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Shinohara M, Fujino T, Wada R, Yao S, Yano K, Akitsu K, Koike H, Kinoshita T, Yuzawa H, Ikeda T. Impact of Atrial Fibrillation Triggers on Long-Term Outcomes of a Second Catheter Ablation of Nonparoxysmal Atrial Fibrillation. Circ Rep 2024; 6:37-45. [PMID: 38464985 PMCID: PMC10920014 DOI: 10.1253/circrep.cr-23-0069] [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: 08/21/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/12/2024] Open
Abstract
Background: Catheter ablation (CA) of atrial fibrillation (AF) triggers, including non-pulmonary vein (PV) foci, contributes to improved procedural outcomes. However, the clinical significance of an AF trigger ablation during second CA procedures for nonparoxysmal AF is unknown. Methods and Results: We enrolled 94 patients with nonparoxysmal AF undergoing a second CA. Intracardiac cardioversion during AF using high-dose isoproterenol was performed to determine the presence or absence of AF triggers. PV re-isolations were performed if PV potentials recurred, and if AF triggers appeared from any non-PV sites, additional ablation was added to those sites. We investigated the incidence of atrial arrhythmia recurrence (AAR) >3 months post-CA. Of the 94 enrolled patients, AF triggers were identified in 65 (69.1%), and of those with AF triggers, successful elimination of the triggers was achieved in 47 patients (72.3%). Multivariate analysis revealed that no observed AF triggers were a significant predictor of AAR (hazard ratio [HR] 1.97, 95% confidence interval [CI] 1.21-3.46, P=0.019). In a subanalysis of the patients with AF triggers, multivariate analysis showed that unsuccessful trigger ablation was significantly associated with AAR (HR 5.84, 95% CI 2.79-12.22, P<0.01). Conclusions: Having no observed AF triggers during a second CA session significantly increased the risk of AAR, as did unsuccessful CA of AF triggers.
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Affiliation(s)
- Masaya Shinohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine Tokyo Japan
| | - Ryo Wada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Shintaro Yao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Kensuke Yano
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Katsuya Akitsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Hideki Koike
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Toshio Kinoshita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Hitomi Yuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine Tokyo Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine Tokyo Japan
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Eberly LA, Lin A, Park J, Khoshnab M, Garg L, Chee J, Kallan MJ, Walsh K, Supple GE, Schaller RD, Santangeli P, Riley MP, Nazarian S, Arkles J, Hyman M, Lin D, Guandalini G, Kumareswaran R, Deo R, Zado ES, Epstein A, Frankel DS, Callans DJ, Marchlinski FE, Dixit S. Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes. J Interv Card Electrophysiol 2023; 66:1455-1464. [PMID: 36525168 DOI: 10.1007/s10840-022-01441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adverse structural and electrical remodeling underlie persistent atrial fibrillation (PersAF). Restoration of sinus rhythm (SR) prior to ablation in PersAF may improve the underlying substrate, thus improving arrhythmia outcomes. The aim of this study was to evaluate if the presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of a limited catheter ablation (CA) strategy in PersAF. METHODS Patients with PersAF undergoing pulmonary vein isolation at our institution from 2014-2018 were included. We compared patients who presented for ablation in SR (by cardioversion and/or antiarrhythmic drugs [AADs]) to those who presented in AF. Primary outcome of interest was freedom from atrial arrhythmias (AAs) on or off AADs at 1 year after single ablation. Secondary outcomes included freedom from AAs on or off AADs overall, freedom from AAs off AADs at 1 year, and time to recurrent AF. RESULTS Five hundred seventeen patients were included (322 presented in AF, 195 SR). The primary outcome was higher in those who presented for CA in SR as compared to AF (85.6% vs. 77.0%, p = 0.017). Freedom from AAs off AAD at 12 months was also higher in those presenting in SR (59.0% vs. 44.4%; p = 0.001) and time to recurrent AF was longer (p = 0.008). Presence of SR at CA was independently associated with the primary outcome at 12 months (OR 1.77; 95% CI 1.08-2.90) and overall (OR 1.89; 95% CI 1.26-2.82). CONCLUSIONS Presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of limited CA in PersAF.
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Affiliation(s)
- Lauren A Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA
| | - Aung Lin
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Joseph Park
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Mirmilad Khoshnab
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Lohit Garg
- Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz, Aurora, USA
| | - Jennifer Chee
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael J Kallan
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Katie Walsh
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Gregory E Supple
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Michael P Riley
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Matthew Hyman
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David Lin
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Gustavo Guandalini
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Rajat Deo
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Erica S Zado
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Andrew Epstein
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David S Frankel
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - David J Callans
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Sanjay Dixit
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA.
