Value of cardiac 123I-mIBG scintigraphy in prognosis of catheter ablation outcome in patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation Background. Previous studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. Thus, the goal of the present study was to estimate the utility of pre-procedural cardiac 123I-mIBG scintigraphy to identify patients at risk for AF recurrence after CA. Methods. 123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patients were followed for 12 months. A blanking period of 3 months was applied. The primary endpoint of the study was AF recurrence between 3 and 12 months after ablation. Results. Multivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53 %, specificity 81.3%, AUC 0,792 , p < 0.001) and WR > 25,11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0,712 , p < 0.001) indicate high probability of AF relapses during 12 months after CA. Kaplan-Meier analysis showed that the H/Mlate < 1.6, WR > 25,11 and LAD > 45 mm significantly increase the risk of AF recurrence after CA (p < 0.001, p < 0.001, p < 0.025 respectively). Conclusion. Pre CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients.

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Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation after Catheter Ablation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.009135 ◽

2021 ◽

Author(s):

Mohammed El Mahdiui ◽

Judit Simon ◽

Jeff M. Smit ◽

Jurrien H. Kuneman ◽

Alexander R. van Rosendael ◽

...

Keyword(s):

Atrial Fibrillation ◽

Adipose Tissue ◽

Catheter Ablation ◽

Left Atrial ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Imaging Biomarker ◽

Rank Test ◽

Increased Risk ◽

Af Recurrence

Background - Atrial fibrillation (AF) recurrence following catheter ablation remains high. Recent studies have shown a relation between epicardial adipose tissue (EAT) and AF. EAT secretes several pro- and anti-inflammatory adipokines that directly interact with the adjacent myocardium. The aim of the current study was to evaluate whether posterior left atrial (LA) adipose tissue attenuation, as marker of inflammation, is related to AF recurrences after catheter ablation. Methods - Consecutive patients with symptomatic AF referred for first AF catheter ablation who underwent CT were included. The total EAT and posterior LA adipose tissue were manually traced and adipose tissue was automatically recognized as tissue with Hounsfield units (HU) between -195 and -45. The attenuation value of the posterior LA adipose tissue was assessed and the population divided according to the mean HU value (-96.4 HU). Results - In total, 460 patients (66% male, age 61 ± 10 years) were included in the analysis. After a median follow-up of 18 months (IQR 6-32), 168 (37%) patients had AF recurrence. Patients with higher attenuation (≥-96.4 HU) of the posterior LA adipose tissue showed higher AF recurrence rates compared to patients with lower attenuation (<-96.4 HU) (log-rank test p=0.046). Univariate analysis showed an association between AF recurrence and higher posterior LA adipose tissue attenuation (≥-96.4 HU) (p<0.05). On multivariable analysis posterior LA adipose tissue attenuation (HR 1.26; 95% CI 0.90-1.76; p=0.181) remained a promising predictor of AF recurrence following catheter ablation. Conclusions - Posterior LA adipose tissue attenuation is a promising predictor of AF recurrence in patients who undergo catheter ablation. Higher adipose tissue attenuation might signal increased local inflammation and serve as an imaging biomarker of increased risk of AF recurrence.

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Prognosis of atrial fibrillation radiofrequency ablation: Iodine-123-MIBG cardiac innervation imaging

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.371 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

Y Varlamova ◽

K Zavadovsky ◽

I Kisteneva ◽

S Sazonova ◽

R Batalov

Keyword(s):

