voltage zones in the left atrium in patients with non-valvular atrial fibrillation. Front Cardiovasc Med 2022; 9:924646. [PMID: 35911525 PMCID: PMC9333900 DOI: 10.3389/fcvm.2022.924646] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/28/2022] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Epicardial adipose tissue (EAT) is related to atrial fibrillation (AF), but the specific mechanism is still unclear. Left atrial (LA) low voltage zones (LVZ) can well reflect atrial fibrosis. This study investigated the relationship between EAT and LVZ in non-valvular AF (NVAF) patients. METHODS This observational study including patients with NVAF (n = 214) undergoing radiofrequency ablation (RFCA) for the first time in our hospital and 62 matched controls. The EAT volume and attenuation were measured by contrast-enhanced computed tomography. A three-dimensional mapping system was used to map the left atrial endocardium and evaluate LA-LVZ. Patients were divided into LVZ and non-LVZ groups according to the presence or absence of LVZ. RESULTS Patients with AF showed higher LA-EAT volume and lower attenuation value than controls (29.7 ± 11.2 cm3 vs. 20.9 ± 8.6 cm3, P = 0.021; -91.2 ± 5.6 HU vs. -88.7 ± 5.9 HU, P < 0.001). Compared with the group without LVZ, there were significant differences in age [65 (59-71) vs. 60 (52-69), P = 0.006], LAVI [75.1 ± 20.7 ml/m2 vs. 67.2 ± 20.9 ml/m2, P = 0.018], LA-EAT volume (34.8 ± 11.5 cm3 vs. 28.1 ± 10.6 cm3, P < 0.001) and LA-EAT attenuation (-93.9 ± 5.3 HU vs. -90.4 ± 5.5 HU, P < 0.001). Multivariate regression analysis showed that age (OR = 1.040; 95%CI: 1.001-1.078, P = 0.042), LAVI (OR = 1.019; 95%CI: 1.002-1.037, P = 0.032), LA-EAT volume (OR = 1.193; 95%CI: 1.015-1.402, P = 0.034) and attenuation value (OR = 0.801; 95%CI: 0.701-0.916 P = 0.001) were independent predictors of LVZ. After LA-EAT attenuation was incorporated into the clinical model, the comprehensive discrimination and net reclassification tended to improve (IDI and NRI > 0, P < 0.05). CONCLUSION LA-EAT volume and attenuation values can independently predict the presence of LVZ, and LA-EAT attenuation has a better predictive value than LA-EAT volume.
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Affiliation(s)
- Yameng Shao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lei Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wensu Chen
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chuanyi Sang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Changjiang Xu
- Department of Cardiology, The Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, Huai’an, China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Atrial Fibrillation Global Changes after Pulmonary Vein and Posterior Wall Isolation: A Charge Density Mapping Study. J Clin Med 2022; 11:jcm11102948. [PMID: 35629074 PMCID: PMC9145946 DOI: 10.3390/jcm11102948] [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: 04/10/2022] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Non-contact charge density (CD) mapping allows a global visualization of left atrium (LA) activation and of activation patterns during atrial fibrillation (AF). The aim of this study was to analyze, with CD mapping, the changes in persistent AF induced by pulmonary vein isolation (PVI) and LA posterior wall isolation (LAPWI). Methods: Patients undergoing PVI + LAPWI using the Arctic Front Advance PROTM cryoballoon system were included in the study. CD maps were created during AF at baseline, after PVI and after LAPWI. Three distinct activation patterns were identified in the CD maps: localized irregular activation (LIA), localized rotational activation (LRA) and focal centrifugal activation (FCA). LA maps were divided into the following regions: anterior, septal, lateral, roof, posterior, inferior. Results: Eleven patients were included, with a total of 33 maps and 198 AF regions analyzed. Global and regional AF cycle lengths significantly increased after PVI and LAPWI. Baseline analysis demonstrated higher LIA, LRA and FCA numbers in the posterior and anterior regions. After PVI, there was no change in LIA, LRA and FCA occurrence. After PVI + LAPWI, a significant decrease in LRA was observed with no difference in LIA and FCA occurrence. In the regional analysis, there was a significant reduction in the LIA number in the inferior region, in the LRA number in the roof and posterior regions and in the FCA number in the lateral region. Conclusions: A global reduction in the LRA number was observed only after PVI + LAPWI; it was driven by a reduction in rotational activity in the roof and posterior regions.