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Cutler MJ, Sattayaprasert P, Pivato E, Jabri A, AlMahameed ST, Ziv O. Low voltage-guided ablation of posterior wall improves 5-year arrhythmia-free survival in persistent atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2475-2484. [PMID: 35332610 PMCID: PMC10084207 DOI: 10.1111/jce.15464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 03/07/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The posterior wall (PW) has been proposed as a standard target for ablation beyond pulmonary vein antral isolation (PVI) in patients with persistent atrial fibrillation (AF). However, studies have shown inconsistent outcomes with the addition of PW ablation. The presence or absence of low voltage on the PW may explain these inconsistencies. We evaluated whether PW ablation based on the presence or absence of low voltage improves long-term arrhythmia-free outcomes. METHODS We retrospectively reviewed 5-year follow-up in 152 consecutive patients who received either standard ablation (SA) with PVI alone or PVI + PW ablation (PWA) based on physician discretion (n = 77) or voltage-guided ablation (VGA) with PVI and addition of PWA only if low voltage was present on the PW (n = 75). RESULTS The two groups were well matched for baseline characteristics. At 5-year follow-up, 64% of patients receiving VGA were atrial tachyarrhythmia (AT)/AF free compared to 34% receiving SA (HR 0.358 p < .005). PWA had similar AF recurrence in SA and VGA groups (0.30 vs. 0.27 p = .96) but higher AT recurrence when comparing SA and VGA groups (0.39 vs. 0.15 p = .03). In multivariate analysis, both VGA and PWA predicted AF arrhythmia-free survival (HR 0.33, p = .001 and HR 0.20, p = .008, respectively). For AT, VGA predicted arrhythmia-free survival (HR 0.22, p = .028), while PWA predicted AT recurrence (HR 4.704, p = .0219). CONCLUSION VGA of the posterior wall ablation beyond PVI in persistent AF significantly improves long-term arrhythmia-free survival when compared with non-voltage-guided ablation. PW ablation without voltage-guidance reduced AF recurrence but at the cost of a higher incidence of AT.
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Affiliation(s)
- Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, Utah, USA
| | | | | | - Ahmad Jabri
- Case Western Reserve, MetroHealth Campus, Cleveland, Ohio, USA
| | | | - Ohad Ziv
- Case Western Reserve, MetroHealth Campus, Cleveland, Ohio, USA
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Amankwah NA, Pothineni NVK, Guandalini G, Santangeli P, Schaller R, Supple GE, Deo R, Nazarian S, Lin D, Epstein AE, Dixit S, Callans DJ, Marchlinski FE, Frankel DS. Impact of atrial fibrillation recurrences during the blanking period following catheter ablation on long-term arrhythmia-free survival: a prospective study with continuous monitoring. J Interv Card Electrophysiol 2022; 65:519-525. [PMID: 35794440 DOI: 10.1007/s10840-022-01291-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The significance of atrial fibrillation (AF) recurrences during the 90-day blanking period following catheter ablation is controversial. Studies to date examining the impact of AF recurrences during the blanking period have been limited by intermittent monitoring. We sought to test whether AF recurrences during the blanking period are associated with long-term recurrences using continuous monitoring. METHODS Patients undergoing AF ablation by a single operator at an academic medical center between 2015 and 2019, who either already had a cardiac implantable electronic device (CIED) with an atrial lead or received an insertable cardiac monitor (ICM), were followed for long-term AF recurrence. Recurrence was defined as > 30 s by CIED and > 2 min by ICM. All device-reported AF episodes were adjudicated by a physician. RESULTS Of 196 consecutive patients, 51 (26%) had AF recurrence in the blanking period and 145 (74%) did not. Over the year following ablation, those who had an AF recurrence in the blanking period were significantly more likely to have long-term AF recurrences than those without AF in the blanking period (log rank p < 0.001). The higher the burden of AF recurrences during the blanking period, the more likely AF was to recur long-term (hazard ratio 1.04 [CI 1.01-1.06] per 1% increase in burden, p = 0.002). CONCLUSION Using continuous monitoring of a sizable population, we confirmed that AF recurrences in the blanking period following ablation are in fact associated with long-term AF recurrences. The higher the burden of recurrence, the more likely AF is to recur long-term.
