scholarly journals P862Relationship of atrial substrate between low-voltage areas and dominant frequencies after pulmonary vein isolation in non-paroxysmal atrial fibrillation

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii163-iii163
Author(s):  
K. Kumagai ◽  
K. Minami ◽  
Y. Sugai ◽  
K. Sasaki ◽  
K. Nakamura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Low Voltage ◽  
Dominant Frequencies

scholarly journals Additional Low‐Voltage‐Area Ablation in Patients With Paroxysmal Atrial Fibrillation: Results of the Randomized Controlled VOLCANO Trial

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Masaharu Masuda ◽  
Mitsutoshi Asai ◽  
Osamu Iida ◽  
Shin Okamoto ◽  
Takayuki Ishihara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Low Voltage ◽  
Strong Predictor ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Group B

Background The efficacy of low‐voltage‐area ( LVA ) ablation has not been well determined. This study aimed to investigate the efficacy of LVA ablation in addition to pulmonary vein isolation on rhythm outcomes in patients with paroxysmal atrial fibrillation ( AF ). Methods and Results VOLCANO (Catheter Ablation Targeting Low‐Voltage Areas After Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation Patients) trial included paroxysmal AF patients undergoing initial AF ablation. Of 398 patients in whom a left atrial voltage map was obtained after pulmonary vein isolation, 336 (85%) had no LVA (group A). The remaining 62 (15%) patients with LVA s were randomly allocated to undergo LVA ablation (group B, n=30) or not (group C, n=32) in a 1:1 fashion. Primary end point was 1‐year AF ‐recurrence‐free survival rate. No adverse events related to LVA ablation occurred. Procedural (124±40 versus 95±33 minutes, P =0.003) and fluoroscopic times (29±11 versus 24±8 minutes, P =0.034) were longer in group B than group C. Patients with LVA s demonstrated lower AF ‐recurrence‐free survival rates (88%) than those without LVA (B, 57%, P <0.0001; C, 53%, P <0.0001). However, LVA ablation in addition to pulmonary vein isolation did not impact AF ‐recurrence‐free survival rate (group B versus C, P =0.67). Conclusions The presence of LVA was a strong predictor of AF recurrence after pulmonary vein isolation in patients with paroxysmal AF . However, LVA ablation had no beneficial impact on 1‐year rhythm outcomes. Registration URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000023403.

scholarly journals Prevalence and Predictors of Additional Ablation Beyond Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Xin Xie ◽  
Gang Yang ◽  
Xiaorong Li ◽  
Jinbo Yu ◽  
Fengxiang Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Low Voltage ◽  
Electrophysiological Study ◽  
Atrial Arrhythmias ◽  
Limited Data ◽  
Index Procedure ◽  
Single Procedure

Background: Pulmonary vein isolation (PVI) is an effective strategy in the treatment of paroxysmal atrial fibrillation (PAF). Yet, there are limited data on additional ablation beyond PVI. In this study, we sought to assess the prevalence, predictors, and outcomes of additional ablation in PAF patients.Methods: A total of 537 consecutive patients with PAF were retrospectively evaluated for the index procedure. PVI was successfully conducted in all patients, after which electrophysiological study and drug provocation were performed, and additional ablations were delivered for concomitant arrhythmias, non-PV triggers, and low voltage zone (LVZ). The prevalence, predictors, and outcomes of additional ablation were analyzed.Results: Among 537 consecutive patients, 372 addition ablations were performed in 241 (44.88%) patients, including 252 (67.74%) concomitant arrhythmias in 198 (36.87%) patients, 56 (15.05%) non-PV triggers in 52 (9.68%) patients and 64 (17.20%) LVZ modification in 47 (8.75%) patients. Lower LVEF (OR = 0.937, p = 0.015), AF episode before procedure (OR = 2.990, p = 0.001), AF episode during procedure (OR = 1.998, p = 0.002) and AF episode induced after PVI (OR = 15.958, p &lt; 0.001) were independent predictors of additional ablation. Single-procedure free from atrial arrhythmias at 58.36 ± 7.12 months post-ablation was 70.48%.Conclusions: Additional ablations were common in patients with PAF for index procedure. Lower LVEF and AF episodes before, during the procedure, and induced after PVI predicts additional ablation.

Changes of QT interval in the acute phase after pulmonary vein isolation for paroxysmal atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Chikata ◽  
T Kato ◽  
K Ududa ◽  
S Fujita ◽  
K Otowa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Female Patient ◽  
Pulmonary Vein Isolation ◽  
Acute Phase ◽  
Paroxysmal Atrial Fibrillation ◽  
Qt Interval ◽  
Qt Prolongation ◽  
Qtc Interval ◽  
The Impact

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&lt;0.001) but shortened at day 1 (376.4±34.1 ms, P&lt;0.001), 1 month (382.2±31.5 ms, P&lt;0.001), and 3 months (385.1±32.8 ms, P&lt;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&lt;0.001; Fridericia: 425.8±27.4 ms, P&lt;0.001), day1 (Bazett: 434.8±22.3 ms, P&lt;0.001; Fridericia: 414.1±23.7 ms, P&lt;0.001), 1M (Bazett: 434.8±22.3 ms, P&lt;0.001; Fridericia: 408.2±21.0 ms, P&lt;0.05), and 3M (Bazett: 420.1±21.8 ms, P&lt;0.001; Fridericia: 407.8±21.1 ms, P&lt;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&lt;0.001; Hodges: 426.8±28.4 ms, P&lt;0.001) and at day1 (Framingham: 412.3±29.3 ms, P&lt;0.01; Hodges: 410.6±40.2 ms, P&lt;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

Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation

EP Europace ◽  
2020 ◽  
Author(s):  
Michelle Lycke ◽  
Maria Kyriakopoulou ◽  
Milad El Haddad ◽  
Jean-Yves Wielandts ◽  
Gabriela Hilfiker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Prospective Trial ◽  
High Rate ◽  
Binary Logistic Regression Analysis ◽  
Ablation Time ◽  
Increased Risk ◽  
Af Recurrence

Abstract Aims Catheter ablation of paroxysmal atrial fibrillation (AF) reduces AF recurrence, AF burden, and improves quality of life. Data on clinical and procedural predictors of arrhythmia recurrence are scarce and are flawed by the high rate of pulmonary vein reconnection evidenced during repeat procedures after pulmonary vein isolation (PVI). In this study, we identified clinical and procedural predictors for AF recurrence 1 year after CLOSE-guided PVI, as this strategy has been associated with an increased PVI durability. Methods and results Patients with paroxysmal AF, who received CLOSE-guided PVI and who participated in a prospective trial in our centre, were included in this study. Uni- and multivariate models were plotted to find clinical and procedural predictors for AF recurrence within 1 year. Three hundred twenty-five patients with a mean age of 63 years (CHA2DS2VASc 1 [1–3], left atrium diameter 41 ± 6 mm) were included. About 60.9% were male individuals. After 1 year, AF recurrence occurred in 10.5% of patients. In a binary logistic regression analysis, the diagnosis-to-ablation time (DAT) was found to be the strongest predictor of AF recurrence (P = 0.011). Diagnosis-to-ablation time ≥1 year was associated with a nearly two-fold increased risk for developing AF recurrence. Conclusion The DAT is the most important predictor of arrhythmia recurrence in low-risk patients treated with durable pulmonary vein isolation for paroxysmal AF. Whether reducing the DAT could improve long-term outcomes should be investigated in another trial.

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