Atrial Fibrillation ◽

Prognostic Value ◽

Nervous Activity ◽

Washout Rate ◽

Mibg Scintigraphy ◽

Coronary Syndrome ◽

Sympathetic Nervous ◽

99Mtc Mibi ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation BACKGROUND To date, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is a valuable treatment option. So far there are no clear predictors of the effectiveness of AF ablation. Nowadays, the association of cardiac sympathetic nervous system and the development and maintenance of AF has been showed. The association between сardiac sympathetic system impairment, assessed by 123I-MIBG scintigraphy and RFCA effectiveness was shown previously. However, the is lack of data concerning to prognostic value of MIBG scintigraphy in patients with different forms of AF – persistent (PAF) and long-standing persistent (LSPAF). PURPOSE To study the prognostic significance of 123I-MIBG scintigraphy in RFCA efficacy in patients with persistent and long-standing persistent AF. METHODS The study enrolled 36 patients with drug-resistant AF (both persistent (n = 20) and long-standing persistent (n = 16) forms). All patients had comorbidity as chronic coronary syndrome and hypertension. A comparison group (n = 10) was also enrolled in the study. It includes patients with chronic coronary syndrome and arterial hypertension (without arrhythmia). All patients underwent 123I-MIBG and 99mTc-MIBI scintigraphy to evaluate the cardiac sympathetic activity and myocardial perfusion, respectively. Patients with AF performed RFCA. After of 1 year follow-up patients were examined for AF recurrence. The AF recurrence was considered to be an AF of at least 30 sec duration on a 12-lead ECG or on the Holter monitoring. RESULTS During the follow-up period, AF recurrences were reported in 7 (35%) PAF patients and in 8 (50%) LSPAF patients. According to multivariate analysis only a high pre-ablation washout rate of 123I-MIBG (WR) in PAF patients (OR: 1.668; 95% CI: 1.093–2.548) and large pre-ablation 123I-MIBG/99mTc-MIBI mismatch score in LSPAF patients (OR: 2.155; 95% CI: 1.192–3.897) were independent predictors of AF recurrence after RFCA. ROC analysis indicated that in PAF patients with higher WR ≥ 20.8% (AUC: 0.968; Sensitivity: 100 %; Specificity: 45%; p < 0.05) and LSPAF patients with larger 123I-MIBG/99mTc-MIBI mismatch score ≥ 12.5 % (AUC: 0.942; Sensitivity: 81 %; Specificity: 28 %; p < 0.05) had a higher risk of AF recurrence after RFCA. CONCLUSION In AF patients the incidence of arrhythmia recurrence after RFCA is associated with impaired cardiac sympathetic nervous activity. In PAF patients the values of 123I-MIBG washout rate can predict AF recurrence. In LSPAF patients innervation/perfusion mismatch has prognostic value in terms of AF recurrence.

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Abstract P172: Circulating Heat Shock Protein 70 and Antiheat Shock Protein 70 Antibodies in Atrial Fibrillation: Relation with Atrial Fibrillation Type and Response to Catheter Ablation

Circulation Research ◽

10.1161/res.109.suppl_1.ap172 ◽

2011 ◽

Vol 109 (suppl_1) ◽

Author(s):

Jelena Kornej ◽

Claudia Reinhardt ◽

Jedrzej Kosiuk ◽

Arash Arya ◽

Gerhard Hindricks ◽

...

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Catheter Ablation ◽

Heat Shock ◽

Heat Shock Protein ◽

Heat Shock Protein 70 ◽

Recurrence Rates ◽

Multivariable Regression Analysis ◽

Multivariable Regression ◽

Af Recurrence

Background: HSP and anti-HSP antibodies have been associated with AF development and progression. This study investigated the possible association between circulating heat shock protein 70 (HSP70) and anti-HSP70 antibodies as well their changes and rhythm outcome after atrial fibrillation (AF) catheter ablation. Methods: In 67 patients with AF (59±11 years, 66 % male, 66 % lone AF) undergoing catheter ablation, circulating HSP70 and anti-HSP70 antibodies levels were quantified before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. Results: At baseline, HSP70 was detectable in 14 patients (21 %), but there was no correlation between clinical or echocardiographic variables and the presence or the level of HSP70. Patients with paroxysmal AF (n=39) showed lower anti-HSP70 antibodies (median 43, IQR 28 - 62 µg/ml) than patients with persistent AF (n=28; 53, 41 - 85 µg/ml, p=.035). Using multivariable regression analysis, AF type was the only variable associated with anti-HSP70 antibodies (Beta=.342, p=.008). At 6 months, HSP70 was present in 27 patients (41 %, p<.001 vs. baseline) with an overall increase (median 0, IQR 0 - 0 vs. 0, 0 - 0.09 ng/ml, p=.029). Similarly, there was an increase of anti-HSP70 antibodies (48, 36 - 72 vs. 57, 43 - 87 µg/ml, p<.001). AF recurrence rates were higher in patients with HSP70 increase >0.025 ng/ml (32 vs. 11 %, p=.038) or anti-HSP70 antibodies increase >2.5 µg/ml (26 vs. 4 %, p=.033). Conclusion: HSP70 and anti-HSP70 antibodies may be involved in the progression of AF and AF recurrence after catheter ablation.

