INCIDENCE, CHARACTERISTIC AND RISK FACTORS OF CEREBRAL THROMBOEMBOLIC COMPLICATIONS FOLLOWING HIGH-FREQUENCY CATHETER ABLATION OF ATRIAL FIBRILLATION: EXPERIENCE OF 3,360 PROCEDURES

Diabetes mellitus (DM) is one of the most important risk factors for atrial fibrillation (AF) and is a predictor of stroke and thromboembolism. DM may increase the incidence of AF, and when it is combined with other risk factors, the incidence of stroke and thromboembolism may also be higher; furthermore, hospitalization due to heart failure appears to increase. Maintenance of well-controlled blood glucose and low levels of HbA1c in accordance with guidelines may decrease the incidence of AF. The mechanisms of AF associated with DM are autonomic remodeling, electrical remodeling, structural remodeling, and insulin resistance. Inhibition of the renin-angiotensin system is suggested to be an upstream therapy for this type of AF. Studies have indicated that catheter ablation may be effective for AF associated with DM, restoring sinus rhythm and improving prognosis. Catheter ablation combined with hypoglycemic agents may further increase the rate of maintenance of sinus rhythm and reduce the need for reablation.

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Gender-specific risk of complications in catheter ablation for atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0591 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J Plasek ◽

P Peichl ◽

D Wichterle ◽

R Cihak ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Body Height ◽

Left Ventricular ◽

Navigation Systems ◽

3D Navigation ◽

Bundle Branch Block ◽

Specific Risk ◽

Gender Specific

Abstract Background Catheter ablation is an established treatment modality for atrial fibrillation (AF). The risk of procedural complications is not negligible. Some studies suggested that female patients have a higher risk of complications. Purpose To identify gender-specific predictors of major complications (MCs) in patients undergoing catheter ablation for AF in a tertiary ablation centre. Methods A total of 4733 catheter ablations for AF (65% paroxysmal, 26% repeated procedures) were performed at our centre between January 2006 and August 2018. Patients (71% males) aged 60±10 years and had body mass index of 29±4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% procedures with the use of 3D navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MCs were defined as those that resulted in permanent injury, required intervention or prolonged hospitalization. Variables were assessed by uni- and multivariate analysis, two-sided α<0.05 was considered significant. Results A total of 160 (3.4%) MCs were detected - 60 (4.4%) in females and 100 (2.9%) in males (P=0.012). Both lower body height and the presence of bundle branch block (BBB) were associated with MCs only in females; for left bundle branch block (LBBB), the effect size was higher. On the contrary, higher left ventricular end-diastolic diameter (LVEDd) and persistent AF were associated with MCs in males (Table). Conclusion Females have a higher risk of MCs during catheter ablation for AF. Body height, AF type, BBB, and LVEDd may belong among gender-specific risk factors for MCs in AF ablation procedures. Whether BBB and LVEDd represent true risk factors warrants a validation in further studies. Funding Acknowledgement Type of funding source: None

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Risk Factors for Thromboembolic Complications in Chronic Atrial Fibrillation

Archives of Internal Medicine ◽

10.1001/archinte.1990.00390160077016 ◽

1990 ◽

Vol 150 (4) ◽

pp. 819 ◽

Cited By ~ 71

Author(s):

Palle Petersen

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Chronic Atrial Fibrillation ◽

Thromboembolic Complications

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Risk Factors for Ischemic Stroke in Atrial Fibrillation Patients Undergoing Radiofrequency Catheter Ablation

Scientific Reports ◽

10.1038/s41598-019-43566-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Yun Gi Kim ◽

Jaemin Shim ◽

Suk-Kyu Oh ◽

Kwang-No Lee ◽

Jong-Il Choi ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation

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Impact of Catheter Ablation on Sleep Quality and Relationship Between Sleep Stability and Recurrence of Paroxysmal Atrial Fibrillation After Successful Ablation: 24‐Hour Holter‐Based Cardiopulmonary Coupling Analysis

Journal of the American Heart Association ◽

10.1161/jaha.120.017016 ◽

2020 ◽

Vol 9 (23) ◽

Author(s):

