P4760New minimally invasive and tailor-made strategy for cryoballoon ablation in patients with paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Nakano ◽  
K Suenari ◽  
K Suruga ◽  
H Takemoto ◽  
Y Hashimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Standard Procedure ◽  
Rank Test ◽  
Cryoballoon Ablation ◽  
Freezing Time ◽  
Free Survival ◽  
Log Rank Test ◽  
Group A ◽  
Group B

Abstract Background Currently, cryoballoon ablation (CBA) has proven to be highly effective in achieving free from atrial fibrillation (AF), especially paroxysmal AF. However, the optimal freezing protocol for each patient to achieve successful pulmonary vein isolation by only CBA is still uncertain. The aim of this study was to evaluate the clinical implications of a reduction in the freezing duration (<180s) during CBA guided by the time to target temperature. Methods From November 2015 to August 2018, 286 consecutive paroxysmal AF patients undergoing CBA were enrolled. We compared 107 patients undergoing a tailor-made CBA procedure (Group A; August 2017-August 2018) to 179 patients with a standard CBA procedure (Group B; November 2015–July 2017). In Group A, the freezing duration was reduced to 150s when the temperature reached ≤−40°C within 40s. Furthermore, we reduced it to 120s when it reached ≤−50°C within 60s. In the other patients, the freezing time was 180s except for excessive freezing over −60°C and/or emergent situations while monitoring the esophageal temperature and for phrenic nerve injury as in Group B. Results The baseline clinical characteristics were similar between two groups. In Group A, 89 patients (83%) underwent CBA with a reduction in the freezing time. The rate of having reduction time in left inferior PV (LIPV) and right inferior PV (RIPV) was lower compared with left superior PV (LSPV) and right superior PV (RSPV) (respectively 17%, 29%, 56%, and 63.5%). However, for right inferior PV, in 31 patients having the reduced freezing time, none of them required touch-up ablation. Although the procedure time and frequency of touch-up ablation did not differ between the 2 groups, total freezing time for each PV was significantly shorter in Group A than Group B as shown in figure (LSPV: 164±28s vs. 216±67s; p<0.001, LIPV: 187±44s vs. 218±69s; p<0.001, RSPV: 147±31s vs. 192±51s; p<0.001, RIPV: 180±50 vs. 218±73s; p<0.001). The AF free survival rate during the follow-up period (356±167 days) was similar between the 2 groups (log-rank test, p=0.38). Furthermore, the complication rate was similar 2 groups. The freezing time for each PV Conclusion The safety and efficacy of the new tailor-made CBA strategy were non-inferior to the standard procedure. This study showed that the unnecessary freezing time could be reduced in most of paroxysmal AF patients.

Cryoballoon pulmonary-vein isolation for atrial fibrillation with heart failure: results from a single-center cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Boehmer ◽  
M Rothe ◽  
S Jaqubi ◽  
A Summ ◽  
C Soether ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Prospective Trial ◽  
Rank Test ◽  
Cryoballoon Ablation ◽  
Single Center ◽  
Primary Analysis ◽  
Free Survival ◽  
Log Rank Test ◽  
Normal Lvef

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are of growing prevalence and increasing mortality. Radiofrequency ablation is safe and effective for patients with AF and HF. Prognosis might be improved in patients treated. However, there is no prospective trial investigating efficacy and safety of cryoballon ablation in patients with AF and HF. Objective To prospectively compare cryoballoon ablation in patients with and without HF (defined as LVEF ≤40%) in terms of safety and efficacy. Methods Ongoing POLAR-HF trial is a prospective, investigator-initiated, single-center, non-inferiority, open-label study. We analyzed 244 consecutive patients who underwent cryoballoon ablation. Of these 217 had normal LVEF (age 68.1±9.6 years, CHA2DS2-VASc Score 2.5±1.3, 55.3% male) while 27 patients (11%) suffered from HF (age 70.4±8.6 years, CHA2DS2-VASc Score 3±1.2, 70.4% male). Follow-up was performed at 3, 6 and 12 months after ablation. Kaplan-Meier method was used to calculate 12-month event-rate estimates. Log-Rank Test to estimate hazard ratios in the primary analysis. Endpoints were: symptomatic AF relapse for efficacy and bleeding, stroke or death for safety. Results Analysis showed no difference in AF-free survival rate between patients with and without HF (81% vs. 76.3%, Log-Rank-Test P=0.81, Figure). Primary safety end point occurred in 5 patients with normal LVEF (2.3%) and none in the HF-group. No deaths were observed. Conclusion Results of POLAR-HF indicate that cryoballoon ablation is an effective ablation method for patients suffering from AF and HF. Event-Free Survival (Efficacy Endpoint) Funding Acknowledgement Type of funding source: None

scholarly journals Low-voltage-area ablation in paroxysmal atrial fibrillation: Extended follow-up results of the VOLCANO trial

