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Popa MA, Hessling G, Deisenhofer I. Reply: Optimal procedural selection for atrial fibrillation catheter ablation to minimize myocardial injury and inflammatory reaction. J Cardiovasc Electrophysiol 2024; 35:868-869. [PMID: 38433305 DOI: 10.1111/jce.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Miruna A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
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Knappe V, Lahrmann C, Funken M, Zietzer A, Gestrich C, Nickenig G, Schrickel JW, Beiert T. Comparison of Arctic Front Advance Pro and POLARx cryoballoons for ablation therapy of atrial fibrillation: an intraprocedural analysis. Clin Res Cardiol 2024:10.1007/s00392-024-02398-2. [PMID: 38358420 DOI: 10.1007/s00392-024-02398-2] [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: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Cryoballoon (CB) ablation has become a popular method for pulmonary vein isolation (PVI) in atrial fibrillation (AF) treatment. This study aimed to compare the intraprocedural ablation characteristics of two cryoballoons, Arctic Front Advance Pro™ (AFA-Pro, Medtronic) and POLARx™ (Boston Scientific). METHODS AND RESULTS In this retrospective single-center study, 230 symptomatic paroxysmal or persistent AF patients underwent CB ablation with either AFA-Pro or POLARx. Propensity-score matching resulted in two cohorts of 114 patients each. Baseline and procedural characteristics were comparable between both CBs. POLARx achieved lower minimal temperatures (e.g., left superior pulmonary vein, LSPV: AFA-Pro - 49.0 °C vs. POLARx - 59.5 °C) and lower temperatures at time-to-isolation (TTI). Additionally, POLARx reached lower temperatures faster, as evidenced by lower temperatures after 40 and 60 s, and a larger mean temperature change between 20 and 40 s. POLARx also had a greater area under the curve below 0 °C and a longer thawing phase. Both CBs achieved comparable high rates of final PV-isolation. TTI, minimal esophagus temperature, and first-pass isolation rates were similar between groups. Periprocedural complications, including phrenic nerve injuries, were comparable. Troponin levels in the left atrium were elevated with both systems. Values and change in troponin were numerically higher in the POLARx group (delta troponin: AFA-Pro 36.3 (26.4, 125.4) ng/L vs. POLARx 104.9 (49.5, 122.2) ng/L), p = 0.077). CONCLUSION AFA-Pro and POLARx are both highly effective and safe CB systems for PVI. POLARx exhibited significant faster and lower freezing characteristics, and numerically higher troponin levels might indicate greater myocardial injury. However, these differences did not translate into improved performance, procedural efficiency, or safety.
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Affiliation(s)
- Vincent Knappe
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Caroline Lahrmann
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Maximilian Funken
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas Zietzer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christopher Gestrich
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jan W Schrickel
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas Beiert
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Popa MA, Bahlke F, Kottmaier M, Foerschner L, Bourier F, Lengauer S, Telishevska M, Krafft H, Englert F, Reents T, Lennerz C, Caluori G, Jaïs P, Hessling G, Deisenhofer I. Myocardial injury and inflammation following pulsed-field ablation and very high-power short-duration ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2024; 35:317-327. [PMID: 38105426 DOI: 10.1111/jce.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) is an established treatment strategy for atrial fibrillation (AF). To improve PVI efficacy and safety, high-power short-duration (HPSD) ablation and pulsed-field ablation (PFA) were recently introduced into clinical practice. This study aimed to determine the extent of myocardial injury and systemic inflammation following PFA, HPSD, and standard RFA using established biomarkers. METHODS We included 179 patients with paroxysmal AF receiving first-time PVI with different ablation technologies: standard RFA (30-40 W/20-30 s, n = 52), power-controlled HPSD (70 W/5-7 s, n = 60), temperature-controlled HPSD (90 W/4 s, n = 32), and PFA (biphasic, bipolar waveform, n = 35). High-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), CK MB isoform (CK-MB), and white blood cell (WBC) count were determined before and after ablation. RESULTS Baseline characteristics were well-balanced between groups (age 63.1 ± 10.3 years, 61.5% male). Postablation hs-cTnT release was significantly higher with PFA (1469.3 ± 495.0 ng/L), HPSD-70W (1322.3 ± 510.6 ng/L), and HPSD-90W (1441.2 ± 409.9 ng/L) than with standard RFA (1045.9 ± 369.7 ng/L; p < .001). CK and CK-MB release was increased with PFA by 3.4-fold and 5.8-fold, respectively, as compared to standard RFA (p < .001). PFA was associated with the lowest elevation in WBC (Δ1.5 ± 1.5 × 109 /L), as compared to standard RFA (Δ3.8 ± 2.5 × 109 /L, p < .001), HPSD-70W (Δ2.7 ± 1.7 × 109 /L, p = .037), and HPSD-90W (Δ3.6 ± 2.5 × 109 /L, p < .001). CONCLUSION Among the four investigated ablation technologies, PFA was associated with the highest myocardial injury and the lowest inflammatory reaction.
