Predictive value of diabetes mellitus for freedom from arrhythmia recurrence after cryoballoon-guided pulmonary vein isolation

Abstract Funding Acknowledgements Type of funding sources: None. Background Diabetes mellitus (DM) has been identified to play an important role in the regulation of atrial fibrillation (AF). Data concerning the impact of DM on the development of individual arrhythmia substrates are still lacking. Purpose Therefore, the primary aim of this study was to examine the outcome of cryoballoon-guided pulmonary vein isolation (PVI) in patients (pts) suffering from DM and coexisting AF. Methods 523 consecutive pts undergoing initial PVI using the 2nd generation cryoballoon were analysed. 273 pts (52%) suffered from paroxysmal AF (PAF) (51 ± 23.2 years old, 26% female), 250 pts (48%) from persistent AF (PERS) (63.9 ± 10.0 years old, 30% female) and 69 pts (13%) were diagnosed with DM (68 ± 19.6 years old, 30% female). Follow-up (FU) visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of any atrial arrhythmia after a 3 months blanking period (> 30 sec.). Results Within the observation period of 12 months AF recurrence occurred in 29% (n = 151 pts). Regardless of the coincidence of DM, PAF pts were significantly younger than those with PERS (p = 0.001). PAF pts additionally suffering from DM presented with a significantly higher risk for arrhythmia recurrence (p = 0.047). Multivariate analyses verified DM as a strong independent predictor for arrhythmia recurrence associated with a > 4 fold higher risk for recurrence after ablation (p = 0.009, hazard ratio (HR) 4.363, confidence interval (CI) 1.46-13.07). PERS pts showed a slightly increased rate of arrhythmia recurrence when additional DM was diagnosed. In these patients multivariate analyses revealed that DM was associated with a 43% higher risk for arrhythmia recurrence (p = 0.321, HR 1.143, CI 0.59-2.22). Beyond that, severe gender disparities were observed with female gender as independent predictor for arrhythmia recurrence (p = 0.027*, HR 1.927, CI 1.079-3.440). Conclusions DM has relevant implication for arrhythmia recurrence after PVI. More distinct effects were observed in PAF patients following AF ablation. This could be related to more severe arrhythmia substrates in PAF pts suffering from DM compared to PAF pts without additional DM and even more substantial structural changes in PERS. Thus, individual paths in ablation management are required in these pts with AF and coexisting DM.

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The impact of substrate and trigger ablation for reduction of functional mitral regurgitation in patients with persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0477 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

T Watanabe ◽

T Yamada ◽

S Tamaki ◽

M Yano ◽

T Hayashi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Independent Predictor ◽

Persistent Atrial Fibrillation ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

The Impact

Abstract Background Functional mitral regurgitation (FMR) is not uncommon in atrial fibrillation (AF) patients. Left atrial (LA) substrate remodeling and corresponding mitral valve annulus dilation has been reported as the most possible cause of FMR. Percutaneous catheter ablation (CA) is an effective treatment for AF. Although significant FMR could be improved by sinus restoration, patients with mitral regurgitation were more likely to experience recurrent AF post ablation, especially those with significant mitral regurgitation. There is no information available on the efficacy of CA for persistent AF in patients with FMR. Purpose The purpose of this study is to investigate the predictors of FMR improvement by CA and to determine the efficacy of substrate and trigger CA for persistent AF in patients with FMR. Methods We prospectively studied 512 consecutive patients admitted for persistent AF ablation from the EARNEST-PVI (Prospective Multicenter Randomized Study of Effect of Extensive Ablation on Recurrence in Patients with Persistent Atrial Fibrillation Treated with Pulmonary Vein Isolation) trial. On admission, enrolled patients were randomly assigned in a 1:1 ratio to pulmonary vein isolation (PVI) or PVI-plus additional ablation (linear ablation or/and CFAE ablation). Of the 512 patients, we studied 94 patients with preoperative echocardiography showing moderate or greater baseline FMR. FMR grades were classified into 5 grades (0/1/2/3/4). The FMR improvement group (FMRI(+)) was defined as a case in which the FMR was improved by two or more grades compared the preoperative echocardiography and the one year follow-up examination. Results Of the 94 patients, 42 were in the PVI group and 52 were in the PVI-plus additional ablation group. There were 30 cases in the FMRI(+) group and 64 cases in the FMRI(−) group. There were no significant baseline differences in age, sinus rhythm maintenance, plasma B-type natriuretic peptide (BNP) level, left ventricular diastolic dimension, or left atrium dimension between the FMRI(+) and FMRI(−) groups. AF duration was significantly shorter in the FMRI(+) group than FMRI(−) groups (5.8±9.4 months vs 12.4±15.4 months, p<0.0001). In addition, significantly more additional ablation cases were observed in the FMRI(+) group than in the FMRI(−) group (73.3% vs 46.8%, p=0.016). In multivariate analyses, only additional ablation was an independent predictor of FMRI (odds ratio 0.226 95% CI 0.081–0.626; p=0.004). Conclusions Catheter ablation is a valid option for the treatment of AF in patients with functional MR and additional substrate and trigger ablation were the only independent predictor of FMR improvement. FUNDunding Acknowledgement Type of funding sources: None.

