THE IMPACT OF PULMONARY VEIN ISOLATION ON ATRIAL FUNCTION IN PATIENTS WITH ATRIAL FIBRILLATION COMPARED TO AGE-PREDICTED DOPPLER PARAMETERS

Abstract Introduction Pulmonary vein isolation (PVI) affects ganglionated plexi (GP) around the atrium, leading to a modification of the intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has a potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in humans remains unclear. Purpose This study aims to evaluate the Impact of PVI on QT interval in patients with paroxysmal atrial fibrillation. Methods We analyzed consecutive 117 PAF patients for their first PVI procedures. 12-lead ECG was evaluated at baseline, 4 hr, day 1, 1 month, and 3 months after ablation. Only patients with sinus rhythm on 12-lead ECG at each evaluation point without antiarrhythmic drugs were included. Results Heart rate significantly increased at 4 hr, day 1, and 1 month. Raw QT interval prolonged at 4 hr (417.1±41.6 ms, P<0.001) but shortened at day 1 (376.4±34.1 ms, P<0.001), 1 month (382.2±31.5 ms, P<0.001), and 3 months (385.1±32.8 ms, P<0.001) compared to baseline (391.6±31.4 ms). Bazett- and Fridericia- corrected QTc intervals significantly prolonged at 4hr (Bazett: 430.8±27.9 ms, P<0.001; Fridericia: 425.8±27.4 ms, P<0.001), day1 (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 414.1±23.7 ms, P<0.001), 1M (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 408.2±21.0 ms, P<0.05), and 3M (Bazett: 420.1±21.8 ms, P<0.001; Fridericia: 407.8±21.1 ms, P<0.05) compared to baseline (Bazett: 404.9±25.2 ms; Fridericia: 400.0±22.6 ms). On the other hand, Framingham- and Hodges- corrected QTc interval significantly prolonged only at 4hr (Framingham: 424.1±26.6 ms, P<0.001; Hodges: 426.8±28.4 ms, P<0.001) and at day1 (Framingham: 412.3±29.3 ms, P<0.01; Hodges: 410.6±40.2 ms, P<0.05) compared to baseline (Framingham: 399.2±22.7 ms; Hodges: 400.7±22.8 ms). At 4 hr after ablation, raw QT and QTc of all formulas significantly prolonged than baseline. Raw QT and QTc prolongation at 4hr after ablation were more frequently observed in female patients. Multiple regression analysis revealed that female patient is a significant predictor of raw QT and QTc interval prolongation of all formulas 4hr after PVI. Conclusions Raw QT and QTc prolonged after PVI, especially in the acute phase. Female patient is a risk factor for QT prolongation in the acute phase after PVI. Funding Acknowledgement Type of funding source: None

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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Cardiology Research and Practice ◽

10.1155/2016/8632509 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Paolo D. Dallaglio ◽

Timothy R. Betts ◽

Matthew Ginks ◽

Yaver Bashir ◽

Ignasi Anguera ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Waiting Time ◽

Critical Review ◽

Recurrence Rates ◽

The Impact ◽

Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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Recovery of left atrial function following pulmonary vein isolation using radiofrequency ablation in chronic atrial fibrillation: An intracardiac doppler echocardiographic study

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(03)81368-2 ◽

2003 ◽

Vol 41 (6) ◽

pp. 448-449 ◽

Cited By ~ 1

Author(s):

Erwan Donal ◽

Richard A. Grimm ◽

Hirotsugu Yamada ◽

Yong Jin Kim ◽

Nassir Marrouche ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Chronic Atrial Fibrillation ◽

Atrial Function ◽

Left Atrial Function ◽

Echocardiographic Study

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The impact of radiofrequency wide circumferential pulmonary vein isolation on left atrial geometry in patients with recurrent atrial fibrillation

10.22541/au.160386492.20351172/v1 ◽

2020 ◽

Author(s):

Konstantinos Iliodromitis ◽

Etelvino Silva ◽

Guy Van Camp ◽

Peter Geelen ◽

Asim Katbeh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Recurrent Atrial Fibrillation ◽

The Impact ◽

Circumferential Pulmonary Vein Isolation

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Changes of Left Atrial Function after Pulmonary Vein Isolation in Chronic Atrial Fibrillation

Journal of Arrhythmia ◽

10.4020/jhrs.27.pe3_048 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. PE3_048

Author(s):

Yoshihiro Seo ◽

Kentaro Yoshida ◽

Yukio Sekiguchi ◽

Tomoko Ishizu ◽

Hiroshi Tada ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Chronic Atrial Fibrillation ◽

Atrial Function ◽

Left Atrial Function

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The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0477 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Watanabe ◽

T Yamada ◽

S Tamaki ◽

M Yano ◽

T Hayashi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Independent Predictor ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

The Impact

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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