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Jin Z, Hwang T, Kim D, Lim B, Kwon OS, Kim S, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins. NPJ Digit Med 2024; 7:81. [PMID: 38532181 DOI: 10.1038/s41746-024-01075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695.
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Affiliation(s)
- Ze Jin
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taehyun Hwang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sangbin Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Sun J, Chen S, Liang M, Zhang Q, Zhang P, Sun M, Ding J, Jin Z, Han Y, Wang Z. Bachmann's Bundle Modification in Addition to Circumferential Pulmonary Vein Isolation for Atrial Fibrillation: A Novel Ablation Strategy. Cardiol Res Pract 2023; 2023:2870188. [PMID: 37927390 PMCID: PMC10624549 DOI: 10.1155/2023/2870188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/17/2023] [Accepted: 06/23/2023] [Indexed: 11/07/2023] Open
Abstract
Background Bachmann's bundle (BB) is the main pathway of interatrial connection that could be involved in the development of atrial fibrillation (AF). Based on this hypothesis, we raised a novel ablation strategy, BB modification in addition to circumferential pulmonary vein isolation (CPVI-BB) in patients with AF. Methods A retrospective cohort of patients with AF who underwent CPVI-BB or CPVI alone from March 2018 to July 2021 was enrolled in our study. Propensity score matching was performed in patients with paroxysmal AF and persistent AF, respectively, to reduce the risk of selection bias between the treatment strategies (CPVI-BB or CPVI alone). The primary endpoint was overall freedom from atrial arrhythmia recurrence through 12 months of follow-up. Results Our propensity score-matched cohort included 82 patients with paroxysmal AF (CPVI group: n = 41; CPVI-BB group: n = 41) and 168 patients with persistent AF (CPVI group: n = 84; CPVI-BB group: n = 84). Among patients with persistent AF, one-year freedom from atrial arrhythmia recurrence rate was 83.3% in the CPVI-BB group and 70.2% in the CPVI group (log-rank P = 0.047). Among patients with paroxysmal AF, no significant difference was found in the primary endpoint between two groups (85.4% in the CPVI-BB group vs. 80.5% in the CPVI group; log-rank P = 0.581). In addition, procedure-related complications and recurrence of atrial tachycardia or atrial flutter were similar between the two treatment groups, regardless of the type of AF. Conclusions BB modification in addition to CPVI is an effective approach in increasing the maintenance of sinus rhythm in patients with persistent AF, while it does not improve the clinical outcomes of radiofrequency catheter ablation in patients with paroxysmal AF.
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Affiliation(s)
- Jiaqi Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Sanbao Chen
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ming Liang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Qi Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Ping Zhang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Mingyu Sun
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Jian Ding
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zhiqing Jin
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Yaling Han
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
| | - Zulu Wang
- Department of Cardiology, The General Hospital of Northern Theater Command, Shenyang, China
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Sun Z, Fan C, Song L, Zhang H, Jiang Z, Tan H, Sun Y, Liu L. Effect of electrophysiological mapping on non-transmural annulus ablation and atrial fibrillation recurrence prediction after 6 months of Cox-Maze IV procedure. Front Cardiovasc Med 2022; 9:931845. [PMID: 35911537 PMCID: PMC9334885 DOI: 10.3389/fcvm.2022.931845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective of this study was to observe the safety and efficacy of electrophysiological mapping following the Cox-Maze IV procedure and to investigate whether a correlation exists between recurrence of atrial fibrillation (AF) with the completeness of bidirectional electrical isolation and the inducibility of AF