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Affiliation(s)
- Nigel Adjei Amankwah
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Naga Venkata K Pothineni
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gustavo Guandalini
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pasquale Santangeli
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Schaller
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Supple
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rajat Deo
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Saman Nazarian
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Lin
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew E Epstein
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjay Dixit
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Callans
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David S Frankel
- Cardiovascular Division, Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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5
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Dhakal BP, Chee J, Dixit S. What should we do for atrial fibrillation patients that experience arrhythmia recurrence despite chronically isolated pulmonary veins? J Cardiovasc Electrophysiol 2022; 33:2001-2002. [PMID: 35689513 DOI: 10.1111/jce.15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Bishnu P Dhakal
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Chee
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Hospital of The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Optimal single procedure strategy of pulmonary vein isolation with cryoballoon or radiofrequency and non-pulmonary vein triggers ablation for non-paroxysmal atrial fibrillation. IJC HEART & VASCULATURE 2022; 40:101021. [PMID: 35399609 PMCID: PMC8987379 DOI: 10.1016/j.ijcha.2022.101021] [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: 02/13/2022] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
Background Limited data exist on pulmonary vein isolation (PVI) using cryoballoon (CB) or radiofrequency (RF) ablation and additional non-pulmonary vein trigger ablation for non-paroxysmal atrial fibrillation (non-PAF). We aimed to assess the outcomes of first-stage catheter ablation for non-PAF patients. Methods Initial PVI was performed on 734 non-PAF patients (age: 64 ± 10 years; male: 584 (80%)) between September 2014 and June 2018 [315 (43%), CB ablation; 419 (57%), RF catheter]. A logistic regression model was used to match 257 pairs (514 patients) according to the propensity scores (CB or RF group). After PVI, additional non-PV trigger ablation was performed if induced by isoproterenol. We analysed the clinical outcomes of both groups. Results The mean procedural time was significantly shorter in the CB group (125 [range, 89–165] min) than in the RF group (190 [160–224] min; P < 0.001). The 1-year Kaplan-Meier event rate revealed similar atrial fibrillation-free survival rates between the two groups (CB: 77.9%, RF: 82.3%; log-rank P = 0.111). The additional ablation percentage for non-PV foci (CB: 39%, RF: 41%; P = 0.653) and complication incidence (CB: 5%, RF: 4%; P = 0.670) were also similar. Conclusions In non-PAF patients, the combination strategy of PVI using CB or RF ablation and non-PV trigger ablation achieved comparable outcomes.
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[Catheter ablation of ventricular tachycardia in patients with structural heart disease]. Herz 2022; 47:129-134. [PMID: 35262743 DOI: 10.1007/s00059-022-05103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
Abstract
Ventricular cardiac rhythm disorders are potentially life-threatening arrhythmias. Ventricular tachycardia (VT) in patients with structural heart disease carries an increased risk of sudden cardiac death. Interventional radiofrequency catheter ablation is increasingly becoming the focus of treatment for ventricular arrhythmias. So far, no randomized study has been able to demonstrate a reduction in mortality; however, depending on the existing cardiomyopathy, interventional VT ablation has proven to be more effective for rhythm stabilization than antiarrhythmic therapy and is subsequently associated with improve quality of life through reduced implantable cardioverter defibrillator (ICD) treatment. The aim of this work is to discuss the pathophysiology, mechanism and treatment of VT with structural heart disease in order to define the role of catheter ablation.
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Pothineni NVK, Amankwah N, Santangeli P, Schaller RD, Supple GE, Deo R, Nazarian S, Garcia FC, Dixit S, Callans DJ, Marchlinski FE, Frankel DS. Continuous rhythm monitoring-guided anticoagulation after atrial fibrillation ablation. J Cardiovasc Electrophysiol 2021; 32:345-353. [PMID: 33382500 DOI: 10.1111/jce.14864] [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: 10/13/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Oral anticoagulation (OAC) based on estimated stroke risk is recommended following catheter ablation (CA) of atrial fibrillation (AF), regardless of the extent of arrhythmia control. However, discontinuing OAC in selected patients may be safe. We sought to evaluate a strategy of OAC discontinuation following AF ablation guided by continuous rhythm monitoring. METHODS AND RESULTS We prospectively studied AF ablations performed at our institution from June 2015 to December 2019. Patients that had pre-existing cardiac implantable electronic devices (CIEDs) or underwent insertable cardiac monitor (ICM) implantation immediately following AF ablation were included. OAC was continued for 6 weeks following CA in all patients, following which OAC management was guided by CHA2 DS2 -VASc score and continuous rhythm monitoring results, according to a prespecified protocol. AF recurrence was defined as ≥30 s (CIEDs) or ≥2 min (ICM). We studied 196 patients (mean age 64.7 ± 11.3 years, 66.8% male, 85.7% ICM, 14.3% CIEDs). Mean CHA2 DS2- VASc score was 2.2 ± 1.5. One-year AF-free survival following CA was 83% for paroxysmal AF and 63% for persistent AF patients. Over 3 year follow-up, OAC was discontinued in 57 (33.7%) patients, mean 7.4 ± 7.1 months following ablation. Following discontinuation, OAC was restarted for AF recurrence in 9 (15.8%) patients, mean 11.7 ± 6.8 months after stopping. This discontinuation protocol led to a 21.9% reduction in overall time exposed to OAC. There were no thromboembolic or major bleeding events. CONCLUSION OAC can be discontinued in a significant percentage of patients following CA of AF. When guided by continuous rhythm monitoring, this practice does not unacceptably increase the risk of thromboembolic events.
