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Messori A, Mamone D, Rivano M, Romeo MR, Vaiani M, Trippoli S. Pulsed-field ablation for paroxysmal atrial fibrillation: An indirect comparison of effectiveness among three proprietary devices conducted in the absence of randomized trials. Int J Cardiol 2024:132025. [PMID: 38583595 DOI: 10.1016/j.ijcard.2024.132025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION In patients with paroxysmal atrial fibrillation, pulsed-field ablation has been developed as an alternative to thermal ablation. Three devices are currently available: Farawave by Boston, PulseSelect by Medtronic, and Varipulse by Johnson. In the present report, we studied the outcomes at 12 months of these three devices using indirect comparisons. METHODS A standard PubMed search was conducted that identified all studies evaluating these devices in patients with paroxysmal atrial fibrillation. The endpoint was freedom from arrhythmia recurrence. Kaplan-Meier curves were subjected to the IPDfromKM method that generated reconstructed patients. Standard time-to-event statistical testss (including heterogeneity assessment) were performed. RESULTS Our analysis included 9 studies (8 single-arm and 1 randomized trial based on Farawave for a total of 1916 patients). A significant heterogeneity was found across the trials using Farawave because the outcomes found in the single-arm trials were better than those found in the randomized trial. Farawave (according exclusively to the results of the randomized trial), PulseSelect, and Varipulse showed a similar time-course of their respective outcomes with no significant difference. The single-arm trials using Farawave showed better outcomes than the randomized trial using Farawave and the pivotal trials using PulseSelect and Varipulse. DISCUSSION Our study provided an updated overview of all the studies that have so far used pulsed-fileld ablation in patients with paroxysmal atrial fibrillation.
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Ruwald MH, Haugdal M, Worck R, Johannessen A, Hansen ML, Sørensen SK, Hansen J. Characterization of durability and reconnection patterns at time of repeat ablation after single-shot pulsed field pulmonary vein isolation. J Interv Card Electrophysiol 2024; 67:379-387. [PMID: 37776356 PMCID: PMC10902076 DOI: 10.1007/s10840-023-01655-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel method of cardiac ablation where there is insufficient knowledge on the durability and reconnection patterns after pulmonary vein isolation (PVI). The aim of this study was to characterize the electrophysiological findings at time of repeat procedure in real-world atrial fibrillation (AF) patients. METHODS Patients who underwent a repeat procedure (n=26) for symptomatic recurrent arrhythmias after index first-time treatment with single-shot PFA PVI (n=266) from July 2021 to June 2023 were investigated with 3D high-density mapping and ad-hoc re-ablation by radiofrequency or focal PFA. RESULTS Index indication for PVI was persistent AF in 17 (65%) patients. The mean time to repeat procedure was 292 ± 119 days. Of the 26 patients (104 veins), complete durable PVI was observed in 11/26 (42%) with a durable vein isolation rate of 72/104 (69%). Two patients (8%) had all four veins reconnected. The posterior wall was durably isolated in 4/5 (80%) of the cases. The predominant arrhythmia mechanism was AF in 17/26 (65%) patients and regular atrial tachycardia (AT) in 9/26 (35%). Reconnection was observed 9/26 (35%) in right superior, 11/26 (42%) in right inferior, 7/26 (27%) in left superior, 5/26 (19%) in left inferior, p=0.31 between veins. The gaps were significantly clustered in the right-sided anterior carina compared to other regions (P=0.009). CONCLUSIONS Durable PVI was observed in less than half of the patients at time of repeat procedure. No significant difference in PV reconnection pattern was observed, but the gap location was preferentially located at the anterior aspects of the right-sided PVs. Predominant recurrence was AF. More data is needed to establish lesion formation and durability and AT circuits after PFA.
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Affiliation(s)
- Martin H Ruwald
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark.
| | - Martin Haugdal
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Rene Worck
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Arne Johannessen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Morten Lock Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Samuel K Sørensen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Jim Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
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Chahine Y, Afroze T, Bifulco SF, Macheret F, Abdulsalam N, Boyle PM, Akoum N. Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence. J Interv Card Electrophysiol 2023; 66:1367-1373. [PMID: 36418664 PMCID: PMC10205917 DOI: 10.1007/s10840-022-01429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA. METHODS BT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence. RESULTS PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: - 33.5 °C [- 36; - 30] vs - 29.5 °C [- 35; - 25.5], p = 0.001; 60 s: - 41 °C [- 44; - 37] vs - 36.5 °C [- 42; - 33.5], p < 0.001; nadir: - 47 °C [- 52; - 43] vs - 41.5 °C [- 47; - 38], p < 0.001). PV reconnection was associated with significantly longer time to reach - 15 °C and - 40 °C (14.5 s [11.5-18.5] vs 12 s [10-15.5], p = 0.023; and 75 s [40-95.5] vs 46 s [37-66.75], p = 0.005) and shorter rewarming time (5.75 s [4.75-8.5] vs 7 s [6-9], p = 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan-Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below - 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below - 40 °C was not achieved in at least one PV (log rank = 6.3, p = 0.012) and patients who had PV reconnections (log rank = 4.1, p = 0.043). CONCLUSIONS Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below - 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.