immediately after the Cox-Maze IV procedure. Methods Totally, 80 consecutive patients who suffered from aortic valve or mitral valve disease and persistent AF were randomly enrolled into the control group and electrophysiological mapping following the Cox-Maze IV group (Electrophysio-Maze group). In the Electrophysio-Maze group, patients underwent concomitant Cox-Maze procedure and following electrophysiological mapping of ablation lines in mitral isthmus, left atrial “box,” and tricuspid annulus. If the bidirectional electrical isolation of tricuspid annulus ablation line is incomplete, whether to implement supplementary ablation will be independently decided by the operator. Before and after the Cox-Maze IV procedure, AF induction was performed. All patients in both groups were continuously followed-up and underwent electrocardiogram Holter monitoring after 6 months. Results In total, 42 Electrophysio-Maze patients and 38 controls were enrolled. Compared with patients in the control group, there were shorter hospital stay, better cardiac remodeling changes, and higher relief from AF during the follow-up period of 6 months in the Electrophysio-Maze group. Within the Electrophysio-Maze group, the rate of incomplete the bidirectional electrical isolation of “box” ablation lines was zero, and the rate of incomplete bidirectional electrical isolation of mitral isthmus ablation line or tricuspid annulus ablation line was 23.8%. After two cases of successful complementary ablation on the tricuspid annulus ablation line, the final incomplete bidirectional electrical isolation of annulus ablation lines was 19.0%. There were correlations between late AF recurrence after 6 months with incomplete bidirectional electrical isolation of annulus ablation lines and AF induction immediately after the Cox-Maze IV procedure. Conclusion Electrophysiological mapping following the Cox-Maze procedure is safe and effective. Electrophysiological mapping in the Cox-Maze procedure can find out the non-transmural annulus ablation lines by assessing the completeness of bidirectional electrical isolation of ablation lines, guide supplementary ablation, and predict AF recurrence after 6 months.
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High Internal Atrial Defibrillation Threshold Is Related to a High Risk of Recurrence After Catheter Ablation for Long-standing Persistent Atrial Fibrillation but not for Persistent Atrial Fibrillation. Heart Lung Circ 2022; 31:1277-1284. [PMID: 35667971 DOI: 10.1016/j.hlc.2022.04.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The atrial defibrillation threshold (ADFT) for internal cardioversion is theoretically related to the critical mass for sustaining atrial fibrillation (AF). OBJECTIVE This study aimed to investigate the association of ADFT for internal cardioversion with the outcome of catheter ablation for non-paroxysmal AF (non-PAF). METHODS We included 368 consecutive patients who underwent first-time catheter ablation for non-PAF. Based on the degree of ADFT recorded by the internal cardioversion before pulmonary vein isolation, we divided the patients into low ADFT (<20 J) and high ADFT (≥20 J) groups and analysed the association between ADFT and atrial tachyarrhythmia recurrence. RESULTS There were 234 and 134 patients in the low and high ADFT groups, respectively. Of these, 39 patients (16.7%) and 41 (30.6%) patients, respectively, had atrial tachyarrhythmia recurrence during the 2.6±1.0 year follow-up. The high ADFT group showed a significantly higher atrial tachyarrhythmia recurrence than the low ADFT group (p=0.002). This finding was also noted in patients with long-standing persistent AF (p=0.032) but not in patients with persistent AF (p=0.159). The significant predictors of arrhythmia recurrence on multivariate analysis were high ADFT (p=0.004) and long-standing persistent AF (p=0.011). In multivariate analysis within the long-standing persistent AF group, only ADFT remained a significant risk factor for AF recurrence (p=0.035). CONCLUSIONS The high ADFT of internal cardioversion was found to be a risk factor for post-catheter ablation recurrence in patients with long-standing persistent AF but not in those with persistent AF.
