Impact of the ablation technique on release of the neuronal injury marker S100B during pulmonary vein isolation

Abstract Aims S100B, a well-known damage-associated molecular pattern protein is released acutely by central and peripheral nerves and upon concomitant denervation in pulmonary vein isolation (PVI). We aimed to investigate whether the ablation technique used for PVI impacts S100B release in patients with paroxysmal atrial fibrillation (AF). Methods and results The study population consisted of 73 consecutive patients (age: 62.7 ± 10.9 years, 54.8% males) undergoing first-time PVI with either radiofrequency (RF; n = 30) or cryoballoon (CB; n = 43) for paroxysmal AF. S100B determined from venous plasma samples taken immediately before and after PVI increased from 33.5 ± 1.8 to 91.1 ± 5.3 pg/mL (P < 0.0001). S100B release in patients undergoing CB-PVI was 3.9 times higher compared to patients with RF-PVI (ΔS100B: 21.1 ± 2.7 vs. 83.1 ± 5.2 pg/mL, P < 0.0001). During a mean follow-up of 314 ± 186 days, AF recurrences were observed in 18/71 (25.4%) patients (RF-PVI: n = 9/28, CB-PVI: n = 9/43). Univariate Cox regression analysis indicated that an increase in S100B was associated with higher freedom from AF in follow-up (hazard ratio per 10 pg/mL release of S100B: 0.83; 95% confidence interval: 0.72–0.95; P = 0.007). Conclusion The ablation technique used for PVI has an impact on the release of S100B, a well-established biomarker for neural damage.

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P2849Prevalence and significance of sustained pulmonary vein isolation in repeat AF ablation procedures

European Heart Journal ◽

10.1093/eurheartj/ehz748.1158 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D J Nascimento Matos ◽

D Cavaco ◽

G Rodrigues ◽

J Carmo ◽

M S Carvalho ◽

...

Keyword(s):

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Cox Regression ◽

Vena Cava ◽

Cox Regression Analysis ◽

Af Ablation ◽

Rf Applications ◽

The Right ◽

Af Recurrence

Abstract Introduction Pulmonary vein (PV) reconnection is a common cause of relapse after catheter ablation of atrial fibrillation (AF). However, some patients have AF recurrence despite durable PV isolation. The aim of this study was to assess the PV isolation status at the time of a second catheter ablation (redo) procedure, and its relationship with subsequent AF relapse. Methods Consecutive patients with symptomatic drug-resistant AF who underwent redo procedures from January 2006 to December 2017 were identified in a single-center observational registry. Pulmonary vein isolation status was assessed during the electrophysiologic study with a circular mapping catheter. Additional radiofrequency (RF) energy applications were also recorded. AF relapse was defined as symptomatic or documented AF/atrial tachycardia/atrial flutter after a 3-month blanking period. Results We identified 240 patients (77 [32%] females, median age 61 [IQR 53–67] years, 85 [35%] with non-paroxysmal AF) undergoing redo procedures during the study period. At the time of redo, 17 (7%) of the patients presented bidirectional conduction block of all PVs. PV reconnection occurred in 157 (65%) of cases in the left superior vein, 142 (59%) in the left inferior vein, 177 (73%) in the right superior vein, and 163 (68%) in the right inferior vein (table). All of the PVs were reconducted in 91 (38%) patients. Additional RF applications were performed in the left atrium (LA) roof, LA posterior wall, cavotricuspid isthmus, mitral isthmus, superior vena cava, coronary sinus, and left atrial appendage ostium, at the operator's discretion (table 1). Over a median follow-up of 2-years (IQR 1–5), 126 patients (53%) suffered AF recurrence, yielding a mean relapse rate of 17%/year. In multivariate Cox regression analysis, the lack of PV reconnection at the time of redo emerged as an independent predictor of subsequent relapse (HR 1.97, 95% CI 1.12–3.49, p=0.019) even after adjustment for univariate predictors including non-paroxysmal AF, body mass index, female sex, and active smoking. Conclusion In patients undergoing redo AF ablation procedures, less than 10% present with complete PV isolation. Despite being relatively infrequent, this finding is independently associated with greater likelihood of subsequent recurrence, suggesting that other mechanisms, not fully addressed by additional RF applications, are at play.