2021 ◽  
Author(s):  
Masaharu Masuda ◽  
Mitsutoshi Asai ◽  
Osamu Iida ◽  
Shin Okamoto ◽  
Takayuki Ishihara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Low Voltage ◽  
Recurrence Rates ◽  
Group A ◽  
C 32 ◽  
Group B ◽  
Group D

Introduction: The randomized controlled VOLCANO trial demonstrated comparable 1-year rhythm outcomes between patients with and without ablation targeting low-voltage areas (LVAs) in addition to pulmonary vein isolation among paroxysmal atrial fibrillation (AF) patients with LVAs. To compare long-term AF/atrial tachycardia (AT) recurrence rates and types of recurrent-atrial-tachyarrhythmia between treatment cohorts during a > 2-year follow-up period. Methods: An extended-follow-up study of 402 patients enrolled in the VOLCANO trial with paroxysmal AF, divided into 4 groups based on the results of voltage mapping: Group A, no LVA (n=336); group B, LVA ablation (n=30); group C, LVA presence without ablation (n=32); and group D, incomplete voltage map (n=4). Results: At 25 (23, 31) months after the initial ablation, AF/AT recurrence rates were 19% in group A, 57% in group B, 59% in group C, and 100% in group D. Recurrence rates were higher in patients with LVAs than those without (group A vs. B+C, p<0.0001), and were comparable between those with and without LVA ablation (group B vs. C, p=0.83). Among patients who underwent repeat ablation, ATs were more frequently observed in patients with LVAs (Group B+C, 50% vs. A, 14%, p<0.0001). In addition, LVA ablation increased the incidence of AT development (group B, 71% vs. C, 32%, p<0.0001), especially biatrial tachycardia (20% vs. 0%, p=0.01). Conclusion: Patients with LVAs demonstrated poor long-term rhythm outcomes irrespective of LVA ablation. ATs were frequently observed in patients with LVAs, and LVA ablation might exacerbate iatrogenic ATs.

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 ◽  
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.

Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease

2002 ◽  
Vol 97 (5) ◽  
pp. 1070-1077 ◽  
Author(s):  
Alexandre Carpentier ◽  
Marc Polivka ◽  
Alexandre Blanquet ◽  
Guillaume Lot ◽  
Bernard George
Keyword(s):  
Clinical Symptoms ◽  
Rank Test ◽  
Aggressive Treatment ◽  
Actuarial Survival ◽  
High Tendency ◽  
Content Type ◽  
Log Rank Test ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. Chordoma is a locally invasive tumor with a high tendency for recurrence for which radical resection is generally recommended. To assess the benefits of aggressive treatment of chordomas, the authors compared results in patients treated aggressively at the first presentation of this disease with results in patients who were similarly treated, but after recurrence. Methods. Among 36 patients with cervical chordomas who were treated at the authors' institution, 22 underwent primary aggressive treatment (Group A) and 14 were treated secondarily after tumor recurrence (Group B). Two cases were excluded from Group A because of unrelated early deaths and three from Group B because of insufficient pre- or postoperative data. Most tumors were located at the suboccipital level and only eight cases at a level below C-2. Radiotherapy and proton therapy were similarly conducted in both groups of patients. The actuarial survival rates were 80 and 65% at 5 and 10 years, respectively, in Group A patients and 50 and 0% at 5 and 10 years, respectively, in Group B patients (p = 0.049, log-rank test). The actuarial recurrence-free rates were 70 and 35% at 5 and 10 years, respectively, in Group A and 0% at 3 years in Group B (p < 0.0001, log-rank test). The numbers of recurrences per year were 0.15 in Group A and 0.62 in Group B (p > 0.05). All other parameters that were analyzed (patient age, delay before diagnosis, clinical symptoms, chondroid type of lesion, and histological features) did not prove to influence prognosis in a statistically significant manner. Conclusions. Aggressive therapy, combining as radical a resection as possible with radiotherapy, seems to improve the prognoses of suboccipital and cervical chordomas when applied at the patient's first presentation with the disease.

