scholarly journals Impact of comorbidities and ablation strategy on outcome after pulmonary vein isolation with cryo-balloon in patients with non- paroxysmal atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Berkowitsch ◽  
J Hutter ◽  
S Zaltsberg ◽  
M Tomic ◽  
P Kahle ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Randomized Study ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Impact ◽  
Improved Outcome

Abstract Background Presence of several comorbidities in patients with atrial fibrillation is well known, but impact of them on outcome after pulmonary vein isolation with cryo-balloon is not enough investigated. First aim of the study was analysis of the impact of comorbidities on long term outcome after PVI with cryo-balloon new generation (CBA) and secondary goal was evaluation of the impact of additional posterior roof ablation (PRA) in these patients. Methods Patients with non-paroxysmal AF ablated with CBA in our institution since May 2012 and completed follow up >3 months were enrolled in the study. The history of AF, cardiac comorbidities (CAD, Non ischemic-cardiomyopathy, heart insufficiency, right ventricular dysfunction) diabetes mellitus, and renal failure were assessed at admission, all patients received echocardiographic examination and blood test. After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. In some patients PRA was performed additionally to PVI at discretion of physician. The primary endpoint of this study was the first documented recurrence of atrial tachyarrhythmia (>30 sec.), hospitalization due to cardio-vascular cause, re-do procedure or re-administration of anti-arrhythmic drugs. Results Among 560 patients 78 (13.9%) had no comorbidity and 299 (53.4%) were lasted with >1 comorbidity. A total of 260 (46.4%) recurrences were obtained within median follow up of 28 (12–57) months. Female gender, long time from first diagnosis >12 months and cardiac comorbidity were revealed to be independent predictors for long term recurrences whereas additional PRA performed in 176 pts independently improved outcome (61.9% vs 49.7%). Conclusion Cardiac comorbidities increased probability of post ablation recurrences, but performing of additional posterior roof ablation improved outcome in our cohort. These results should be confirmed in multi-center randomized study FUNDunding Acknowledgement Type of funding sources: None.

Pulmonary vein isolation: The impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation

Heart Rhythm ◽  
2014 ◽  
Vol 11 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Alex J.A. McLellan ◽  
Liang-han Ling ◽  
Diego Ruggiero ◽  
Michael C.G. Wong ◽  
Tomos E. Walters ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Venous Anatomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Impact

Abstract 1737: A Strategy for Continuous ECG Recording in Patients Post Pulmonary Vein Isolation for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Andrew D Choi ◽  
Sandeep Joshi ◽  
Daniel Marrero ◽  
Farbod Raiszadeh ◽  
Apurva Badheka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Procedural Success

Introduction : Following pulmonary vein isolation (PVI) for management of atrial fibrillation (AF), may centers obtain continuous ECG recordings for several weeks in order to detect early recurrences of AF. However, the implications of early AF following PVI in an individual patient are unknown as is the optimal duration of monitoring in these patients. Methods : We evaluated 72 pts (60 ± 11 yrs, 67% male, 67% paroxysmal AF) who underwent PVI and were followed for >= 6 months. At hospital discharge, all pts were fitted with an external event loop recorder (LifeWatch AF Express) for 14 weeks for the continuous automatic detection of AF (defined as an episode lasting >= 30 sec). Clinical follow-up occurred at 1, 3 and 6 months post-PVI; procedural success was defined by freedom from AF at the 6 month follow-up. Results : During the 14-week loop monitoring period, no AF was observed in 25 (35%) patients. Only 2 of these pts subsequently developed AF; in both cases, AF occurred 3– 6 months post-PVI. In contrast, 47 (65%) patients had at least 1 AF episode, most commonly (39/47 pts, 83%) within the first 2 weeks of PVI. In fact, absence of AF during the first 2-weeks of loop monitoring identified a cohort of patients with high likelihood of procedural success at 6 months (Figure ). Conclusions : Our data support a rationale for at least 2-weeks of continuous automatic loop ECG monitoring in all pts post-PVI. Patients without AF during this period can be expected to have excellent long-term outcome. Longer periods of ECG monitoring may be better limited to patients in whom AF is observed during initial 2-week monitoring.