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Abstract 131: Cognitive Impairment Predicts Mortality in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.131 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Howard Lan ◽

Lee Ann Hawkins ◽

Helme Silvet

Keyword(s):

Heart Failure ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Study Population

Introduction: In our previously published study, we evaluated a Veteran cohort of 250 outpatients with heart failure (HF) and found 58% (144 of 250) incidence of previously undiagnosed cognitive impairment (CI). Previous studies have suggested that HF patients with CI have worse clinical outcomes including higher mortality but this has not been studied in the Veteran population. Methods: Current study was designed to prospectively follow this cohort of 250 patients. Cognitive function was previously evaluated in all patients at baseline using the St. Luis University Mental Status (SLUMS) exam. The primary outcome for this follow-up study was all-cause mortality. Data analysis including Cox regression analysis and Kaplan-Meier curves were generated using SPSS. Results: The study population was predominantly Caucasian (72%, 179 of 250) and male (99%, 247 of 250) with mean age of 69 ± 10 years. Mean follow up was 31 ± 11 months. During follow up, 26% (64 of 250) of patients died. Univariate and multivariate Cox proportional hazards regression analyses were performed and shown in Table 1. Using the SLUMS score, subjects were stratified into three groups: no CI (42%, 106 of 250), mild CI (42%, 104 of 250), and severe CI (16%, 40 of 250). Kaplan-Meier survival curves were generated to compare the three CI groups in Figure 1. Conclusion: Current study demonstrates that CI is an independent risk factor for mortality in outpatient HF patients. This is an important finding because CI is commonly unrecognized in this vulnerable population. Routine CI screening could help to identify those who are at greater risk for worse outcomes. Future studies are needed to derive possible interventions to improve outcomes in these patients.

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MO820INTRACELLULAR WATER BEFORE HEMODIALYSIS PREDICTS ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Robert Ekart ◽

Gasper Keber ◽

Nina Vodošek Hojs ◽

Eva Jakopin ◽

Nejc Piko ◽

...

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Cox Regression ◽

Volume Status ◽

Dialysis Patients ◽

Cox Regression Analysis ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Before And After

Abstract Background and Aims Several factors may be responsible for the increased mortality in dialysis patients, but volume overload is considered among the main mechanisms of this association. Volume status is usually estimated using clinical criteria, i.e., patien's signs and symptoms, peridialytic blood pressure measurements, and intradialytic hemodynamic instability. Bioimpedance analysis (BIA) is another way to measure volume status in dialysis patients. BIA can measure overhydration (OH), extracellular water (ECW), intracellular water (ICW) and ECW/ICW ratio. The aim of our study was to analyze the role of BIA parameters before and after hemodialysis (HD) on all-cause mortality. Method Eighty-three patients (mean age 64.2 years; 51 men) on maintenance HD were included. BIA was performed and blood pressure was measured before and after the HD session. Patients were followed for assigned time, until transplantation or death. The mean follow-up time was 1181±564 days. Results Descriptive statistics of our patients are shown in Table 1. During the follow-up period, 6 (7.2%) patients were transplanted and 39 (47%) patients died. Univariate Cox regression analysis showed that only ICW before HD was a significant predictor of all-cause mortality (HR=1.089; 95%CI: 1.01-1.17, p=0.018). OH, ECW, ECW/ICW ratio before and after HD and ICW after HD were not associated with survival. In multivariate Cox regression analysis including ICW before dialysis, age, dialysis vintage, pulse pressure before HD, hemoglobin, CRP and serum albumin, ICW before dialysis was an independent predictor of all-cause mortality (HR=1.102; 95%CI: 1.01-1.20, p=0.029) (Table 2). Conclusion ICW before HD predicts all-cause mortality in HD patients.

