Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?

Abstract OBJECTIVES Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7 years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7 years. METHODS Fifty consecutive patients {mean age 55 [standard deviation (SD): 11.2] years, previous catheter ablation in 56%, left ventricular ejection fraction 60% (SD: 4.6), left atrium volume 65 ml (SD: 17)} with stand-alone symptomatic paroxysmal AF underwent PVI through bilateral thoracoscopy ablation between 2005 and 2014. The CHA2DS2-VASc score was ≥2 in 12 patients (24%). RESULTS No hospital deaths occurred. At hospital discharge all patients but 1 (2%) were in sinus rhythm (SR). Follow-up was 100% complete [mean 8.4 years (SD: 2.3), max 15]. The 8-year cumulative incidence function of AF recurrence, with death as a competing risk, on or off class I/III antiarrhythmic drugs (AADs)/electrocardioversion/re-transcatheter ablation (TCA) was 20% (SD: 5; 95% confidence interval: 10, 32); and off class I/III AADs/electrocardioversion/re-TCA was 52% (SD: 7; 95% confidence interval: 0.83, 8.02). At 8 years, the predicted prevalence of patients in SR was 87% and 53% were off class I/III AADs/electrocardioversion/re-TCA. The recurrent arrhythmia was AF in all patients except 2, who had atypical atrial flutter (4%). No predictors of AF recurrence were identified. At the last follow-up, 76% of the patients showed European Heart Rhythm Association class I. No strokes or thromboembolic events were documented and 76% of the subjects were off anticoagulation therapy. CONCLUSIONS Despite a considerable AF recurrence rate, our single-centre, long-term outcome of surgical PVI showed encouraging data, with the majority of patients remaining in SR, although many of them were on antiarrhythmic therapy.

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Surgical Ablation of Permanent Atrial Fibrillation: Age, LV Dilatation, Obesity

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1731772 ◽

2021 ◽

Author(s):

Susanne Rohrbach ◽

Elisabeth Dominik ◽

Nikolas Mirow ◽

Sebastian Vogt ◽

Andreas Böning ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Reverse Remodeling ◽

Loop Recorder ◽

Surgical Ablation ◽

Ventricular Ejection Fraction ◽

Permanent Atrial Fibrillation ◽

Af Recurrence

Abstract Objectives Although concomitant surgical ablation can help to reach freedom from atrial fibrillation (FREEAF) even in patients with permanent atrial fibrillation (AF), some cardiac surgeons hesitate to perform concomitant ablation to avoid perioperative risk escalation. Here, we investigated outcome and predicators of therapeutic success of concomitant surgical ablation in an all-comers study. Methods Ablation-naïve patients with formerly accepted permanent AF (FAP, n = 41) or paroxysmal AF (parAF, n = 24) underwent concomitant epicardial bipolar radio frequency ablation and implantable loop recorder (ILR) at two surgical departments. Follow-up examination for 24 months included electrocardiogram, ILR readout, 24h Holter monitoring, echocardiography, and blood sampling. Results Eighty-six percent of parAF and 70% of FAP patients reached FREEAF (month 24). Mortality was low (parAF/FAP: 5.3 ± 0.2%/4.1 ± 0.3%; p < 0.05; EuroScoreII; 6.1 ± 0.7%/6.4 ± 0.4%, p = ns) and no strokes occurred. FREEAF induced atrial reverse remodeling (left atrial [LA] diameter: −6.7 ± 2.2 mm) and improved cardiac function (left ventricular ejection fraction [LVEF]: +7.3 ± 2.8%), while AF resulted in further atrial dilation (+8.0 ± 1.0 mm, p < 0.05) and LVEF reduction (−7.0 ± 1.3%, p < 0.05). Higher LV (odds ratio [OR]: 1.164) and LA diameter (OR: 1.218), age (OR: 1.180) and body mass index (BMI) (OR: 1.503) increased the risk factors of AF recurrence. Patients remaining in sinus rhythm (SR) demonstrated a decrease in BMI, while AF recurrence was associated with stable overweight. Further aging did not reduce FREEAF. Conclusions Long-term SR is achievable by concomitant surgical ablation even in FAP patients. Therefore, it should be offered routinely. Obesity influences therapeutic long-term success but may also offer addressable therapeutic targets to reach higher FREEAF rates.

