Long-term outcome of dual site right atrial pacing in patients with drug-refractory paroxysmal versus persistent or permanent atrial fibrillation

Summary Objectives: Termination of atrial fibrillation (AF) during transcatheter ablation has been associated with improved outcomes in some studies. Our aim was to determine if termination of AF during beating-heart surgical ablation affects long-term results. Design and methods: This observational, retrospective study included 69 patients who underwent minimally invasive stand-alone surgical epicardial ablation for non-valvular, persistent AF using a bipolar ablation device. Patients with confirmed pulmonary vein isolation were included in the evaluation. Absence of arrhythmia was confirmed at 3, 6, and 12 months and annually thereafter with 24-h Holter monitoring. Results: Altogether, 39 (57%) patients were in AF at the beginning of surgical procedure. Among them, 21 (54%) recovered their sinus rhythm (SR) during the ablation: 7 (18%) had AF termination during left atrial ablation, 14 (36%) had AF termination during right atrial (RA) ablation. The remaining 18 (46%) patients required cardioversion to achieve SR. The mean follow-up was 55 ± 24 months. There were no significant differences in the patients’ preoperative and intraoperative data. The percentages of patients without AF termination during ablation who experienced freedom from AF and antiarrhythmic medications at 1, 2, 3, 4, and 5 years postoperatively were 78%, 63%, 50%, 33%, and 43%, respectively. The corresponding percentages in patients with AF termination were 83%, 74%, 67%, 71%, and 75%, respectively. Conclusions: There is a trend towards better long-term results if arrhythmia was terminated during surgical epicardial ablation on beating heart. Termination of AF during RA ablation (observed in 36% of patients), suggests that AF is a biatrial disease in patients with persistent AF.

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Syncope in relation to pulmonary arterial obstructive burden, hemodynamic status and short- and long-term outcome in patients with acute pulmonary embolism

European Heart Journal ◽

10.1093/ehjci/ehaa946.2278 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Keskin ◽

H.C Tokgoz ◽

O.Y Akbal ◽

A Hakgor ◽

S Tanyeri ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Right Atrial ◽

Term Outcome ◽

Risk Status ◽

Long Term Outcome ◽

Short And Long Term ◽

Severity Indexes

Abstract Background and aims Although syncope (S) has been reported as one of the presenting findings in patients (pts) with acute pulmonary embolism (APE), its clinical and haemodynamic correlates and impacts on the long-term outcome in this setting remains to be determined. In this single-centre study we evaluated the clinical and haemodynamic significance of S in APE in initial asessment, and during short- and long-term follow-up period. Methods Our study was based on the retrospective and prospective analysis of the overall 641 pts (age 65 (51–74 IQR) yrs, 56.2% female) with diagnosis of documented APE who underwent anticoagulant (n=207), thrombolytic (n=164), utrasound-facilitated thrombolysis (UFT) (n=218) or rheolytic thrombectomy (RT) (n=52). The systematic work- up including multidetector computed tomography (MDCT), Echo, biomarkers, and PE severity indexes were performed in all pts, and Qanadli score (QS) was used as the measure of the thrombotic burden in the pulmonary arteries (PA). Results The S as the presenting symptom In 30.2% of pts with APE. At baseline assessment, S(+) vs S(−) APE subgroups had a significantly shorter symptom-diagnosis interval, a higher risk status according to the significant elevations in troponin T, D-dimer, the higher PE severity indexes, a more deteriorated right ventricle/left ventricle ratio (RV/LV r), right atrial/left atrial ratio (LA/RAr) and RV longitudinal function indexes including tricuspid annular planary excursion (TAPSE) and tissue velocity (St), a significantly higher PA obstructive burden as assessed by QS and PA pressures. Thrombolytic therapy (36.2% vs 21%, p<0.001) and RT (11.9% vs 6.47%, p=0.037) were more frequently utilized S(+) as compared to S(−) group. However, all these differences between two subgroups were found to disappear after evidence-based APE treatments. In-hospital mortality (IHM) (12.95% vs 6%, p=0.007) and minor bleeding (10.36% vs 2.9%, p<0.001) were significantly higher in S(+) pts as compared to those in S(−) subgroup. Binominal logistic regression analysis revealed that PESI score and RV/LVr independently associated with S while IHM was only predicted by age and heart rate. The COX proportional hazard method showed that RV/LVr at discharge and malignancy were independently associated with cumulative mortality during follow-up duration of 620 (200–1170 IQ) days. Conclusions The presence of S in pts with APE was found to be asociated with a higher PA obstructive burden, a more deteriorated RV function and haemodynamics and higher risk status which may need more agressive reperfusion treatments. However, in the presence of the optimal treatments, S did not predict neither in-hospital outcome, nor long-term mortality. Funding Acknowledgement Type of funding source: None

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P-271 Occurence of atrial fibrillation after catheter ablation of the cavotricuspid isthmus: Long-term outcome

EP Europace ◽

10.1016/eupace/4.supplement_2.b130-a ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B130-B130

Author(s):

H. Mlcochova ◽

R. Cihak ◽

J. Kautzner ◽

J. Bytesnik ◽

V. Vancura ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Term Outcome ◽

Long Term Outcome ◽

Cavotricuspid Isthmus

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Electrocardiographic Spectral Features for Long-Term Outcome Prognosis of Atrial Fibrillation Catheter Ablation

Annals of Biomedical Engineering ◽

10.1007/s10439-016-1641-3 ◽

2016 ◽

Vol 44 (11) ◽

pp. 3307-3318 ◽

Cited By ~ 10

Author(s):

Raúl Alcaraz ◽

Fernando Hornero ◽

José J. Rieta

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Spectral Features ◽

Term Outcome ◽

Long Term Outcome

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Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.18649 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Xue Zhao ◽

Jianqiang Hu ◽

Yan Huang ◽

Yawei Xu ◽

Yanzhou Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Holter Monitoring ◽

Pericardial Tamponade ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up ◽

One Year

Objectives: The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up. Background: The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF. Methods: The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients. Results: The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group ( P <0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group ( P= 0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade. Conclusions: PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms. Registration: ChiCTR-TRC-11001191

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