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Jin Z, Hwang I, Lim B, Kwon OS, Park JW, Yu HT, Kim TH, Joung B, Lee MH, Pak HN. Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study. Front Physiol 2022; 13:846620. [PMID: 35370797 PMCID: PMC8968313 DOI: 10.3389/fphys.2022.846620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/24/2022] [Indexed: 01/22/2023] Open
Abstract
Background Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps). Methods We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps. Results Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010). Conclusion CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hui-Nam Pak
- Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
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Millenaar D, Becker N, Pavlicek V, Wintrich J, Böhm M, Mahfoud F, Ukena C. Inducibility of atrial fibrillation after catheter ablation predicts recurrences of atrial fibrillation: a meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:667-676. [PMID: 33686680 DOI: 10.1111/pace.14216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/28/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is a component of standard care for patients with symptomatic atrial fibrillation (AF). Procedural inducibility of AF following PVI has been suggested as predictor of AF recurrence but is discussed controversially. This meta-analysis aimed at evaluating the relevance of electrophysiological inducibility of AF following PVI for future AF recurrences. METHODS A literature search of MEDLINE and Web of Science was performed until April 2020. Prospective trials of PVI in patients with AF and post-procedural atrial stimulation to test for inducibility of AF as well as adequate follow-up for AF recurrence (defined as AF >10 s to >10 min at follow-up) were included. Odds ratios (ORs) were analyzed using random-effects models. RESULTS A total of 11 trials with 1544 patients (follow-up 7-39 months, age 56 ± 6 years, predominantly male 74 ± 6%) were included. Inducibility of AF post-PVI was predictive for AF recurrence during follow-up (OR 2.08; 95% CI 1.25 to 3.46). Prediction for AF recurrence at follow-up was better for patients with paroxysmal AF (OR 4.06; 95% CI 1.39 to 11.91), stimulation in the CS (OR 2.82, 95% CI 1.17 to 6.79). A trend towards higher ORs was seen without the use of isoproterenol (OR 2.43; 95% CI 1.17 to 5.07), as well as few stimulations during induction and a short definition of AF in meta-regression analyses. CONCLUSIONS Electrophysiological inducibility of AF following PVI was predictive for future recurrence of AF, in particular in patients with paroxysmal AF, stimulation in only CS and no use of isoproterenol.
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Affiliation(s)
- Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Nicolas Becker
- Personality Psychology and Psychological Assessment, Saarland University, Saarbrücken, Germany
| | - Valérie Pavlicek
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Jan Wintrich
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Son NKL, Park JW, Kim M, Yang SY, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Efficacy and Safety of Outpatient Clinic-based Elective External Electrical Cardioversion in Patients with Atrial Fibrillation. Korean Circ J 2020; 50:511-523. [PMID: 32212425 PMCID: PMC7234846 DOI: 10.4070/kcj.2019.0310] [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: 09/23/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the outcomes of outpatient clinic-based elective external cardioversion (OPC-ECV) for persistent atrial fibrillation (PeAF). We investigated the acute, short-term, and long-term elective external cardioversion (ECV) outcomes. METHODS We included 1,718 patients who underwent OPC-ECV (74% male, 61.1±11.0 years old, 90.9% long-standing PeAF, 9.1% after atrial fibrillation [AF] ablation) after excluding patients with atrial tachycardia or inappropriate antiarrhythmic drug medication, and in-patient ECV. Biphasic shocks were delivered sequentially until successful cardioversion was achieved (70-100-150-200-250 J). If ECV failed at 150 J, we administered intravenous amiodarone 150 mg and delivered 200 J. RESULTS ECV failed in 11.4%, and the complication rate was 0.47%. Within 3 months, AF recurred in 55.5% (44.7% as sustaining AF, 10.8% as paroxysmal AF), and the AF duration was independently associated (odds ratio [OR], 1.01 [1.00-1.02]; p=0.006), but amiodarone was independently protective (OR, 0.46 [0.27-0.76]; p=0.002, Log rank p<0.001) against an early recurrence. Regarding the long-term recurrence, pre-ECV heart failure was protective against an AF recurrence (hazard ratio, 0.63 [0.41-0.96], p=0.033) over 32 (9-66) months of follow-up. ECV energy (p<0.001) and early recurrence rate within 3 months (p=0.007, Log rank p=0.006) were significantly lower in post-ablation patients than in those with long-standing persistent AF. CONCLUSIONS The success rate of OPC-ECV was 88.6%, and the complication rate was low. However, AF recurred in 55.5% within 3 months. Amiodarone was protective against short-term AF recurrences, and long-term AF recurrences were less in patients with baseline heart failure.
