Analysis of risk factors for recurrence after video-assisted pulmonary vein isolation of lone atrial fibrillation—results of 5 years of follow-up

Objective Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI. Methods The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs). Results The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2–203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6–78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%). Conclusions This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution.

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Video-Assisted Bilateral Epicardial Pulmonary Vein Isolation for the Treatment of Lone Atrial Fibrillation

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2006.12.009 ◽

2007 ◽

Vol 83 (5) ◽

pp. 1724-1730 ◽

Cited By ~ 39

Author(s):

Ertan Sagbas ◽

Belhhan Akpinar ◽

Ilhan Sanisoglu ◽

Barış Caynak ◽

Burak Tamtekin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Lone Atrial Fibrillation ◽

Video Assisted

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Surgical treatment of lone atrial fibrillation

Sao Paulo Medical Journal ◽

10.1590/s1516-31802010000600010 ◽

2010 ◽

Vol 128 (6) ◽

pp. 367-370

Author(s):

Shi-Min Yuan ◽

Hua Jing ◽

Leonid Sternik

Keyword(s):

Atrial Fibrillation ◽

Surgical Treatment ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Attractive Alternative ◽

Lone Atrial Fibrillation ◽

Surgical Strategies ◽

Off Pump ◽

Video Assisted

Currently, off-pump video-assisted thoracoscopic epicardial pulmonary vein isolation offers an attractive alternative to on-pump Maze procedures for surgical treatment of lone atrial fibrillation. Nevertheless, on-pump Maze procedures through a mid-sternotomy approach still play an important role in patients with lone atrial fibrillation on many occasions, especially in patients with failed percutaneous pulmonary vein alone. The aim of this article was to give a brief review of the surgical strategies for treating lone atrial fibrillation, and present the possible indications for on-pump Maze procedures through a mid-sternotomy approach.

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Impact of clinical risk factor profile vs. atrial fibrillation phenotype on outcome after pulmonary vein isolation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0373 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Wittmer ◽

L Chollet ◽

S Baldinger ◽

H Servatius ◽

J Seiler ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Female Gender ◽

Clinical Risk Factors ◽

Clinical Risk ◽

Artery Disease

Abstract Aims Catheter ablation for atrial fibrillation (AF) is increasingly performed. Both clinical risk factors as well as the AF phenotype have been shown to influence ablation outcomes. The inter-relationship of the two however is incompletely understood. Methods In a retrospective analysis of a prospective registry of patients undergoing a first pulmonary vein isolation, the association of 8 predefined clinical risk factors (age >70 years, female gender, hypertension, BMI >30 kg/m2, coronary artery disease, heart failure, chronic kidney disease (CKD; eGFR<60ml/min/1.73m2) and diabetes mellitus) and the AF phenotype (paroxysmal vs. persistent AF) were assessed as well as their impact on AF recurrence during follow-up. Results Overall, 715 patients were enrolled (median age 63 years, 27% females, 69% paroxysmal AF). The prevalence of obesity, hypertension, heart failure and CKD was significantly higher in persistent AF, while female gender was more prevalent in paroxysmal AF. After 2 years of follow-up, overall freedom from recurrence was 46%, and was higher in paroxysmal AF compared to persistent AF (54.1% vs. 29.1%, p<0.001). Of the clinical risk factors, obesity (p=0.02), CKD (p=0.01) and heart failure (p=0.01) were significantly associated with lower arrhythmia-free survival, and there was a trend for hypertension and coronary artery disease (both p<0.2). A risk score composed of those 5 factors was associated with recurrences in patients with paroxysmal AF (p=0.04, Figure 1), but not in those with persistent AF (p=0.85, Figure 2). Conclusion Clinical risk factors predict outcome after pulmonary vein isolation in patients with paroxysmal, but not persistent AF. This is likely due to a strong association of those risk factors with the occurrence of persistent AF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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B-PO02-073 ONE-YEAR FOLLOW-UP AFTER WIDE-AREA PULMONARY VEIN ISOLATION USING THE VISUALLY GUIDED LASER BALLOON FOR ATRIAL FIBRILLATION

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.328 ◽

2021 ◽

Vol 18 (8) ◽

pp. S125-S126

Author(s):

Takashi Yamasaki ◽

Tetsuhisa Hattori Keisuke Ohta ◽

Nobuyuki Miyai, Reo Nakamura ◽

Takayoshi Sawanishi Noriyuki Kinosita ◽

Ken Kakita

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Wide Area ◽

Visually Guided ◽

One Year ◽

Laser Balloon

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Up to 6-year follow-up after pulmonary vein isolation for persistent/permanent atrial fibrillation: Importance of sinus node function