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Affiliation(s)
- Naga Venkata K Pothineni
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nigel Amankwah
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ikenouchi T, Inaba O, Takamiya T, Inamura Y, Sato A, Matsumura Y, Sato H, Hirakawa A, Takahashi Y, Goya M, Sasano T, Nitta J. The impact of left atrium size on selection of the pulmonary vein isolation method for atrial fibrillation: Cryoballoon or radiofrequency catheter ablation. Am Heart J 2021; 231:82-92. [PMID: 33098808 DOI: 10.1016/j.ahj.2020.10.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is the cornerstone of ablation strategies for atrial fibrillation (AF), and noninferiority of cryoballoon (CB) over radiofrequency (RF) ablation has been previously reported. One of the risk factors of recurrence is left atrium (LA) enlargement. This study aimed to analyze the impact of LA enlargement on the selection of CB or RF ablation for AF patients. METHODS A total of 2,224 AF patients (64.4 ± 10.7 years, 65.5% male) who underwent PVI were analyzed retrospectively. Left atrial diameter (LAD) and volume (LAV) were measured using echocardiography before the procedures. LA enlargement was defined as LAD ≥40 mm and LAV index (LAVI) ≥35 mL/m2. Patients undergoing CB and RF ablation were propensity score matched, and 376 matched pairs were evaluated. RESULTS Cox proportional hazard analysis revealed that LAD (95% CI, 1.01-1.05), LAV (95% CI, 1.01-1.02), and LAVI (95% CI, 1.01-1.03) were independent predictors of recurrence. CB showed equivalent clinical outcomes to those of RF with shorter procedure time required for patients without LA enlargement. CB was inferior to RF in patients with LA enlargement (LAD, 74.5% vs 84.6%, P = .028; LAVI, 74.7% vs 83.4%, P = .015), and large LAVI was associated with a higher prevalence of non-PV foci (35% vs 29%, P = .008). CONCLUSIONS CB ablation may be recommended for patients without enlarged LA based on the short procedure time and efficacy, whereas RF would be more appropriate in large LAs. LAVI may be a valuable reference to predict PVI outcomes and in selecting the ablation method.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan.
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Tomomasa Takamiya
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Yutaka Matsumura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama City, Saitama, Japan
| | - Hiroyuki Sato
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Hirakawa
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu-shi, Tokyo, Japan
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10
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Mariani MV, Pothineni NVK, Arkles J, Deo R, Frankel D, Supple G, Garcia F, Lin D, Hyman MC, Kumareswaran R, Riley M, Nazarian S, Schaller RD, Epstein AE, Bermudez C, Dixit S, Callans D, Marchlinski FE, Santangeli P. Catheter ablation of atrial arrhythmias following lung transplant: Electrophysiological findings and outcomes. J Cardiovasc Electrophysiol 2020; 32:49-57. [PMID: 33205513 DOI: 10.1111/jce.14816] [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: 08/02/2020] [Revised: 08/20/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Data on the mechanisms of atrial arrhythmias (AAs) and outcomes of catheter ablation (CA) in lung transplantation (LT) patients are insufficient. We evaluated the electrophysiologic features and outcomes of CA of AAs in LT patients. METHODS AND RESULTS: We conducted a retrospective study of all the LT patients who underwent CA for AAs at our institution between 2004 and 2019. A total of 15 patients (43% males, age: 61 ± 10 years) with a history of LT (60% bilateral and 40% unilateral) were identified. All patients had documented organized AA on surface electrocardiogram and seven patients also had atrial fibrillation (AF; 47% with >1 clinical arrhythmia). At electrophysiological study, 19 organized AAs were documented (48% focal and 52% macro-re-entrant). Focal atrial tachycardias/flutters were targeted along the pulmonary vein (PV) anastomotic site at the left inferior PV (n = 2), ridge and carina of the left superior PV (n = 2), left atrium (LA) posterior wall (n = 3), LA roof (n = 1), and tricuspid annulus (n = 1). Macro-re-entrant AAs included cavotricuspid isthmus-dependent flutter (n = 2), incisional LA flutter (n = 4), LA roof-dependent flutter (n = 1), and mitral annular flutter (n = 3). In patients with LA mapping (n = 13), PV reconnection on the side of the LT was found in six patients (40%, all with clinically documented AF), with a mean of 2.1 ± 0.9 PVs reconnected per patient. Patients with AF underwent successful PV isolation. After a median follow-up of 19 months (range: 6-86 months), 75% of patients remained free from recurrent AAs. No procedural major complications occurred. CONCLUSION In patients with prior LT, recurrent AAs are typically associated with substrate surrounding the surgical anastomotic lines and/or chronically reconnected PVs. CA of AAs in this population is safe and effective to achieve long-term arrhythmia control.