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Jiang X, Liao J, Ling Z, Meyer C, Sommer P, Futyma P, Martinek M, Schratter A, Acou WJ, Wang J, Zhu L, Kiuchi MG, Pürerfellner H, Schmidt B, Chun JKR, Yin Y, Chen S. Adjunctive Left Atrial Posterior Wall Isolation in Treating Atrial Fibrillation: Insight From a Large Secondary Analysis. JACC Clin Electrophysiol 2022; 8:605-618. [PMID: 35589173 DOI: 10.1016/j.jacep.2022.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study evaluated the role of adjunctive left atrium posterior wall isolation (PWI) in preventing atrial fibrillation (AF) recurrence. BACKGROUND The left atrium posterior wall is an arrhythmogenic substrate that contributes to the development of AF. METHODS This was an updated pooled analysis that included clinical data regarding PWI plus pulmonary vein isolation (PVI) in treating AF. The primary outcome was recurrence of atrial tachyarrhythmias. RESULTS A total of 26 studies with 3,287 patients with AF (age 61.7 ± 10.8 years) were included. Mean follow-up was 15.2 ± 8.4 months. Procedural success to achieve PWI was 92.8%. In paroxysmal AF, adjunctive PWI did not reduce the recurrence of all atrial arrhythmias (P = 0.21) or AF (P = 0.37); however, in persistent AF, adjunctive PWI was associated with substantially lower recurrence of all atrial arrhythmias (risk ratio: 0.74; P < 0.001) and AF (risk ratio: 0.67; P = 0.01), particularly when randomized data were included. Subgroup analyses based on meta-regression demonstrated that patients with older age, a larger left atrial diameter, and persistent AF benefited more significantly from the adjunctive PWI. Adjunctive PWI using either radiofrequency or a cryoballoon reduced AF recurrence, whereas using radiofrequency seemed to be associated with higher recurrence rate of atrial tachycardias and/or atrial flutter. Non-BOX adjunctive PWI rather than BOX PWI was associated with significantly lower recurrence of AF. The incidence of procedural adverse events between the PVI+PWI (3.2%) and PVI (2.8%) groups was low and similar. PVI+PWI needed longer ablation and/or procedural time but had similar fluoroscopy time. CONCLUSIONS Adjunctive PWI can be achieved in most patients without compromising safety. Patients with persistent AF appear to benefit from this approach. The ablation technology and/or approach may affect the clinical outcome of PWI.
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Affiliation(s)
- Xi Jiang
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Liao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Christian Meyer
- Department of Cardiology, Angiology, Intensive Care, NEP, Cardiac Neuro- and Electrophysiology Research Consortium, Evangelisches Krankenhaus (EVK) Düsseldorf, Düsseldorf, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Institute of Neural and Sensory Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Piotr Futyma
- St. Joseph's Heart Rhythm Center, Medical College at University of Rzeszów, Rzeszów, Poland
| | - Martin Martinek
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | | | | | - Jiazhi Wang
- Intensivmedizin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lin Zhu
- Medizinisch-Geriatrische Klinik, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Márcio Galindo Kiuchi
- School of Medicine-Royal Perth Hospital Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Helmut Pürerfellner
- Department für Kardiologie und Elektrophysiologie, Akademisches Lehrkrankenhaus, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany; Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaojie Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Cardioangiologisches Centrum Bethanien, Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany; Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany; Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany.