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2010.04.045 ◽

2011 ◽

Vol 141 (6) ◽

pp. 1455-1460 ◽

Cited By ~ 3

Author(s):

Yoshiharu Soga ◽

Hitoshi Okabayashi ◽

Yoshio Arai ◽

Takuya Nomoto ◽

Jota Nakano ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Sinus Node ◽

Permanent Atrial Fibrillation

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Catheter ablation for lone atrial fibrillation in individuals aged under 35 years

Cardiology in the Young ◽

10.1017/s1047951119000416 ◽

2019 ◽

Vol 29 (5) ◽

pp. 643-648 ◽

Cited By ~ 1

Author(s):

Jindong Chen ◽

Hao Wang ◽

Mengmeng Zhou ◽

Liang Zhao

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Atrial Tachyarrhythmia ◽

Lone Atrial Fibrillation ◽

Significant Independent Predictor ◽

Atrial Size

AbstractBackground:To assess the effectiveness of radiofrequency catheter ablation for lone atrial fibrillation in young adults.Methods:This single-centre, retrospective, observational study enrolled 75 consecutive patients (86.7% men) under 35 (median, 30) years old with lone atrial fibrillation (68% paroxysmal, 26.7% persistent, and 5.3% long-standing persistent) without other cardiopulmonary diseases who underwent catheter ablation between April 2009 and May 2017. Procedural endpoints were circumferential pulmonary vein ablation for atrial fibrillation with pulmonary vein trigger, and target ablation or bidirectional block of lines and disappearance of complex fractionated atrial electrograms for atrial fibrillation with clear and unclear non-pulmonary vein triggers, respectively.Results:Main study outcome was rate of survival free from atrial tachyarrhythmia recurrence, which at median 61 (range, 5–102) months follow-up was 62.7% (64.7 and 58.3% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after single ablation, and 69.3% (68.6 and 70.8% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after mean 1.2 ablations (two and three ablations in 11 and 2 patients, respectively). In multivariate analysis, non-pulmonary vein trigger was a significant independent predictor of recurrent atrial tachyarrhythmia (OR, 10.60 [95%CI, 2.25–49.96]; p = 0.003). There were no major periprocedural adverse events.Conclusions:In patients under 35 years old with lone atrial fibrillation, radiofrequency catheter ablation appeared effective particularly for atrial fibrillation with pulmonary vein trigger and regardless of left atrial size or atrial fibrillation duration or type. Atrial tachyarrhythmia recurrence after multiple ablations warrants further study.

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Cryoballoon Atrial Fibrillation Ablation in a Patient with an Atrial Septal Defect Closure Device

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v16i1.6602 ◽

2021 ◽

Author(s):

Meisam Mokhtari ◽

Zahra Khajali ◽

Mona Heidarali ◽

Majid Haghjoo

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Septal Defect ◽

Closure Device ◽

Atrial Septal Defect Closure ◽

Occluder Device ◽

Asd Closure

Atrial fibrillation (AF) is the most commonly treated arrhythmia in clinical practice and is often found in association with an atrial septal defect (ASD). However, ASD closure rarely confers complete arrhythmia control. A 23-year-old man presented to our center with frequent episodes of palpitations. AF was documented in 12-lead electrocardiography, and echocardiography showed a secundum-type ASD, 14 mm in size, with a significant left-to-right shunt. ASD closure was performed successfully with an ASD occluder device with no residual shunting. During follow-up, the patient experienced several episodes of AF. Thirteen months after the ASD closure, cryoballoon pulmonary vein isolation was done successfully with no complications. During a 12-month follow-up, he had no symptoms or AF recurrences, and echocardiography showed no residual shunting. This study showed that cryoballoon pulmonary vein isolation could be performed successfully without residual shunts in patients with ASD closure devices.

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Clinical success of cryoballoon pulmonary vein isolation in patients with atrial fibrillation

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2018-7-4s-6-14 ◽

2019 ◽

Vol 7 (4S) ◽

pp. 6-14

Author(s):

T. Y. Chichkova ◽

S. E. Mamchur ◽

E. A. Khomenko

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Direct Current ◽

Clinical Success ◽

Persistent Atrial Fibrillation ◽

Cryoballoon Ablation ◽

Clinical Effects ◽

Rf Ablation

Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).Methods.230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.Results.77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).Conclusion.The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

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