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Affiliation(s)
- Miruna A Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Leonie Foerschner
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université & INSERM-U1045, University of Bordeaux, Pessac, France
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
- Munich Arrhythmia Research and Study Center (MARS), German Heart Center Munich, Munich, Germany
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High-power short-duration ablation index-guided pulmonary vein isolation protocol using a single catheter. J Interv Card Electrophysiol 2022; 65:633-642. [PMID: 35596105 PMCID: PMC9726791 DOI: 10.1007/s10840-022-01226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation (AF) is the most commonly performed electrophysiological procedure. To improve healthcare utilization, we aimed to compare the efficacy, efficiency, and safety of a minimalistic, streamlined single catheter ablation approach using a high-power short-duration ablation index-guided protocol (HPSD) vs. a control single-catheter protocol (SP). METHODS Pulmonary vein isolation (PVI) with a single transseptal puncture without a multipolar mapping catheter was performed in 91 patients. Left atrial mapping was performed with the ablation catheter, only. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD (n = 34) vs. a control (n = 57) ablation protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month blanking period. RESULTS Using the HPSD protocol the median procedure and RF ablation time were significantly shorter compared to the SP, 84 (IQR 76-100) vs. 118 min (IQR 104-141) and 1036 (898-1184) vs. 1949s (IQR 1693-2261), respectively, p < .001 for all. First-pass PVI was achieved using the HPSD protocol in 88% and using the SP in 87% of patients, p = 1.0. No procedural complications were observed. High-sensitivity cardiac troponin levels were significantly higher in patients using the HPSD protocol compared to the SP. At 12 months follow-up, 87% patients remained free from AF with no differences between groups. CONCLUSIONS A minimalistic, HPSD ablation index-guided PVI with a single-catheter approach is very efficient, safe, and associated with excellent clinical outcomes at 1 year.
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Sousa PA, Puga L, Barra S, Campos D, António N, Elvas L, Gonçalves L. High-sensitivity Troponin I and Ablation Effectiveness Quotient after Ablation Index-guided pulmonary vein isolation-markers of arrhythmia recurrence? J Interv Card Electrophysiol 2022; 65:115-121. [PMID: 35469051 DOI: 10.1007/s10840-022-01229-6] [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: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are conflicting data regarding the relationship between high-sensitivity cardiac Troponin I (Hs-cTnI) and the ablation effectiveness quotient (AEQ) with arrhythmia recurrence following atrial fibrillation (AF) ablation. Our goals were to evaluate the impact of the Ablation Index (AI) software on Hs-cTnI and AEQ levels and to assess whether these markers are predictors of arrhythmia recurrence. METHODS Prospective single-center study of 75 consecutive patients referred for paroxysmal AF ablation from October 2017 to January 2019. Procedural endpoints and 2-year outcomes were assessed and compared to those of 75 propensity score-matched patients submitted to non-AI-guided pulmonary vein isolation (PVI) [control group]. RESULTS Compared to the control group, patients having AI-guided PVI had lower Hs-cTnI values (1580 [IQR 1180-2140] ng/L vs. 2600 [IQR 1840 - 3900], p < 0.001) and a lower AEQ (0.9 [IQR 0.6-1.2] ng/L/s vs. 1.4 [0.8-1.6] ng/L/s, p < 0.001). After a median follow-up of 26 (IQR 20-32) months, there was a significant reduction in arrhythmia recurrence in the AI group (15% vs. 31%, HR 0.67 [95% CI, 0.32-1.40], p = 0.02). However, neither Hs-cTnI nor AEQ was predictors of arrhythmia recurrence in AI-guided PVI. CONCLUSIONS The use of the AI software led to reduced levels of Hs-cTnI and lower AEQ in AF patients submitted to PVI. However, none of these markers predicted arrhythmia recurrence.
