Late procedural success after ablation of atrial fibrillation correlates with BMI and adipokine-profiles

2014 ◽  
Vol 62 (S 01) ◽  
Author(s):  
B. Niemann ◽  
E. Dominik ◽  
I. Schweizer ◽  
P. Roth ◽  
C. Orhan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Procedural Success

Abstract 2753: The Relationship Between Pulmonary Vein Antrum Scarring Following Atrial Fibrillation Ablation and Procedural Success: Does Pulmonary Vein Isolation Matter?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Troy J Badger ◽  
Robert S Oakes ◽  
Akram Shabaan ◽  
Nazem W Akoum ◽  
Nathan M Segerson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Procedural Success ◽  
The Relationship ◽  
Af Recurrence

Background. A mechanism of atrial fibrillation (AF) recurrence following ablation may be incomplete pulmonary vein antrum (PVA) scarring that allows for conduction between the pulmonary veins (PV) and the left atrium (LA). We report the relationship between circumferential PV scarring detected by delayed enhancement MRI (DE-MRI) and AF recurrence following PVAI. Methods. Eighty-six patients presenting for PVAI underwent DE-MRI 3 months post ablation. Circumferential ablation with posterior wall debulking was performed in all patients. PV ostia were marked on 3D images generated from the MRI data and assessed by consensus of two independent reviewers for the extent of scarring. Complete PVA scarring was defined as a continuous ring of enhancement surrounding the PVA. For patients with incomplete scarring, the degree of scarring was estimated. Results. The figure shows two patients from the cohort, Patient 1 exhibits successful scarring of all PVA. Patient 2 shows scarring of 1 PVA. At three months post ablation, complete circumferential lesion was seen on 131/335 PVA (39.1%). Complete scarring of 4 PVA was seen in 9 patients (10.5%), scarring of 3 PVA in 11 patients (12.8%) and scarring of 2 PVA was seen in 17 patients (19.8). Twenty-nine patients (33.7%) exhibited complete scarring in 1 PVA while 20 patients (23.3%) exhibited scarring in 0 PVA. Kaplan Meier analysis (Figure [E] ), suggests that PVA isolation may be important for long-term procedural success. Conclusion: Complete pulmonary vein antrum scarring exists in a very limited number of patients, despite its apparent importance for long-term procedural success.

scholarly journals Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Karim ◽  
N Kozhuharov ◽  
J Jarman ◽  
S Furniss ◽  
R Veasey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
De Novo ◽  
Lv Function ◽  
P Value ◽  
Complication Rates ◽  
Success Rates ◽  
Af Ablation ◽  
Funding Sources ◽  
Procedural Success

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Sven Knecht and the International Octogenarian AF ablation group Background Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group. Purpose Investigation of complications & outcomes in octogenarians undergoing CA for AF. Methods Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged <80 years.  The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure. Results 216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged <80 years (62.4 ± 9.5 years, 34.7% females), p <0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively.  17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively. Conclusion In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged < 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) < 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) < 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 < 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073

Abstract 5664: Left Atrial Strain In Patients With Atrial Fibrillation: Relationship To Fibrosis By Delayed Enhancement-MRI

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Suman S Kuppahally ◽  
Robert S Oakes ◽  
Eric N Fish ◽  
Eugene Kholmovski ◽  
Sathya Vijayakumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Strain Rate ◽  
Left Atrial ◽  
Delayed Enhancement ◽  
Left Atrial Strain ◽  
Chamber View ◽  
Strain And Strain Rate ◽  
Procedural Success ◽  
Atrial Strain