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Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Tanzina Afroze
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Savannah F Bifulco
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Fima Macheret
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Patrick M Boyle
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Spittler R, Witte N, Hoffmann BA, Marx A, Mollnau H, Quesada-Ocete B, Konrad T, Rostock T. Automated three-dimensional activation versus conventional mapping for catheter ablation of atrial tachycardia - A prospective randomized trial. Int J Cardiol Heart Vasc 2023; 47:101222. [PMID: 37252196 PMCID: PMC10220253 DOI: 10.1016/j.ijcha.2023.101222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
Background The automated NavX Ensite Precision latency-map (LM) algorithm aims to identify atrial tachycardia (AT) mechanisms. However, data on a direct comparison of this algorithm with conventional mapping are scarce. Methods Patients scheduled for AT ablation were randomized to mapping with the LM- algorithm (LM group) or to conventional mapping (conventional only group: ConvO), using entrainment and local activation mapping techniques. Several outcomes were exploratively analyzed. Primary endpoint was intraprocedural AT Termination. If AT termination with only automated 3D-Mapping failed, additional conventional methods were applied (conversion). Results A total of 63 patients (mean 67 years, 34 % female) were enrolled. In the LM group (n = 31), the correct AT mechanism was identified in 14 patients (45 %) using the algorithm alone compared to 30 patients (94 %) with conventional methods. Time to termination of the first AT was not different between groups (LM group 34 ± 20 vs. ConvO 43.1 ± 28.3 min; p = 0.2). However, when AT termination did not occur with LM algorithm, time to termination prolonged significantly (65 ± 35 min; p = 0.01). After applying conventional methods (conversion), procedural termination rates did not differ between LM group (90 %) vs. ConvO (94 %) (p = 0.3). During a follow-up time of 20 ± 9 months, no differences were observed in clinical outcomes. Conclusion In this small prospective, randomized study, the use of the LM algorithm alone may lead to AT termination, but less accurate than conventional methods.
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Affiliation(s)
- Raphael Spittler
- Corresponding author at: Department of Cardiology II/Electrophysiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Noujaim C, Lim C, Mekhael M, Feng H, Chouman N, Younes H, Assaf A, Shan B, Shamaileh G, Dhore-Patil A, Nelson D, Lanier B, Makan N, Marrouche N, Donnellan E. Identifying the prognostic significance of early arrhythmia recurrence during the blanking period and the optimal blanking period duration: insights from the DECAAF II study. Europace 2023; 25:euad173. [PMID: 37337683 PMCID: PMC10292951 DOI: 10.1093/europace/euad173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE Early atrial arrhythmia recurrence following atrial fibrillation (AF) ablation is common. Current guidelines promulgate a 3-month blanking period. We hypothesize that early atrial arrhythmia recurrence during the blanking period may predict longer-term ablation outcomes. METHODS AND RESULTS A total of 688 patients with persistent AF undergoing catheter ablation were included in the DECAAF II trial database. The primary endpoint of the study was the first confirmed recurrence of atrial arrhythmia. Recurrence was also monitored during the 90-day blanking period. A total of 287 patients experienced recurrent atrial arrhythmia during the blanking period, while 401 remained in sinus rhythm. Rates of longer-term arrhythmia recurrence were substantially higher among those who developed recurrence during the blanking period compared to those who remained in sinus rhythm throughout the blanking period (68% vs. 32%, P < 0.001). The study cohort was divided into three groups according to the timing of arrhythmia recurrence during the blanking period. Of those who had recurrent arrhythmia during the first month of the blanking period (Group 1), 43.9% experienced longer-term recurrence, compared to 61.6% who recurred during the second month of the blanking period (Group 2), and 93.3% of those who had arrhythmia recurrence during the third month (Group 3, P < 0.001). The risk of recurrent arrhythmia was highest in Group 3 (HR = 10.15), followed by Group 2 (HR = 2.35) and Group 1 (HR = 1.5). Receiver operating characteristic analysis was performed to assess the relationship between the timing of arrhythmia recurrence and the primary outcome (AUC = 0.746, P < 0.001). The optimal blanking period duration was identified as 34 days. Atrial fibrillation burden determined by smartphone electrocardiogram technology over the 18 months follow-up period was significantly higher in Group 3 (29%) compared to Groups 1 (6%) and 2 (7%) and in patients who stayed in sinus rhythm during the blanking period (5%) (P < 0.0001). CONCLUSION Early atrial arrhythmia recurrence during the blanking period, particularly during the third month, is significantly associated with later recurrence. Although a blanking period is warranted, it should be abbreviated.