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Affiliation(s)
- Pedro A Sousa
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Luís Puga
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrábida, V. N. Gaia, Portugal
| | - Diana Campos
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Natália António
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, ICBR, University of Coimbra, Coimbra, Portugal
| | - Luís Elvas
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal
| | - Lino Gonçalves
- Pacing & Electrophysiology Unit, Cardiology Department, Coimbra's Hospital and University Center, Morada: Praceta Prof Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, ICBR, University of Coimbra, Coimbra, Portugal
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Yano M, Egami Y, Kawanami S, Sugae H, Ukita K, Kawamura A, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Matsunaga-Lee Y, Nishino M, Tanouchi J. Acute myocardial injury after radiofrequency catheter ablation: impact on pulmonary vein reconnection and relevant factors. Heart Vessels 2021; 37:812-820. [PMID: 34668989 DOI: 10.1007/s00380-021-01972-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) causes myocardial injury and induces high-sensitive cardiac troponin I (hs-TnI) release into the systemic circulation. Several factors are considered to be associated with myocardial injury after ablation, but few studies showed the relationship between the value of myocardial injury marker after the RFCA and relevant factors. AF patients who underwent primary RFCA were enrolled from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry. The relationship between hs-TnI after the RFCA and PV reconnection (PVR) was evaluated. The impact of relevant factors, including baseline patient characteristics, detail of procedure on myocardial injury was investigated. This study included 407 patients (median age was 71 years, the ratio of female was 30.7%). Late arrhythmia recurrence was observed in 111 patients (27.3%) and 66 patients were underwent repeated ablation. PVR was observed in 33 patients (50.0%). The hs-TnI level was significantly lower in the patients with PVR than those without PVR (1.150 ng/ml vs 1.921 ng/ml, p = 0.040). Paroxysmal AF and age were significantly associated with acute myocardial injury after the RFCA (standardized beta coefficient = 0.206 and p < 0.001, standardized beta coefficient = - 0.114 and p = 0.043, respectively). The hs-TnI after RFCA was significantly higher in PAF patients than PerAF (p < 0.001), even if application number and total application time were taken into consideration. Acute myocardial injury after RFCA was significantly lower in the patients with PVR than those without PVR. Age and AF type were significantly and strongly associated with acute myocardial injury after the RFCA.
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Affiliation(s)
- Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Syodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hiroki Sugae
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Hitoshi Nakamura
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yutaka Matsuhiro
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan.
