Sex differences in atrial fibrillation ablation outcomes: insights from a large-scale multicentre registry

EP Europace ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. 1345-1357 ◽  
Author(s):  
Nobuaki Tanaka ◽  
Koichi Inoue ◽  
Atsushi Kobori ◽  
Kazuaki Kaitani ◽  
Takeshi Morimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Sex Differences ◽  
Clinical Outcomes ◽  
Large Scale ◽  
De Novo ◽  
Long Term Follow Up ◽  
Af Recurrence

Abstract Aim The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We investigated the sex differences regarding the efficacy and clinical outcomes of RFCA of AF. Methods and results We conducted a large-scale, prospective, multicentre, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centres (64 ± 10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. Female patients (n = 1369, 27.3%) were older (female vs. male, 68 ± 9 vs. 63 ± 11 years, P < 0.0001) with a lower prevalence of non-paroxysmal AF (27.1% vs. 38.9%, P < 0.0001). Fewer females experienced time-dependent pulmonary vein (PV) reconnections and more females received a non-PV foci ablation than males in the index RFCA. The 3-year cumulative incidence of AF recurrences in the multivariate analysis after single procedures was significantly higher in females than males (43.3% vs. 39.0%, log rank P = 0.0046). Females remained an independent predictor of AF recurrence (hazard ratio 1.24; 95% confidence interval 1.12–1.38, P < 0.0001). The AF recurrence rates after multiple procedures were also higher in females, but fewer females experienced PV reconnections during second sessions. More females experienced de novo pacemaker implantations during the long-term follow-up. Females were associated with a higher risk of heart failure hospitalizations and major bleeding after RFCA in the multivariate analysis. Conclusions Females experienced more frequent AF recurrences probably due to non-PV arrhythmogenicity and de novo pacemaker implantations than males during the long-term follow-up after RFCA of AF.

P1913Implantable Loop Recorder Detected Pattern of Atrial Fibrillation Recurrence Following Cryoballoon Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Musat ◽  
N Milstein ◽  
R Shaw ◽  
A Bhatt ◽  
M Preminger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Limited Data ◽  
Loop Recorder ◽  
Long Term Follow Up ◽  
Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is increasingly being used in patients (pts) with persistent atrial fibrillation (AF). However, there are limited data about the pattern of atrial fibrillation (AF) recurrence in these pts. Objective To assess, using an implantable loop recorder (ILR), the patterns of AF recurrence following CB PVI in pts with persistent atrial fibrillation. Methods We enrolled consecutive pts with persistent AF ablation undergoing their first CB ablation. Other cavotricuspid isthmus ablation when indicated, no other ablation was performed. A Reveal LINQ ILR (Medtronic) was implanted <3 months following ablation; all pts had a minimum of 1-year follow-up. The recurrence of any atrial arrhythmia was determined and adjudicated; 4 distinct AF patterns were characterized (Figure). Results We studied 64 pts (66±9 years; 50 [78%] male; CHA2DS2-VASc 2.6±1.9) with persistent AF; 52 (81%) pts were on an antiarrhythmic drug (AAD) peri-ablation. During 803±361 days of follow-up, 33 (52%) pts had their 1st AF recurrence 91–365 days post-ablation and another 17 (27%) pts had their 1st AF recurrence >365 days post-ablation. No AF was seen in 14 (31%) pts. Most pts (33 of 50, 66%) with AF recurrence presented with 1 of 3 distinct patterns of paroxysmal AF (Figure), which ranged from 22 min to 124 hours. In 2/3 of these pts, all AF recurrences lasted <24 hours. Only 17 (34%) pts recurred with persistent AF. Conclusion Following single CB PVI, most pts with persistent AF remained free of persistent AF during long-term follow-up. Most pts with recurrent AF have 1 of 3 distinct patterns with episodes commonly last <24 hours. These data suggest that CB PVI ablation may halt AF progression in pts initially presenting with persistent AF.

scholarly journals Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients’ Age: Results from a Large Real-World Multicenter Observational Project

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Luigi Sciarra ◽  
Saverio Iacopino ◽  
Giuseppe Arena ◽  
Claudio Tondo ◽  
Paolo Pieragnoli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Real World ◽  
Age Groups ◽  
Cryoballoon Ablation ◽  
Efficacy And Safety ◽  
Long Term Follow Up ◽  
High Degree ◽  
Af Recurrence

Background. The real-world efficacy and safety of atrial fibrillation (AF) ablation in particularly young and elderly patients are still under debate. The aim of the analysis was to investigate the effect of age on the efficacy and safety of cryoballoon ablation (CBA). Methods. 2,534 patients underwent pulmonary vein isolation (PVI) by way of CBA for paroxysmal or persistent drug-resistant and symptomatic AF. The population was divided into age quartiles for evaluation, including (1) <53 years, (2) ≥53 and <61 years, (3) ≥61 and <67 years, and (4) ≥67 years. Furthermore, outcomes were analyzed in patients <41 years, ≥41 and ≤74, and >74 years old. Procedural data and complications were collected, and atrial fibrillation recurrences were evaluated during follow-up. Results. Procedural-related complications (4.1%) were similar in the four subgroups according to age. At the 12-month follow-up, freedom from AF recurrence was 79.2%, 77.4%, 76.8%, and 75.2% ( p = 0.21 ), respectively (with increasing age). At 24-month follow-up, similar incidences of AF recurrence were observed in the four subgroups. When the sample was arbitrarily divided into the three age groups, a higher rate of recurrence was observed in older patients with regard to long-term follow-up (freedom from AF recurrence was 71.8% and 40.9%, respectively, at 12 and 24-month follow-up). In the univariate and multivariate analysis, age did not result in a significant predictor of AF recurrence during follow-up; however, a trend toward higher AF recurrences rates in patients ≥67 years was observed. Conclusion. The data demonstrated a high degree of safety during CBA across all patient ages. Procedural performance and complications were similar between different ages; AF recurrences seem to be more frequent in patients over 74 years.

Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318282
Author(s):  
Hui-Nam Pak ◽  
Je-Wook Park ◽  
Song-Yi Yang ◽  
Min Kim ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Paroxysmal Atrial Fibrillation ◽  
De Novo ◽  
Volume Index ◽  
Registration Number ◽  
Second Procedure ◽  
Fat Volume

ObjectiveThe risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures.MethodsAmong 3282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5±10.3 years old, 61.5% with paroxysmal atrial fibrillation) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications and long-term clinical recurrences after propensity score matching.ResultsLA volume index (43.1±18.6 vs 35.8±11.6 mL/m2, p<0.001) was higher, but LA dimension (40.0±6.8 vs 41.6±6.3 mm, p=0.018), LA voltage (0.94±0.55 vs 1.20±0.68 mV, p=0.002) and pericardial fat volume (89.5±43.1 vs 122.1±53.9 cm3, p<0.001) were lower in women with repeat ablation than in their male counterparts. Pulmonary vein (PV) reconnections were lower (58.7% vs 74.9%, p=0.001), but the proportion of extra-PV triggers (27.5% vs 17.0%, p=0.026) and elevated LA pulse pressures (79.7% vs 63.7%, p=0.019) was significantly higher in women than in men. There was no significant sex difference in the rate of procedure-related complications (4.6% vs 4.2%, p=0.791). During a 31-month (8–60) median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log-rank p=0.039, antiarrhythmic drug (AAD)-free log-rank p<0.001) and the second procedure (log-rank p=0.006, AAD-free log-rank p=0.093). Female sex (HR 1.51, 95% CI 1.06 to 2.15, p=0.023), non-paroxysmal atrial fibrillation (HR 1.78, 95% CI 1.30 to 2.34, p<0.010) and extra-PV triggers (HR 1.88, 95% CI 1.28 to 2.75, p=0.001) were independently associated with clinical recurrences after repeat procedures.ConclusionsDuring repeat AFCA procedures, PV reconnections were lower in women than in men, and the existence of extra-PV triggers and an LA pressure elevation were more significant, which resulted in poor rhythm outcomes.Trial registration numberNCT02138695.

scholarly journals Sex differences in mapping and rhythm outcomes of a repeat atrial fibrillation ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
HN Pak ◽  
JW Park ◽  
SY Yang ◽  
M Kim ◽  
HT Yu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
De Novo ◽  
Volume Index ◽  
Related Complication ◽  
Funding Sources ◽  
Second Procedure ◽  
Fat Volume

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The risk of procedure-related complications and rhythm outcomes differ between men and women after atrial fibrillation catheter ablation (AFCA). We evaluated whether consistent sex differences existed in mapping and rhythm outcomes in repeat ablation procedures. Methods Among 3,282 patients in the registry, we analysed 443 consecutive patients (24.6% female, 58.5 ± 10.3 years old, 61.5% paroxysmal AF) who underwent a second AFCA. We compared the clinical factors, mapping, left atrial (LA) pressure, complications, and long-term clinical recurrences after propensity score matching. Results The LA volume index (43.1 ± 18.6 vs. 35.8 ± 11.6 ml/m2, p &lt; 0.001) was higher, but LA dimension (40.0 ± 6.8 vs. 41.6 ± 6.3mm, p = 0.018), LA voltage (0.94 ± 0.55 vs. 1.20 ± 0.68 mV, p = 0.002), and pericardial fat volume (89.5 ± 43.1 vs. 122.1 ± 53.9 cm3, p &lt; 0.001) lower in women with a repeat ablation than in their male counterparts. The pulmonary vein (PV) reconnections were lower (58.7% vs. 74.9%, p = 0.001), but the proportion of extra-PV triggers (27.5% vs. 17.0%, p = 0.026) and elevated LA pulse pressures (79.7% vs. 63.7%, p = 0.019) was significantly higher in women than men. There was no significant sex difference in the procedure-related complication rate (4.6% vs. 4.2%, p = 0.791). During a 31(8∼60) month median follow-up, clinical recurrences were significantly higher in women after both the de novo procedure (log rank p = 0.039, antiarrhythmic drug [AAD]-free log rank p &lt; 0.001) and second procedure (log rank p = 0.006, AAD-free log rank p = 0.093). A female sex (HR 1.51 [1.06-2.15], p = 0.023), non-paroxysmal AF (HR 1.78 [1.30-2.34], p &lt; 0.010), and extra-PV triggers (HR 1.88 [1.28-2.75], p = 0.001) were independently associated with clinical recurrences after repeat procedures. Conclusions During the repeat AFCA procedures, PV reconnections were lower in women than men, and the existence of extra-PV triggers and an LA pressure elevation was more significant, which resulted in poor rhythm outcomes.

Long‐Term Follow‐Up of a Patient with a De Novo p. Arg769Cys Mutation in the ATP1A3 Gene

2021 ◽  
Author(s):  
Anjali Chouksey ◽  
Asish Vijayaraghavan ◽  
Sony Mohan ◽  
Srija Inturi ◽  
A.T. Prabhakar ◽  
...  
Keyword(s):  
De Novo ◽  
Long Term Follow Up ◽  
Atp1a3 Gene

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

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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