Benefits of early intervention with catheter ablation in patients with atrial fibrillation

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: >12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p<0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

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Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2010.02903.x ◽

2010 ◽

Vol 34 (2) ◽

pp. 163-170 ◽

Cited By ~ 17

Author(s):

GANG CHEN ◽

JIAN ZENG DONG ◽

XING PENG LIU ◽

XIN YONG ZHANG ◽

DE YONG LONG ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava

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Macro-Reentrant Atrial Tachycardia Conducting Through a Left Superior Vena Cava After Catheter Ablation in a Patient With Paroxysmal Atrial Fibrillation

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2014.09.024 ◽

2015 ◽

Vol 31 (1) ◽

pp. 103.e13-103.e15 ◽

Cited By ~ 1

Author(s):

Toshiya Kurotobi ◽

Naoto Kino ◽

Daisuke Tonomura ◽

Yoshihisa Shimada

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Superior Vena Cava ◽

Paroxysmal Atrial Fibrillation ◽

Atrial Tachycardia ◽

Superior Vena ◽

Vena Cava ◽

Left Superior Vena Cava

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Catheter ablation of atrial fibrillation in patients with persistent left superior vena cava is associated with major intraprocedural complications

Heart Rhythm ◽

10.1016/j.hrthm.2010.08.005 ◽

2010 ◽

Vol 7 (12) ◽

pp. 1755-1760 ◽

Cited By ~ 30

Author(s):

Erik Wissner ◽

Roland Tilz ◽

Melanie Konstantinidou ◽

Andreas Metzner ◽

Boris Schmidt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena

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Long-Term Outcome of Catheter Ablation in Patients with Atrial Fibrillation Originating from the Superior Vena Cava

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2012.02337.x ◽

2012 ◽

Vol 23 (9) ◽

pp. 955-961 ◽

Cited By ~ 29

Author(s):

HUNG-YU CHANG ◽

LI-WEI LO ◽

YENN-JIANG LIN ◽

SHIH-LIN CHANG ◽

YU-FENG HU ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Term Outcome ◽

Long Term Outcome

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Transseptal puncture and catheter ablation via the superior vena cava approach for persistent atrial fibrillation in a patient with polysplenia syndrome and interruption of the inferior vena cava: contact force–guided pulmonary vein isolation

EP Europace ◽

10.1093/europace/euw095 ◽

2016 ◽

pp. euw095

Author(s):

Hiroshi Kato ◽

Shoichi Kubota ◽

Takuya Goto ◽

Koichi Inoue ◽

Naohiko Oku ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Inferior Vena Cava ◽

Pulmonary Vein ◽

Superior Vena Cava ◽

Inferior Vena ◽

Superior Vena ◽

Vena Cava ◽

Persistent Atrial Fibrillation ◽

Transseptal Puncture

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471 Arrhythmia-free survival in early-persistent atrial fibrillation patients undergoing radiofrequency catheter ablation

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.049 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Michele Magnocavallo ◽

Domenico Giovanni Della Rocca ◽

Carlo Lavalle ◽

Cristina Chimenti ◽

Gianni Carola ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Success Rate ◽

Pulmonary Vein ◽

Survival Data ◽

Radiofrequency Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Posterior Wall ◽