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Contrast Induced Nephropathy and Gender Variation

University Heart Journal ◽

10.3329/uhj.v6i1.7184 ◽

1970 ◽

Vol 6 (1) ◽

pp. 18-20

Author(s):

Md Abu Siddique ◽

Bikash Subedi ◽

Jahanara Arzu ◽

Quazi Arif Ahmed ◽

Anisul Awal ◽

...

Keyword(s):

Diabetes Mellitus ◽

Multivariate Analysis ◽

Independent Risk Factor ◽

Independent Predictor ◽

Female Gender ◽

Contrast Induced Nephropathy ◽

Percutaneous Interventions ◽

Male Patients ◽

And Gender ◽

The Impact

Contrast-induced nephropathy (CIN) is a recognized complication after percutaneous interventions (PCI). We sought to determine the impact of gender on incidence of CIN. Of a total 200 patients who underwent PCI, there were 33 (16.5%) who developed CIN (defined as > 25% rise in creatinine after PCI). CIN was present in 23.6% of female versus 17.4% of male patients (p < 0.0001). Multivariate analysis showed that female gender (p < 0.0001), pre-PCI chronic renal failure (CRF) (OR= 1.8, 95% CI = 1.53a€"2.10, p < 0.0001), diabetes mellitus (OR = 1.5, 95%, p < 0.0001), age (OR = 1.01, p < 0.0001), and hypertension (OR = 1.2, p = 0.0035) were independent predictors of CIN. By multivariate analysis only baseline CRF, diabetes, age, functional NYHA IV class were identified as independent risk factor for CIN. Female gender is an independent predictor of CIN development. Key words: Contrast-induced nephropathy; Percutaneous interventions; Serum Creatinine. DOI: 10.3329/uhj.v6i1.7184University Heart Journal Vol.6(1) 2010 pp.18-20

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The impact of left atrium size on selection of the pulmonary vein isolation method for atrial fibrillation: Cryoballoon or radiofrequency catheter ablation

American Heart Journal ◽

10.1016/j.ahj.2020.10.061 ◽

2021 ◽

Vol 231 ◽

pp. 82-92

Author(s):

Takashi Ikenouchi ◽

Osamu Inaba ◽

Tomomasa Takamiya ◽

Yukihiro Inamura ◽

Akira Sato ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Radiofrequency Catheter Ablation ◽

Isolation Method ◽

The Impact ◽

Left Atrium Size ◽

Selection Of

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Changes of QT interval in the acute phase after pulmonary vein isolation for paroxysmal atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0414 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Chikata ◽

T Kato ◽

K Ududa ◽

S Fujita ◽

K Otowa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Female Patient ◽

Pulmonary Vein Isolation ◽

Acute Phase ◽

Paroxysmal Atrial Fibrillation ◽

Qt Interval ◽

Qt Prolongation ◽

Qtc Interval ◽

The Impact

Abstract Introduction Pulmonary vein isolation (PVI) affects ganglionated plexi (GP) around the atrium, leading to a modification of the intrinsic cardiac autonomic system (ANS). In animal models, GP ablation has a potential risk of QT prolongation and ventricular arrhythmias. However, the impact of PVI on QT intervals in humans remains unclear. Purpose This study aims to evaluate the Impact of PVI on QT interval in patients with paroxysmal atrial fibrillation. Methods We analyzed consecutive 117 PAF patients for their first PVI procedures. 12-lead ECG was evaluated at baseline, 4 hr, day 1, 1 month, and 3 months after ablation. Only patients with sinus rhythm on 12-lead ECG at each evaluation point without antiarrhythmic drugs were included. Results Heart rate significantly increased at 4 hr, day 1, and 1 month. Raw QT interval prolonged at 4 hr (417.1±41.6 ms, P<0.001) but shortened at day 1 (376.4±34.1 ms, P<0.001), 1 month (382.2±31.5 ms, P<0.001), and 3 months (385.1±32.8 ms, P<0.001) compared to baseline (391.6±31.4 ms). Bazett- and Fridericia- corrected QTc intervals significantly prolonged at 4hr (Bazett: 430.8±27.9 ms, P<0.001; Fridericia: 425.8±27.4 ms, P<0.001), day1 (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 414.1±23.7 ms, P<0.001), 1M (Bazett: 434.8±22.3 ms, P<0.001; Fridericia: 408.2±21.0 ms, P<0.05), and 3M (Bazett: 420.1±21.8 ms, P<0.001; Fridericia: 407.8±21.1 ms, P<0.05) compared to baseline (Bazett: 404.9±25.2 ms; Fridericia: 400.0±22.6 ms). On the other hand, Framingham- and Hodges- corrected QTc interval significantly prolonged only at 4hr (Framingham: 424.1±26.6 ms, P<0.001; Hodges: 426.8±28.4 ms, P<0.001) and at day1 (Framingham: 412.3±29.3 ms, P<0.01; Hodges: 410.6±40.2 ms, P<0.05) compared to baseline (Framingham: 399.2±22.7 ms; Hodges: 400.7±22.8 ms). At 4 hr after ablation, raw QT and QTc of all formulas significantly prolonged than baseline. Raw QT and QTc prolongation at 4hr after ablation were more frequently observed in female patients. Multiple regression analysis revealed that female patient is a significant predictor of raw QT and QTc interval prolongation of all formulas 4hr after PVI. Conclusions Raw QT and QTc prolonged after PVI, especially in the acute phase. Female patient is a risk factor for QT prolongation in the acute phase after PVI. Funding Acknowledgement Type of funding source: None

