|
1
|
Karanikola AE, Tzortzi M, Kordalis A, Doundoulakis I, Antoniou CK, Laina A, Tsioufis P, Argyriou N, Sakalidis A, Pamporis K, Tsioufis K, Tsiachris D. Clinical, Electrocardiographic and Echocardiographic Predictors of Atrial Fibrillation Recurrence After Pulmonary Vein Isolation. J Clin Med 2025; 14:809. [PMID: 39941478 PMCID: PMC11818469 DOI: 10.3390/jcm14030809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 01/20/2025] [Accepted: 01/23/2025] [Indexed: 02/16/2025] Open
Abstract
Atrial fibrillation (AF) is a supraventricular arrhythmia and the most common heart rhythm disorder in the adult population worldwide with an estimated prevalence of 2% to 4% of the population. Cases of AF have shown an increasing trend in recent decades, while its frequency is expected to rise even more. Given the significant impact on patients' quality of life, as well as its major complications, including thromboembolic events, effective rhythm control strategies other than antiarrhythmic medication have emerged, with catheter ablation (CA) being the cornerstone of these. In recent years, CA has been upgraded to a first-line treatment for selected patients. However, complications do exist and arrhythmia-free survival is not always guaranteed. The need to better identify patients more suitable for this specific therapeutic measure is crucial in improving outcomes and preventing arrhythmia recurrences. This review aims to present currently identified predictors of AF recurrence after catheter ablation based on clinical characteristics and electrocardiographic and echocardiographic parameters, in an era of increasing interventional rhythm control approaches for the management of atrial fibrillation.
Collapse
Affiliation(s)
- Aikaterini-Eleftheria Karanikola
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Melpomeni Tzortzi
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Athanasios Kordalis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Ageliki Laina
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Nikos Argyriou
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Athanasios Sakalidis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Konstantinos Pamporis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| | - Dimitrios Tsiachris
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece; (A.-E.K.); (A.K.); (I.D.); (C.-K.A.); (A.L.); (P.T.); (N.A.); (A.S.); (K.P.); (K.T.)
| |
Collapse
|
|
2
|
Ding Q, Wang Z, Lu L, Song Z, Ge M, Zhou Q. QTc interval prolongation and risk of atrial fibrillation recurrence: a meta-analysis and observational cohort study. Front Cardiovasc Med 2024; 11:1483591. [PMID: 39582525 PMCID: PMC11582060 DOI: 10.3389/fcvm.2024.1483591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/28/2024] [Indexed: 11/26/2024] Open
Abstract
Introduction Corrected QT interval (QTc) is a ventricular repolarization marker on electrocardiography. Previous studies evaluated its value in predicting atrial fibrillation (AF) occurrence. However, its predictive efficacy for AF recurrence remains controversial. Methods We searched PubMed and Google databases for studies before January 2024 evaluating the association between QTc interval and AF incidence. A meta-analysis of the eligible datasets was conducted using Bazett's formula, with subgroup analysis to explore the heterogeneity. Additionally, thirty-eight patients with AF who underwent radiofrequency catheter ablation were enrolled and followed-up for 3-36 months. Univariate and multivariate Cox models were used to calculate the hazard ratios (HRs) and determine the relationship between clinical factors and AF recurrence. Kaplan-Meier survival analysis and ROC curve were conducted to assess the impact and predictive efficacy of individual factors. Results Eleven datasets from nine eligible studies were enrolled and meta-analysed. We found that patients with prolonged QTc interval was associated with a significantly higher AF incidence risk, and the risk increased with every 10-ms prolongation. However, this association was not significant in the AF recurrence subgroup. In our prospective cohort, the preoperative body mass index, QTc, left atrial diameter (LAD), and uric acid levels influenced AF recurrence. Multivariate Cox regression analysis identified LAD as an independent factor affecting AF recurrence in patients with a high predictive efficiency. Kaplan-Meier survival analysis showed that increased LAD (>4.5 cm) was associated with postoperative AF recurrence. Discussion Therefore, LAD has better predictive power and can be an indicator for predicting postoperative AF recurrence.