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238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES

Diseases of the Esophagus ◽

10.1093/dote/doab052.238 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Ismail Labgaa ◽

Styliani Mantziari ◽

Michael Winiker-Seeberger ◽

Jerôme Pasquier ◽

Marguerite Messier ◽

...

Keyword(s):

Predictive Value ◽

Independent Predictor ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Major Surgery ◽

Roc Curve Analysis ◽

Comprehensive Complication Index ◽

Major Complications ◽

Patients At Risk

Abstract The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy. Methods Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS). Results A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009). Conclusion Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.

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Cost-effectiveness of catheter ablation versus medical therapy for the treatment of atrial fibrillation in the United Kingdom

EP Europace ◽

10.1093/europace/euab116.531 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

L Leung ◽

RJ Imhoff ◽

D Frame ◽

PJ Mallow ◽

L Goldstein ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Cost Effectiveness ◽

Catheter Ablation ◽

Medical Therapy ◽

Rhythm Control ◽

Uk National Health Service ◽

The Uk ◽

The Cost ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This research study was funded by Biosense Webster, Inc. Dr Leung has received research support from Attune Medical (Chicago, IL) towards a research fellowship at St. George"s University of London. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Background Randomised data on patient-related outcomes comparing catheter ablation to medical therapy for the treatment of atrial fibrillation (AF) have shown the effectiveness of catheter ablation. Ablation versus medical therapy should also be analysed from a health economics perspective to achieve optimal healthcare resource allocation. Purpose To determine the cost effectiveness of catheter ablation compared to medical therapy for the treatment of atrial fibrillation, from the perspective of the UK National Health Service. Methods A patient-level Markov health-state transition model was used to conduct a cost utility analysis comparing catheter ablation and medical therapy for the treatment of AF. A systematic review and meta-analysis of catheter ablation treatment versus medical therapy (rhythm and/or rate control drugs) was conducted to enable comparison of AF recurrence between treatment groups utilising the model. Additional model parameters were established based upon a best-evidence review of the literature. The model simulated care delivered from a secondary care perspective. Total patients simulated in this model over a lifetime were 250,000, with patients entering the model at age 64. Only previously treated AF patients were included, including those with concomitant heart failure. A separate scenario analysis was conducted to determine the cost effectiveness specifically in the cohort of patients with AF and heart failure. Main outcomes measures Incremental cost-effectiveness ratio (ICER) and average total expected costs and quality-of-life years (QALYs) incurred over the lifetime of a patient. AF recurrence, complications and cardiovascular adverse events were compared over the total duration inside the model. Results In the base case analysis, catheter ablation resulted in a favourable ICER of £8,614 per additional QALY gained when compared to medical therapy, well below the national Willingness-to-Pay threshold of £20,000. Catheter ablation was associated with an expected increase of 1.01 QALYs, while adding an additional cost £8,742 over a patient’s lifetime. The cost-effectiveness of catheter ablation was improved in the heart failure sub-group analysis, with an ICER of £6,438. A significantly greater proportion of patients in the medical therapy group failed rhythm control at any stage compared to catheter ablation (72% vs 24%) and at a faster rate (median time to treatment failure: 3.8 vs 10 years). Conclusion Catheter ablation appears to be a highly cost-effective treatment for atrial fibrillation, compared to medical therapy, from the perspective of the UK National Health Service. With low rates of adverse events and superiority in achieving rhythm control, AF ablation services should be prioritised with appropriate allocation of healthcare resources.

