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Ngo LTH, Peng Y, Denman R, Yang I, Ranasinghe I. Long-term outcomes after hospitalization for atrial fibrillation or flutter. Eur Heart J 2024:ehae204. [PMID: 38678737 DOI: 10.1093/eurheartj/ehae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 11/24/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND AIMS Atrial fibrillation (AF) and flutter are common causes of hospitalizations but contemporary long-term outcomes following these episodes are uncertain. This study assessed outcomes up to 10 years after an acute AF or flutter hospitalization. METHODS Patients hospitalized acutely with a primary diagnosis of AF or flutter from 2008-17 from all public and most private hospitals in Australia and New Zealand were included. Kaplan-Meier methods and flexible parametric survival modelling were used to estimate survival and loss in life expectancy, respectively. Competing risk model accounting for death was used when estimating incidence of non-fatal outcomes. RESULTS A total of 260 492 adults (mean age 70.5 ± 14.4 years, 49.6% female) were followed up for 1 068 009 person-years (PY), during which 69 167 died (incidence rate 6.5/100 PY) with 91.2% survival at 1 year, 72.7% at 5 years, and 55.2% at 10 years. Estimated loss in life expectancy was 2.6 years, or 16.8% of expected life expectancy. Re-hospitalizations for heart failure (2.9/100 PY), stroke (1.7/100 PY), and myocardial infarction (1.1/100 PY) were common with respective cumulative incidences of 16.8%, 11.0%, and 7.1% by 10 years. Re-hospitalization for AF or flutter occurred in 21.3% by 1 year, 35.3% by 5 years, and 41.2% by 10 years (11.6/100 PY). The cumulative incidence of patients undergoing catheter ablation of AF was 6.5% at 10 years (1.2/100 PY). CONCLUSIONS Patients hospitalized for AF or flutter had high death rates with an average 2.6-year loss in life expectancy. Moreover, re-hospitalizations for AF or flutter and related outcomes such as heart failure and stroke were common with catheter ablation used infrequently for treatment, which warrant further actions.
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Affiliation(s)
- Linh Thi Hai Ngo
- Faculty of Medicine, The University of Queensland, 627 Rode Road, Chermside, Queensland 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland 4032, Australia
| | - Yang Peng
- Faculty of Medicine, The University of Queensland, 627 Rode Road, Chermside, Queensland 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland 4032, Australia
| | - Russell Denman
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland 4032, Australia
| | - Ian Yang
- Faculty of Medicine, The University of Queensland, 627 Rode Road, Chermside, Queensland 4032, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland 4032, Australia
| | - Isuru Ranasinghe
- Faculty of Medicine, The University of Queensland, 627 Rode Road, Chermside, Queensland 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, 627 Rode Road, Chermside, Queensland 4032, Australia
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Wilson-Smith AR, Wilson-Smith CJ, Smith JS, Ng D, Muston BT, Eranki A, Williams ML, Ussher N, Gupta AK. The outcomes of concomitant catheter ablation in non-mitral valve cardiac surgery-a systematic review and meta-analysis of the literature. Ann Cardiothorac Surg 2024; 13:108-116. [PMID: 38590993 PMCID: PMC10998963 DOI: 10.21037/acs-2023-afm-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/17/2024] [Indexed: 04/10/2024]
Abstract
Background Atrial fibrillation (AF) is the most common form of cardiac arrythmia, with a key importance in the perioperative setting of cardiac surgery. In recent years, the question as to whether pre-existent AF should be treated concomitantly when undergoing cardiac surgery has been heatedly debated. This systematic review and meta-analysis sought to delineate the outcomes of patients undergoing concomitant AF ablation procedures alongside cardiac surgery. Methods The methods for this systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Four databases were searched, ultimately yielding 22 papers for inclusion, using appropriate search terminology. Meta-analysis using proportions or means, as appropriate, were applied. Kaplan-Meier curves were digitized and aggregated using previously reported and validated techniques. Results A total of 9,428 patients (67% male) were identified across the study period as having received non-mitral cardiac surgery and concomitant AF ablation procedures. On actuarial assessment, freedom from AF was found to be 93%, 88%, 85%, 82%, and 79% at 1 through to 5 years, respectively. Freedom from mortality was found to be 94%, 93%, 91%, 90%, and 87% at 1 through to 5 years, respectively. Conclusions This review demonstrated excellent freedom from AF out to a long-term follow-up of 5 years. Freedom from mortality was also encouraging. Emerging data are increasingly illustrating that in this patient cohort, concurrent treatment of pre-existent AF with cardiac and/or valvular disease at the point of operation should be the standard of care. Robust data in the form of randomized control trials will hopefully solidify this assertion.