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P1922Ablation index-guided ablation versus second-generation cryoballoon for first pulmonary vein isolation in atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0669 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Felix-Oliveira ◽

J Carmo ◽

P Carmo ◽

D Cavaco ◽

A Fontes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Cox Regression ◽

Accurate Estimation ◽

Phrenic Nerve Palsy ◽

Recent Trial ◽

Baseline Characteristics

Abstract Background In a recent trial, cryoballoon (CB) ablation was non-inferior to radiofrequency ablation regarding effectiveness in atrial fibrillation (AF). Ablation index (AI) provides a more accurate estimation of ablation quality using three variables: power delivered with time, contact force and catheter stability. The additional benefit of AI-guided ablation versus CB ablation is unknown. Objective To compare AI-guided ablation and CB ablation for first pulmonary vein isolation (PVI) in patients with AF. Methods We assessed 141 patients (62±12 years old, 76 men and 126 paroxysmal AF) with drug refractory symptomatic AF submitted to AI-guided PVI or second-generation CB catheter. Endpoint was AF/AT/AFL recurrence after a 3-month blanking period with a minimum follow-up of 6 months. Cox regression was used to assess the relationship between type of ablation and AF recurrence. Results Fifty-seven patients underwent AI-guided PVI and 84 patients underwent CB ablation. The baseline characteristics are described in table 1. Procedure duration was significantly higher in AI group (150 vs 111 min, P<0.001) although requiring significant less fluoroscopy time (5 min vs 20 min; P<0.001). There was a transient phrenic nerve palsy in CB group and a cardiac tamponade in AI group. During a mean follow-up of 10±3 months there were 23 recurrences (27%) in CB group vs 7 recurrences (12%) in AI group (log rank 0.042) (Fig B). When adjusted for CHA2DS2-VASc score, left atrium diameter (mm) and type of AF (Cox regression), there was lower arrhythmia recurrence in AI group (HR 0.42; 95% CI 0.18–0.99; p=0.047). Table 1. Baseline characteristics Conclusion In this analysis, AI-guided ablation was associated with lower arrhythmia recurrence when compared with CB ablation. This hypothesis should be further evaluated in a prospective randomized trial.

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Predictive factors for recurrent febrile seizures in children

Paediatrica Indonesiana ◽

10.14238/pi52.6.2012.317-23 ◽

2012 ◽

Vol 52 (6) ◽

pp. 317

Author(s):

Pengekuten Marudur ◽

Elisabeth Herini ◽

Cahya Dewi Satria

Keyword(s):

Predictive Factors ◽

Febrile Seizure ◽

Cox Regression ◽

Febrile Seizures ◽

Cox Regression Analysis ◽

First Degree Relatives ◽

History Of ◽

First Recurrence ◽

First Time

Background One􀁡third of children who experience febrile seizureshave a recurrence, '\.Vith rates of75% in the first year, and 90% mthinthe second year following the first febrile seizure. Predictive factorsfor recurrent febrile seizures have been reported in studies from othercountries, but there have been few of these studies in Indonesia.Objective To determine predictive factors for the recurrence offebrile seizures in children.Methods Children w i t h first􀁡time febrile seizures wereprospectively followed up, for at least 12 months. Subjects wererecruited consecutively from August 2008 to April 20 1 0 from twohospitals in Yogyakarta and one hospital in Klaten. We monitoredrecurrences of febrile seizure by telephone or home visits to parentsevery 3 months. Time to first recurrence of febrile seizures wasanalyzed using the Cox regression model.Results T here were 196 children v,ith first􀁡time febrile seizures whocompleted the follow up. Recurrent seizures were observed in 56children (28.6%). Me811 follow up time was 21.7 (SD 6.6) months.Temperature of <40"C at the time of seizure (RR=2.29, 95%CI 135to 3.89, P=0.OO2), history of febrile seizures in first􀁡degree relatives(RR=330, 95%CI 1.25 to 8.08, P<O.OOl), age at first febrile seizureof <12 months (RR􀁢2.40, 95%CI 1.42 to 4.06, P􀁢O.OOI) andduration of fever before the seizure of:51 hour (RR=4.62, 95%CI:1.35 to 15.80, P=0.015) were significantly associated v,ith recurrenceof febrile seizures. Furthermore, Cox regression analysis revealedthat the age of < 12 months, history of febrile seizures in first􀁡degreerelatives and temperature of < 40" C were significantpredictive factorsfor the recurrence of febrile seizures.Conclusion Age at first seizure of < 12 months, history of febrileseizures in first􀁡degree relatives, and seizure v,ith temperature of<40"C were independent predictive factors for recurrent febrileseizures in children. [Paediatr lndones. 2012;52:317,23].