scholarly journals Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Treatment Strategy, Characteristics of Consecutive Atrial Tachycardia and Long‐Term Outcome

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Leon Dinshaw ◽  
Paula Münkler ◽  
Benjamin Schäffer ◽  
Niklas Klatt ◽  
Christiane Jungen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Hypertrophic Cardiomyopathy ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Antiarrhythmic Drug Therapy ◽  
Af Ablation

Background Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and is associated with a deterioration of clinical status. Ablation of symptomatic AF is an established therapy, but in HCM, the characteristics of recurrent atrial arrhythmias and the long‐term outcome are uncertain. Methods and Results Sixty‐five patients with HCM (aged 64.5±9.9 years, 42 [64.6%] men) underwent AF ablation. The ablation strategy included pulmonary vein isolation in all patients and ablation of complex fractionated atrial electrograms or subsequent atrial tachycardias (AT) if appropriate. Paroxysmal, persistent AF, and a primary AT was present in 13 (20.0%), 51 (78.5%), and 1 (1.5%) patients, respectively. Twenty‐five (38.4%) patients developed AT with a total number of 54 ATs. Stable AT was observed in 15 (23.1%) and unstable AT in 10 (15.3%) patients. The mechanism was characterized as a macroreentry in 37 (68.5%), as a localized reentry in 12 (22.2%), a focal mechanism in 1 (1.9%), and not classified in 4 (7.4%) ATs. After 1.9±1.2 ablation procedures and a follow‐up of 48.1±32.5 months, freedom of AF/AT recurrences was demonstrated in 60.0% of patients. No recurrences occurred in 84.6% and 52.9% of patients with paroxysmal and persistent AF, respectively ( P <0.01). Antiarrhythmic drug therapy was maintained in 24 (36.9%) patients. Conclusions AF ablation in patients with HCM is effective for long‐term rhythm control, and especially patients with paroxysmal AF undergoing pulmonary vein isolation have a good clinical outcome. ATs after AF ablation are frequently observed in HCM. Freedom of atrial arrhythmia is achieved by persistent AF ablation in a reasonable number of patients even though the use of antiarrhythmic drug therapy remains high.

P4764Relationship of the duration of pulmonary vein isolation-refractory non-paroxysmal atrial fibrillation to the middle- to long-term outcome of the ExTRa Mapping-guided ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Okuyama ◽  
T Ashihara ◽  
T Ozawa ◽  
Y Fujii ◽  
K Kato ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real Time ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Density ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mapping System ◽  
Phase Mapping

Abstract Introduction It is reported that for patients with non-paroxysmal (persistent or long-standing persistent) atrial fibrillation (Non-PAF), extended ablation to atrial walls in addition to pulmonary vein isolation (PVI) did not improve the long-term outcome. On the other hand, modulation of Non-PAF drivers (or perpetuators) has been proposed as one of the alternative effective ablation strategies for Non-PAF. Purpose To clarify whether the rotor ablation under online real-time high-density phase mapping system is effective for PVI-refractory Non-PAF ablation. Methods Under such circumstances, our academic group had recently developed the online real-time high-density phase mapping system (ExTRa Mapping™) by industrial alliance. The phase map moving images were based on 41 intra-atrial bipolar signals recorded by a 20-pole spiral-shaped catheter (2.5 cm in diameter) and on in silicorapid prediction of spatio-temporal atrial excitations (artificial intelligence system). Then we applied the ExTRa Mapping to clinical practice in order to directly visualize rotors in patients with Non-PAF, and investigated the middle- to long-term outcome of the ExTRa Mapping-guided rotor ablation (ExTRa-ABL). Results Thirty-eight patients (63±8 y/o, 30 males) with Non-PAF demonstrating refractoriness to PVI were enrolled in this study. Ablation for cavo-tricuspid isthmus and/or superior vena cava isolation was additionally performed at physicians' discretion. After these procedures, the ExTRa-ABL was performed in order to modify Non-PAF substrates, causing rotor control. The modification of the rotors was evaluated by re-mapping with the use of the ExTRa Mapping at the end of each ablation session. Patients were followed at 1, 3, 6 months and every year after the procedure. All of them were followed for 21±8 months. During the follow-up period, Non-PAF was recurred in only 8 of 38 (21%). Furthermore, we found if PVI-refractory Non-PAF duration was shorter than 6 years, the non-recurrence rate remained ≥80% (see Figure), which was markedly better outcome comparing with previous reports with regard to Non-PAF ablation. Figure 1 Conclusion Comparing with conventional Non-PAF ablation strategies, our novel approach with the use of the online real-time high-density phase mapping system might improve medium- to long-term outcome of PVI-refractory Non-PAF treatment.

