16-07: Long-Term Results of Catheter Ablation for Persistent Atrial Fibrillation in Very Young Adults – Lessons from a 4-year follow up

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (> 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

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Catheter ablation of atrial fibrillation in patients under 45 years of age. Longterm outcome

European Heart Journal ◽

10.1093/eurheartj/ehab724.0520 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Calero Nunez ◽

V.M Hidalgo-Olivares ◽

M Cubells-Pastor ◽

A Prieto-Lobato ◽

S Gil-Gomez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Young Adults ◽

Catheter Ablation ◽

Young Patients ◽

Older Population ◽

Af Ablation ◽

Group A ◽

Group B

Abstract Introduction Young patients (p) with atrial fibrillation (AF) tend to be more symptomatic and more reluctant to take long-term antiarrhythmic drugs. However, AF ablation (especially when persistent) is often used as second-line treatment regardless of age. Purpose The aim is to compare clinical outcome and safety of catheter ablation of atrial fibrillation in young adults in comparison to older adults. Secondary endpoints were to compare the influence of other comorbidities in AF ablation outcomes. Methods From 2012–2019, consecutive patients (mean age 56±9,4 years; 72,8% men) with symptomatic paroxysmal AF (PAF 68,8%) and persistent (Pers) AF (31,2%) underwent PVI through radiofrequency (91%) or cryoballoon (9%) at our centre. Two groups were defined (group A ≤45 years, group B >45 years). Follow-up was based on outpatient visits including 24h Holter-ECG at 3, 6 and, 12 months post ablation, and every 12 months thereafter. Results A total of 202 patients undergoing AF ablation were included (group A: 35, 17,3%; group B: 167, 82,7%). Male gender (91,4 vs 68,9%, p=0,006) and smoking (37,1% vs 13,2%, p=0,001) were significantly more often present in group A. HTA (50,9% vs 22,9%, p=0,002) and CHA2DS2-VASc score (1,3±1 vs 0,4±0,6; p=0,01) were higher in the older population group. Median follow-up was 29±18 months. After 12 months AF recurrence were less common in group A: 1-year arrhythmia-free survival was 88,6% (31/35) vs 73,7% (123/167) in the older group [P 0.049]. However, outcomes at the end of follow up were similar between the two groups, the freedom from AF was 57.1% (20/35) in young patients vs 65,3% (109/167) in older group, p=0,42. Multivariate analysis demonstrated that left atrial volume was a predictor of being freedom from AF recurrent [HR 0,96 (95% IC 0,95–0,99), p=0.003]. Major complications occurred more frequently in older patients, although without reaching statistical significance (4.8% (8) vs 2.9% (1); p=0.61), in the young there was only one complication that was pulmonary vein stenosis. Redo AF ablation rate was comparable between the two groups. Conclusion(s) Catheter ablation of AF in young adults is associated with higher 1-year success rates but similar long-term outcomes. The young patients tended to have lower rates of complications in comparison to the older population. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group, but further study may be needed to confirm this FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Table 1

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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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Circumferential pulmonary vein ablation with or without a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (9-year follow-up)

European Heart Journal ◽

10.1093/ehjci/ehaa946.0568 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Kettering

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

Pulmonary Vein Ablation ◽

Group A ◽

Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 240 patients (125 men, 115 women; mean age 70 years (SD ± 15 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96, 102 and 108 months after the ablation procedure. The long-term follow-up data was compared to 240 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-five out of 240 patients (22.9%) in group A and 58 out of 240 patients (24.2%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 108-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 135/240 patients (56.3%) in group A and in 111/220 patients (46.3%) in group B. In 73/240 patients (30.4%) in group A and 66/240 patients (27.5%) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 32 patients (13.3%) in group A, a recurrence of persistent atrial fibrillation (>48 hours) was revealed by the long-term recordings (group B: 63 patients (26.2%)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up. Funding Acknowledgement Type of funding source: None

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Long term follow up after catheter ablation of persistent atrial fibrillation using the "stepwise approach" with the attempted endpoint of atrial fibrillation termination

European Heart Journal ◽

10.1093/eurheartj/eht309.p4120 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4120-P4120

Author(s):

D. Schreiber ◽

H. Servatius ◽

B. Hoffmann ◽

J. Lueker ◽

A. Sultan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Stepwise Approach ◽

Long Term Follow Up

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Long-term observation of catheter ablation vs. pharmacotherapy in the management of persistent and long-standing persistent atrial fibrillation (CAPA study)

EP Europace ◽

10.1093/europace/euaa356 ◽

2020 ◽

Author(s):

Gang Wu ◽

He Huang ◽

Lin Cai ◽

Yanzong Yang ◽

Xu Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Controlled Trial ◽

Persistent Atrial Fibrillation ◽

Primary Endpoints ◽

Ischaemic Attack ◽

Long Term Observation ◽

New Onset

Abstract Aims The roles of radiofrequency catheter ablation (RFCA) and pharmacotherapy in treating persistent and long-standing persistent atrial fibrillation (AF) have not been sufficiently investigated. We conducted a multicentre, randomized, controlled trial to compare the effects of RFCA and pharmacotherapy on the prognosis of these patients. Methods and results A total of 648 patients with persistent and long-standing persistent AF were enrolled from 30 centres and randomized to either the ablation group (n = 327) or the pharmacotherapy group (n = 321). After 54.2 ± 10.6 months of follow-up, the primary endpoints occurred significantly more rarely in the ablation group than in the pharmacotherapy group (10.4% vs. 17.4%; hazard ratio 0.59, 95% confidence interval 0.48–0.75; P < 0.001). The incidence of stroke/transient ischaemic attack (TIA) was significantly lower in the ablation group (4.2% vs. 7.2%, P < 0.001). Likewise, the incidence of new-onset congestive heart failure (CHF) was lower in the ablation group (2.8% vs. 7.2%, P < 0.001). More patients had sinus rhythm in the ablation group than in the pharmacotherapy group (60.6% vs. 20.9%, P < 0.001), but fewer patients were on antiarrhythmic drugs (24.4% vs. 41.6%, P < 0.001) and warfarin (60.8% vs. 83.9%, P = 0.001). Both the 6-min walk distance and the quality of life (QoL) were improved in the ablation group at the end of follow-up. Conclusion In patients with persistent and long-standing persistent AF, RFCA-based treatment was superior to pharmacotherapy in decreasing stroke/TIA and new-onset CHF and improving QoL.

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Optimal Substrate Modification Strategies using Catheter Ablation in Patients with Persistent Atrial Fibrillation: 3‐Year Follow‐up Outcomes

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.15033 ◽

2021 ◽

Author(s):

Yu Cheng Hsieh ◽

Yenn Jiang Lin ◽

Men Tzung Lo ◽

Yun Yu Chen ◽

Chin Yu Lin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Substrate Modification

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

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab138 ◽

2021 ◽

Author(s):

Igor Belluschi ◽

Elisabetta Lapenna ◽

Davide Carino ◽

Cinzia Trumello ◽

Manuela Cireddu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Confidence Interval ◽

Paroxysmal Atrial Fibrillation ◽

Left Ventricular ◽

Class I ◽

Long Term Results ◽

Left Ventricular Ejection ◽

Af Recurrence

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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