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High-sensitivity cardiac Troponin T delta concentration after repeat pulmonary vein isolation

Biochemia Medica ◽

10.11613/bm.2019.020902 ◽

2019 ◽

Vol 29 (2) ◽

pp. 407-412

Author(s):

Ivan Zeljkovic ◽

Sven Knecht ◽

Christian Sticherling ◽

Michael Kühne ◽

Stefan Osswald ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Cardiac Troponin ◽

Troponin T ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cox Regression Analysis ◽

Prognostic Power ◽

Af Recurrence

Introduction: Difference between high-sensitivity cardiac troponin T concentrations (hs-cTnT) before and after ablation procedure (delta concentration) reflects the amount of myocardial injury. The aim of the study was to investigate hs-cTnT prognostic power for predicting atrial fibrillation (AF) recurrence after repeat pulmonary vein isolation (PVI) procedure. Materials and methods: Consecutive patients with paroxysmal AF undergoing repeat PVI using a focal radiofrequency catheter were included in the study. Hs-cTnT was measured before and 18-24 hours after the procedure. Standardized 3, 6 and 12-month follow-up was performed. Cox-regression analysis was used to identify predictors of AF recurrence. Results: A total of 105 patients undergoing repeat PVI were analysed (24% female, median age 61 years). Median (interquartile range) hs-cTnT delta after repeat PVI was 283 (127 - 489) ng/L. After a median follow-up of 12 months, AF recurred in 24 (23%) patients. A weak linear relationship between the total radiofrequency energy delivery time and delta hs-cTnT was observed (Pearson R2 = 0.31, P = 0.030). Delta Hs-cTnT was not identified as a significant long-term predictor of AF recurrence after repeated PVI (P = 0.920). Conclusion: This was the first study evaluating the prognostic power of delta hs-cTnT in predicting AF recurrence after repeat PVI. Delta hs-cTnT does not predict AF recurrence after repeat PVI procedures. Systematic measurement of hs-cTnT after repeat PVI does not add information relevant to outcome.

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P435Reproducibility and predictive value of a simple novel method to measure pulmonary vein activity in persistent atrial fibrillation FARS AF CL study

EP Europace ◽

10.1093/europace/euaa162.345 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