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Affiliation(s)
- Marco V Mariani
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Frankel
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Supple
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin Garcia
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew C Hyman
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael Riley
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew E Epstein
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Bermudez
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Callans
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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11
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Durability of posterior wall isolation after catheter ablation among patients with recurrent atrial fibrillation. Heart Rhythm 2020; 17:1740-1744. [DOI: 10.1016/j.hrthm.2020.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/22/2020] [Accepted: 05/03/2020] [Indexed: 11/17/2022]
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12
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Radiofrequency-Assisted Transseptal Access for Atrial Fibrillation Ablation Via a Superior Approach. JACC Clin Electrophysiol 2020; 6:272-281. [PMID: 32192677 DOI: 10.1016/j.jacep.2019.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study describes the technique and outcomes of atrial fibrillation (AF) ablation via a superior approach in patients with interrupted or absent inferior vena cavas (IVCs). BACKGROUND In patients with interrupted or absent IVCs, transseptal access cannot be obtained via standard femoral venous access. In these patients, alternative strategies are necessary to permit catheter ablation in the left atrium (LA). This study reports on the outcomes of AF ablation from a superior venous access with a radiofrequency (RF)-assisted transseptal puncture (TSP) technique. METHODS This study identified patients with interrupted or absent IVCs who underwent AF ablation via a superior approach at 2 ablation centers from 2010 to 2019. RESULTS Fifteen patients (mean age: 50.8 ± 11.2 years; 10 men; 10 with paroxysmal AF) with interrupted or absent IVCs underwent AF ablation with transseptal access via a superior approach. Successful TSP was performed either with a manually bent RF transseptal needle (early cases: n = 4) or using a RF wire (late cases: n = 11); this approach permitted LA mapping and ablation in all patients. Mean time required to perform single (n = 8) or double (n = 7) TSP was 16.1 ± 4.8 min, and mean total procedure time was 227.9 ± 120.7 min (fluoroscopy time: 57.0 ± 28.5 min). LA mapping and ablation were successfully performed in all patients. CONCLUSIONS In patients with AF undergoing catheter ablation and who had a standard transseptal approach via femoral venous approach is impossible due to anatomic constraints, RF-assisted transseptal access via a superior approach can be an effective alternative strategy to permit LA mapping and ablation.
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13
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Maheshwari A, Shirai Y, Hyman MC, Arkles JS, Santangeli P, Schaller RD, Supple GE, Nazarian S, Lin D, Dixit S, Callans DJ, Marchlinski FE, Frankel DS. Septal Versus Lateral Mitral Isthmus Ablation for Treatment of Mitral Annular Flutter. JACC Clin Electrophysiol 2019; 5:1292-1299. [PMID: 31753435 DOI: 10.1016/j.jacep.2019.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to compare efficacy and safety of the septal mitral isthmus line (SMIL) with that of the lateral mitral isthmus line (LMIL) for treatment of mitral annular flutter (MAF). BACKGROUND MAF is the most common left atrial macro-re-entrant organized atrial tachycardia (OAT) occurring after catheter ablation of atrial fibrillation. The 2 most common lesion sets for treating MAF include linear ablation from the anteroseptal mitral annulus to the right superior pulmonary vein (SMIL) and from the lateral mitral annulus to left inferior pulmonary vein (LMIL). METHODS The study included all mitral isthmus ablations performed at the Hospital of the University of Pennsylvania in 2016 and 2017. Acute procedural results and long-term arrhythmia-free survival were compared between groups. RESULTS Of 114 total MILs, conduction block was achieved across 73 (93.6%) SMILs compared with 29 (80.6%) LMILs (p = 0.05). Although the length of the SMIL was longer (48.9 ± 12.8 cm vs. 38.7 ± 12.8 cm; p = 0.001), time required to achieve block was shorter (25.2 ± 15.9 min vs. 36.6 ± 21.3 min; p = 0.03). Coronary sinus ablation was required in 58.3% of LMILs due to inability to achieve conduction block with left atrial ablation alone. In multivariate analysis, only failure to achieve acute MIL block remained significantly associated with subsequent OAT recurrence (hazard ratio: 6.39; 95% confidence interval: 1.37 to 29.9; p = 0.02). CONCLUSIONS The SMIL requires less time to complete and more frequently results in acute MIL block than the LMIL. Additionally, ablation is rarely required outside the left atrium. Failure to achieve acute MIL block is strongly associated with subsequent OAT recurrence.