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Stereotactic arrhythmia radioablation for refractory scar-related ventricular tachycardia

10.1101/19012880 ◽

2019 ◽

Cited By ~ 1

Author(s):

Carola Gianni ◽

Douglas Rivera ◽

J David Burkhardt ◽

Brad Pollard ◽

Edward Gardner ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Ventricular Arrhythmia ◽

Stereotactic Radiosurgery ◽

Left Ventricular ◽

The Body ◽

Long Term Results ◽

Radiotherapy Planning ◽

Left Ventricular Ejection

AbstractBackgroundStereotactic radiosurgery is a form of radiotherapy that is performed in a single session and focuses high-dose ionizing radiation beams from a collimated radiation source to a small, localized area of the body. Recently, stereotactic radiosurgery has been applied to arrhythmias (stereotactic arrhythmia radioablation - STAR), with promising results reported in patients with refractory, scar-related ventricular tachycardia (VT), a cohort with known high morbidity and mortality.ObjectiveHerein, we describe our experience with the use of CyberKnife, a frameless image-guided linear accelerator stereotactic radiosurgery system, in conjunction with CardioPlan, a cardiac specific radiotherapy planning software, to treat patients with scar-related VT, detailing its early and mid-to long-term results.MethodsThis is a pilot, prospective study of patients undergoing STAR for refractory VT. The anatomical target for radioablation was defined based on the clinical VT morphology, electroanatomical mapping, and study-specific pre-procedural imaging with cardiac computed tomography. The target volume delineated with the aid of CardioPlan was treated with a prescription radiation dose of 25 Gy delivered in a single fraction by CyberKnife in an outpatient setting. Ventricular arrhythmias and radiation-related adverse events were monitored at follow-up to determine STAR efficacy and safety.ResultsFive patients (100 % male, 63 ± 12 years old, 80 % ischemic cardiomyopathy, left ventricular ejection fraction 34 ± 15 %) with refractory VT underwent STAR between January and June 2018. Radioablation was delivered in 82 ± 11 minutes without acute complications. During a mean follow-up of 12 ± 2 months, all patients experienced clinically significant mid-to late-term ventricular arrhythmia recurrence; two patients died of complications associated with their advanced heart failure. There were no clinical or imaging evidence of radiation necrosis or other radiation-induced complications in the organs at risk surrounding the scar targeted by radioablation.ConclusionDespite good initial results, STAR did not result in effective ventricular arrhythmia control in the long term in a selected, high-risk population of patients with scar-related VT. The safety profile was confirmed to be favorable, with no radiation-related complications observed during follow-up. Further studies are needed to explain these disappointing results.

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Abstract 2991: Percutaneous Vs Surgical Revascularization For Multi-vessel Coronary Artery Disease: A Single Center 10 Year Follow-up Of Sos Trial Patients.

Circulation ◽

10.1161/circ.116.suppl_16.ii_669 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Pawel E Buszman ◽

Szymon Wiernek ◽

Radoslaw Szymanski ◽

Bozena Bialkowska ◽

Piotr P Buszman ◽

...

Keyword(s):

Systolic Function ◽

Myocardial Revascularization ◽

Left Ventricular ◽

Wilcoxon Test ◽

Long Term Results ◽

Left Ventricular Ejection ◽

Term Survival ◽

Ventricular Ejection Fraction

Aim: The aim of the study was to evaluate PCI and CABG long-term results in patients with multivessel disease during 8–10 years observation based on the CCS scale, vital status and left ventricular ejection fraction (LVEF). Materials and methods: The analysis involved 100 patients, who were randomized to SOS study (PCI-49; CABG-51) in 1997–2000 in the Silesian Heart Center, Katowice, Poland. There was no difference between both groups according to the basic demographic and angiographic data. The average time of observation was 8,4 ± 0,85 years. Echocardiography was performed four times in each patient: before and after the procedure, 3–4 years later and last time 8–10 years after the procedure. Stenocardia was assessed in accordance with the CCS classification. Results: During nearly 10 years follow-up there was 9 deaths in the PCI group (18%, 4 cardiac -8%) and 8 deaths in the CABG group (16%, 4 cardiac, 8%) (F-Cox-test: p=ns for all cause mortality and cardiac death). LVEF and intensification of stenocardia estimated based on CCS classification were not statistically different between both groups at the end of observation. However, in PCI group LVEF increased significantly (p=0,03), while in CABG group it was unchanged. In both groups improvement of symptoms after revascularization was maintained during the follow-up (Wilcoxon test: p<0.001) but it was achieved with repeat revascularization, which was more frequent in PCI group (30 vs 6%, p=0.003). Conclusions: Long-term results demonstrate that both methods of the myocardial revascularization are equal in terms of long-term survival, release of angina and preservation of left ventricular systolic function.