F Spera ◽

M Rodriguez-Manero ◽

A Baluja ◽

P Mortelmans ◽

J Saenen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Cycle Length ◽

Cox Regression ◽

Vena Cava ◽

Morphological Characteristics ◽

Right Atrial ◽

Simple Method ◽

Cox Regression Analysis

Abstract Funding Acknowledgements No disclosure Introduction. Pulmonary vein (PV) firing can trigger or act as a rapid driver to maintain atrial fibrillation (AF). Automated 1-minute measurement of fragmented and non-fragmented PV activity cycle length (CL) showed contradictory results to predict ablation outcome in persistent AF. Purpose. This study investigated the reproducibility of a novel non-automated simple method to measure non-fragmented fastest discrete consecutive AF signal cycle length and the value of this measurement in the PVs to predict long-term success after pulmonary vein isolation (PVI) only ablation in persistent AF. Methods. Consecutive 75 patients with persistent AF undergoing first-time PVI between 2015 and 2018 were included. The mean of 10 FAstest Repetitive Similar morphology discrete signal cycle lengths (FARS-AF CL) were measured twice with > 2 minutes between in the coronary sinus (CS), superior vena cava (SVC), left and right atrial appendage (LAA, RAA) and PVs. FARS discrete AF signals were defined as (I) signal duration ≤80 msec; (II) repetitive similar morphological characteristics; (III) fastest consecutive 10 intervals during 1-minute observation. The reproducibility of the FARS–AF CL measurement was compared to traditional 10 consecutive interval measurements of fragmented CS signals. The CL gradient between the PV and the LA was quantified by the computing the ratio of the PV and LAA or CS CL. Results. Good correlation was found between two FARS CL measurements in the CS, PVs, LAA and RAA (Correlation Kendall area: 0.882, 0.675-0.941, 0.859, 0.944, respectively). The correlation between two traditional CL measurements of fragmented CS signals was low (Correlation Kendall area:-0.006). After a mean follow-up of 20 months, freedom from atrial arrhythmias was achieved in 50 (66%) patients after the single PVI procedure with or without the use of AADs. Patient without recurrence were more likely to have FARS CL ≤140 msec (8 vs. 42%, p= 0.002), higher FARS PV CL/LAA CL and FARS PV CL/CS CL ratio (96 ± 13% vs. 86 ± 23 %, p= 0.04; 95 ± 13% vs. 82 ± 22%, p= 0.036). Patients with recurrence at follow-up had more dilated left atria (LAVI: 44 ± 12 vs. 38 ± 9 ml/m2, p= 0.02; LA diameter: 49 ± 6 vs. 45 ± 6 mm, p= 0.01), less AF termination during the procedure (16 vs. 37%, p= 0.049) and less first pass isolation (44 vs. 68%, p= 0.04). Multivariable Cox regression analysis showed that LAVI (p = 0.035) and FARS-PV CL (0.011) were significant predictors of arrhythmia free survival. After adjusting for LAVI, FARS-PV CL remained a significant predictor of AF recurrence (p = 0.028). Conclusions. Traditional non-automated AF CL measurement of fragmented CS signals is poorly reproducible. FARS-AF CL measurements in the PVs, RA and LA structures are highly reproducible. FARS-AF CL measurement in the PVs could predict the success of PVI-only procedure in persistent AF independent of left atrial size.

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Abstract 17041: Outcomes After Atrial Fibrillation Ablation With and Without CTI Ablation: Insights From the UC San Diego AF Ablation Registry

Circulation ◽

10.1161/circ.142.suppl_3.17041 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Praneet S Mylavarapu ◽

Omar M Aldaas ◽

Chaitanya Malladi ◽

Florentino Lupercio ◽

Frederick Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

San Diego ◽

Atrial Arrhythmias ◽

Af Ablation ◽

Procedural Complications ◽

First Time

Introduction: Pulmonary vein isolation (PVI) is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. Several studies have examined short term outcomes, but none beyond several years post procedure. Methods: We performed a retrospective study of all patients who underwent first-time radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off anti-arrhythmic drugs (AAD). Results: Of 534 total patients, 63 (11.8%) underwent pulmonary vein isolation (PVI) without CTI ablation, 471 (88.2%) underwent PVI with CTI ablation. Median follow-up duration was 3.9 (0.4 - 6.8) years. CTI ablation did not improve freedom from atrial arrhythmias in those with either paroxysmal AF [Adjusted Hazard Ratio (AHR) 1.15 (95% CI 0.59-2.24) for CTI vs non-CTI ablation] or persistent AF [AHR 0.82 (95% CI 0.38-1.77) for CTI vs non-CTI ablation]. Among all patients, there were also no differences in procedural complications [AHR 1.09 (95% CI 0.33-3.62) for CTI vs. non-CTI ablation] or all-cause mortality [AHR 1.12 (95% CI 0.57-2.23) for CTI vs. non-CTI ablation]. Conclusion: In this registry analysis, prophylactic CTI ablation at the time of first PVI did not improve freedom from recurrent atrial arrhythmias at 5 years among those with paroxysmal or persistent AF as compared to PVI alone.

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P1401Electrophysiological findings during repeat procedures in patients exhibiting electrical isolation in all veins after an index cryoballoon procedure for paroxysmal atrial fibrillation

EP Europace ◽

10.1093/europace/euaa162.251 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

V Varnavas ◽

M Terasawa ◽

J Sieira ◽

J P Abugattas ◽

E Stroker ◽

...