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Abstract 15257: Epicardial and Peri-atrial Fat Attenuation Predict Recurrence in Patients Undergoing Repeat Catheter Ablation for Refractory Atrial Fibrillation

Circulation ◽

10.1161/circ.142.suppl_3.15257 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mark S Brahier ◽

Fengwei Zou ◽

Frank Migliarese ◽

Milos Tomovic ◽

Alexandra Taylor ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Adipose Tissue ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Volume ◽

Epicardial Fat ◽

Volume Index ◽

Atrial Volume ◽

Af Recurrence

Background: Identifying factors predictive of atrial fibrillation (AF) recurrence after catheter ablation (CA) can improve patient selection. It has been hypothesized that inflammatory paracrine signaling by metabolically active adipose tissue induces pathologic changes in surrounding cardiovascular tissue. In fact, fat attenuation on CT has been previously associated with AF recurrence after de novo CA. The purpose of this study was to investigate the predictive qualities of epicardial and peri-atrial adipose tissue in a population undergoing repeat CA. We hypothesized that higher epicardial and left peri-atrial fat attenuation would predict recurrence as markers of increased localized inflammation. Methods: The study population consisted of 84 patients with symptomatic, drug and ablation-refractory AF undergoing repeat CA. All patients had a pre-ablation, contrast-enhanced cardiac CT, which was analyzed for mean fat attenuation in Hounsfield units (HU) and left atrial volume using the post-processing program 3D Slicer. Patients were followed for recurrence of atrial tachyarrhythmias after a 3-month blanking period. We performed logistic regression to adjust for age, sex, BMI, hypertension, smoking history, diabetes, obstructive sleep apnea, and left atrial volume index. Results: Repeat CA patients with recurrence (n=52) had a higher epicardial fat attenuation (-84.8 ±5.6 vs -88.1 ±5.2 HU; p=0.009) and peri-atrial fat attenuation (-81.0 ±4.7 vs -83.2 ±4.3 HU; p=0.036) than those without recurrence (n=32) at a mean follow-up period of 26 ±18 months. Logistic regression analysis showed that epicardial fat attenuation (OR 1.21; p=0.005) and peri-atrial fat attenuation (OR 1.27; p=0.007) are predictive of AF recurrence independent of traditional risk factors. Conclusions: Epicardial and left peri-atrial adipose attenuation are predictive of recurrence in patients undergoing repeat CA for AF.

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Abstract 12368: Impact of Weight Trends on Long-term Outcomes After Atrial Fibrillation Ablation in Obese Patients

Circulation ◽

10.1161/circ.132.suppl_3.12368 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

T J Bunch ◽

Heidi T May ◽

Tami L Bair ◽

Victoria Jacobs ◽

Brian G Crandall ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Weight Loss ◽

Catheter Ablation ◽

Obese Patients ◽

Long Term Outcomes ◽

Sustained Weight Loss ◽

Index Weight ◽

Af Recurrence

Introduction: Catheter ablation of atrial fibrillation (AF) is an established therapeutic rhythm approach in symptomatic patients. Obesity is a dominant driver of AF recurrence after ablation. Weight reduction strategies lower general AF burden and as such may be critical to long-term success rates after ablation. Hypothesis: Long-term outcomes after AF ablation will be better in obese patients with sustained weight loss. Methods: All patients that underwent an index ablation with a BMI recorded and >30 kg/m 2 and at least 3 years of follow-up were included (n=407). The group was separated and compared by weight trends over the 3 years (1. Lost >3% of index weight, n=141; 2. Maintained index weight ±3%, n=147; 3. Gained >3% of index weight at 3 years, n=119). Long-term outcomes included AF recurrence and a composite defined as major adverse clinical events, MACE (stroke/TIA, heart failure (HF) hospitalization, and death). Results: The average age was 63.6±10.4 years, 59.3% were male and 51.7% had paroxysmal AF. AF comorbidities include: hypertension (79.5%), heart failure (36.0%), sleep apnea (35.2%), diabetes (28.9%), and stroke/TIA (5.9%). Those that maintained their weight (HR: 1.45, p=0.05) and those that gained weight (HR 1.54, p=0.07) were more likely to have AF recurrence compared to those that lost weight. Similarly, MACE increased from 18.4% in those that lost weight at 3 years compared to 18.6% (HR 1.32, p=0.29) in those that maintained their weight and 26.5% in those that gained weight (HR 2.01, p=0.02). A small group of patients (n=5), lost >3% then gained it back and ultimately increased their weight by 3%. This group had the highest rates of AF recurrence (100%). Conclusion: Maintained weight loss is a critical component in reducing AF recurrence rates after index catheter ablation in obese patients. Sustained weight loss also results in a reduction in AF-related comorbidities and mortality.