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Affiliation(s)
- Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Chanho Lim
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Han Feng
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Nour Chouman
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Ala Assaf
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Botao Shan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Ghaith Shamaileh
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Aneesh Dhore-Patil
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Daniel Nelson
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Brennan Lanier
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Noor Makan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
| | - Eoin Donnellan
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA
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Papathanasiou KA, Vrachatis DA, Kazantzis D, Kossyvakis C, Giotaki SG, Deftereos G, Raisakis K, Kaoukis A, Avramides D, Lambadiari V, Siasos G, Deftereos S. Left atrial appendage morphofunctional indices could be predictive of arrhythmia recurrence post-atrial fibrillation ablation: a meta-analysis. Egypt Heart J 2023; 75:29. [PMID: 37079174 PMCID: PMC10119349 DOI: 10.1186/s43044-023-00356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Left atrium changes are implicated in atrial fibrillation (AF) substrate and are predictive of AF outcomes. Left atrial appendage (LAA) is an integral component of left atrial structure and could be affected by atrial cardiomyopathy. We aimed to elucidate the association between LAA indices and late arrhythmia recurrence after atrial fibrillation catheter ablation (AFCA). METHODS The MEDLINE database, ClinicalTrials.gov, medRxiv and Cochrane Library were searched for studies evaluating LAA and late arrhythmia recurrence in patients undergoing AFCA. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was pre-ablation difference in LAA anatomic or functional indices. RESULTS A total of 34 studies were found eligible and five LAA indices were analyzed. LAA ejection fraction and LAA emptying velocity were significantly lower in patients with AF recurrence post-ablation [SMD = - 0.66; 95% CI (- 1.01, - 0.32) and SMD = - 0.56; 95% CI (- 0.73, - 0.40) respectively] as compared to arrhythmia free controls. LAA volume and LAA orifice area were significantly higher in patients with AF recurrence post-ablation (SMD = 0.51; 95% CI 0.35-0.67, and SMD = 0.35; 95% CI 0.20-0.49, respectively) as compared to arrhythmia free controls. LAA morphology was not predictive of AF recurrence post-ablation (chicken wing morphology; OR 1.27; 95% CI 0.79-2.02). Moderate statistical heterogeneity and small case-control studies are the main limitations of our meta-analysis. CONCLUSIONS Our findings suggest that LAA ejection fraction, LAA emptying velocity, LAA orifice area and LAA volume differ between patients suffering from arrhythmia recurrence post-ablation and arrhythmia free counterparts, while LAA morphology is not predictive of AF recurrence.
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Affiliation(s)
- Konstantinos A Papathanasiou
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece.
| | - Dimitrios A Vrachatis
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
| | - Dimitrios Kazantzis
- Bristol Eye Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Sotiria G Giotaki
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Konstantinos Raisakis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Andreas Kaoukis
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Dimitrios Avramides
- Department of Cardiology, "G. Gennimatas" General Hospital of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 12462, Athens, Greece
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Attikon University Hospital, 1 Rimini Str., Chaidari, Attiki, 12462, Athens, Greece
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Murata K, Takahashi Y, Inaba O, Nitta J, Kobori A, Sakamoto Y, Nagata Y, Tanimoto K, Matsuo S, Yamane T, Morita N, Satomi K, Sato H, Hanazawa R, Hirakawa A, Goya M, Sasano T. Efficacy of left atrial posterior wall isolation guided by lesion size prediction module for non-paroxysmal atrial fibrillation. Europace 2022; 24:1769-1776. [PMID: 35851606 DOI: 10.1093/europace/euac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022] Open
Abstract
AIMS The efficacy of left atrial posterior wall isolation (PWI) is controversial. Lesion durability may be a major cause of arrhythmia recurrence. The use of the lesion size prediction module improves lesion durability. This study aimed to compare the clinical outcomes of pulmonary vein isolation (PVI) alone and PWI in addition to PVI (PVI + PWI) in patients with non-paroxysmal atrial fibrillation (AF) using a lesion size prediction module. METHODS AND RESULTS This study is a sub-analysis of the recently published prospective multicentre observational study called ALCOHOL-AF (association of alcohol consumption with outcome of catheter ablation of AF). In this sub-analysis, patients with non-paroxysmal AF in whom PVI alone or PVI + PWI was performed using the lesion size prediction module were included. Freedom from atrial tachyarrhythmia was compared between PVI alone and PVI + PWI groups using propensity score analyses. Of the 3474 patients registered in the ALCOHOL-AF study, 572 patients (age 65.6 ± 10.1 years, male 77.4%, longstanding persistent AF 25.5%) were included in this sub-analysis. We selected 212 patients treated with PVI alone and 212 treated with PVI + PWI using one-to-one propensity score matching. During the follow-up period, atrial tachyarrhythmia recurrence was documented in 92 (43.4%) and 50 (23.6%) patients in the PVI alone and PVI + PWI groups, respectively. Freedom from atrial tachyarrhythmia recurrence without anti-arrhythmic drugs after a single procedure was significantly higher in PVI + PWI than in PVI alone groups (hazard ratio: 0.452, 95% confidence interval: 0.308-0.664, P < 0.001). CONCLUSION In this hypothesis-generating study, lesion size prediction module-guided PVI + PWI was associated with better clinical outcomes than PVI alone in patients with persistent or longstanding persistent AF.