Introduction: The extent of left atrial (LA) wall fibrosis detected by delayed enhancement (DE)-cardiac MRI prior to catheter ablation of atrial fibrillation (AF) appears to predict procedural success. However, it is currently unknown how the degree of fibrosis affects atrial mechanical function. Methods: Prior to catheter ablation of AF, 31 patients underwent DE-CMRI and 2-dimensional transthoracic echocardiography. 3D segmentation of LA was performed and the degree of fibrosis was determined using a semi-automated quantification algorithm. Longitudinal mid-septal and mid-lateral LA wall velocity, strain and strain rate were measured during ventricular systole from the apical 4-chamber view by velocity vector imaging. Results : There was greater percent of fibrosis as LA maximum (R = 0.4, p = 0.05) and minimum (R=0.52, p = 0.008) volumes increased. Figure shows examples of DE-CMRI and strain curves (C) for two patients: Patient 1(A) with mild fibrosis and patient 2 (B) with extensive fibrosis. Patient 1 shows much larger strain than patient 2. Larger LA volumes correlated inversely with maximal LA mid-lateral systolic wall strain (p < 0.005). The percent fibrosis also correlated inversely with maximal LA mid-lateral systolic wall strain (R=0.56, p < 0.005) and the systolic strain rate (R = 0.58, p = 0.002). Conclusion: LA strain and strain rate can be assessed using standard echocardiographic gray scale images. LA strain is related to both atrial volumes and fibrosis, which are markers of atrial disease progression. This relationship may represent changes in the properties of LA substrate. These novel imaging approaches may be helpful in predicting outcomes in patients with AF.

P2834Diagnostic yield of holter recording after atrial fibrillation ablation - detection of asymptomatic recurrences during a one-year follow-up period

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S P G Van Vugt ◽  
R H J A Volleberg ◽  
S W Westra ◽  
J Thannhauser ◽  
R Evertz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Diagnostic Yield ◽  
Holter Monitoring ◽  
Implantable Devices ◽  
Cryoballoon Ablation ◽  
Procedural Success ◽  
One Year ◽  
The One

Abstract Background Strategies to detect recurrences after atrial fibrillation (AF) catheter ablation vary widely. Whereas a symptom-based approach may overestimate procedural success due to asymptomatic recurrences, continuous invasive monitoring with implantable devices may be refused by patients and is not routinely recommended. In trial settings, Holter monitoring is recommended at one year after ablation, though more frequent and intensive follow-up is encouraged for more accurate detection of arrhythmia recurrences. Purpose To study the diagnostic yield of Holter monitoring in the detection of asymptomatic recurrent arrhythmias after cryoballoon catheter ablation for AF. Methods Prospective registry on AF patients who underwent cryoballoon ablation with subsequent follow-up in our centre. Follow-up comprised routine (i.e. at 3, 6, and 12 months) and symptom-driven electrocardiographic (ECG) registrations after a three-month blanking period. In addition, patients were scheduled for six-day Holter monitoring shortly after the blanking period, at six months and at the end of the one-year follow-up period. For the current analysis, we studied the Holter recordings of the patients without previously detected arrhythmia recurrence and determined the proportion of asymptomatic recurrences at each respective monitoring period. Results We studied 364 patients with a median age of 60 years (IQR 54–66) and a median CHA2DS2-VASc score of 1 (IQR 1–2). One-year recurrences were documented in 119 (32.7%) patients, of which 90 were initially detected on Holter recording and 39 on ECG registrations (Table). A total of 34 patients did not report symptoms during the documentation of recurrent arrhythmia and comprised 28.6% (34/119) of all recurrences and 37.8% (34/90) of the Holter-detected recurrences. At the three-month Holter registration, 33.3% of the patients with recurrences did not report symptoms, which was 29.4% and 62.5% at the six- and twelve-month registrations, respectively (Figure). Timing and detection of recurrences Time after ablation 3 months 3–6 months 6 months 6–12 months 12 months Patients with Holter-detected recurrences 57/119 (47.9%) 17/119 (14.3%) 16/119 (13.4%) Patients with ECG-documented recurrences 18/119 (15.1%) 11/119 (9.2%) Proportions of asymptomatic recurrences Conclusions In this cohort of AF patients with serial six-day Holter monitoring after cryoballoon ablation, up to one-third of the patients had asymptomatic recurrences. Whereas Holter monitoring shortly after the blanking period detected nearly half of all one-year recurrences, the proportion of asymptomatic detected recurrences was higher in recordings at one year and seems therefore important in the detection of asymptomatic recurrences after catheter ablation.

scholarly journals Surgical Treatment of Concomitant Atrial Fibrillation: Focus onto Atrial Contractility

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Claudia Galli ◽  
Moreno Naliato ◽  
Fabrizio Veglia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Right Atrial ◽  
Lv Function ◽  
Factors Associated ◽  
Procedural Success ◽  
Cox Analysis

Background. Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation.Methods. 122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied.Results. At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes.Conclusions. SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia “chronic state” (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and “kick” restoring and an influence of RA contraction onto LV function.

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