| | - Jun Tanouchi
- Division of Cardiology, Osaka Rosai Hospital, 3-1179 Nagasonecho, Kita-ku, Sakai, Osaka, 591-8025, Japan
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Zeljkovic I, Brusich S, Scherr D, Velagic V, Traykov V, Pernat A, Anic A, Szavits Nossan J, Jan M, Bakotic Z, Pezo Nikolic B, Radeljic V, Bojko A, Benko I, Manola S, Pavlovic N. Differences in activated clotting time and total unfractionated heparin dose during pulmonary vein isolation in patients on different anticoagulation therapy. Clin Cardiol 2021; 44:1177-1182. [PMID: 34196416 PMCID: PMC8364723 DOI: 10.1002/clc.23681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 02/05/2023] Open
Abstract
Background Periprocedural pulmonary vein isolation (PVI) anticoagulation requires balancing between bleeding and thromboembolic risk. Intraprocedural anticoagulation is monitored by activated clotting time (ACT) with target value >300 s, and there are no guidelines specifying an initial unfractionated heparin (UFH) dose. Methods We aimed to assess differences in ACT values and UFH dosage during PVI in patients on different oral anticoagulants. We conducted an international, multi‐center, registry‐based study. Consecutive patients with atrial fibrillation (AF) undergoing PVI, on uninterrupted anticoagulation therapy, were analyzed. Before transseptal puncture, UFH bolus of 100 IU/kg was administered regardless of the anticoagulation drug. Results Total of 873 patients were included (median age 61 years, IQR 53–66; female 30%). There were 248, 248, 189, 188 patients on warfarin, dabigatran, rivaroxaban, and apixaban, respectively. Mean initial ACT was 257 ± 50 s, mean overall ACT 295 ± 45 s and total UFH dose 158 ± 60 IU/kg. Patients who were receiving warfarin and dabigatran compared to patients receiving rivaroxaban and apixaban had: (i) significantly higher initial ACT values (262 ± 57 and 270 ± 48 vs. 248 ± 42 and 241 ± 44 s, p < .001), (ii) significantly higher ACT throughout PVI (309 ± 46 and 306 ± 44 vs. 282 ± 37 and 272 ± 42 s, p < .001), and (iii) needed lower UFH dose during PVI (140 ± 39 and 157 ± 71 vs. 171 ± 52 and 172 ± 70 IU/kg). Conclusion There are significant differences in ACT values and UFH dose during PVI in patients receiving different anticoagulants. Patients on warfarin and dabigatran had higher initial and overall ACT values and needed lower UFH dose to achieve adequate anticoagulation during PVI than patients on rivaroxaban and apixaban.
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Affiliation(s)
- Ivan Zeljkovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sandro Brusich
- Department of Cardiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Daniel Scherr
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Vedran Velagic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Andrej Pernat
- Department of Cardiology, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Ante Anic
- Department of Cardiology, University Hospital Centre Split, Split, Croatia
| | | | - Matevz Jan
- Department of Cardiac Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Zoran Bakotic
- Department of Cardiology, General Hospital Zadar, Zadar, Croatia
| | - Borka Pezo Nikolic
- Department of Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Vjekoslav Radeljic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ana Bojko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlovic
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia.,Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
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8
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Zeljković I, Bulj N, Kordić K, Pavlović N, Radeljić V, Benko I, Zadro Kordić I, Đula K, Kos N, Delić Brkljačić D, Manola Š. Atrial appendages’ mechanics assessed by 3D transoesophageal echocardiography as predictors of atrial fibrillation recurrence after pulmonary vein isolation. IJC HEART & VASCULATURE 2020; 31:100642. [PMID: 33015318 PMCID: PMC7522341 DOI: 10.1016/j.ijcha.2020.100642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/05/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
Data on atrial appendages' mechanics as predictors of AF recurrence after PVI is scarce. 3D and 2D-TEE have potential to provide additional data on LAA function. Patients with AFR had significantly lower LAA tissue velocity and ostium surface area. RAA tissue velocity and SVC ostium surface area were not correlated to AF recurrence.
Background Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Methods Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. Results This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p < 0.001) and LAA ostium surface area(HR 1.58, 95%CI 1.06–1.81, p = 0.033) both independently predicted AFR after single PVI. RAA TDI velocity and SVC ostium surface area were not correlated to AFR. Conclusion Paroxysmal AF patients with lower LAA TDI tissue velocity and LAA ostium surface area have higher risk of developing AFR after PVI. To our knowledge, this is the first study assessing atrial appendages’ mechanics in predicting AFR after PVI. Clinical trial registration: www.drks.de(Identifier: DRKS00010495)
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Affiliation(s)
- Ivan Zeljković
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- Corresponding author at: Department of Cardiology, Sestre milosrdnice University Hospital Centre, Vinogradska cesta 29, 10 000 Zagreb, Croatia.