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Affiliation(s)
- Kazuya Murata
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku Saitama 330-8553, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.,Department of Cardiology, Shin-yurigaoka General Hospital Furusawa-tsuko, 255, Kawasaki Asao-ku, Kanagawa 215-0026, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku Saitama 330-8553, Japan
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo 183-0003, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Kobe Chuo-ku, Hyogo 650-0047, Japan
| | - Yuichiro Sakamoto
- Department of Cardiology, Toyohashi Heart Center, 21-1, Oyamacho-Gobutori, Toyohashi, Aichi 441-8071, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, 1-26-1, Kyonancho, Musashino, Tokyo 180-8610, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Seiichiro Matsuo
- Department of Cardiovascular Medicine, Jikei University Katsushika Medical Center, 6-41-2, Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Teiichi Yamane
- Department of Cardiovascular Medicine, Jikei University, 3-19-18, Nishi-Shimbashi, Minato-ku, Tokyo 105-8471, Japan
| | - Norishige Morita
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital, Ishikawamachi 1838, Hachioji, Tokyo 192-0032, Japan
| | - Kazuhiro Satomi
- Department of Cardiovascular Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hiroyuki Sato
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ryoichi Hanazawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical & Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Silva Cunha P, Portugal G, Laranjo S, Alves M, Luísa Papoila A, Valente B, Sofia Delgado A, Lousinha A, Paulo M, Brás M, Guerra C, Cruz Ferreira R, Martins Oliveira M. The atrial fibrillation burden during the blanking period is predictive of time to recurrence after catheter ablation. Int J Cardiol Heart Vasc 2022; 43:101138. [PMID: 36275421 PMCID: PMC9579489 DOI: 10.1016/j.ijcha.2022.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
Objective This study aimed to assess whether atrial fibrillation (AF) occurrence or its corresponding daily mean burden (in minutes/day) during the mid to late blanking period after pulmonary vein isolation (PVI), predicts AF recurrence. Methods Analysis of consecutive first PVI ablation patients undergoing prolonged electrocardiogram (ECG) monitoring during the second and third months after PVI. The clinical variables, total AF burden, and their relationship with time to recurrence were studied. Results 477 patients with a mean age of 56.9 (SD = 12.3) years (63.7 % male; 71.7 % paroxysmal AF), from which 317 (66.5 %) had an external event recorder between 30 and 90 days after ablation. Median follow-up of 16.0 (P 25:12.0: P 75:33.0) months, 177 (37 %) patients had an AF recurrence, with 106 (22.2 %) having the first episode after 12 months of follow-up. In the group of patients with an event recorder, 80 (25.2 %) had AF documented during the blanking period. Multivariable analysis showed that AF during the blanking period was associated with a 4-fold higher risk of recurrence (HR: 3.98; 95 %CI: 2.95–5.37), and, compared to patients in sinus rhythm, those with an AF burden ≥ 23 min/day had an approximately 7-fold higher risk of recurrence (HR estimate: 6.79; 95 %CI: 4.56–10.10). Conclusions The probability of experiencing AF recurrence can be predicted by atrial tachyarrhythmia episodes during the second and third months after PVI. Atrial arrhythmias burden > 23 min/day has a high predictive ability for recurrence.
