Sex differences and arrhythmia recurrence after catheter ablation for atrial fibrillation

Abstract Background Several previous studies reported female sex is associated with high recurrence rate of atrial tachyarrhythmia (ATA) after catheter ablation (CA) for atrial fibrillation (AF). Purpose We investigated the relationship between sex differences and recurrence rate of ATA after CA for AF in a large single-center database. Methods We enrolled consecutive 2033 patients undergoing first time CA for AF in our institution between Feb.2004 and Dec. 2017. We compared the long-term outcomes between female (N=603) and male (N=1430). Results Female patients were older (70.8 vs. 66.3, p<0.0001), and had lower prevalence of persistent AF (23.1% vs. 33.5%, p<0.0001). Also, left atrial dimension was smaller (40.0 vs. 41.1, p=0.0005). and prior antiarrhythmic drug use was more prevalent (38.2% vs. 28.7%, p<0.0001) in female patients. Ablation method for pulmonary vein isolation (PVI) was radiofrequency catheter ablation in 1634 patients (80.4%) and cryoballoon ablation in 399 (20.6%). Median follow-up duration was 1342±115 days. The 3-year ATA recurrence rate after first CA was 35.8% overall: 39.9% in female and 34.2% in male (Log-rank P=0.01). A multivariate analysis revealed that the factors associated with higher ATA recurrence rate were female (p=0.01), persistent AF (p=0.006), and larger left atrial dimension (p=0.007). Conclusions Female gender is an independent predictor of arrhythmia recurrence after CA for AF. Funding Acknowledgement Type of funding source: None

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Left Atrial Pressure as a Predictor of Success in Catheter Ablation of Atrial Fibrillation in a Real-Life Cohort

Journal of Clinical Medicine ◽

10.3390/jcm10153208 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3208

Author(s):

Massimiliano Manfrin ◽

Giacomo Mugnai ◽

Werner Rauhe ◽

Vedran Velagic ◽

Matthias Unterhuber

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

Real Life ◽

Female Gender ◽

Cryoballoon Ablation ◽

Clinical Role ◽

Cox Analysis ◽

Af Recurrence

Aims: The clinical role of the left atrial (LA) hypertension in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyze the role of LA pressure in patients with nonvalvular AF who underwent PV isolation and its implication for AF catheter ablation. Methods: Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were included in this analysis. Results: A total of 132 consecutive patients (97 males, 73%; mean age 58.0 ± 13.2 years) were included in the analysis. Eleven patients (8%) underwent radiofrequency ablation and 121 (92%) cryoballoon ablation. Higher LA pressures were found in 54 patients (40.9%). At a mean follow up of 14.3 ± 8.2 months (median 12 months), the success rate without antiarrhythmic therapy was 65.9% (87/132; considering the blanking period). Female gender and continuous mean LA pressure were significantly associated with AF recurrence and remained significant on multivariable Cox analysis (respectively, HR 1.845, 1.00–3.40, p = 0.05 and HR 1.066, 1.002–1.134, p = 0.04). We identified a LA mean pressure of >15 mmHg as ideal cutoff and constructed a model to predict AF recurrence which fitted with a concordance index (C-index) of 0.65 (95% CI 0.56–0.75), logrank score p = 0.003.

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Impact of radiofrequency catheter ablation of accessory pathways on the frequency of atrial fibrillation during long-term follow-up; High recurrence rate of atrial fibrillation in patients older than 50 years of age

European Heart Journal ◽

10.1053/euhj.2000.2429 ◽

2001 ◽

Vol 22 (5) ◽

pp. 423-427 ◽

Cited By ~ 51

Author(s):

N Dagres

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Recurrence Rate ◽

Radiofrequency Catheter Ablation ◽

High Recurrence Rate ◽

Accessory Pathways ◽

Long Term Follow Up

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GW29-e1705 Left Atrial Appendage Closure Combined With Catheter Ablation in Chinese Atrial Fibrillation Patients: Including Cryoballoon Ablation and Radiofrequency Ablation

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.687 ◽

2018 ◽

Vol 72 (16) ◽

pp. C149

Author(s):

Fangyi Xiao ◽

Xiaodong Zhou ◽

Weijian Huang

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Cryoballoon Ablation ◽

Left Atrial Appendage Closure

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Abutting left atrial appendage and left superior pulmonary vein predicts recurrence of atrial fibrillation after point-by-point pulmonary vein isolation

EP Europace ◽

10.1093/europace/euab116.188 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

