The impact of age on the efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p<0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. FUNDunding Acknowledgement Type of funding sources: None.

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The Impact of Catheter Ablation on Biochemical Markers of Collagen Turnover in Patients with Persistent Atrial Fibrillation

Journal of Arrhythmia ◽

10.4020/jhrs.27.op09_4 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. OP09_4

Author(s):

Yuko Toyoshima ◽

Koichi Inoue ◽

Ryusuke Kimura ◽

Masaharu Masuda ◽

Atsushi Doi

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Biochemical Markers ◽

Persistent Atrial Fibrillation ◽

Collagen Turnover ◽

The Impact

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P980Post-procedural plasma brain natriuretic peptide level early after catheter ablation predicts the future clinical outcome in patients with persistent atrial fibrillation and reduced ejection fraction

European Heart Journal ◽

10.1093/eurheartj/ehz747.0573 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Okada ◽

K Tanaka ◽

Y Ninomiya ◽

Y Hirao ◽

T Oka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Outcome ◽

Ejection Fraction ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Persistent Atrial Fibrillation ◽

Cardiovascular Death ◽

The Impact ◽

Af Recurrence

Abstract Background Successful restoration of sinus rhythm (SR) by catheter ablation (CA) for persistent atrial fibrillation (AF) improves cardiac function, resulting in decrease of plasma brain natriuretic peptide (BNP) level. The exact significance and prognostic implications of this change have yet to be determined. Purpose To examine the impact of pre- and post-procedural BNP level on the clinical outcome after CA in patients with persistent AF and reduced left ventricular ejection fraction (LVEF). Methods Out of 242 patients with LVEF <50% who underwent first-time CA for persistent AF between March 2012 and September 2018 at our institute, we enrolled 137 patients (61±10 years, 83% male) whose plasma BNP level was available both at baseline and early after CA (during 1–3 month). We evaluated the impact of the BNP levels on future AF recurrence 3 months after CA as the primary endpoint. Additional secondary endpoints included heart failure (HF) hospitalization and cardiovascular death. Results All patients successfully restored SR at the end of CA. Within 3 months of a blanking period (BP), improvement of LVEF (from 39±10% to 65±12%, p<0.001) and reduction of BNP levels (from 178 [107–332] pg/ml to 42.3 [21.1–78.6] pg/ml, p<0.001) were observed. During the median follow-up of 21 months after BP, the incidence of AF recurrence, HF hospitalization, and cardiovascular death was 37% (n=50), 3% (n=4), and 1% (n=1), respectively. Cox proportional hazard regression analysis after adjustment for age and gender revealed that post-procedural BNP level was a significant predictor of the AF recurrence (hazard ratio [HR] per 100-pg/ml increase, 1.13; 95% confidence interval [CI], 1.02–1.25; p=0.023), but pre-procedural BNP level was not (1.02; 0.95–1.09; p=0.56). Receiver operating curve analysis determined the post-procedural BNP level of 55.5 pg/ml as the best cut-off value for predicting the AF recurrence, with area under the curve of 0.620 (95% CI, 0.534–0.702; p=0.018). The incidence of AF recurrence was significantly higher in patients with post-procedural BNP level >55.5 pg/ml (n=50) than the others (50% vs. 29%; HR, 3.99; 95% CI, 2.07–7.68; p<0.001). No patients with post-procedural BNP level ≤55.5 pg/ml experienced HF hospitalization and cardiovascular death (8% vs. 0% and 2% vs. 0%, p=0.006 and p=0.17, respectively) Conclusions Not pre-procedural but post-procedural BNP level early after CA predicted the future clinical outcome in patients with persistent AF and reduced LVEF. Decreased but still elevated BNP level after restoration of SR would identify the residual risk for developing unfavorable outcome.

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The impact of age on the atrial substrate: insights from patients with a low scar burden undergoing catheter ablation of persistent atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-011-9657-y ◽

2012 ◽

Vol 34 (3) ◽

pp. 287-294 ◽

Cited By ~ 12

Author(s):

Miki Yokokawa ◽

Rakesh Latchamsetty ◽

Eric Good ◽

Thomas Crawford ◽

Krit Jongnarangsin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Scar Burden ◽

The Impact

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Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST)

EP Europace ◽

10.1093/europace/euaa298 ◽

2020 ◽

Author(s):

Karl-Heinz Kuck ◽

Dmitry S Lebedev ◽

Evgeny N Mikhaylov ◽

Alexander Romanov ◽

László Gellér ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Primary Endpoint ◽