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Affiliation(s)
- Pedro Silva Cunha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal,Corresponding author at: Santa Marta Hospital, Cardiology Service, Arrhythmology, Pacing, and Electrophysiology Unit, R. de Santa Marta 50, 1169-024 Lisboa, Portugal.
| | - Guilherme Portugal
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio Laranjo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,ComprehensiveHealth Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Marta Alves
- NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Ana Luísa Papoila
- NOVAMedical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa and CEAUL (Center of Statistics and Its Applications), Lisbon, Portugal,Epidemiology and Statistics Unit, Research Centre, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Bruno Valente
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Sofia Delgado
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Lousinha
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Paulo
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Manuel Brás
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Guerra
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rui Cruz Ferreira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Mário Martins Oliveira
- Arrhythmology, Pacing and Electrophysiology Unit, Cardiology Service, Santa Marta Hospital, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal,LisbonSchool of Medicine, Universidade de Lisboa, Lisbon, Portugal
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9
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Bhagirath P, Campos FO, Costa CM, Wilde AAM, Prassl AJ, Neic A, Plank G, Rinaldi CA, Götte MJW, Bishop MJ. Predicting arrhythmia recurrence following catheter ablation for ventricular tachycardia using late gadolinium enhancement magnetic resonance imaging: Implications of varying scar ranges. Heart Rhythm 2022; 19:1604-1610. [PMID: 35644355 DOI: 10.1016/j.hrthm.2022.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Thresholding-based analysis of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) can create scar maps and identify corridors that might provide a reentrant substrate for ventricular tachycardia (VT). Current recommendations use a full-width-at-half-maximum approach, effectively classifying areas with a pixel signal intensity (PSI) >40% as border zone (BZ) and >60% as core. OBJECTIVE The purpose of this study was to investigate the impact of 4 different threshold settings on scar and corridor quantification and to correlate this with postablation VT recurrence. METHODS Twenty-seven patients with ischemic cardiomyopathy who had undergone catheter ablation for VT were included for retrospective analysis. LGE-CMR images were analyzed using ADAS3D LV. Scar maps were created for 4 PSI thresholds (40-60, 35-65, 30-70, and 45-55), and the extent of variation in BZ and core, as well as the number and weight of conduction corridors, were quantified. Three-dimensional representations were reconstructed from exported segmentations and used to quantify the surface area between healthy myocardium and scar (BZ + core), and between BZ and core. RESULTS A wider PSI threshold was associated with an increase in BZ mass and decrease in scar (P <.001). No significant differences were observed for the total number of corridors and their mass with increasing PSI threshold. The best correlation in predicting arrhythmia recurrence was observed for PSI 45-55 (area under the curve 0.807; P = .001). CONCLUSION Varying PSI has a significant impact on quantification of LGE-CMR parameters and may have incremental clinical value in predicting arrhythmia recurrence. Further prospective investigation is warranted to clarify the functional implications of these findings for LGE-CMR-guided ventricular ablation.
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Affiliation(s)
- Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Department of Cardiology, St. Thomas' Hospital, London, United Kingdom.
| | - Fernando O Campos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Caroline M Costa
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anton J Prassl
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Aurel Neic
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Gernot Plank
- Gottfried Schatz Research Center, Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martin J Bishop
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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10
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Erhard N, Metzner A, Fink T. Late arrhythmia recurrence after atrial fibrillation ablation: incidence, mechanisms and clinical implications. Herzschrittmacherther Elektrophysiol 2022; 33:71-76. [PMID: 35006336 PMCID: PMC8873127 DOI: 10.1007/s00399-021-00836-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022]
Abstract
Background and objectives Catheter ablation of atrial fibrillation (AF) has become a well-established and widely used therapy, with pulmonary vein isolation (PVI) being the key modality of ablation. However, arrhythmia recurrences after PVI are common, with a relevant number of patients undergoing repeat ablation. Arrhythmia recurrence after PVI may vary regarding time point and mode of recurrence. While early arrhythmia recurrences of AF after PVI are mostly found to be the product of electrical reconnection of the pulmonary veins, the exact mechanisms of very late arrhythmia recurrence, occurring later than 12 months after successful PVI, remain unclear. This review provides an overview on the current evidence on time point and mechanisms of arrhythmia recurrence after PVI focussing on late arrhythmia recurrence. Recent findings The incidence of late arrhythmia recurrence after PVI can lie at a rate of up to 30% according to long-term follow-up studies. Mechanisms of recurrence include electrical reconnection of previously isolated pulmonary veins and development of atrial fibrosis. The use of cryoballoon ablation is likely to be more effective in reducing late arrhythmia recurrences compared to radiofrequency ablation. Novel scores such as the MB-LATER score or the APPLE score may become useful tools in predicting arrhythmia recurrence after PVI. Results and conclusion Late arrhythmia recurrence after PVI is common and leads to a relevant impairment of long-term success. Relevant data are currently limited and exact mechanisms of arrhythmia recurrence remain unclear. Further studies are needed to elucidate pathogenetic mechanisms of late arrhythmia recurrence after PVI in order to improve treatment strategies.