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Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Bulgarian Cardiology ◽

10.3897/bgcardio.27.e71311 ◽

2021 ◽

Vol 27 (3) ◽

pp. 55-68

Author(s):

Svetla Dineva ◽

Milko Stoyanov ◽

Aneliya Partenova ◽

Boyan Kunev ◽

Victoria Stoyanova ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Local Population ◽

Venous Drainage ◽

Anatomical Variant ◽

Cox Regression Analysis ◽

Anatomical Variants ◽

The Impact ◽

Variant Anatomy ◽

Af Recurrence

Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial ﬁ brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signiﬁ cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after ﬁ rst pulmonary vein isolation.

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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

Cardiology Research and Practice ◽

10.1155/2016/8632509 ◽

2016 ◽

Vol 2016 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Paolo D. Dallaglio ◽

Timothy R. Betts ◽

Matthew Ginks ◽

Yaver Bashir ◽

Ignasi Anguera ◽

...

Keyword(s):

Atrial Fibrillation ◽

At Risk ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Waiting Time ◽

Critical Review ◽

Recurrence Rates ◽

The Impact ◽

Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

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Intraprocedural endpoints to predict durable pulmonary vein isolation: a randomized trial of four post-ablation techniques

EP Europace ◽

10.1093/europace/euz301 ◽

2019 ◽

Vol 22 (4) ◽

pp. 567-575 ◽

Cited By ~ 4

Author(s):

Ruhong Jiang ◽

Minglong Chen ◽

Bing Yang ◽

Qiang Liu ◽

Zuwen Zhang ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Af Ablation ◽

Group 4 ◽

Initial Procedure ◽

Group 2 ◽

Waiting Periods ◽

The Impact ◽

Af Recurrence

Abstract Aims The optimal procedural endpoint to achieve permanent pulmonary vein isolation (PVI) during ablation of atrial fibrillation (AF) remains unknown. We aimed to compare the impact of prolonged waiting periods and adenosine triphosphate (ATP) testing after PVI on long-term freedom from AF. Methods and results In total, 538 patients (median age 61 years, 62% male) undergoing first-time radiofrequency ablation for paroxysmal AF were randomized into four groups: Group 1 [PVI (no testing), n = 121], Group 2 (PVI + 30min waiting phase, n = 151), Group 3 (PVI+ATP, n = 131), and Group 4 (PVI + 30min+ATP, n = 135). The primary endpoint was freedom from AF. Repeat mapping to assess for late pulmonary vein (PV) reconnection was performed in patients who remained AF-free for >3 years (n = 46) and in those who had repeat ablation for AF recurrence (n = 82). During initial procedure, acute PV reconnection was observed in 33%, 26%, and 42% of patients in Groups 2, 3, and 4, respectively. At 36 months, no significant differences in freedom from AF recurrence were observed among all four groups (55%, 61%, 50%, and 62% for Groups 1, 2, 3, and 4, respectively; P = 0.258). Late PV reconnection was commonly observed, with a similar incidence between patients with and without AF recurrence (74% vs. 83%; P = 0.224). Conclusion Although PVI remains the cornerstone for AF ablation, intraprocedural techniques to assess for PV reconnection did not improve long-term success. Patients without AF recurrence after 3 years exhibited similarly high rates of PV reconnection as those that underwent repeat ablation for AF recurrence. The therapeutic mechanisms of AF ablation may not be solely predicated upon durable PVI.

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