Free Survival ◽

One Year

Abstract Aims Despite advances in success rate of paroxysmal atrial fibrillation (PAF) ablation, outcomes of radiofrequency catheter ablation (RFCA) in patients with persistent AF are highly variable. Early persistent AF (EPsAF) is defined as AF that is sustained beyond 7 days but is less than 3 months in duration. Arrhythmia-free survival data after RFCA in this specific population are still limited. We sought to report the outcomes of RFCA in the subgroup of patients with EPsAF, compared to those with PAF and with ‘late’ persistent AF (LPsAF) lasting between 3 and 12 months. Methods and results Data from 1143 consecutive AF patients receiving their first RFCA were prospectively collected. Patients with EPsAF (n = 190) were compared with PAF (n = 531) and LPsAF (n = 422) patients. All patients received pulmonary vein antrum isolation + posterior wall and sustained non-pulmonary vein (PV) trigger ablation. Non-sustained non-PV triggers were ablated based on operator discretion. Non-PV triggers were defined as sites of firing leading to sustained (>30 s) or non-sustained arrhythmias (<30 s, including premature atrial contractions ≥10 beats/min) with earliest activation outside the PVs. Mean age of the population was 64 ± 11 years. Female patients were more in PAF group (39%) compared to EPsAF (26%) and LPsAF (28%) (P < 0.001). There was no difference in other clinical characteristics among populations. Non-PV triggers were detected more in EPsAF [127 (66.8%)], and LPsAF [296 (70.1%)] patients compared to PAF [185 (34.8%)] (P < 0.001).One-year arrhythmia-free survival rate after a single procedure was 75.0% (398), 74.2% (141), and 64.5% (272) in PAF, EPsAF, and LPsAF, respectively. Success rate was significantly higher in PAF {[HR: 0.67 (0.53, 0.84), P = 0.001] and EPsAF [HR: 0.67 (0.49, 0.93)], P = 0.015} compared to LPsAF. Conclusions In patients with EPsAF, RFCA may result in significantly better freedom from atrial arrhythmias, compared to LPsAF. In this cohort, ablation might be reasonable as first line approach to improve outcomes and prevent AF progression.

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Catheter ablation of atrial fibrillation without pulmonary vein isolation

EP Europace ◽

10.1093/europace/euab116.258 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

P Futyma ◽

L Zarebski ◽

A Wrzos ◽

M Futyma ◽

P Kulakowski

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Superior Vena ◽

Vena Cava ◽

Funding Sources ◽

The Right ◽

Ganglionated Plexus

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation (PVI) is a cornerstone for catheter ablation (CA) of atrial fibrillation (AF), however, long-term efficacy of PVI is frequently below expectations. PVI is invasive, expensive and may be associated with devastating complications. It has been postulated that vagally-mediated AF can be treated by attenuation of parasympathetic drive to the heart using cardioneuroablation by means of radiofrequency CA (RFCA) of the right anterior ganglionated plexus (RAGP), however, data in literature and guidelines are lacking. Purpose To examine the efficacy of RFCA targeting RAGP without PVI in management of vagal AF. Methods We included consecutive 9 male patients with vagal AF who underwent RFCA of RAGP without PVI. RAGP was targeted anatomically from the right atrium (RA) at the postero-septal area below superior vena cava (SVC) and from the left atrium (LA) if needed. The aim was to achieve >30% increase in heart rate (HR) . The follow up consisted of regular visits and Holter ECG conducted every 3 months. Results A total number of 9 patients (age 52 ± 13) with vagally-mediated AF underwent RFCA of RAGP (mean RAGP RF time 147 ± 85, max power 34 ± 8W). The mean procedure time was 60 ± 29min. HR increase >30% was achieved in 8 (89%) patients (pre-RF vs post-RF: 58 ± 8bpm vs 87 ± 12bpm, p = 0.00002) . Transseptal to reach RAGP also from the LA was needed in 2 (22%) patients. There were no major complications during the procedures. The follow up lasted 6 ± 2 months. Antiarrhythmic drugs were discontinued in 8 (89%) patients. There was 1 (11%) AF recurrence in the patient in whom targeted HR acceleration during RFCA was not achieved. B-blockers were administered in 6 (67%) patients due to increased HR and such treatment was well tolerated by all. Conclusions Catheter ablation of RAGP without performing PVI is feasible and can be effective in majority of patients with vagally-mediated AF. Increased HR after such cardioneuroablation can be well controlled using b-blockers and is usually associated with mild symptoms. The role of cardioneuroablation for treatment of vagally-mediated AF needs to be determined in prospective trials. Abstract Figure. Cardioneuroablation in vagal AF

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