P1239His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Slawuta ◽  
K Boczar ◽  
A Zabek ◽  
A Ciesielski ◽  
J Hiczkiewicz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Dual Chamber ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Narrow Qrs ◽  
Group A ◽  
Group B

Abstract The heart rate regularization is crucial for proper treatment of patients with atrial fibrillation and congestive heart failure. The standard resynchronization can be applied, but in patients with narrow QRS this procedure is of no use. The aim of our study is to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using dual chamber ICD implanted for prevention of sudden cardiac death. Methods The study population included 78 patients with CHF and chronic AF: group A - 56 pts treated with direct His-bundle pacing using atrial port of dual chamber ICD and group B - 22 patients implanted with single chamber ICD as recommended by the guidelines. The patients in group B constituting clinical controls were derived from the Heart Failure Outpatients Clinic with established clinical status and pharmacotherapy. Results The demographic data, clinical characteristics and echocardiography measurements at baseline and during follow-up were presented in the table: Table 1 Group A Group B P value Age (years) 69.7±6.9 66.7±11.3 n.s. Sex (% of male sex) 84.0 86.4 n.s. Ventricular pacing (%) – 46.3±31.2 – His-bundle pacing (%) 81.7±9.2 – – pre post pre post pre vs. post LVEDD (mm) 66.9±4.9 59.9±4.7 64.8±8.0 64.7±8.1 <0.01 n.s. EF (%) 29.6±3.8 43.6±5.9 28.1±6.1 28.8±7.3 <0.01 n.s. NYHA class 2.7±0.6 1.4±0.6 2.5±0.6 2.0±0.2 <0.05 n.s. B-blocker dose (metoprolol equivalent dose) 104.6±41.6 214.3±82.6 78.3±56.6 103.1±49.2 <0.001 <0.05 During 12-months of follow-up the mean values of NYHA functional class, EF and LV dimensions did not change in group B but significantly improved in group A. The physiological His-bundle based pacing enabled optimal beta-blocker dosing. The studied groups had no tachyarrhythmia at baseline so the presumable atrial fibrillation-related harm depends on the rhythm irregularity. Conclusions His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The CHF-patients with narrow QRS and chronic AF benefit from substantially higher beta-blockade which can be instituted in His-bundle pacing group.

RA05.08: OPTIMAL RADIATION DOSE IN THE NEOADJUVANT TREATMENT OF ESOPHAGEAL CANCER: A COMPARATIVE EUROPEAN STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-29
Author(s):  
Styliani Mantziari ◽  
Pierre Allemann ◽  
Michael Winiker ◽  
Marguerite Messier ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Anastomotic Leakage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Disease Free

Abstract Background Current guidelines recommend the use of neoadjuvant chemo-radiation (NCR) for the treatment of locally advanced esophageal cancer, both types, adenocarcinoma (AC) and squamous cell carcinoma (SCC). So far, the optimal dose of radiotherapy to achieve a maximal tumor response within an acceptable toxicity is not yet determined. The aim of this study was to assess the impact of preoperative radiation dose on postoperative outcomes and long-term survival. Methods Consecutive patients operated in two European tertiary centers for AC or SCC, treated with NCR and surgery from 2000–2016 were assessed. Specific postoperative complications (i.e. anastomotic leakage, atrial fibrillation), histological tumor regression grade (TRG, Mandard score), overall and disease-free survival were compared among three patients groups: group A (41.4Gy), group B (45Gy), and group C (50.4Gy). The x2 or Fisher test were used for categorical variables and ANOVA for continuous variables. Survival analysis was done with the Kaplan-Meier method and log-rank test. Results There were 294 patients included; 41.5% (n = 122) had AC and 58.5% (n = 172) SCC. Overall, 9.2%/27 patients received 41Gy, 57.8%/170 patients 45Gy and 33%/97 patients received 50.4Gy. Carboplatin-Paclitaxel was the most frequently used chemotherapy for group A (62.9%), and 5FU-Cisplatin for groups B (69.4%) and C (51.5%). Postoperative anastomotic leakage was lower for group B (7.1%) compared to group A (22.2%) and C (13.4%) (P = 0.036), as was the occurrence of atrial fibrillation (11.8% group B, 33.3% group A and 19.6% group C, P = 0.013). Complete or excellent response (TRG 1–2) was significantly better for group B (58.2%), followed by group C (49.5%) and A (25.9%) patients (P = 0.012). Median overall survival was 48, 27 and 29 months for group A, B and C (P = 0.498), and median disease-free survival was 13, 27 and 18 months (P = 0.411), respectively. Conclusion Preoperative radiotherapy dose of 45Gy with 5FU-Cisplatin was associated with a better histological response and less postoperative adverse outcomes compared to 41Gy and 50.4Gy, with no significant differences in long-term recurrence and survival. The role of the type of chemotherapy and histological tumor type are important co-factors affecting outcome and must be further assessed. Disclosure All authors have declared no conflicts of interest.