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Affiliation(s)
- Nguyen Khac Le Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Je Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Song Yi Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Moon Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
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Kim JO, Shim J, Lee SH, Yu HT, Kim TH, Uhm JS, Choi JI, Choi JY, Lee MH, Kim YH, Chang BC, Pak HN. Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation. J Cardiol 2019; 73:488-496. [PMID: 30850308 DOI: 10.1016/j.jjcc.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. METHODS We compared 77 patients with VAF (46.8% male, 52.7±8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. RESULTS The left atrial (LA) diameter was greater (p<0.001), LA voltage lower (p<0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p=0.004) for VAF than NVAF. During 70.2±1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p=0.399), even after excluding patients with maze procedures (log rank p=0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p=0.244), or between patients with prior maze procedures and those without (log rank p=0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. CONCLUSIONS Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.
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Affiliation(s)
- Jung Ok Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jaemin Shim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jong-Il Choi
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Jae Young Choi
- Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyung Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Park JW, Yu HT, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Trends and Outcome of Catheter Ablation of Atrial Fibrillation Over 9 Years ― Focus on Empirical Extra-Pulmonary Vein Ablation ―. Circ J 2019; 83:304-312. [DOI: 10.1253/circj.cj-18-0928] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Efremidis M, Vlachos K, Letsas KP, Bazoukis G, Martin R, Frontera A, Asvestas D, Saplaouras A, Kitamura Τ, Georgopoulos S, Valkanas K, Karamichalakis N, Takigawa M, Sideris A, Derval N, Sacher F, Jais P. Targeted ablation of specific electrogram patterns in low-voltage areas after pulmonary vein antral isolation in persistent atrial fibrillation: Termination to an organized rhythm reduces atrial fibrillation recurrence. J Cardiovasc Electrophysiol 2018; 30:47-57. [PMID: 30288830 DOI: 10.1111/jce.13763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ablation strategies have been developed to improve outcomes in patients with persistent atrial fibrillation (PsAF). However, the impact of atrial fibrillation (AF) termination on late AF recurrence is not well known. The aim of our study was to evaluate the impact of AF termination to atrial tachycardia (AT) or sinus rhythm (SR) during catheter ablation on late AF recurrence after the 3-month blanking period. METHODS AND RESULTS We prospectively recruited 140 patients (mean age: 58.5 ± 12.3 years old, 74.3% males) with uninterrupted PsAF of a mean duration of 3.7 months. Pulmonary vein antral isolation (PVAI) was the first ablation step, and if AF did not terminate (to SR or AT), we ablated low-voltage areas less than 0.4 mV with specific electrogram characteristics. We successfully converted AF to AT or SR in 56 patients (40%) during PVAI (n = 24) or low-voltage ablation ( n = 32). The remaining 84 patients (60%) were electrically cardioverted to SR at the end of the procedure. One hundred patients (71.4%) maintained SR after a single procedure during a mean follow-up of 21.1 ± 0.8 months. Of the 56 patients with AF termination, 46 (82.1%) had no recurrence, while in the group of 84 patients without AF termination, 54 patients (64.3%) remained in SR ( P < 0.02). CONCLUSION Ablation of PVAI and specific electrograms in low-voltage areas less than 0.4 mV can lead to encouraging outcomes with a low recurrence rate as well as a lower need for redo procedures.