Persistent Atrial Fibrillation ◽

Published Data ◽

Rf Ablation ◽

Open Label ◽

Randomized Controlled ◽

Kaplan Meier ◽

The Impact

Abstract Aims Delay of progression from paroxysmal to persistent atrial fibrillation (AF) is an important measure of long-term success of AF treatment. However, published data on the impact of catheter ablation on AF progression are limited. This study evaluates whether radiofrequency (RF) catheter ablation delays the progression of AF compared with antiarrhythmic drug (AAD) treatment using current AF management guidelines. Methods This prospective, randomized, controlled, two-arm, open-label trial was conducted at 29 hospitals and medical centres across 13 countries. Patients were randomized 1 : 1 to RF ablation or AAD treatment. The primary endpoint was the rate of persistent AF/atrial tachycardia (AT) at 3 years. Results After early study termination following slow enrolment, 255 (79%) of the planned 322 patients were enrolled (RF ablation, n = 128, AAD, n = 127); 36% of patients in the RF ablation group and 41% in the AAD group completed 3 years of follow-up. For the primary endpoint, the Kaplan–Meier estimate of the rate of persistent AF/AT at 3 years was significantly lower with RF ablation [2.4% (95% confidence interval (CI), 0.6–9.4%)] than with AAD therapy [17.5% (95% CI, 10.7–27.9%); one-sided P = 0.0009]. Patients ≥65 years were ∼4 times more likely to progress to persistent AF/AT than patients <65 years, suggesting RF ablation can delay disease progression [hazard ratio: 3.87 (95% CI, 0.88–17.00); P = 0.0727]. Primary adverse events were reported for eight patients in the RF ablation group. Conclusions Radiofrequency ablation is superior to guideline-directed AAD therapy in delaying the progression from paroxysmal to persistent AF.

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Efficacy and Safety of Catheter Ablation for Long-Standing Persistent Atrial Fibrillation in Women

Pacing and Clinical Electrophysiology ◽

10.1111/pace.12212 ◽

2013 ◽

pp. n/a-n/a ◽

Cited By ~ 5

Author(s):

XIAO-DONG ZHANG ◽

HONG-WEI TAN ◽

JUN GU ◽

WEI-FENG JIANG ◽

LIANG ZHAO ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Efficacy And Safety

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Impact of Additional Transthoracic Electrical Cardioversion on Cardiac Function and Atrial Fibrillation Recurrence in Patients with Persistent Atrial Fibrillation Who Underwent Radiofrequency Catheter Ablation

Cardiology Research and Practice ◽

10.1155/2016/4139596 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Deguo Wang ◽

Fengxiang Zhang ◽

Ancai Wang

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Cardiac Function ◽

Left Atrial ◽

Radiofrequency Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Electrical Cardioversion ◽

Additional Line ◽

The Impact

Backgrounds and Objective. During the procession of radiofrequency catheter ablation (RFCA) in persistent atrial fibrillation (AF), transthoracic electrical cardioversion (ECV) is required to terminate AF. The purpose of this study was to determine the impact of additional ECV on cardiac function and recurrence of AF.Methods and Results. Persistent AF patients received extensive encircling pulmonary vein isolation (PVI) and additional line ablation. Patients were divided into two groups based on whether they need transthoracic electrical cardioversion to terminate AF: electrical cardioversion (ECV group) and nonelectrical cardioversion (NECV group). Among 111 subjects, 35 patients were returned to sinus rhythm after ablation by ECV (ECV group) and 76 patients had AF termination after the ablation processions (NECV group). During the 12-month follow-ups, the recurrence ratio of patients was comparable in ECV group (15/35) and NECV group (34/76) (44.14% versus 44.74%,P=0.853). Although left atrial diameters (LAD) decreased significantly in both groups, there were no significant differences in LAD and left ventricular cardiac function between ECV group and NECV group.Conclusions. This study revealed that ECV has no significant impact on the maintenance of SR and the recovery of cardiac function. Therefore, ECV could be applied safely to recover SR during the procedure of catheter ablation of persistent atrial fibrillation.

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Biomarkers Determining Prognosis of Atrial Fibrillation Ablation

Current Medicinal Chemistry ◽

10.2174/0929867325666180320122930 ◽

2019 ◽

Vol 26 (5) ◽

pp. 925-937 ◽

Cited By ~ 4

Author(s):

Dimitris Tsiachris ◽

George Giannopoulos ◽

Spyridon Deftereos ◽

Charis Kossyvakis ◽

Constantinos Tsioufis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Inflammatory Markers ◽

Persistent Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

Oxidative Stress Biomarkers ◽

Specific Patient ◽

Term Administration ◽

The Impact

Catheter ablation for rhythm control is recommended in specific patient populations with paroxysmal, persistent, or long-standing persistent atrial fibrillation. Pulmonary vein isolation is the cornerstone of the ablative therapy for atrial fibrillation. However, relapse is still common since the single procedure efficacy of atrial fibrillation ablation was estimated to be 60-80% in paroxysmal and 50-70% in persistent atrial fibrillation. It is important to identify predictors of successful atrial fibrillation patients ablation. In the present review, we will assess the role of available biomarkers to predict responders of an initial atrial fibrillation catheter ablation. Emphasis has been given on the role of myocardial injury biomarkers, natriuretic peptides and traditional inflammatory markers. Novel inflammatory markers, oxidative stress biomarkers and microRNAs have also been examined as predictors of a successful atrial fibrillation procedure. Notably, the impact of procedural and short-term administration of steroids, as well as the role of colchicine on preventing atrial fibrillation recurrence after ablation is thoroughly presented.

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