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P3691Intra-aortic balloon counterpulsation in takotsubo syndrome complicated by cardiogenic shock: short- and long-term results from a cohort of 2250 patients of the German-Italian-Spanish registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.0545 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F Santoro ◽

I.-J Nunez-Gil ◽

T Stiermaier ◽

I El-Battrawy ◽

F Guerra ◽

...

Keyword(s):

Cardiogenic Shock ◽

Left Ventricular ◽

Long Term Results ◽

Left Ventricular Ejection ◽

Takotsubo Syndrome ◽

Ventricular Ejection Fraction ◽

Long Term Follow Up ◽

Short And Long Term

Abstract Background Takotsubo syndrome (TTS) is featured by an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock. Intra-aortic balloon pumping (IABP) use in this setting is controversial, and few data are available from large populations. Aim of this study was therefore to evaluate short- and long-term impact of IABP on mortality in TTS complicated by cardiogenic shock. Methods The GEIST registry is a multicenter, international registry on TTS involving 38 centers from Germany, Italy and Spain. Between 2006 and 2017, 2250 consecutive patients with TTS were enrolled. Results Of the 2250 patients, 211 (9%) experienced cardiogenic shock during hospitalization for TTS. Admission left ventricular ejection fraction (LVEF) was 30±15% and systolic blood pressure was 90±35 mmHg. Apical ballooning pattern was found in 77%, mid-ventricular/basal pattern in 11%, and 2% of the patients, respectively. Forty-two patients out of 211 (19%) received IABP after coronary angiography. Patients receiving IABP compared to standard medical therapy did not differ in terms of age, gender, cardiovascular risk factors and admission LVEF. No differences were found in term of in-hospital mortality (9.5% vs 17% p=0.35), length of hospitalization (19.3 vs 16.3 days p=0.34), need of invasive ventilation (35% vs 41% p=0.60), stroke (4.7% vs 11% p=0.17) and LV thrombus (0.5% vs 1.7%, p=0.98). At long-term follow-up, with a median of 2 years, overall mortality in patients with cardiogenic shock and TTS was 34.1%. Mortality was not different between the IABP and the control group (33.7% vs 35.0%; p=0.85). Conclusions In this large multicenter observational registry, the use of IABP has no impact on mortality at short and long-term follow-up. Further studies are needed to evaluate the best therapeutic strategy in TTS complicated by cardiogenic shock.

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Loop neochord versus leaflet resection techniques for minimally invasive mitral valve repair: long-term results

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa255 ◽

2020 ◽

Vol 59 (1) ◽

pp. 180-186

Author(s):

Bettina Pfannmueller ◽

Martin Misfeld ◽

Alexander Verevkin ◽

Jens Garbade ◽

David M Holzhey ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Left Ventricular ◽