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Affiliation(s)
- Michael Efremidis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Ruairidh Martin
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Antonio Frontera
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Dimitrios Asvestas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Τakeshi Kitamura
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Stamatios Georgopoulos
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Kosmas Valkanas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Nikolaos Karamichalakis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Masateru Takigawa
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Nicolas Derval
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Frederic Sacher
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jais
- Hôpital Cardiologique Haut Lévêque, Lyric Institute, Université de Bordeaux, Bordeaux-Pessac, France
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11
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Lim B, Hwang M, Song JS, Ryu AJ, Joung B, Shim EB, Ryu H, Pak HN. Effectiveness of atrial fibrillation rotor ablation is dependent on conduction velocity: An in-silico 3-dimensional modeling study. PLoS One 2017; 12:e0190398. [PMID: 29287119 PMCID: PMC5747478 DOI: 10.1371/journal.pone.0190398] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We previously reported that stable rotors are observed in in-silico human atrial fibrillation (AF) models, and are well represented by a dominant frequency (DF). In the current study, we hypothesized that the outcome of DF ablation is affected by conduction velocity (CV) conditions and examined this hypothesis using in-silico 3D-AF modeling. METHODS We integrated 3D CT images of left atrium obtained from 10 patients with persistent AF (80% male, 61.8±13.5 years old) into in-silico AF model. We compared AF maintenance durations (max 300s), spatiotemporal stabilities of DF, phase singularity (PS) number, life-span of PS, and AF termination or defragmentation rates after virtual DF ablation with 5 different CV conditions (0.2, 0.3, 0.4, 0.5, and 0.6m/s). RESULTS 1. AF maintenance duration (p<0.001), spatiotemporal mean variance of DF (p<0.001), and the number of PS (p = 0.023) showed CV dependent bimodal patterns (highest at CV0.4m/s and lowest at CV0.6m/s) consistently. 2. After 10% highest DF ablation, AF defragmentation rates were the lowest at CV0.4m/s (37.8%), but highest at CV0.5 and 0.6m/s (all 100%, p<0.001). 3. In the episodes with AF termination or defragmentation followed by 10% highest DF ablation, baseline AF maintenance duration was shorter (p<0.001), spatiotemporal mean variance of DF was lower (p = 0.014), and the number of PS was lower (p = 0.004) than those with failed AF defragmentation after DF ablation. CONCLUSION Virtual ablation of DF, which may indicate AF driver, was more likely to terminate or defragment AF with spatiotemporally stable DF, but not likely to do so in long-lasting and sustained AF conditions, depending on CV.
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Affiliation(s)
- Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Ah-Jin Ryu
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Ganwon-do, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Ganwon-do, Republic of Korea
| | - Hyungon Ryu
- NVIDIA, Yonsei University, Department of Mathematics, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
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12
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Yang PS, Park YA, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Which patients recur as atrial tachycardia rather than atrial fibrillation after catheter ablation of atrial fibrillation? PLoS One 2017; 12:e0188326. [PMID: 29145517 PMCID: PMC5690680 DOI: 10.1371/journal.pone.0188326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/03/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The ablation gaps have been known as the main mechanism of recurrence as atrial tachycardia (AT) rather than atrial fibrillation (AF) after AF catheter ablation. However, AF organization due to reduction of critical mass or focal trigger may also be the mechanism of AT recurrence. We sought to find out the main clinical factors of recurrence as AT rather than AF after AF ablation in the absence of antiarrhythmic drug effect. METHODS We analyzed 521 patients (70.8% men, 64.1% paroxysmal AF) who experienced AT or AF recurrence without antiarrhythmic drug effect during 44.7 ± 25.4 months follow-up. RESULTS Among 521 patients with recurrence, 42.0% (219 of 521) recurred with AT. The proportion of AT recurrence was not different between the pulmonary vein isolation only group and additional linear ablation group (45.1% vs. 38.1%, p = 0.128). The absence of hypertension (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.29-0.83, p = 0.007), small left atrial (LA) volume index (OR 0.89 per 10 mL/m2, 95% CI 0.79-1.00, p = 0.049), and high mean LA bipolar voltage (OR 2.03 per 1 mV, 95% CI 1.30-3.16, p = 0.002) were independently associated with AT recurrence, whereas additional linear ablation was not. Among 90 patients who underwent repeat ablation procedure, rates of PV reconnection (p = 0.358) and gap in prior linear ablations (p = 0.269) were not significantly different between AT recurrence group and AF recurrence group. CONCLUSION The degree of LA remodeling is significantly associated with recurrence as AT after AF ablation, irrespective of potential ablation gap in linear lesion.