Thalidomide Based Regimens (TBR) for Relapsed/Refractory Multiple Myeloma Patients: Long Term Follow Up, Unmaintained Remissions and Disease Control after Subsequent Treatments.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4812-4812
Author(s):  
Maria Roussou ◽  
Efstathios Kastritis ◽  
Athanasios Anagnostopoulos ◽  
Evangelos Eleftherakis-Papaiakovou ◽  
Charis Matsouka ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Refractory Multiple Myeloma ◽  
Long Term Follow Up ◽  
Group A ◽  
Pulse Dexamethasone ◽  
Group B

Abstract Introduction: The effectiveness of thalidomide based regimens (TBR) in patients with relapsed/refractory multiple myeloma is well established. However, there are still limited data regarding the long term follow up after such regimens and the outcome of patients when they progress and they receive further treatment. In order to answer these questions we evaluated a series of 114 patients with relapsed/refractory multiple myeloma who were treated with TBR. None of these patients had previously received thalidomide, bortezomib or lenalidomide. Patients and Methods: All patients were treated with thalidomide and dexamethasone with or without other oral agents. More specifically 41 patients had received continuous thalidomide and pulse dexamethasone, 25 patients clarithromycin, continuous thalidomide and pulse dexamethasone, 43 patients intermittent thalidomide, pulse dexamethasone and cyclophosphamide and 5 patients continuous thalidomide, pulse dexamethasone and cyclophosphamide. Type of treatment at the time of progression after TBR, response to this treatment and progression free survival were recorded for each patient. Moreover, patients who received novel agents after progression to TBR, were divided into 2 subgroups, according to their resistance to thalidomide. In group A, patients had refractory or progressive myeloma while on TBR or within 2 months after discontinuation of TBR. In group B, myeloma progressed more than 2 months after discontinuation of TBR. Results: Among the 114 patients, 41 had not responded to TBR and 73 (64%) had achieved at least a partial response. The median PFS for all patients was 8 months. As of June 2007, 10 patients remain without progression from 28 to 81 months (median 54 months). Eight patients remain off treatment and without progression for a median of 56 months (range 28–81). Patients who did not respond to or progressed after TBR were analyzed for further treatment and outcome. Thirty eight patients (37%) died before receiving further treatment, 23 patients (23%) received conventional chemotherapy and 41 patients (40%) received continuous thalidomide and dexamethasone +/− clarithromycin or cyclophosphamide (17 patients), bortezomib and dexamethasone (7 patients), melphalan-bortezomib-dexamethasone and intermittent thalidomide (12 patients) or lenalidomide with dexamethasone (5 patients). Among these 41 patients, 24 were classified in group A (thalidomide resistant) and 17 in group B. Overall 17 (41%) achieved at least partial response after retreatment with novel agent-based regimens. A response was observed in 46% of patients in group A and in 35% of patients in group B. The median progression free survival of the 41 patients who received retreatment with novel agents was 9.2 months and the median survival was 17 months. Among the 23 patients who received conventional chemotherapy only five (21%) patients responded and the progression free survival and the median survival were 5.3 and 10.2 months, respectively. Conclusions: After an oral TBR regimen 6 (5%) patients remain without treatment and free of progression for more than 4 years. A significant number of patients who progressed after TBR and who received further treatment which included a novel agent achieved a response, including several patients who were resistant to TBR.