Woohyeun Kim ◽

Jin Oh Na ◽

Robert J. Thomas ◽

Won Young Jang ◽

Dong Oh Kang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Sleep Quality ◽

High Frequency ◽

Low Frequency ◽

Coupling Analysis ◽

Very Low Frequency ◽

Cardiopulmonary Coupling ◽

Frequency Coupling ◽

Af Recurrence

Background Sleep fragmentation and sleep apnea are common in patients with atrial fibrillation (AF). We investigated the impact of radio‐frequency catheter ablation (RFCA) on sleep quality in patients with paroxysmal AF and the effect of a change in sleep quality on recurrence of AF. Methods and Results Of 445 patients who underwent RFCA for paroxysmal AF between October 2007 and January 2017, we analyzed 225 patients who had a 24‐hour Holter test within 6 months before RFCA. Sleep quality was assessed by cardiopulmonary coupling analysis using 24‐hour Holter data. We compared cardiopulmonary coupling parameters (high‐frequency coupling, low‐frequency coupling, very‐low‐frequency coupling) before and after RFCA. Six months after RFCA, the high‐frequency coupling (marker of stable sleep) and very‐low‐frequency coupling (rapid eye movement/wake marker) was significantly increased (29.84%–36.15%; P <0.001; and 26.20%–28.76%; P =0.002, respectively) while low‐frequency coupling (unstable sleep marker) was decreased (41.25%–32.13%; P <0.001). We divided patients into 3 tertiles according to sleep quality before RFCA, and the risk of AF recurrence in each group was compared. The second tertile was used as a reference; patients with unstable sleep (Tertile 3) had a significantly lower risk of AF recurrence (hazard ratio [HR], 0.32; 95% CI, 0.12–0.83 for high‐frequency coupling; and HR, 0.22; 95% CI, 0.09–0.58 for low‐frequency coupling). Conclusions Sleep quality improved after RFCA in patients with paroxysmal AF. The recurrence rate was significantly lower in patients who had unstable sleep before RFCA. These results suggest that RFCA can influence sleep quality, and sleep quality assessment before RFCA may provide a risk marker for recurrence after RFCA in patients with paroxysmal AF.

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Incidence and risk factors for very late recurrence of atrial fibrillation after radiofrequency catheter ablation

EP Europace ◽

10.1093/europace/eut076 ◽

2013 ◽

Vol 15 (11) ◽

pp. 1581-1586 ◽

Cited By ~ 25

Author(s):

Y. Sotomi ◽

K. Inoue ◽

N. Ito ◽

R. Kimura ◽

Y. Toyoshima ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Late Recurrence

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Atrial Remodeling in Atrial Fibrillation. Comorbidities and Markers of Disease Progression Predict Catheter Ablation Outcome

Current Cardiology Reviews ◽

10.2174/1573403x16666200721153620 ◽

2020 ◽

Vol 16 ◽

Author(s):

Judit Szilágyi ◽

László Sághy

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Disease Progression ◽

Patient Selection ◽

Atrial Remodeling ◽

Supraventricular Arrhythmia ◽

Improve Patient Selection ◽

Number Of Patients ◽

Improve Patient

: Atrial fibrillation is the most common supraventricular arrhythmia affecting an increasing proportion of the population in which the mainstream therapy, catheter ablation provides freedom from arrhythmia for only a limited number of patients. Understanding the mechanism is key in order to find more effective therapies and to improve patient selection. In this review, we will detail the structural and electrophysiological changes of the atrial musculature that constitute atrial remodeling in atrial fibrillaton and how risk factors and markers of disease progression can predict catheter ablation outcome.

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Specific Features of the Course of Acute Coronary Syndrome in Patients with Newly Developed Atrial Fibrillation in Clinical Practice According to the Data of the Register of Acute Coronary Syndrome

Kardiologiia ◽

10.18087/cardio.2019.7.2503 ◽

2019 ◽

Vol 59 (7) ◽

pp. 19-25

Author(s):

Z. G. Tatarintseva ◽

E. D. Kosmacheva ◽

S. A. Raff ◽

S. V. Kruchinova ◽

V. A. Porkhanov

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Clinical Practice ◽

Hospital Discharge ◽

Oral Anticoagulant Therapy ◽

Inhospital Mortality ◽

Thromboembolic Complications ◽

Coronary Syndrome ◽

Number Of Patients

Aim: to elucidate risk factors of development of atrial fibrillation (AF) in patients with acute coronary syndrome (ACS), and to assess of patient’s adherence to oral anticoagulant therapy (OAT) during 12 months after ACS episode according to the data of the Total ACS Registry for the Krasnodar Territory.Materials and methods. In this retrospective analysis we used Registry data on patients with ACS and concomitant AF, consecutively admitted to cardiological departments of the S.V. Ochapovsky Territorial Clinical Hospital from 20/11/2015 to 20/02/18. Number of patients in the analyzed group was 201 (52 with AF which first appeared in connection with the index ACS). Survivors after hospital discharge were contacted by telephone and at planned visits. The analysis included assessment of rates of the following outcomes: inhospital death, hemorrhagic and thromboembolic complications, prognostic efficacy of the CRISADE and HAS BLED scores, and expediency of prescription to patients with ACS and concomitant first AF episode of prolonged OAT after hospital discharge.Results. Demographic and anamnestic data of patients with the first AF attack at the background of ACS were like those of patients with other types of AF. This group of patients was characterized by more severe course of the disease, but this produced no impact on inhospital mortality and rate of complications, as well as on mortality for 12 months after hospital discharge.Conclusion. The results of this analysis are important for understanding distinctive characteristics of patients with AF first developed during ACS.

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