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Affiliation(s)
- Ankit Maheshwari
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yasuhiro Shirai
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Arkles
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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14
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Ikenouchi T, Nitta J, Nitta G, Kato S, Iwasaki T, Murata K, Junji M, Hirao T, Kanoh M, Takamiya T, Kato N, Inamura Y, Negi K, Sato A, Yamato T, Matsumura Y, Takahashi Y, Goya M, Hirao K. Propensity-matched comparison of cryoballoon and radiofrequency ablation for atrial fibrillation in elderly patients. Heart Rhythm 2019; 16:838-845. [DOI: 10.1016/j.hrthm.2018.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 11/29/2022]
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15
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Otsuka T, Sagara K, Arita T, Yagi N, Suzuki S, Ikeda T, Yamashita T. Impact of electrophysiological and pharmacological noninducibility following pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation. J Arrhythm 2018; 34:501-510. [PMID: 30327695 PMCID: PMC6174500 DOI: 10.1002/joa3.12085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/27/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Two methods for testing inducibility of atrial fibrillation (AF)-atrial pacing and isoproterenol infusion-have been proposed to determine the endpoint of catheter ablation. However, the utility of the combination for testing electrophysiological inducibility (EPI) and pharmacological inducibility (PHI) is unclear. METHODS After pulmonary vein isolation (PVI), inducibility of atrial tachyarrhythmia was assessed with the dual methods in 291 consecutive patients with AF (65% paroxysmal) undergoing initial catheter ablation. RESULTS The incidence of EPI was significantly higher in patients with persistent AF than paroxysmal AF (32.0% vs 11.7%, respectively, P < .001). The incidence of PHI was not significantly different between the two groups (25.2% vs 26.1%, respectively, P = .87). There was no significant difference in AF recurrence according to inducibility in paroxysmal AF. In persistent AF, however, patients achieving neither EPI nor PHI under PVI-only strategy had significantly lower rates of AF recurrence than those achieving either EPI or PHI and consequently requiring additional ablation for inducible atrial tachyarrhythmia (68.5% vs 49.0%, respectively; log-rank test, P = .022). In persistent AF, multivariate Cox regression analysis showed that achieving neither EPI nor PHI was a negative independent predictor of AF recurrence (HR 0.492, 95% CI 0.254-0.916, P = .026). CONCLUSIONS Achieving neither EPI nor PHI following PVI was associated with favorable outcome in patients with persistent AF. The combination of tests may discriminate patients responsive to the PVI-only strategy. Further selective approaches are necessary to improve outcome for inducible atrial tachyarrhythmia in patients with persistent AF.
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Affiliation(s)
- Takayuki Otsuka
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Koichi Sagara
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takuto Arita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Naoharu Yagi
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Shinya Suzuki
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Graduate School of MedicineTokyoJapan
| | - Takeshi Yamashita
- Department of Cardiovascular MedicineThe Cardiovascular InstituteTokyoJapan
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16
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Xing Y, Xu B, Sheng X, Xu C, Peng F, Sun Y, Wang S, Guo H. Transformation from persistent atrial fibrillation to paroxysmal type after initial ablation predicts success of repeated ablation. Int J Cardiol 2018; 268:120-124. [DOI: 10.1016/j.ijcard.2018.03.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/14/2018] [Accepted: 03/09/2018] [Indexed: 11/28/2022]
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17
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Bailout Atrial Balloon Septoplasty to Overcome Challenging Left Atrial Transseptal Access for Catheter Ablation of Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:1011-1019. [DOI: 10.1016/j.jacep.2018.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/26/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
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18
