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Persistent phrenic nerve palsy after atrial fibrillation ablation: follow-up data from the Netherlands Heart Registration. Europace 2022. [DOI: 10.1093/europace/euac053.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Persistent phrenic nerve palsy (PNP) is an established complication of atrial fibrillation (AF) ablation, especially during cryoballoon and thoracoscopic ablation. Data on persistent PNP reversibility is limited because most patients recover <24hours.
Purpose
This study aims to investigate persistent PNP recovery, freedom of PNP-related symptoms after AF ablation and identify baseline variables associated with the occurrence and early PNP recovery in a large nationwide registry study.
Methods
In this study, we used data from the Netherlands Heart Registration, comprising data from 9,549 catheter and thoracoscopic AF ablations performed in 2016 and 2017. PNP data was available of 7,433 procedures, and additional follow-up data were collected for patients who developed persistent PNP.
Results
Overall, mean age was 62±10 years, and 67.7% were male. Fifty-four (0.7%) patients developed persistent PNP and follow-up was available in 44 (81.5%) patients. PNP incidence was 0.07%, 0.29%, 1.41%, and 1.25% for patients treated with conventional-RF, phased-RF, cryoballoon, and thoracoscopic ablation respectively. Seventy-one percent of the patients fully recovered, and 86% were free of PNP-related symptoms after a median follow-up of 203[113 – 351] and 184[82 – 359] days, respectively (Figure 1A/C). In addition, in 20/28 (71.4%) patients recovery was confirmed with imaging (Figure 1B). Female sex, cryoballoon, and thoracoscopic ablation were associated with a higher risk to develop PNP, with corresponding adjusted OR of 2.32 95% CI 1.07 – 5.06, OR 21.12 95% CI 6.49 – 129.75, and 18.93 95% CI 4.86 – 124.41, respectively. Patients with PNP recovering ≤180 days had a larger left atrium volume index than those with late or no recovery.
Conclusion
After AF ablation, persistent PNP recovers in the majority of patients, and most are free of symptoms. Female patients and patients treated with cryoballoon or thoracoscopic ablation are more prone to develop PNP.
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Strategies for repeat ablation for atrial fibrillation: a multicentre comparison of non-pulmonary vein versus pulmonary vein target ablation. Europace 2022. [DOI: 10.1093/europace/euac053.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Approximately 18% of patients with atrial fibrillation (AF) undergo a repeat ablation within 12 months after their index ablation. Despite the high prevalence, comparative studies on non-pulmonary vein (PV) target strategies in repeat AF ablation are scarce.
Purpose: This study aims to describe 12 months efficacy of non-PV and PV target ablations as a repeat ablation strategy.
Methods
A multicentre retrospective, descriptive study was conducted with data of 280 patients who underwent repeat AF ablation. Ablation strategy for repeat ablation was at the operators’ discretion. Non-PV target ablation (n=140) included posterior wall isolation, mitral line, roofline and/or complex fractionated atrial electrogram ablation. PV target ablation (n=140), included re-isolation and/or wide atrium circumferential ablation. Patients’ demographics and rhythm outcomes during 12-months follow-up were analysed.
Results: Overall, the mean age was 63 ± 9 years, 64% were male, and body mass index was 27.1 ± 4.2. Patients undergoing non-PV target ablation had more frequently persistent AF (47.9% vs 14.3%, p < 0.001), and had a higher CHA2DS2 VASc (2.0 vs 1.3, p < 0.001). At 12 months, more atrial tachyarrhythmias were observed in the non-PV target group (48.6%) compared to the PV target group (29.3%, p=0.001). Similarly, a significantly higher AF and atrial tachycardia (AT) recurrence rate was observed after non-PV target ablation compared to PV target ablation (36.4% versus 22.1% and 22.9% versus 10.7%). After adjusting for several associated covariates, a significantly higher AT recurrence risk remained in the non-PV target group (adjusted OR 2.19 95% CI 1.18 – 4.42, p = 0.023) (Figure 1C). Sensitivity analysis was performed with inverse propensity weighting to assess the robustness of the multivariate model and demonstrated comparable outcomes. Both groups significantly de-escalated anti-arrhythmic drug use, de-escalation was more profound after PV target ablation. Patients with isolated PVs during non-PV target ablation had a significantly higher risk for AF recurrence than those with reconnected PVs (Figure 1B).
Conclusion: Compared to PV target ablation, non-PV target repeat ablation did not improve outcomes after 12 months and was independently associated with a higher risk for AT recurrences.
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1003Ganglion Plexus Ablation in Patients with Advanced Atrial Fibrillation: 2-Year Outcomes of the AFACT study. Europace 2018. [DOI: 10.1093/europace/euy015.552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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