N Szegedi ◽

J Simon ◽

B Szilveszter ◽

Z Sallo ◽

S Herczeg ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Left Atrial ◽

Left Atrial Appendage ◽

Female Gender ◽

Atrial Appendage ◽

Female Sex ◽

Superior Pulmonary Vein ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation is the cornerstone for rhythm control in patients with drug-refractory atrial fibrillation (AF). Baseline predictors of AF recurrence after catheter ablation are well established, such as female gender and left atrial enlargement. The role of the spatial relationship between the left superior pulmonary vein (LSPV) and left atrial appendage (LAA) is unknown. Purpose We sought to evaluate whether juxtaposed LSPV and LAA plays a role in AF recurrence after catheter ablation for paroxysmal AF. Methods Consecutive patients, who underwent point-by-point radiofrequency catheter ablation for paroxysmal AF at our hospital between January of 2014 and December of 2017, were enrolled in the study. All patients underwent pre-procedural cardiac CT-angiography (CTA) for the assessment of left atrial (LA) and pulmonary vein (PV) anatomy. Abutting LAA-LSPV was defined as cases when LSPV touched the posterior aspect of LAA (distance less than 2 mm). Results We included 428 patients (60.7 ± 10.8 years, 35.5% female). AF recurrence rate was 33.4% with a median recurrence-free time of 21.2 (IQR = 8.8-43.0) months. In the univariate analysis, female sex (HR = 1.45; 95%CI = 1.04-2.01; p = 0.028), LA volume (HR = 1.01; 95%CI = 1.00-1.01; p = 0.042), and cases when LSPV touched the posterior wall of LAA (HR = 1.53; 95%CI = 1.09-2.14; p = 0.013) were associated with AF recurrence. In the multivariate analysis, female sex (adjusted HR = 1.55; 95%CI = 1.06-2.28; p = 0.024), LA volume (adjusted HR = 1.01; 95%CI = 1.00-1.02; p = 0.028), and abutting LAA-LSPV (adjusted HR = 1.60; 95%CI = 1.13-2.50; p = 0.008) remained significant predictors of AF recurrence. Conclusion Female gender, higher LA volume, and abutting LSPV and LAA predispose patients to have a higher chance for arrhythmia recurrence after catheter ablation for paroxysmal AF.

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Abstract 17472: Association of Recurrence During Blanking Period With Poor Left Atrial Reverse Remodeling After Initial Catheter Ablation of Non-paroxysmal Atrial Fibrillation: Their Impact on the Clinical Outcome

Circulation ◽

10.1161/circ.132.suppl_3.17472 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Takafumi Oka ◽

Koichi Inoue ◽

Koji Tanaka ◽

Yuko Toyoshima ◽

Nobuaki Tanaka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Clinical Outcome ◽

Recurrence Rate ◽

Left Atrial ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Reverse Remodeling ◽

The Impact ◽

Atrial Reverse Remodeling

Background: Left atrial reverse remodeling (LARR) after catheter ablation (CA) to atrial fibrillation (AF) indicates reduction of AF substrates in left atrium (LA). In this study, we investigated the impact of LARR on the outcome after CA of non-paroxysmal AF (non-PAF; persistent AF and long-standing persistent AF) and determined the predictor of LARR. Methods and Results: Consecutive 303 patients who underwent initial CA of non-PAF in our institute were retrospectively analyzed. We performed multi-detector computed tomography (MDCT) to evaluate LA end-systolic volume (LAESV) before and 90 days after CA. We determined LARR using %LA reduction [defined as (pre LAESV - post LAESV) / pre LAESV x100]. The average %LA reduction was 20.2±16.8% (median 22.2%). Then we divided them into LARR group (%LA reduction >20%, N=167) and non-LARR group (%LA reduction<20%, N=136). We followed them for 630±153 days to observe their recurrence rate after 90 days blanking period (BP). The recurrence was less frequently observed in LARR group than non-LARR (31.1% vs 56.4%, p<0.01, log-rank test). Next, we examined the predictor of LARR. In univariate analysis, there were no significant differences in age, sex, CHADS2 score, AF duration before CA, anti-arrhythmic drug administration after CA, CA procedure, echocardiographic data and MDCT parameters. Only the recurrence rate during BP was significantly smaller in LARR than non-LARR (43% vs 61%, p=0.002). Then, we divided BP into three parts, early BP, mid BP and late BP (within 7 days, 8 to 30 days, and 31 to 90 days after CA, respectively). The recurrence rate in LARR group was lower than in non-LARR during early BP (27.5% vs 36.8%, p=0.09), mid BP (30.5% vs 42.6%, p=0.03), and late BP (9.0% vs 31.6%, p<0.01). In multivariable analysis, recurrence in late BP revealed to be the predictor of LARR (odds ratio 0.19, [95% confidence interval: 0.10-0.37]). Conclusions: The LARR was associated with better clinical outcome. The absence of recurrence during late BP (31-90 days after CA) was the strong predictor of LARR. These parameters can be acquired at the time point of 3 months after CA and they may be useful for predicting the CA results. Recurrence during late BP might be one of the causes of the poor LARR after CA for non-PAF.

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