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Yubing W, Yanping X, Zhiyu L, Weijie C, Li S, Huaan D, Peilin X, Zengzhang L, Yuehui Y. Long-term outcome of radiofrequency catheter ablation for persistent atrial fibrillation. Medicine (Baltimore) 2018; 97:e11520. [PMID: 30024535 PMCID: PMC6086529 DOI: 10.1097/md.0000000000011520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Catheter ablation has been wildly used to treat atrial fibrillation (AF) and has achieved a better efficacy for paroxysmal AF (PAF) but not for persistent AF (PerAF). Furthermore, a few data on the efficacy and safety of catheter ablation for PerAF were reported. This study aimed to investigate long-term efficacy of radiofrequency catheter ablation (RFCA) for PerAF and explore predictors of late recurrence of atrial fibrillation (LRAF).A total of 92 consecutive patients with PerAF (64 males, aged 56.42 ± 11.24 years) were enrolled in this study and accepted circumferential pulmonary vein isolation (CPVI) alone or CPVI combined additional ablation.Maintenance rate of sinus rhythm (SR) was 40.2% after a single procedure with median follow-up of 15 months and 52.2% after mean 1.3 ± 0.6 procedures with median follow-up of 26 months. Long-term SR maintenance rate was no statistical difference between patients with CPVI alone and with CPVI combined additional ablation (48.6% vs 35.1%, log rank test, P = .152). Patients with AF duration < 24 months had a higher long-term SR maintenance rate than those with AF duration ≥ 24 months (55.6% vs 30.4%, log rank test, P = .022). AF duration (OR = 1.015, 95%CI 1.001-1.030, P = .015), and early recurrence of AF (ERAF) (OR = 10.654, 95%CI 3.853-29.460, P < .001) were predictors of LRAF after a single procedure.In conclusion, long-term maintenance SR rate was 52.2% in patients with PerAF after multiple procedures with a median over 2-year follow-up. Patients with AF duration < 24 months had better outcome. AF duration and ERAF were predictors of LRAF after a single procedure.
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Affiliation(s)
- Wang Yubing
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
- Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Xu Yanping
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Ling Zhiyu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Chen Weijie
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Su Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Du Huaan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Xiao Peilin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Liu Zengzhang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
| | - Yin Yuehui
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing
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19
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Approaches to Catheter Ablation of Nonparoxysmal Atrial Fibrillation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:39. [DOI: 10.1007/s11936-018-0632-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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20
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Liang JJ, Elafros MA, Mullen MT, Muser D, Hayashi T, Enriquez A, Pathak RK, Zado ES, Santangeli P, Arkles JS, Schaller RD, Supple GE, Frankel DS, Garcia FC, Deo R, Lin D, Riley MP, Nazarian S, Dixit S, Marchlinski FE, Callans DJ. Anticoagulation use and clinical outcomes after catheter ablation in patients with persistent and longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol 2018. [PMID: 29513397 DOI: 10.1111/jce.13476] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Whether successful catheter ablation for atrial fibrillation (AF) reduces risk of cerebrovascular events (CVEs) remains controversial and whether oral anticoagulation therapy (OAT) can be safely discontinued in patients rendered free of AF recurrences remains unknown. We evaluated OAT use patterns and examined long-term rates of CVEs (stroke/TIA) and major bleeding episodes (MBEs) in patients with nonparoxysmal AF treated with catheter ablation. METHODS AND RESULTS Four hundred patients with nonparoxysmal AF (200 persistent, 200 longstanding persistent; mean age 60.3 ± 9.7 years, 82% male) undergoing first AF ablation were followed for 3.6 ± 2.4 years. OAT discontinuation during follow-up was permitted in selected patients per physician discretion. At last follow-up, allowing for multiple ablations, 172 (43.0%) patients were free of AF recurrence. Two hundred and seven (51.8%) discontinued OAT at some point; 174 (43.5%) were off OAT at last follow-up. Patients without AF recurrence were more likely to remain off OAT (HR 0.23 [95% CI 0.17-0.33]). Patients with persistent (versus longstanding persistent) AF type prior to ablation (HR 0.6 [CI 0.44-0.83]) and those with CHA2 DS2 -VASc score <2 (HR 0.56 [0.39-0.80]) were less likely to continue OAT. Seven patients had CVEs (incidence: 0.49/100 patient years) and 14 experienced MBE during follow-up (incidence: 0.98/100 patient years). Older age (P = 0.001) and coronary artery disease (P = 0.028) were associated with CVE. CONCLUSION Anticoagulation discontinuation in well selected, closely monitored patients following successful ablation of nonparoxysmal AF was associated with a low rate of clinical embolic CVEs. Prospective studies are required to confirm safety of OAT discontinuation after successful AF ablation.