The Prognostic Value of Serum APRIL Levels in Patients with Chronic Lymphocytic Leukemia

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5648-5648
Author(s):  
Sinem Nihal Esatoglu ◽  
Dilek Keskin ◽  
Muge Kutnu ◽  
Tugrul Elverdi ◽  
Ayse Salihoglu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Demographic Data ◽  
Lymphocytic Leukemia ◽  
Rank Test ◽  
Healthy Controls ◽  
Log Rank Test ◽  
Treatment Naïve ◽  
Group A ◽  
Group B ◽  
Time To First Treatment

Abstract Introduction: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with variable clinical course. Several studies have been conducted to predict outcome in patients with CLL and also have been going on. A proliferation inducing ligand (APRIL) has been shown to involve in survival and resistance to apoptosis in CLL, and APRIL molecule has been investigated as a prognostic marker in CLL patients. However, there are limited and controversial data regarding APRIL and its impact on prognosis in CLL. We aimed to compare serum APRIL levels in CLL patients with those of age and gender matched healthy subjects, and to investigate the relationship between APRIL and the other common prognostic factors, and to determine whether serum APRIL levels predict time to first treatment in CLL. Methods: After ethical approval and informed consent were obtained, between May and December 2012, venous blood samples were driven from 96 CLL patients’ and 25 healthy controls’, and serum APRIL levels were measured by ELISA. Demographic data and the prognostic markers were obtained from the patients’ files, and patients have been followed for a minimum of 12 months. We tested the correlation between APRIL with the, clinical and biological parameters, and used the log rank test to compare their Kaplan Meier curves. Results: Patients were divided into three groups: Treatment naive (group A, n=49), chemotherapy receiving (group B, n=25) and who had previously received chemotherapy (group C, n=22). Median APRIL level was higher in group A (2.78 vs 1.29; p=0.034) and group C (3.54 vs 1.29; p=0.001) when compared to healthy controls, but was not different in group B (1.56 vs 1.29; p=0.3) (Figure 1). Serum APRIL level in group A was negatively correlated with hemoglobin levels (r=-0.298; p=0.037) and platelet counts (r=-0.321; p=0.025) whereas no correlation with age, Rai and Binet stages, lymphocyte counts, β2-microglobulin and CD38 levels were detected. Group A patients were also divided into 2 subgroups (APRIL levels low, n=20 and APRIL levels high, n=29) using median natural logarithm of serum APRIL level as cut off. April low and high subgroups were similar with respect to demographic data and prognostic factors. Median time to first treatment was not reached in the APRIL low group, but was 104 months in the APRIL high group (p=0.13, log-rank test). Conclusions: Among the treatment naive patients, serum APRIL levels only negatively correlate with hemoglobin levels and platelet counts. These correlations seem to be associated with tumor burden rather than the prognosis, because APRIL levels were not different in chemotherapy receiving patients compared to healthy controls. Since a median survival time could not be reached in the APRIL low group, short follow up time might be an explanation why the APRIL levels did not predict the time to first treatment. In conclusion, our findings let us to think APRIL levels are not a useful marker to predict prognosis in patients with CLL. Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Figure 1. Median APRIL levels of CLL patients and healthy controls (ng/mL) Disclosures No relevant conflicts of interest to declare.

scholarly journals 10-year clinical outcomes after radiofrequency catheter ablation for atrial fibrillation. A single center experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J.F Alderete Martinez ◽  
S Shizuta ◽  
F Yoneda ◽  
S Nishiwaki ◽  
M Tanaka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Adverse Events ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Radiofrequency Catheter Ablation ◽  
Rank Test ◽  
Log Rank Test