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Affiliation(s)
- Nico Erhard
- Department of Electrophysiology, German Heart Centre Munich, Lazarettstr. 36, 80636, Munich, Germany.
| | - Andreas Metzner
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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11
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Akhtar T, Wallace R, Daimee UA, Sivasambu B, Hart E, Yang E, Marine JE, Berger R, Calkins H, Spragg D. Safety and efficacy of cryoballoon versus radiofrequency ablation for atrial fibrillation in elderly patients: A real-world evidence. Indian Pacing Electrophysiol J 2021; 22:24-29. [PMID: 34838748 PMCID: PMC8811282 DOI: 10.1016/j.ipej.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are limited data describing the experience of radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial fibrillation (AF) among elderly patients in the United States. METHODS We conducted a retrospective analysis of patients ≥75 years of age undergoing index RF vs. CB ablation between January 2014 and May 2020 at our center. The choice of ablation technique was left to the operator's discretion. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 s after one year of follow-up, were assessed in patients with index RF vs. CB ablation. RESULTS In our cohort of 186 patients, the median age was 78 (76-81) years, 54.8% were men, and 39.2% had persistent AF. The median CHA2DS2-VASc score was 4 (3-4), while the median duration of AF was 3 (1-7) years. The majority (n = 112, 60.2%) underwent RF ablation. The median procedure time was significantly lower in CB group (197 vs 226.5 min, p=<0.01). The incidence of complications was similar in the two sub-groups (RF: 1.8% vs. CB: 2.7%, p = 0.67). Similarly, arrhythmia-free survival rate on antiarrhythmic drugs at 1-year follow-up remained statistically comparable (63.4% vs. 68.9%, p = 0.33) between patients receiving RF vs. CB ablation. CONCLUSION The safety and efficacy of RF vs. CB ablation for AF remained comparable in our cohort of patients older than 75 years. CB ablation was associated with a shorter procedure time.
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Affiliation(s)
- Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Ryan Wallace
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Usama A Daimee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Bhradeev Sivasambu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Erica Hart
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eunice Yang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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12
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Eichenlaub M, Mueller-Edenborn B, Minners J, Allgeier M, Lehrmann H, Allgeier J, Trenk D, Neumann FJ, Jander N, Arentz T, Jadidi A. Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation. Clin Res Cardiol 2021; 110:1770-1780. [PMID: 33914144 PMCID: PMC8563528 DOI: 10.1007/s00392-021-01850-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/25/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Relevant atrial cardiomyopathy (ACM), defined as a left atrial (LA) low-voltage area ≥ 2 cm2 at 0.5 mV threshold on endocardial contact mapping, is associated with new-onset atrial fibrillation (AF), higher arrhythmia recurrence rates after pulmonary vein isolation (PVI), and an increased risk of stroke. The current study aimed to assess two non-invasive echocardiographic parameters, LA emptying fraction (EF) and LA longitudinal strain (LAS, during reservoir (LASr), conduit (LAScd) and contraction phase (LASct)) for the diagnosis of ACM and prediction of arrhythmia outcome after PVI. METHODS We prospectively enrolled 60 consecutive, ablation-naive patients (age 66 ± 9 years, 80% males) with persistent AF. In 30 patients (derivation cohort), LA-EF and LAS cut-off values for the presence of relevant ACM (high-density endocardial contact mapping in sinus rhythm prior to PVI at 3000 ± 1249 sites) were established in sinus rhythm and tested in a validation cohort (n = 30). Arrhythmia recurrence within 12 months was documented using 72-h Holter electrocardiograms. RESULTS An LA-EF of < 34% predicted ACM with an area under the curve (AUC) of 0.846 (sensitivity 69.2%, specificity 76.5%) similar to a LASr < 23.5% (AUC 0.878, sensitivity 92.3%, specificity 82.4%). In the validation cohort, these cut-offs established the correct diagnosis of ACM in 76% of patients (positive predictive values 87%/93% and negative predictive values 73%/75%, respectively). Arrhythmia recurrence in the entire cohort was significantly more frequent in patients with LA-EF < 34% and LASr < 23.5% (56% vs. 29% and 55% vs. 26%, both p < 0.05). CONCLUSION The echocardiographic parameters LA-EF and LAS allow accurate, non-invasive diagnosis of ACM and prediction of arrhythmia recurrence after PVI.