Long Term Results ◽

Left Ventricular Ejection ◽

Loop Technique ◽

Chordal Replacement

Abstract OBJECTIVES Non-leaflet resection techniques including loop chordal replacement are being used with increasing frequency, but the long-term results of these techniques are still unknown. The aim of this study was to compare the long-term results of loop neochord replacement with leaflet resection techniques in patients undergoing minimally invasive mitral valve (MV) repair for MV prolapse. METHODS Between 1999 and 2014, 2134 consecutive MV prolapse patients underwent minimally invasive MV repair with isolated loop (n = 1751; 82.1%) or resection techniques (n = 383, 17.9%) at our institution. Follow-up data were available for 86% of patients with a mean follow-up time of 6.1 ± 4.3 years. RESULTS The 30-day mortality was 0.8% for all patients (loop: 0.7%, resection: 1.6%; P = 0.09). Leaflet resection was associated with more moderate or more mitral regurgitation on predischarge echocardiography (P = 0.003). The 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003). Significant predictors for late mortality were MV repair technique (P = 0.004), left ventricular ejection fraction (P < 0.001), age (P < 0.001) and myocardial infarction (P < 0.001). Freedom from MV reoperation at 1, 5 and 10 years was 98 ± 1%, 97 ± 1%, 97 ± 1% and 97 ± 1%, 97 ± 1%, 96 ± 1% for patients operated on with the loop technique and leaflet resection (P = 0.4). CONCLUSIONS In our patient cohort, MV repair with loop chordal replacement is associated with less early recurrent mitral regurgitation and very good long-term results when compared to classical leaflet resection techniques for MV prolapse and is therefore an excellent option for such patients.

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56-06: Long-Term Results of Catheter Ablation for Paroxysmal Atrial Fibrillation in Very Young Adults – A 5-Year Follow-Up Study

EP Europace ◽

10.1093/europace/18.suppl_1.i33a ◽

2016 ◽

Vol 18 (suppl_1) ◽

pp. i33-i33 ◽

Cited By ~ 1

Author(s):

Ardan Saguner ◽

Tilman Maurer ◽

Christine Lemes ◽

Francesco Santoro ◽

Erik Wissner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Young Adults ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Long Term Results ◽

Follow Up Study

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Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA)

10.22541/au.162525134.49788108/v1 ◽

2021 ◽

Author(s):

Ermengol Valles ◽

Jesus Jimenez ◽

Julio Martí-Almor ◽

Jorge Toquero ◽

Jose Ormaetxe ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Structural Heart Disease ◽

Persistent Atrial Fibrillation ◽

Long Term Results ◽

Cryoballoon Ablation ◽

Arterial Line ◽

Post Market

Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8±10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs 11.4%; p<0.001) and left atrium dilation (72.6 vs 43.3%; p<0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs 22.2%; p<0.001), with an arterial line (32.2 vs 44.6%; p<0.001) and assisted transeptal puncture (11.9 vs 17.9%; p=0.025). During an application, PeAF patients had a longer time to -30°C (35.91±14.20 vs 34.93±12.87 sec; p=0.021) and a colder balloon nadir temperature during vein isolation (-35.04±9.58 vs -33.61±10.32ºC; p=0.004), but received fewer bonus freeze applications (30.7 vs 41.1%; p<0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p=0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.

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99 New onset atrial fibrillation in STEMI patients: main prognostic factors and clinical outcome

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Beatrice Dal Zotto ◽

Lucia Barbieri ◽

Gabriele Tumminello ◽

Massimo Saviano ◽

Domitilla Gentile ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Mortality ◽

Independent Predictor ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Short And Long Term ◽

Long Term Mortality ◽

New Onset

Abstract The treatment of patients with known atrial fibrillation (AF) undergoing percutaneous coronary intervention has clear indications in the actual guidelines. Remarkable lack of evidence regarding new-onset AF (NOAF) in particular during STEMI is the reason for this study. We retrospectively analysed 1455 consecutive STEMI patients. The primary outcomes are in-hospital, 1-year and long-term follow-up mortality. Cerebral ischaemic events and major bleedings were considered clinical endpoints at 1 year. NOAF was detected in 102 subjects, 62.7% males, mean age 74.8 ± 10.6 years. Mean left ventricular ejection fraction (LVEF) was 43.5 ± 12.1% and left atrial enlargement (58 ± 20.9 ml) was observed. Anterior STEMI accounted for the majority (46%). NOAF has been predominantly recorded in the acute phase (mean duration of 8.1 ± 12.5 h). CHA2DS2-VASc score >2 was recorded in 83% of cases, while HAS-BLED score of 2 or 3 was the most represented. All patients acutely received enoxaparin, but only 21.6% were discharged on oral anticoagulation (OAC). In-hospital mortality was 14.2%, while 1-year and long-term mortality were 17.2% and 32.1%, respectively. We identified age as an independent predictor of short- and long-term mortality, while LVEF was the only other independent predictor for in-hospital mortality and arrhythmia duration for 1-year mortality. After 1-year of follow-up we recorded three ischaemic events and no major bleeding. In conclusion, STEMI patients who present NOAF are a very high-risk population with increased short- and long-term mortality. Our data suggest that the indication for OAC should be always driven by CHA2DS2-VASC and HAS-BLEED score, even in patients with a single episode indeed. 99 Figure 1Kaplan-Meier curve representing the long-term survival of the entire population from hospital admission up to the maximum follow-up time was performed