Abstract 2752: Pulmonary Vein Isolation With And Without Additional Ablation Of Complex Fractionated Electrograms In Paroxysmal Atrial Fibrillation: Long-term Results Of A Prospective Randomized Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Isabel Deisenhofer ◽  
Tilko Reents ◽  
Heidi L Estner ◽  
Stephanie Fichtner ◽  
Christian von Bary ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Randomized Study ◽  
Intention To Treat ◽  
Long Term Follow Up ◽  
Treat Analysis

Introduction: Segmental pulmonary vein isolation (PVI) leads to elimination of paroxysmal atrial fibrillation (AF) in approximately 75% of patients. Ablation of complex fractionated atrial electrograms (CFAE) is an alternative ablation strategy. In this prospective randomized study the long-term effect of PVI alone is compared to the effect of combined PVI and CFAE ablation in paroxysmal AF. Methods: 98 patients with paroxysmal AF (57±10 years, 74 male) were randomly assigned to PVI (48 patients) or PVI+CFAE ablation (50 patients). Additional CFAE ablation was performed in the PVI+CFAE group if AF was still inducible after PVI. Follow-up results were assessed with repetitive 7 days Holter ECG and clinical evaluation including repeat ablations. Results: Additional CFAE ablation was performed in 30/50 (60%) patients of the PVI+CFAE group with still inducible AF after PVI. In each group, 2 patients were lost to long term follow-up. In the intention-to-treat analysis at 3 months and after 19±8 months, there was no significant difference between both groups (36/48 [75%] and 34/46 [74%] patients in the PVI and 37/50 [73%] and 40/48 [83%] of patients in the PVI+CFAE ablation group in sinus rhythm [p=0.32]). In subgroup analysis, patients actually treated with the combined PVI+CFAE ablation approach had a significantly better long-term success (25/28; 89%) than patients with still inducible AF who underwent PVI only (22/30;73%; p=0.02). In both groups repeat ablations were performed in 31% (PVI group; 15/48 patients) and 35% (PVI+CFAE group; 17/48 patients) (p=n.s). After 9 months, significantly more patients in the PVI+CFAE group experienced sustained regular atrial tachycardia than in the PVI group (6/44 versus 1/39 patients, P=0.02). Conclusion: The combination of PVI and CFAE ablation was equally effective than PVI alone in reaching freedom of AF in the intention-to-treat analysis. During long-term follow-up, patients actually treated with combined PVI+CFAE ablation had a significantly better outcome (89% vs. 73%). However, the rate of ablation-induced regular atrial tachycardias is inreased.

scholarly journals Defining the optimal blanking period duration after cryoballoon pulmonary vein isolation in patients with atrial fibrillation who have never been treated with an antiarrhythmic drug