Abstract Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is becoming a routine procedure to treat patients with drug-refractory symptomatic AF. However, data regarding very long-term clinical outcomes is limited. The aim of the present study was to evaluate the 10-year clinical outcomes of patients who underwent RFCA for paroxysmal and persistent AF. Methods We retrospectively enrolled 503 consecutive patients (mean age 66,9±9,51 years; 71,6% male) who underwent RFCA for drug-refractory symptomatic AF between February 2004 and June 2011. Follow-up information was obtained using medical records and/or telephonic interviews with the patient, relatives and/or referring physicians. Results Among 503 patients enrolled in this study, 362 had paroxysmal atrial fibrillation (PAF) and 141 had persistent atrial fibrillation (PeAF) (72% and 28%, respectively). Mean follow-up was 8,84±3,05 years. The 10-year event-free rate for recurrent atrial tachyarrhythmia (AT) after the first procedure was 44,5% (49,4% for PAF vs 31,9% for PeAF; p=0,002 by log-rank test) and 81,9% after the last procedure (87,3% for PAF and 67,9% for PeAF; p≤0,001 by log-rank test). AT recurrence was observed most commonly during the first 12 months of the initial procedure (56%), with only 18% of them occurring after 60 months. Multivariate analysis revealed that persistent AF (hazard ratio=1,366; 95% confidence interval 1,058–1,76; p=0,017) and duration of AF &gt;5 years (hazard ratio=1,357; 95% confidence interval 1,064–1,732; p=0,005) were independent risk factors for AT recurrence. Regarding adverse events, there were 24 (4,8%) hospitalizations for acute decompensated heart failure, 20 (4%) ischemic strokes and 14 (2,8%) bleeding complications requiring hospital admissions. Patients taking oral anticoagulation and antiarrhythmic drugs at the end of the study accounted for 32,8% and 16,7% respectively. Conclusions RFCA for AF provided favorable results in terms of arrhythmia event-free survival in long-term follow-up with better results in patients with paroxysmal AF. Persistent AF and long-standing AF (beyond 5 years) were associated with AT recurrence. Despite the large number of patients who discontinued oral anticoagulation, thromboembolic adverse events were rare. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals The Effect of Preoperative Pulmonary Arterial Hypertension on Incidence of Postoperative Atrial Fibrillation after Surgical Closure of Atrial Septal Defect (Secundum)

2018 ◽  
Vol 13 (1) ◽  
pp. 17-20
Author(s):  
AKM ManzurulAlam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Mohammad Ashraf ◽  
Mamun Hossaim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Group A ◽  
Pulmonary Arterial ◽  
Group B ◽  
Substantial Morbidity

Background: Atrial tachyarrhythmias are common among adults with ASD and contribute to substantial morbidity. Atrial flutter and atrial fibrillation are well-described complications of atrial septal defect (ASD) and are associated with substantial morbidity. The cause of AF in ASD is multifactorial in nature. It has been proposed that it is related to atrial dilatation, the increase in pulmonary pressure, and ventricular dysfunction. Early surgical intervention may reduce the long-term risk of developing atrial arrhythmias. Studies demonstrated that cardiac remodeling occurred after closure of an ASD, even in older patients. This study aimed to find out the pulmonary hypertension (PAH) as a predictor of postoperative atrial fibrillation in patients after surgery for secundum type atrial septal defect closure.Methods: This Prospective Observational Study carried out in department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) and Hospital, Dhaka, Bangladesh during the period of July, 2015 to June, 2016. Total 54 patients are taken and then grouped into group A and group B. Each group contains 27 patients. Group A include Patients with ASD secundum without PAH. Group B Patients with ASD secundum with PAH. All patients were evaluated with M-mode, 2D and color Doppler transthoracic echocardiography and ECG before operation, at discharge, after one month and at 3 months follow-up. Statistical analysis of the results was obtained by windows based computer software with statistical package for the social sciences program (SPSS version 21).Results: To compare atrial fibrillation postoperative at discharge and postoperative after 1 and 3 months follow-up it was found In group B 8 (29.62%) patients had AF postoperatively, during discharge 8 (29.62%) patients had AF, after 1 month 7 (25.93%) patient had AF, after 3 months 6 (22.22%) patients had AF. No AF was found in Group A patients during postoperatively, during discharge, after 1 month & 3 months follow up. Statistical significant difference was found in between two groups (p<0.05).Conclusion: The surgical correction of atrial septal defect (ASD) is safe and effective procedure. Our studyshowed that the haemodynamic and electrophysiological results of the surgical repair of ASD secundum was superior before the development of pulmonary arterial hypertension. After surgical correction of ASD secundum raised pulmonary artery pressure became lower gradually. Atrial fibrillation developed in patient group with pulmonary arterial hypertension in postoperative period remain persistent in most patients in the follow up period, few converted to sinus rhythmUniversity Heart Journal Vol. 13, No. 1, January 2017; 17-20

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