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Affiliation(s)
- Ashley R. Wilson-Smith
- Chris O’Brien Lifehouse Center, Sydney, Australia
- Collaborative Research Group (CORE), Sydney, Australia
- Hunter Medical Research Institute (HMRI), Newcastle, Australia
- University of New South Wales Medical School, Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
- University of Sydney, Camperdown, Australia
- Macquarie University, Sydney, Australia
| | | | | | - Dominic Ng
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Benjamin T. Muston
- Collaborative Research Group (CORE), Sydney, Australia
- University of New South Wales Medical School, Sydney, Australia
| | - Aditya Eranki
- Collaborative Research Group (CORE), Sydney, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | | | - Nathan Ussher
- Royal Prince Alfred Hospital, Camperdown, Sydney, Australia
| | - Aashray K. Gupta
- University of Adelaide, Adelaide, Australia
- Prince of Wales Hospital, Sydney, Australia
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Kataoka S, Shoda M, Ejima K, Kato K, Yazaki K, Hasegawa S, Sakai M, Higuchi S, Yagishita D, Yamaguchi J. Hybrid ablation for persistent atrial fibrillation: a narrative review. J Thorac Dis 2024; 16:1702-1714. [PMID: 38505041 PMCID: PMC10944770 DOI: 10.21037/jtd-23-1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
Background and Objective Treatment for atrial fibrillation (AF) has evolved significantly, with pulmonary vein isolation (PVI) becoming an established treatment. However, the outcomes following catheter ablation for persistent AF remain unsatisfactory. Hybrid catheter-surgical ablation has emerged as a therapeutic approach for persistent AF, combining the strengths of both interventions. The purpose of this narrative review is to comprehensively examine the current state of knowledge regarding hybrid ablation for AF. Methods A thorough PubMed search using the terms "hybrid ablation", "atrial fibrillation", "catheter ablation", and "guideline on cardiology" within the timeframe of 1980 to 2024 resulted in 138,969 articles. Consensus on the selected articles was reached through a series of structured meetings and discussions. Key Content and Findings PVI has demonstrated higher sinus rhythm maintenance rates, especially for paroxysmal AF. However, the efficacy is not as high for persistent AF. Additional ablation strategies, such as linear ablation, complex fractionated atrial electrogram ablation, low voltage zone ablation as well as posterior wall isolation, lack consistent evidence of effectiveness. Hybrid ablation, involving collaboration between cardiac surgeons and electrophysiologists, presents a promising alternative for hard-to-treat AF. Recent studies report favorable outcomes of hybrid ablation, with atrial arrhythmia-free rates ranging from 53.5% to 76%, surpassing those of catheter ablation alone, which might result from better lesion durability or intervention for non-PV foci and left atrial appendage excision or closure during hybrid ablation. The rate of complications associated with hybrid ablation is higher than catheter ablation alone. Conclusions While favorable outcomes of hybrid ablation for persistent AF have been reported, it is not recommended for all AF patients due to its invasiveness compared to catheter ablation. Additionally, some patients with persistent AF maintain sinus rhythm with catheter ablation alone. More clinical data are needed to determine which patients are suitable candidates for hybrid ablation.
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Affiliation(s)
- Shohei Kataoka
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Minamino Cardiology Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masayuki Sakai
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
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Nekić A, Prepolec I, Pašara V, Bogdanić JE, Posavec JP, Kardum D, Katić Z, Štajduhar A, Nikolić BP, Puljević D, Miličić D, Chierchia GB, de Asmundis C, Velagić V. Treatment of atrial fibrillation with second-generation cryoballoon followed by contact-sensing radiofrequency catheter ablation for arrhythmia recurrences-results of a 5-year follow-up. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01752-8. [PMID: 38261100 DOI: 10.1007/s10840-024-01752-8] [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: 11/26/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The aim of this study was to report the long-term follow-up results of cryoballoon (CB) ablation in patients with atrial fibrillation. METHODS All consecutive patients who underwent second-generation CB ablation from February 2015 to December 2017 were included in our study. In all procedures, we used a 28-mm CB placed via a single transseptal puncture guided by intracardiac ultrasound. A 20-mm octapolar intraluminal circular catheter was used for intracardiac recordings. A single 180-s freeze strategy was employed. Repeated procedures were performed with a 3D mapping system and radiofrequency catheters. RESULTS A total of 126 patients (69.8% male, mean age 57 ± 11 years), of which 77.0% had paroxysmal atrial fibrillation (PAF), were included in the study. After a 5-year period, 52.4% of patients were in sinus rhythm without AF recurrence, off antiarrhythmic drugs. A total of 61.9% of patients were free of AF recurrence when redo PVI procedures were performed. When accounting for redo pulmonary vein isolation and antiarrhythmic drugs, a total of 73.8% of the patients were without AF recurrence in long-term follow-up. The patients who underwent redo pulmonary vein isolation procedures had statistically significant lower rates of AF recurrence (p = 0.006). In patients with PAF, long-term success rates improved from 62.9 to 79.4% for patients who underwent the redo procedure (p = 0.020). In patients with persistent atrial fibrillation (PersAF), success rates went up from 41.4 to 55.1% for patients with single or repeated PVI procedure (p = 0.071). In the whole cohort, a total of 3 (2.4%) procedure-related major complications occurred which included persistent PNP, arterial pseudoaneurysm, and arteriovenous fistula. CONCLUSION Our data suggest a favorable long-term safety and efficacy profile of second-generation CB ablation. In the mixed paroxysmal and persistent population, up to 73.8% of patients remained free of AF recurrence in the 5-year follow-up, when accounting for redo procedures and AADs. Only 2.4% of patients experienced major complications of the ablation procedure, none with permanent sequelae.
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Affiliation(s)
- Andrija Nekić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Ivan Prepolec
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Vedran Pašara
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | | | - Domagoj Kardum
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zvonimir Katić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | - Borka Pezo Nikolić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Puljević
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Miličić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - G B Chierchia
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | - Vedran Velagić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia.
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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Dar BY, Yusuf YA, Esmati MH. Analysis of pulsed field ablation using focal contact force-sensing catheters for treatment of atrial fibrillation: acute and 90-day invasive remapping results. Europace 2023; 25:euad287. [PMID: 37725509 PMCID: PMC10521902 DOI: 10.1093/europace/euad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Bilaal Yousaf Dar
- GKT School of Medical Education, Kings College London, 17 Meadow Hill, KT3 5RQ New Malden, UK
| | - Yusuf Abdirahman Yusuf
- GKT School of Medical Education, Kings College London, 17 Meadow Hill, KT3 5RQ New Malden, UK
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