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
T Sichrovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antiarrhythmic Drug ◽  
Loop Recorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First 90 Days ◽  
Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is an approved method for ablation in patients with paroxysmal (PAF) or persistent (PeAF) atrial fibrillation (AF). Although the first 90 days post-ablation are considered within the blanking period (BP), the optimal duration of the BP remains undefined. Purpose To objectively define the BP duration in pts undergoing CB PVI by evaluating a cohort never treated with an antiarrhythmic drug (AAD). Methods We enrolled consecutive pts with either PAF or PeAF who underwent initial CB PVI; all pts had an implantable loop recorder (ILR) for long-term ECG monitoring. No pt received an AAD either before or after ablation. We determined the time to last AF episode within the first 90 days of ablation. We then correlated this to the likelihood a patient had recurrent AF between 91 and 365 days of ablation. Results There were 45 pts (67±8 years; 26 [58%] male; 40 [89%] PAF; CHA2DS2-VASc 2.6±1.3). We defined 4 distinct groups post ablation based on whether or not they had AF in the BP: (1) no AF days 0–90 (n=19 [42%]), (2) last AF days 0–30 (n=11 [24%]), (3) last AF days 31–60 (n=3 [7%]), and (4) last AF days 61–90 (n=12 [27%]). After the 90-day BP, 15 (33%) pts had AF recurrence. Pts with no AF and those with AF only within 30 days of ablation had similar long-term outcome; however, recurrent AF more than 32 days after ablation predicted long-term ablation failure (Figure). Conclusion The post CB PVI blanking period is just a month. AF recurrences beyond a month in patients not on an AAD are associated with AF recurrence in the majority of pts. FUNDunding Acknowledgement Type of funding sources: None. Blanking Group by AF Recurrence

scholarly journals Formal infectious diseases specialist consultation improves long-term outcome of methicillin-sensitive Staphylococcus aureus bacteremia

2019 ◽  
Author(s):  
E Forsblom ◽  
H Frilander ◽  
E Ruotsalainen ◽  
A Järvinen
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Staphylococcus Aureus Bacteremia ◽  
Long Term Follow Up ◽  
The Impact ◽  
Improved Outcome

Abstract Background Formal infectious diseases specialist (IDS) consultation has been shown to improve short-term outcome of Staphylococcus aureus bacteremia (SAB) but its effect on long-term outcome lacks evaluation. Methods Retrospective study of 367 methicillin-sensitive (MS) SAB patients followed for 10 years. The impact of formal IDS consultation on risk for new bacteremia and outcome during long-term follow-up were evaluated. Patients who died within 90 days were excluded to avoid interference from early deceased patients. Results 304 (83%) patients had formal IDS consultation whereas 63 (17%) received informal or no IDS consultation. Formal consultation, compared to informal or lack of consultation, associated to a reduced risk for a new bacteremia caused by any pathogen within 1-year (OR, 0.39; 95% CI, .18-.84; p=.014; 8% vs. 17%), and within 3-years (OR, 0.39; 95% CI, .19-.80; p=.010; 9% vs. 21%) whereas a trend towards a lower risk was observed within 10-years (OR, 0.56; 95% CI, .29-1.08; p=.079; 16% vs. 25%). Formal consultation, compared to informal or lack of consultation, improved outcome at 1-year (OR, 0.16; 95% CI, .06-.44; p<0.001; 3% vs. 14%), at 3-years (OR, 0.19; 95% CI, .09-.42; p<.001; 5% vs. 22%) and at 10-years (OR, 0.43; 95% CI, .24-.74; p=.002; 27% vs. 46%). Considering all prognostic parameters formal consultation improved outcome (HR, 0.42; 95% CI, .27-.65, p<.001) and lowered risk for any new bacteremia (OR, 0.45; 95% CI, .23-.88, p=.02) during 10-years follow-up. Conclusion MS-SAB management by formal IDS consultation, compared to informal or lack of IDS consultation, reduces risk for any new bacteremia episodes and improves long-term prognosis up to ten years.

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