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Abstract 17775: Predictive Value of Endothelial Function for the Recurrence of Atrial Fibrillation After Catheter Ablation

Circulation ◽

10.1161/circ.132.suppl_3.17775 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Hisanori Kanazawa ◽

Hiroshige Yamabe ◽

Seigo Sugiyama ◽

Satomi Iwashita ◽

Tadashi Hoshiyama ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Endothelial Function ◽

Predictive Value ◽

Hazard Analysis ◽

Reactive Hyperemia ◽

Rank Test ◽

Peripheral Arterial Tonometry ◽

The Difference ◽

Af Recurrence

Introduction: Endothelial function has been shown to be deteriorated by the presence of atrial fibrillation (AF). Therefore, we hypothesized that serial change in the endothelial function can predict the recurrence of AF after catheter ablation (CA). Objectives: The purpose of this study was to examine the predictive value of endothelial function as a marker for recurrence of AF after CA. Methods: The consecutive 156 AF patients who underwent CA for AF were included in this study. All patients assessed their endothelial function by the reactive hyperemia-peripheral arterial tonometry (RH-PAT) and the RH-PAT index (RHI) was measured before CA, and 3 and 6 months after CA. To investigate the factors correlated with AF recurrence, clinical variables and RHI before CA, 3 and 6 months after CA were examined in patients with and without recurrence of AF. The recurrence of AF was defined as the occurrence of AF at the time of 6 months after CA. Results: AF recurrence was not observed in 125 patients (80%), but was observed in the remaining 31 patients (20%). Disease duration of AF (p=0.028), RHI before CA (p<0.001), RHI 3 month after CA (p=0.037), the difference in RHI before and 3 month after CA (p<0.001) were significantly correlated with AF recurrence. The multivariate Cox hazard analysis revealed that the difference in RHI before and 3 month after CA independently correlated with the recurrence of AF (p<0.001, Hazard ratio: 0.168). Furthermore, the value of RHI 3 month after CA, which decreased 0.015 or more compared with that before CA, was the independent predictor of AF recurrence (sensitivity: 0.613, specificity: 0.880, area under curve 0.722). Kaplan-Meier analysis demonstrated a significantly higher probability of AF recurrence when the RHI value 3 months after CA showed a decrease over 0.015 (log-rank test: p<0.001). Conclusions: The change in the endothelial function following CA sensitively reflects the recurrence of AF. The decrease in the RHI 3 months after CA compared to that before CA, with a cu-off value of 0.015, was an independent significant predictor of AF recurrence. Therefore, no recurrence of AF can be expected by the absence of decrease in RHI. We might be able to stop anti-arrhythmic drugs and anticoagulants according to the RHI improvement 3 month after CA.

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Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Circulation ◽

10.1161/circ.142.suppl_3.17296 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Nobuaki Tanaka ◽

KOICHI INOUE ◽

Atsushi Kobori ◽

Kazuaki Kaitani ◽

Takeshi Morimoto ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Large Scale ◽

Multicenter Observational Study ◽

History Of ◽

Group A ◽

Group B ◽

Af Recurrence

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p<0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p<0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p<0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

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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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