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Affiliation(s)
- Pil-Sung Yang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Young-Ah Park
- Division of Cardiology, Inje University, Busan Paik Hosipital, Busan, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea
- * E-mail:
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13
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Yu HT, Park J, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Endurance Ablation Facilitates Long-lasting Circumferential Pulmonary Vein Isolation and Better Clinical Outcomes in Patients with Paroxysmal Atrial Fibrillation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Yu HT, Shim J, Park J, Kim IS, Kim TH, Uhm JS, Joung B, Lee MH, Kim YH, Pak HN. Pulmonary Vein Isolation Alone Versus Additional Linear Ablation in Patients With Persistent Atrial Fibrillation Converted to Paroxysmal Type With Antiarrhythmic Drug Therapy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004915. [DOI: 10.1161/circep.116.004915] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
Abstract
Background—
Atrial fibrillation (AF) type can vary depending on condition and timing, and some patients who initially present with persistent AF may be changed to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether circumferential pulmonary vein isolation (CPVI) alone is an effective rhythm control strategy in patients with persistent AF to paroxysmal AF.
Methods and Results—
We enrolled 113 patients with persistent AF to paroxysmal AF (male 75%, 60.4±10.1 years old) who underwent catheter ablation for nonvalvular AF at 3 tertiary hospitals. The participants were randomly assigned to 2 groups: CPVI alone (n=59) or CPVI plus linear ablation (CPVI+Line; posterior box+anterior line, n=54). Compared with the CPVI+Line, CPVI alone required shorter procedure (187.2±58.0 versus 211.2±63.9 min;
P
=0.043) and ablation times (4922.1±1110.5 versus 6205.7±1425.2 s;
P
<0.001) without difference in procedure-related major complication (3% versus 2%;
P
=0.611). Antiarrhythmic drug utility rates after ablation were not different between the 2 groups (22% versus 30%;
P
=0.356). Overall, AF-free survival (log-rank;
P
=0.206) and AF and antiarrhythmic drug–free survival (log-rank;
P
=0.321) were not different between groups.
Conclusions—
CPVI alone is an effective rhythm control strategy with a shorter procedure time in persistent AF patients converted to paroxysmal AF compared with CPVI with linear ablation.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02176616.
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Affiliation(s)
- Hee Tae Yu
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Jaemin Shim
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Junbeom Park
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - In-Soo Kim
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Tae-Hoon Kim
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Jae-Sun Uhm
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Boyoung Joung
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Moon-Hyoung Lee
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Young-Hoon Kim
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
| | - Hui-Nam Pak
- From the Yonsei University Health System, Seoul, Republic of Korea (H.T.Y., I.-S.K., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.); Korea University Cardiovascular Center, Seoul, Republic of Korea (J.S., Y.-H.K.); and Ewha Womans University, Seoul, Republic of Korea (J.P.)