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Affiliation(s)
- Jackson J Liang
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Melissa A Elafros
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael T Mullen
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniele Muser
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tatsuya Hayashi
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andres Enriquez
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rajeev K Pathak
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Erica S Zado
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Pasquale Santangeli
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey S Arkles
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert D Schaller
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Supple
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David S Frankel
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Fermin C Garcia
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rajat Deo
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Lin
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael P Riley
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Saman Nazarian
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjay Dixit
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Callans
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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21
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Liang JJ, Dixit S. Early Recurrences During the Blanking Period after Atrial Fibrillation Ablation. J Atr Fibrillation 2018; 10:1726. [PMID: 29988237 DOI: 10.4022/jafib.1726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022]
Abstract
Early recurrences of atrial arrhythmias (ERAA) after ablation are common and predict late recurrences and ablation failure.However,becausea proportion of patients with ERAA will have no subsequent arrhythmias after the blanking period, consensus guidelines recommend against immediate repeat ablation for ERAA episodes occurring during the first 3 months post-ablation. In this review, we summarize the predictors, significance, and treatment of ERAA after AF ablation.
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Affiliation(s)
- Jackson J Liang
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dixit
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
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22
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Della Rocca DG, Mohanty S, Trivedi C, Di Biase L, Natale A. Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation? Arrhythm Electrophysiol Rev 2018; 7:256-260. [PMID: 30588313 DOI: 10.15420/aer.2018.56.2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
Pulmonary vein antrum isolation is the most effective rhythm control strategy in patients with paroxysmal AF. However, catheter ablation of non-paroxysmal AF has a lower success rate, even when persistent isolation of pulmonary veins (PVs) is achieved. As a result of arrhythmia-related electophysiological and structural changes in the atria, sites other than the PVs can harbour triggers. These non-PV triggers contribute to AF relapse. In this article, we summarise the rationale and current evidence supporting the arrhythmogenic role of non-PV triggers and our ablation approach to patients with non-paroxysmal AF.
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Affiliation(s)
| | | | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St David's Medical Center Austin, Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St David's Medical Center Austin, Texas.,Arrhythmia Services, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine New York, USA.,Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center Austin, Texas.,Interventional Electrophysiology, Scripps Clinic La Jolla, CA, USA.,Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine Cleveland, OH, USA.,Division of Cardiology, Stanford University Stanford, CA, USA
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23
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Okamatsu H, Okumura K. Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation - Impact of Progress in the Mapping and Ablation Technologies. Circ J 2017; 82:2-9. [PMID: 29187667 DOI: 10.1253/circj.cj-17-1205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area with low-voltage electrograms, a surrogate marker for atrial fibrosis. Ablation for non-PV triggers in addition to PVAI improves the outcome of persistent AF. Further, durable isolation of the left atrial posterior wall may reduce AF recurrence. These ablation strategies with concomitant use of the emerging technologies are strongly expected to enhance the effectiveness of catheter ablation for persistent AF.
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Affiliation(s)
- Hideharu Okamatsu
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
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Lo LW, Lin YJ, Chang SL, Hu YF, Chung FP, Chen SA. Beyond Pulmonary Vein Isolation: the Role of Additional Sites in Catheter Ablation of Atrial Fibrillation. Curr Cardiol Rep 2017; 19:86. [PMID: 28795289 DOI: 10.1007/s11886-017-0884-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the long-term procedural outcome remains suboptimal and there is a frequent need for repeat ablation procedure, especially in patients with non-paroxysmal AF. The review article summarizes the rationales, recent evidences, and strategies of ablation of extra-PV sites and its clinical outcomes. RECENT FINDINGS It is a consensus that durable PV isolations are a definite therapy in patients with paroxysmal AF. In non-paroxysmal AF, many laboratories still believe that adequate substrate ablation outside PVs is definitely required. Empirical linear ablation is not recommended because of difficulty in achieving complete linear block, unless macro-reentry atrial tachycardia developed during procedure. Most of laboratories applied complex fractionated atrial electrogram (CFAE) ablation after PV isolation in non-paroxysmal AF, but the efficacy is limited in the long-term follow-up studies. A combined approach using CFAE, non-linear similarity, and phase mapping strategy to identify rotors or focal sources for substrate modification increases the ablation outcome, when compared to CFAE ablation alone. Provocative test with mapping of non-PV triggers is also recommended in all patients to improve long-term ablation success. Ablation beyond PV isolation is important, especially in non-paroxysmal AF patients, to modify the diseased atrial substrate and eliminate the non-PV triggers, which in turn improve the ablation outcome.
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Affiliation(s)
- Li-Wei Lo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Lin Chang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Fa-Po Chung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Shih-Ann Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital; Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
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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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Liang JJ, Dixit S, Santangeli P. Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation. World J Cardiol 2016; 8:638-646. [PMID: 27957250 PMCID: PMC5124722 DOI: 10.4330/wjc.v8.i11.638] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 09/06/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Early recurrence of atrial arrhythmias (ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo post-ablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of long-term ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.
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