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10
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Bisignani A, Pannone L, Miraglia V, Sieira J, Iacopino S, Bala G, Ströker E, Overeinder I, Almorad A, Gauthey A, Monaco C, Paparella G, Osório TG, Sorgente A, Jordaens L, Brugada P, Chierchia G, de Asmundis C. Feasibility and safety of left atrial posterior wall isolation with a new Cryoballoon technology in patients with persistent atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:605-611. [PMID: 35352363 PMCID: PMC9325381 DOI: 10.1111/pace.14495] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left atrial posterior wall isolation (LAPWI) is often performed in addition to pulmonary vein isolation (PVI) in the setting of persistent atrial fibrillation (AF) ablation. The aim of this study was to evaluate the feasibility and safety of a new cryoballoon ablation system in achieving PVI + LAPWI isolation. METHODS The study was a prospective, non-randomized, single center study. Forty consecutive patients, undergoing PVI + LAPWI with the novel POLARx™, were compared to 40 consecutive patients who underwent the same procedure with the established Arctic Front Advance PRO™. RESULTS Acute isolation was achieved in all PVs in both groups and left posterior wall isolation (LAPWI) was achieved in 38 patients (95%) in the POLARx group and in 36 patients (90%) in Arctic Front group. Procedural outcomes were similar between both groups, except for lower temperatures during cryoenergy in the POLARx group, for both pulmonary vein isolation (PVI) and LAPWI. CONCLUSION LAPWI + PVI with the novel POLARx™ Cryoballoon is feasible and safe; the results are comparable with the Arctic Front Advance PRO™ system.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
- Institute of CardiologyCatholic University of the Sacred HeartRomeItaly
| | - Luigi Pannone
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
- Electrophysiology UnitMaria Cecilia HospitalCotignolaItaly
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Luc Jordaens
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Gian‐Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard‐HeartVrije Universiteit BrusselBrusselsBelgium
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11
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Miraglia V, Bisignani A, Pannone L, Iacopino S, Chierchia GB, de Asmundis C. Cryoballoon ablation beyond pulmonary vein isolation in the setting of persistent atrial fibrillation. Expert Rev Med Devices 2022; 19:431-439. [PMID: 35786107 DOI: 10.1080/17434440.2022.2096437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins (PVI) is the main strategy in paroxysmal AF, since pulmonary vein triggers have a pivotal role in its pathogenesis; non-paroxysmal AF is a complex arrhythmia that results from the interplay of a substrate, namely AF-induced electrical and structural atrial remodeling, and a trigger that can be often found outside pulmonary veins, namely non-pulmonary veins triggers. AREAS COVERED The aim of this review is to provide a state-of-the-art overview of non-pulmonary veins triggers with special focus on cryoballoon (CB) catheter ablation. EXPERT OPINION Besides PVI, CB catheter ablation of non-pulmonary veins triggers is a novel and promising strategy for non-paroxysmal AF.