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Early assessment of left atrial function after cardioversion predicts recurrence of atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.173 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Kupczynska ◽

BW Michalski ◽

E Trzos ◽

D Miskowiec ◽

L Szyda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Early Assessment ◽

Ventricular Ejection Fraction ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background The restoration of sinus rhythm (SR) improves the mechanical function of the heart. Purpose To assess left atrial (LA) function before and within 24 hours after successful electrical cardioversion (EC) and its prognostic value for atrial fibrillation (AF) recurrence during 24 months follow-up. Methods Prospective study involved 71 patients with non-valvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echocardiography before and after EC. We analysed standard parameters in two-dimensional echo, pulse-wave Doppler and tissue Doppler echocardiography. Using speckle-tracking method we assessed peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). Results During follow-up we noticed AF recurrence in 48 (68%) patients. Median time to AF recurrence was 2.4 (IQR 1 to 6.9) months. Left ventricular ejection fraction as well as E/E’ and PALS assessed during AF were statistically insignificant as potential predictors in univariate regression model. Receiver operating characteristic curve analysis revealed that left atrial volume index >37 ml/m² (AUC = 0.811, p < 0.0001), E/A ratio >2.1 (AUC = 0.828, p < 0.0001), A wave ≤0.4 m/s (AUC = 0.662, p = 0.01), mean E/E’ ratio during sinus rhythm >8.5 (AUC = 0.815, p < 0.0001), mean A’ wave of ≤5.5 cm/s (AUC = 0.848, p < 0.0001), PALS-SR ≤14.1% (AUC = 0.767, p < 0.0001), PACS ≤4.3% (AUC = 0.883, p < 0.0001) were the optimal cut-off values for predicting AF recurrence. Conclusions The assessment of LA and diastolic function conducted within 24 hours after successful cardioversion predicts long-term maintenance of sinus rhythm.

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Coronary Artery Bypass With Only In Situ Bilateral Internal Thoracic Arteries and Right Gastroepiploic Artery

Circulation ◽

10.1161/circ.104.suppl_1.i-76 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Hiroshi Nishida ◽

Yasuko Tomizawa ◽

Masahiro Endo ◽

Hitoshi Koyanagi ◽

Hiroshi Kasanuki

Keyword(s):

Patency Rate ◽

Graft Patency ◽

Left Ventricular ◽

Long Term Results ◽

Gastroepiploic Artery ◽

Left Ventricular Ejection ◽

Right Gastroepiploic Artery ◽

The Right

Background With the rapid advance of catheter intervention, the direction taken by surgeons is not only to make conventional CABG less invasive but also to pursue better long-term results by using more arterial conduits. Methods and Results Between July 1989 and April 2000, 239 patients (218 men, 21 women) with a mean age of 59.7 (range 39 to 79) years underwent CABG with exclusive use of both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). ITA grafts were harvested by using the skeletonization technique. Most patients (96%) had either triple-vessel or left main disease. Fifty percent of the patients were diabetic, and 16 were being treated with insulin. The left ventricular ejection fraction was ≤40% in 46 patients (19%). Eleven patients (5%) had chronic renal failure and were on hemodialysis. Follow-up was completed in 235 patients (98%). Postoperative follow-up averaged 43 (range 1 to 129) months. Sequential grafting was performed in 64 patients, and the mean number of anastomoses was 3.3. One patient (0.4%) died of mediastinitis on the 53rd postoperative day. Graft patency was confirmed angiographically in 230 patients (96%) 2 to 3 weeks after surgery. The patency rate was 97.1% for the left ITA, 99.6% for the right ITA, and 95.5% for the RGEA. Five-year actuarial survival rate was 92.9%, and the cardiac death-free rate was 97.8%. Conclusions Complete arterial grafting with both ITAs and RGEA was associated with minimal operative risk, a high early graft patency rate, and excellent long-term results.

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