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15
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Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Does Additional Electrogram-Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study. J Am Heart Assoc 2017; 6:JAHA.116.004811. [PMID: 28174170 PMCID: PMC5523774 DOI: 10.1161/jaha.116.004811] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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 Although circumferential pulmonary vein isolation (CPVI) catheter ablation may not be sufficient for long‐standing persistent atrial fibrillation (L‐PeAF), it is not clear which ablation strategy is beneficial in addition to CPVI. We sought to investigate whether additional complex fractionated atrial electrogram (CFAE)‐guided ablation improves clinical outcomes in L‐PeAF patients who exhibit continuous atrial fibrillation (AF) after CPVI and linear ablation (Line). Methods and Results This study enrolled 137 L‐PeAF patients (71.4% male, 61.6±10.9 years old) who underwent radiofrequency catheter ablation. We conducted CPVI+Line based on the Dallas lesion set (posterior box+anterior line) after baseline CFAE mapping in all patients. If AF was defragmented (terminated or changed to atrial tachycardia), the procedure was stopped (AF‐Defrag group, n=29). If AF was maintained after CPVI+Line, we mapped the CFAE again and randomly assigned the patient to the CPVI+Line group (n=54) or the additional CFAE ablation group (CPVI+Line+CFAE group, n=54). L‐PeAF was defragmented during CPVI+Line in 21.2% of patients (29/137, AF‐Defrag group). The mean CFAE cycle length was prolonged (P<0.001), and CFAE area (CFAE cycle length <120 milliseconds) was reduced (P<0.001) after CPVI+Line in the remaining patients. Procedure time was longer in the CPVI+Line+CFAE group than the CPVI+Line group (P=0.023), but procedure‐related complication rates did not vary. During 22.3±13.2 months of follow‐up, the clinical recurrence rates were 17.2% in the AF‐Defrag group, 18.5% in the CPVI+Line group, and 32.1% in the CPVI+Line+CFAE group (log rank, P=0.166). Conclusions Although CPVI+Line reduces and localizes CFAE area, additional CFAE ablation after CPVI+Line does not improve the clinical outcomes of catheter ablation in patients with L‐PeAF.
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Affiliation(s)
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Korea
| | | | | | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Korea
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16
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Kim IS, Kim TH, Yang PS, Uhm JS, Joung B, Lee MH, Pak HN. Minimal energy requirement for external cardioversion and catheter ablation for long-standing persistent atrial fibrillation. J Cardiol 2016; 69:162-168. [PMID: 26987790 DOI: 10.1016/j.jjcc.2016.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/01/2016] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The minimal energy requirement (Emin) for electrical cardioversion (ECV) reflects the atrial substrate in patients with long-standing persistent atrial fibrillation (L-PeAF), but the relationship between EminECV and radiofrequency catheter ablation (RFCA) has not yet been studied. We hypothesize that EminECV before ablation (EminECVpre) predicts clinical outcome of RFCA, and that catheter ablation reduces EminECVpost. METHODS We included 172 patients with L-PeAF who underwent RFCA (79.7% males, 57.5±10.0 years) due to AF recurrence after ECV with an anti-arrhythmic drug (AAD). ECV began with 70J (patch electrode on anterior-posterior position) and was serially increased to 100, 150, 200, and 250J until sinus rhythm was achieved, at an average 5.0±5.6 months before RFCA. After RFCA, ECV was repeated (ECVpost) in 42 patients with recurrent AF that was not controlled by AAD. RESULTS (1) During 34.8±20.0 months of follow-up after RFCA, 103 patients (59.9%) showed clinical recurrence of AF after RFCA. EminECVpre was significantly higher in patients with recurrent AF (129.0±58.6J) than those who remained in sinus rhythm (94.2±39.4J, p<0.001). (2) EminECVpre ≥150J (HR=3.31, 95% CI 2.18-5.03, p<0.001) and left atrial volume index (HR=1.02, 95% CI 1.00-1.04, p=0.021) were significantly associated with post-RFCA recurrence. (3) Shorter post-RFCA recurrence timing was also independently related to EminECVpre (β=-0.147, 95% CI -0.20 to -0.09, p<0.001). (4) Among 103 patients with recurrent AF after RFCA, 42 AAD-resistant AF patients underwent ECVpost. EminECVpost (100.9±50.8J) was significantly lower than EminECVpre (130.0±66.1J, p=0.006). CONCLUSIONS Higher EminECVpre was independently associated with clinical recurrence and earlier recurrence timing of AF after catheter ablation among patients with AAD-resistant L-PeAF. Catheter ablation for L-PeAF significantly reduces EminECV.