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Affiliation(s)
- Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
| | - Bjoern Mueller-Edenborn
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Martin Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Juergen Allgeier
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Dietmar Trenk
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Nikolaus Jander
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Thomas Arentz
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
| | - Amir Jadidi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany
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13
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Spittler R, Bahlke F, Hoffmann BA, Marx A, Mollnau H, Quesada-Ocete B, Konrad T, Rostock T. Durable pulmonary vein isolation but not complex substrate ablation determines the type of arrhythmia recurrence after persistent atrial fibrillation ablation. J Interv Card Electrophysiol 2021; 64:417-426. [PMID: 34373981 DOI: 10.1007/s10840-021-01048-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complex ablation for persistent atrial fibrillation (AF) aims to modify the arrhythmogenic substrates to become incapable to perpetuate the arrhythmia. Ablation-associated determinants of atrial tachycardia (AT) rather than AF recurrences are unknown. The aim of the study was to evaluate the association between the type of arrhythmia recurrence and electrophysiological findings during redo procedures. METHODS A total number of 384 consecutive patients with persistent AF underwent complex ablation consisting of PV isolation (PVI), biatrial electrogram-guided ablation, and linear ablation with the desired procedural endpoint of AF termination. Electrophysiological findings during redo procedures and its relation to AR type are the subject of this study. RESULTS Overall, 177 (46%) patients underwent a second procedure. Patients with AT recurrences had significantly more often persistent PVI (47 vs. 25%; P = 0.002). Moreover, a higher number of recovered PVs were associated with AF recurrence (3 PVs recovered, AF = 16.1% vs. AT = 5.2%; P = 0.02; 4 PVs recovered, AF = 18.5% vs. AT = 6.3%; P = 0.01), regardless of the extent of substrate ablation during the first procedure. CONCLUSIONS Durable PV isolation but not the extent of atrial substrate ablation determines the type of arrhythmia recurrence. Thus, the PVs may represent dominant perpetuators (and not only triggers) of persistent AF even in the presence of a significantly modified atrial substrate.
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Affiliation(s)
- Raphael Spittler
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany.
| | - Fabian Bahlke
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | | | - Alexandra Marx
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Hanke Mollnau
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Blanca Quesada-Ocete
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Torsten Konrad
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
| | - Thomas Rostock
- Department of Cardiology II - Electrophysiology, University Hospital Mainz, Mainz, Germany
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14
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Kaneko M, Nagata Y, Nakamura T, Mitsui K, Nitta G, Nagase M, Okata S, Watanabe K, Miyazaki R, Nagamine S, Hara N, Lee T, Nozato T, Ashikaga T, Goya M, Hirao K, Sasano T. Geriatric nutritional risk index as a predictor of arrhythmia recurrence after catheter ablation of atrial fibrillation. Nutr Metab Cardiovasc Dis 2021; 31:1798-1808. [PMID: 33985896 DOI: 10.1016/j.numecd.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The nutritional risk of patients who undergo atrial fibrillation (AF) ablation varies. Its impact on the recurrence after ablation is unclear. We sought to evaluate the relationship between the nutritional risk and arrhythmia recurrence in patients who undergo AF ablation. METHODS AND RESULTS We enrolled 538 patients (median 67 years, 69.9% male) who underwent their first AF ablation. Their nutritional risk was evaluated using the pre-procedural geriatric nutritional risk index (GNRI), and the patients were classified into two groups: No-nutritional risk (GNRI ≧ 98) and Nutritional risk (GNRI < 98). The primary endpoint was a recurrence of an arrhythmia, and its relationship to the nutritional risk was evaluated. We used propensity-score matching to adjust for differences between patients with a GNRI-based nutritional risk and those without a nutritional risk. A nutritional risk was found in 10.6% of the patients, whereas the remaining 89.4% had no-nutritional risk. During a mean follow-up of 422 days, 91 patients experienced arrhythmia recurrences. The patients with a nutritional risk had a significantly higher arrhythmia recurrence rate both in the entire study cohort (Log-rank p = 0.001) and propensity-matched cohort (Log-rank p = 0.006). In a Cox proportional hazard analysis, the nutritional risk independently predicted arrhythmia recurrences in the entire study cohort (hazard ratio [HR]: 3.91, 95% confidence interval [CI]: 1.84-8.35, p < 0.001) and propensity-matched cohort (HR: 6.49, 95% CI: 1.42-29.8, p = 0.016). CONCLUSION A pre-procedural malnutrition risk was significantly associated with increased arrhythmia recurrences in patients who underwent AF ablation.