Collapse
Affiliation(s)
| | | | | | | | - Min Ge
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qing Zhou
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
|
3
|
Fumagalli C, Zocchi C, Ciabatti M, Milazzo A, Cappelli F, Fumagalli S, Pieroni M, Olivotto I. From Atrial Fibrillation Management to Atrial Myopathy Assessment: The Evolving Concept of Left Atrium Disease in Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:876-886. [PMID: 38286174 DOI: 10.1016/j.cjca.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most prevalent genetically inherited cardiovascular disorder in adults and a significant cause of heart failure and sudden cardiac death. Historically, atrial fibrillation (AF) has been considered as a critical aspect in HCM patients as it is considered to be a marker of disease progression, escalates the frequency of heart failure hospitalisations, increases the risk of thromboembolic events, and worsens quality of life and outcome. Increasing evidence suggests that AF is the result of a subtle long-standing process that starts early in the history of HCM. The process of left atrial dilation accompanied by morphologic and functional remodelling is the quintessential prerequisite for the onset of AF. This review aims to describe the current understanding of AF pathophysiology in HCM, emphasising the role of left atrial myopathy in its development. In addition, we discuss risk factors and management strategies specific to AF in the context of HCM, providing insights into the complexities and challenges of treating this specific patient population.
Collapse
Affiliation(s)
- Carlo Fumagalli
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
| | - Chiara Zocchi
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Cardiovascular Department, San Donato Hospital, Arezzo, Italy
| | | | - Alessandra Milazzo
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Cappelli
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Fumagalli
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy
| | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Meyer Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Florence, Italy
| |
Collapse
|
|
4
|
Faraz F, Rehman MEU, Sabir B, Ghaffar A, Iftikhar A, Maqsood A, Ahmad Cheema H, Yasmin F, Aamir M, Ahmed MU, Asghar MS. Efficacy of Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101524. [PMID: 36455792 DOI: 10.1016/j.cpcardiol.2022.101524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Catheter ablation (CA) has emerged as an effective therapy for AF. We conducted a meta-analysis to update the current clinical evidence on the efficacy of CA for AF in patients with HCM. We searched PubMed, Embase, Cochrane and Clinicaltrials.gov for interventional and observational studies assessing single and multiple procedure success rate of CA in HCM patients. Our meta-analysis included 25 studies involving 1817 patients. Success rate following single procedure was 40.4% (95% CI 33.1 to 48.0%) at latest follow-up. The pooled success rate following multiple procedures was 51.4% (95% CI 42.9% to 60.0%) at latest follow-up. In the subgroup analysis for AF subtype, TCA was more successful for paroxysmal AF compared to non-paroxysmal AF. For the subset of studies reporting drug-free success rate, single and multiple procedures had a success rate of 33.4% (95% CI 19.3 to 49.1%) and 51.8% (95% CI 41.3 to 62.2%) at latest follow-up, respectively. CA is a suitable option for AF in patients with HCM. Success rate is greater in paroxysmal AF, after multiple procedures and with antiarrhythmic drugs.
Collapse
Affiliation(s)
- Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Beenish Sabir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Areeba Ghaffar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ahmad Iftikhar
- Department of Medicine, The University of Arizona, Tucson, AZ
| | - Aimen Maqsood
- Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad and Jammu Kashmir
| | | | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown, PA
| | | | | |
Collapse
|
|
5
|
Atrial fibrillation in hypertrophic cardiomyopathy-a contemporary mini review. Hellenic J Cardiol 2022; 67:66-72. [DOI: 10.1016/j.hjc.2022.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
|
|
6
|
Hua TR, Zhang SY. Cardiomyopathies in China: A 2018-2019 state-of-the-art review. Chronic Dis Transl Med 2020; 6:224-238. [PMID: 33336168 PMCID: PMC7729112 DOI: 10.1016/j.cdtm.2020.05.006] [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: 03/29/2020] [Indexed: 11/02/2022] Open
Abstract
Cardiomyopathies are diseases of the cardiac muscle and are often characterized by ventricular dilation, hypertrophy, and cardiac arrhythmia. Patients with cardiomyopathies often experience sudden death and cardiac failure and require cardiac transplantation during the course of disease progression. Early diagnosis, differential diagnosis, and genetic consultation depend on imaging techniques, genetic testing, and new emerging diagnostic tools such as serum biomarkers. The molecular genetics of cardiomyopathies has been widely studied recently. The discovery of mechanisms underlying heterogeneity and overlapping of the phenotypes of cardiomyopathies has revealed the existence of disease modifiers, and this has led to the emergence of novel disease-modifying therapy. This 2018-2019 state-of-the-art review outlines the pathogenesis, diagnosis, and treatment of cardiomyopathies in China.
Collapse
Affiliation(s)
- Tian-Rui Hua
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|