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Affiliation(s)
- Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
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12
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Weng W, Birnie DH, Ramirez FD, Van Stiphout C, Golian M, Nery PB, Hansom SP, Redpath CJ, Klein A, Nair GM, Alqarawi W, Green MS, Davis DR, Santangelli P, Schaller RD, Marchlinski FE, Sadek MM. Outcomes of a comprehensive strategy during repeat atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 65:391-399. [DOI: 10.1007/s10840-022-01190-4] [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: 11/27/2021] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
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13
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Bisignani A, Pannone L, Bala G, Kazawa S, Calburean P, Overeinder I, Monaco C, Lipartiti F, Miraglia V, Rizzi S, Al Housari M, Mojica J, Strazdas A, Osório TG, Sieira J, Iacopino S, Almorad A, Ströker E, Sorgente A, Brugada P, de Asmundis C, Chierchia GB. Repeat procedures for recurrent persistent atrial fibrillation: A propensity-matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon. J Arrhythm 2021; 37:1287-1294. [PMID: 34621427 PMCID: PMC8485792 DOI: 10.1002/joa3.12614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
AIMS To evaluate the clinical outcome in patients undergoing repeat procedures for recurrent persistent atrial fibrillation following an index cryoballoon (CB-A) pulmonary vein isolation ablation on a mid-term follow-up of 12 months. METHODS In this propensity score-matched comparison, 50 patients undergoing left atrial posterior wall isolation (LAPWI) with the CB-A were matched to 50 patients treated with additional linear ablation using radiofrequency catheter ablation (RFCA). RESULTS Meantime to repeat the procedure was 9.74 ± 4.36 months. At 12 months follow-up freedom from atrial tachyarrhythmias (ATas) was achieved in 82% of patients in the LAPWI group and in 62% of patients in the linear ablation group (P = .03). Regression analysis demonstrated that relapses during the blanking period and LA dimensions were independent predictors of ATas recurrences following the repeat procedure. CONCLUSION LAPWI using CB-A is associated with a significantly higher freedom from atrial arrhythmias when compared with the RFCA mediated left atrial linear lesions on a mid-term follow-up of 12 months in patients with persAF undergoing a redo procedure.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
- Institute of Cardiology Catholic University of the Sacred Heart Rome Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Paul Calburean
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Sergio Rizzi
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Antanas Strazdas
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
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14
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Aryana A, O'Neill PG, Okishige K, Natale A. Reply: Radiofrequency Is Not Always Necessary for Left Atrium Posterior Wall Isolation. JACC Clin Electrophysiol 2021; 7:678-679. [PMID: 34016397 DOI: 10.1016/j.jacep.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
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15
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Aryana A, Su W, Kuniss M, Okishige K, de Asmundis C, Tondo C, Chierchia GB. Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III. Heart Rhythm 2021; 18:1435-1444. [PMID: 33905811 DOI: 10.1016/j.hrthm.2021.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | - Wilber Su
- Banner University Medical Center, Phoenix, Arizona
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | | | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS; Department of Biochemical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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16
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Bisignani A, Cecchini F, Mugnai G, Overeinder I, Sieira J, Osório TG, Miraglia V, Monaco C, Sofianos D, Boveda S, Bala G, Ströker E, Paparella G, Westra SW, Brouwer MA, Brugada P, de Asmundis C, Chierchia GB. Single procedural outcomes in the setting of percutaneous ablation for persistent atrial fibrillation: a propensity-matched score comparison between different strategies. J Interv Card Electrophysiol 2021; 64:9-16. [PMID: 33629193 DOI: 10.1007/s10840-021-00968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catheter ablation for persistent atrial fibrillation (persAF) is associated with less favorable outcomes than for paroxysmal AF. To improve success rates, left atrial (LA) substrate modification is frequently performed in addition to pulmonary vein isolation (PVI). The purpose of the study was to compare 4 different ablation approaches using radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB-A) for persAF and to evaluate the respective outcomes on a midterm follow-up of 12 months. METHODS We did a propensity score-matched comparison of 30 patients undergoing PVI + LA posterior wall isolation (LAPWI) with CB-A, 30 patients who underwent PVI + linear ablation (roof and mitral lines) using RFCA, 60 patients with PVI alone using CB-A, and 60 patients who had PVI alone using RFCA. The endpoint was recurrence of documented atrial tachyarrhythmias (ATas) > 30 s at 1-year follow-up. RESULTS After 12 months, freedom from ATas after a single procedure was 83.3% in the PVI + LAPWI group, 46.7% in the PVI + linear ablation group, 58.3% in the PVI-alone CB-A group, and 61.6% PVI-alone RFCA (p = 0.03). Moreover, freedom from ATas was significantly higher comparing the PVI + LAPWI group with each of the other groups. CONCLUSIONS In this propensity-matched comparison of strategies for persAF, LAPW ablation in addition to PVI with CB-A seems to improve 1-year outcome in comparison to PVI + linear ablation using RFCA and to PVI alone using RFCA or CB-A. Randomized comparisons are eagerly awaited.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Cecchini
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium.
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