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Affiliation(s)
- Masakazu Kaneko
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tomofumi Nakamura
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kentaro Mitsui
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Giichi Nitta
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Sho Nagamine
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsumin Lee
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital, Kanagawa, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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15
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Kornej J, Schumacher K, Sommer P, Potpara T, Arya A, Dagres N, Bollmann A, Husser-Bollmann D, Lip GYH, Hindricks G. Very late arrhythmia recurrences in patients with sinus rhythm within the first year after catheter ablation: The Leipzig Heart Center AF Ablation Registry. Europace 2020; 21:1646-1652. [PMID: 31504447 DOI: 10.1093/europace/euz233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/30/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) still remain an important management issue. Recently, the APPLE score had been introduced to predict rhythm outcomes within 12 months after catheter ablation, while the simple MB-LATER score was developed for the prediction of very late recurrence of AF (VLRAF) occurring after 12 months. The aim of this study was to compare APPLE and MB-LATER scores in predicting VLRAF. METHODS AND RESULTS The study population included arrhythmia-free patients within first 12 months after first radiofrequency catheter ablation from The Heart Center Leipzig AF Ablation Registry. The APPLE [one point for Age >65 years, Persistent AF, imPaired eGFR <60 mL/min/1.73 m2, Left atrial (LA) diameter ≥43 mm, EF <50%] and MB-LATER scores [one point for Male gender, Bundle branch block or QRS >120 ms, LA diameter ≥47 mm, AF Type (persistent AF), Early Recurrence <3 months] were calculated before and 3 months after ablation, respectively. We followed 482 patients {age 61 [interquartile range (IQR) 54-68] years, 66% males, 32% persistent AF} for median 40 (IQR 35-50) months. There were 184 patients (38.3%) with arrhythmia recurrences within 13-60 months after ablation. On multivariate analysis, APPLE [odds ratio (OR) 1.517, 95% confidence interval (CI) 1.244-1.850, P < 0.001] and MB-LATER (OR 1.437, 95% CI 1.211-1.705, P < 0.001) scores and diabetes mellitus (OR 2.214, 95% CI 1.353-3.625, P = 0.002) were significantly associated with arrhythmia recurrences. Receiver operating characteristic curve analyses demonstrated moderate prediction for both scores [area under the curve (AUC) 0.607, P < 0.001 for APPLE score, AUC 0.604, P < 0.001 for MB-LATER]. CONCLUSION Prediction of VLRAF is similar for both APPLE and MB-LATER scores. A better score remains still a clinical unmet need.
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Affiliation(s)
- Jelena Kornej
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany.,University of Leipzig, Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig, Germany
| | - Katja Schumacher
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, Višegradska 26, Belgrade, Serbia
| | - Arash Arya
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, Struempellstrasse 39, Leipzig, Germany
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16
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Bellut H, Guillemet L, Bougouin W, Charpentier J, Ben Hadj Salem O, Llitjos JF, Paul M, Valade S, Spagnolo S, Lamhaut L, Chiche JD, Marijon E, Pène F, Varenne O, Mira JP, Dumas F, Cariou A. Early recurrent arrhythmias after out-of-hospital cardiac arrest associated with obstructive coronary artery disease: Analysis of the PROCAT registry. Resuscitation 2019; 141:81-87. [PMID: 31185259 DOI: 10.1016/j.resuscitation.2019.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE After out-of-hospital cardiac arrest (OHCA) associated with obstructive coronary artery disease (CAD), the risk of recurrence during the early period is unclear and the indication for anti-arrhythmic treatment is debated. We assessed the incidence and predisposing factors for severe cardiac arrhythmias in this population. DESIGN Retrospective study in a cardiac arrest center. SETTINGS The primary endpoint was the occurrence of major cardiac arrhythmias from hospital admission to intensive care unit (ICU) discharge in patients admitted after an OHCA associated with obstructive CAD. A major arrhythmia was defined as any arrhythmic event (auricular or ventricular) associated with cardiac arrest recurrence and/or severe arterial hypotension. Secondary outcomes were time from ICU admission to arrhythmia occurrence and all-cause in-ICU mortality. Risk factors for recurrence of a major arrhythmia were assessed using multivariate analysis. PATIENTS We included all consecutive OHCA patients resuscitated from ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm associated with obstructive CAD, and who had a successful primary percutaneous coronary intervention. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Among 256 patients, a major arrhythmia occurred in 29 (11.3%), within the first 24 h in 79.3% of cases and were mostly VF (44.8%). Mortality rate was significantly increased in patients with major arrhythmia recurrence (69% vs 41%; p = 0.006). Factor significantly associated with recurrence of severe arrhythmia was male gender (OR 0.32 [0.12-0.92]; p = 0.034). Treatment with prophylactic anti-arrhythmic in the ICU was not associated with a change in the risk of recurrence (OR 0.85 [0.21-3.65], p = 0.82). CONCLUSION An early recurrence of major arrhythmia was observed in more than 10% of post-cardiac arrest patients. These events happened mostly within the first 24 h. The interest of prophylactic anti-arrhythmic treatment remains to be evaluated in this population.
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Affiliation(s)
- Hugo Bellut
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Lucie Guillemet
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France.
| | - Wulfran Bougouin
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | | | - Omar Ben Hadj Salem
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Marine Paul
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Shirley Spagnolo
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France
| | - Lionel Lamhaut
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; SAMU 75, Necker Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Daniel Chiche
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Eloi Marijon
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Cardiology Department, European Georges Pompidou Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Olivier Varenne
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Cardiology Department, Cochin Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France
| | - Florence Dumas
- Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; Emergency Department, Cochin Hospital (APHP), Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970 (team 4), Paris Cardiovascular Research Centre, Paris, France
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