| | - Nikola Bulj
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Krešimir Kordić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Pavlović
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivica Benko
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Ines Zadro Kordić
- Department of Internal Medicine, County Hospital “dr. Ivo Pedišić”, Sisak, Croatia
| | - Kristijan Đula
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nikola Kos
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Diana Delić Brkljačić
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Yano M, Egami Y, Yanagawa K, Nakamura H, Matsuhiro Y, Yasumoto K, Tsuda M, Okamoto N, Tanaka A, Matsunaga‐Lee Y, Yamato M, Shutta R, Nishino M, Tanouchi J. Comparison of myocardial injury and inflammation after pulmonary vein isolation for paroxysmal atrial fibrillation between radiofrequency catheter ablation and cryoballoon ablation. J Cardiovasc Electrophysiol 2020; 31:1315-1322. [DOI: 10.1111/jce.14475] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/23/2020] [Accepted: 03/28/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Masamichi Yano
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Yasuyuki Egami
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | | | | | | | - Koji Yasumoto
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Masaki Tsuda
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Naotaka Okamoto
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Akihiro Tanaka
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | | | - Masaki Yamato
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Ryu Shutta
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Masami Nishino
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
| | - Jun Tanouchi
- Division of CardiologyOsaka Rosai Hospital Sakai Osaka Japan
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10
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Pranata R, Chintya V, Raharjo SB, Yamin M, Yuniadi Y. Longer diagnosis-to-ablation time is associated with recurrence of atrial fibrillation after catheter ablation-Systematic review and meta-analysis. J Arrhythm 2020; 36:289-294. [PMID: 32256876 PMCID: PMC7132183 DOI: 10.1002/joa3.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diagnosis-to-ablation time (DTAT) has been postulated to be one of the predictors of atrial fibrillation (AF) recurrence, and it is a "modifiable" risk factor unlike that of many electrocardiographic or echocardiographic parameters. This development may change our consideration for ablation. In this systematic review and meta-analysis, we aim to analyze the latest evidence on the importance of DTAT and whether they predict the AF recurrence after catheter ablation. METHODS We performed a comprehensive search on topics that assess diagnosis-to-ablation time (DTAT) and AF recurrence from inception up until August 2019 through PubMed, EuropePMC, Cochrane Central Database, and http://ClinicalTrials.gov. RESULTS There was a total of 3548 patients from six studies. Longer DTAT was associated with increased risk for AF recurrence in all studies included. Meta-analysis of these studies showed that DTAT had a hazard ratio (HR) of 1.19 [1.02, 1.39], P = .03; I 2: 92% for AF recurrence. Upon sensitivity analysis by removing a study, HR became 1.24 [1.16, 1.32], P < .001; I 2: 29%. Meta-analysis on DTAT time >3 years had HR 1.73 [1.54, 1.93], P < .001; I 2: 45% for the recurrence of AF. Upon subgroup analysis of data that compared >6 years to <1 year, the HR was 1.93 [1.62, 2.29], P < .001; I 2: 0%. CONCLUSION Longer DTAT time is associated with an increased risk of AF recurrence. Hence, determining management at the earliest possible moment to avoid delay is of utmost importance.
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Affiliation(s)
- Raymond Pranata
- Faculty of MedicineUniversitas Pelita HarapanTangerangIndonesia
| | - Veresa Chintya
- Faculty of MedicineUniversitas Kristen Krida WacanaJakartaIndonesia
| | - Sunu B. Raharjo
- Department of Cardiology and Vascular MedicineFaculty of Medicine Universitas IndonesiaNational Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Muhammad Yamin
- Division of CardiologyDepartment of Internal MedicineFaculty of Medicine Universitas IndonesiaCipto Mangunkusumo National General HospitalJakartaIndonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular MedicineFaculty of Medicine Universitas IndonesiaNational Cardiovascular Center Harapan KitaJakartaIndonesia
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