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Affiliation(s)
- In-Soo Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Pil-Sung Yang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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17
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Kim IS, Yang PS, Kim TH, Park J, Park JK, Uhm JS, Joung B, Lee MH, Pak HN. Clinical Significance of Additional Ablation of Atrial Premature Beats after Catheter Ablation for Atrial Fibrillation. Yonsei Med J 2016; 57:72-80. [PMID: 26632385 PMCID: PMC4696975 DOI: 10.3349/ymj.2016.57.1.72] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/28/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The clinical significance of post-procedural atrial premature beats immediately after catheter ablation for atrial fibrillation (AF) has not been clearly determined. We hypothesized that the provocation of immediate recurrence of atrial premature beats (IRAPB) and additional ablation improves the clinical outcome of AF ablation. MATERIALS AND METHODS We enrolled 200 patients with AF (76.5% males; 57.4±11.1 years old; 64.3% paroxysmal AF) who underwent catheter ablation. Post-procedure IRAPB was defined as frequent atrial premature beats (≥6/min) under isoproterenol infusion (5 μg/min), monitored for 10 min after internal cardioversion, and we ablated mappable IRAPBs. Post-procedural IRAPB provocations were conducted in 100 patients. We compared the patients who showed IRAPB with those who did not. We also compared the IRAPB provocation group with 100 age-, sex-, and AF-type-matched patients who completed ablation without provocation (No-Test group). RESULTS 1) Among the post-procedural IRAPB provocation group, 33% showed IRAPB and required additional ablation with a longer procedure time (p=0.001) than those without IRAPB, without increasing the complication rate. 2) During 18.0±6.6 months of follow-up, the patients who showed IRAPB had a worse clinical recurrence rate than those who did not (27.3% vs. 9.0%; p=0.016), in spite of additional IRAPB ablation. 3) However, the clinical recurrence rate was significantly lower in the IRAPB provocation group (15.0%) than in the No-Test group (28.0%; p=0.025) without lengthening of the procedure time or raising complication rate. CONCLUSION The presence of post-procedural IRAPB was associated with a higher recurrence rate after AF ablation. However, IRAPB provocation and additional ablation might facilitate a better clinical outcome. A further prospective randomized study is warranted.
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Affiliation(s)
- In Soo Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Pil Sung Yang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Junbeum Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Jin Kyu Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Moon Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
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Hwang M, Park J, Lee YS, Park JH, Choi SH, Shim EB, Pak HN. Fibrillation Number Based on Wavelength and Critical Mass in Patients Who Underwent Radiofrequency Catheter Ablation for Atrial Fibrillation. IEEE Trans Biomed Eng 2015; 62:673-9. [DOI: 10.1109/tbme.2014.2363669] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Kim TH, Park J, Park JK, Uhm JS, Joung B, Hwang C, Lee MH, Pak HN. Linear ablation in addition to circumferential pulmonary vein isolation (Dallas lesion set) does not improve clinical outcome in patients with paroxysmal atrial fibrillation: a prospective randomized study. Europace 2014; 17:388-95. [DOI: 10.1093/europace/euu245] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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20
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Clinical application of the fibrillation number in patients with an implantable cardioverter defibrillator. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:33-9. [DOI: 10.1016/j.pbiomolbio.2014.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/05/2014] [Accepted: 09/07/2014] [Indexed: 11/21/2022]
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21
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Won H, Uhm JS, Shim J, Joung B, Lee MH, Pak HN. The effectiveness of anti-arrhythmic drugs on recurrent atrial tachyarrhythmias after catheter ablation of atrial fibrillation. Int J Cardiol 2013; 168:1570-2. [PMID: 23465248 DOI: 10.1016/j.ijcard.2013.01.186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 01/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Hoyun Won
- Yonsei University Health System, Seoul, Republic of Korea
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