Keyword(s):

Pulmonary Vein ◽

Cox Regression ◽

Statistical Significance ◽

Categorical Variables ◽

P Value ◽

Cox Regression Analysis ◽

Inferior Pulmonary Vein ◽

Superior Pulmonary Vein ◽

Electrophysiological Findings

Abstract Introduction The purpose of this study was to analyze and compare the electrophysiological findings in redo radiofrequency (RF)-ablation of AF in a series of patients with durable PV isolation (PVI) and with PV reconnection after index procedure with the second-generation cryoballon (CB). Methods and results A total of 132 patients (81 males, 60.7 ± 12.4 years) who underwent CB-A for paroxysmal AF (PAF) were enrolled. Indication for the redo procedure was symptomatic (PAF) in 83 (63%) and persistent AF (PeAF) or persistent regular atrial tachycardia (RAT) in 49 (37%). Seventy-five (57%) patients presented a PV reconnection (PV group), whereas 57 (43%) no PV reconnection (non-PV group). The non-PV group exhibited significantly more atrial flutters and non-PV foci than the PV group after induction protocol (67% vs. 36%, p = 0.003 and 51% vs. 24% p = 0.002, respectively) (Table 1). Twenty-two (29.3%) patients of the PV group and 20 (35%) patients of the non-PV group had AF/RAT recurrence after a mean follow-up of 12.5 ± 8 months. The survival analysis demonstrated no statistical significance in recurrence between the two groups (log rank p = 0.358). In the cox regression analysis only the AF/RAT recurrence in the blanking period could predict independently an AF/RAT relapse. Conclusions AF/RAT recurrence in patients after CB-A with durable PVI is significantly associated to atrial flutters and non-PV foci. No statistically different success rate regarding AF/RAT freedom was detected between PV and non-PV Group after redo RF-CA. Table 1. Electrophysiological findings PV Groupn = 75 non-PV Groupn = 57 p-value PV trigger (n of patients) 75(100) 0(0) <0.001 LSPV 29 (39) 0 (0) <0.001 LIPV 15 (20) 0 (0) <0.001 RSPV 27 (36) 0 (0) <0.001 RIPV 33 (44) 0 (0) <0.001 Atrial flutters (n of patients) 27 (36) 38 (67) 0.003 Roof-flutter 13 (17) 34 (60) 0.0001 Peri-mitral-flutter 9 (12) 20 (35) 0.003 Right flutter 13 (17) 5 (9) 0.2 Non-PV foci (n of patients) 18 (24) 29 (51) 0.002 Categorical variables are expressed as absolute and percentage (in brackets). LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.

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Effect of cervical curvature reduction after ACCF on adjacent segmental lesions

10.21203/rs.2.12934/v1 ◽

2019 ◽

Author(s):

Lifeng Li ◽

Na Li ◽

Jiahui Zhou ◽

Handong Li ◽

Xianping Du ◽

...

Keyword(s):

Cobb Angle ◽

Cox Regression ◽

Cervical Vertebrae ◽

Cervical Vertebra ◽

Adjacent Segment ◽

Short Term ◽

Cox Regression Analysis ◽

Significant Difference ◽

Before And After

Abstract Objective: To investigate the relationship of adjacent segment degeneration (RASP) and the variation of cervical curvature and vertebral height after Anterior Cervical Corpectomy and Fusion (ACCF). Methods: A retrospective analysis of 80 patients with cervical spondylotic myelopathy (CSM) who had been followed up for at least 1 year after ACCF. The patients were divided into RASP group and no RASP group according to whether the RASP occured after surgery. On the standing cervical lateral radiograph of all patients before and after surgery at the short-term and final follow-up, the C2-7 Cobb angle of the cervical vertebrae, the Cobb angle of the surgical segment and the height of the fusion segment for the anterior and posterior segments of the vertebral body were measured. The difference between the two groups of patients before and after surgery was calculated, as well as its correlation with the occurrence of RASP. Result: there were 37 patients in the RASP group and 43 patients in the no-RASP group. In RASP group, the short-term average curvature of cervical vertebra was significantly reduced after surgery. However, there was no significant difference in no RASP group. The height of the anterior and posterior fusion segments in two groups was significantly higher than that before surgery, however, which was significantly lower during the final follow-up than that in the short-term after surgery. Cox regression analysis showed that only the variation of postoperative C2-7Cobb angle was associated with RASP. Conclusion: The reduction of cervical curvature after ACF may be related to postoperative RASP. Maintaining good cervical curvature after operation may be expected to reduce the occurrence of RASP after ACF.

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