QT as a predictor of recurrence after atrial fibrillation ablation and the impact of amiodarone: results from the placebo-controlled AMIO-CAT trial

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1055-1062 ◽  
Author(s):  
Søren Zöga Diederichsen ◽  
Stine Darkner ◽  
Xu Chen ◽  
Arne Johannessen ◽  
Steen Pehrson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Qt Interval ◽  
Atrial Tachycardia ◽  
Cox Regression ◽  
Drug Discontinuation ◽  
Short Term ◽  
Af Ablation ◽  
Amiodarone Treatment ◽  
The Impact

Aims Prolonged corrected QT interval (QTc) might be associated with arrhythmia recurrence after atrial fibrillation (AF) ablation. The effect of short-term amiodarone in this setting remains unknown. This study seeks to quantify short-term amiodarone’s impact on QTc, and to investigate QTc and amiodarone treatment as predictors of recurrence of arrhythmia after ablation. Methods and results The Short-term AMIOdarone treatment after CATheter ablation for atrial fibrillation (AMIO-CAT) trial randomized patients to 8 weeks of oral amiodarone or placebo following AF ablation. Scheduled and symptom-driven 12-lead electrocardiography and 3-day Holter-monitorings were performed. The endpoint was atrial fibrillation, atrial flutter or atrial tachycardia (AF/AT) lasting >30 s. The cut-off for prolonged QTc was 450 ms for men and 460 ms for women. A total of 212 patients were included, of which 108 were randomized to amiodarone and 104 to placebo. From baseline to 1 month QTc in the amiodarone group increased by 27 (±30) ms, while at 6 months QTc had normalized. After 3-months of blanking, new AF/AT recurrence was detected in 63% of patients with prolonged QTc vs. 41% of patients with normal QTc at baseline, and in multivariate Cox regression, prolonged QTc was associated with AF/AT recurrence [hazard ratio (HR) 2.19, P = 0.023]. Among patients with baseline QTc below median, amiodarone treatment decreased the rate of AF/AT recurrences (HR 0.43, P = 0.008). Conclusions Amiodarone increased QTc with 27 ms compared to placebo, and this effect decreased rapidly after drug discontinuation. Prolonged QTc at baseline independently predicted AF/AT recurrence, and baseline QTc identified patients who would possibly benefit from short-term amiodarone following ablation.

Abstract 16237: Zero Fluoroscopy Ablation of Atrial Fibrillation: A Safety and Feasibility Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Rodney Horton ◽  
Chintan Trivedi ◽  
Prasant Mohanty ◽  
Sanghamitra Mohanty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Radiation Risk ◽  
Control Group ◽  
Short Term ◽  
Af Ablation ◽  
And Control ◽  
Zero Fluoroscopy

Introduction: Radiofrequency catheter ablation of atrial fibrillation is performed under fluoroscopic guidance and therefore carries radiation risk exposure for the both the patient and the operator. Three-dimensional mapping systems and newer technologies to allow non-fluoroscopic catheter visualization together with intracardiac echo have reduced but not abolished the fluoroscopy exposure. We aim to demonstrate the feasibility, the safety and the efficacy of catheter ablation for atrial fibrillation without the use of fluoroscopy. Methods: A totally fluoro-less approach was developed for AF ablation at our Institution. 94 consecutive AF patients underwent zero fluoroscopy catheter ablation for atrial fibrillation. In the zero fluoroscopy cases, the fluoroscopy arm was kept far away from the patient table. Access including double trans-septal, mapping with the Carto 3 system and ablation were all performed without fluoroscopy with the use of ICE and the Carto 3 system. These 94 patients were compared with 94 control patients matched for age, sex and type of AF who underwent AF ablation by the same operator with the use of fluoroscopy. Results: Baseline characteristics were similar between fluoroless (N=94, Age=64.5 ± 10.1, 75.5% male, 48% paroxysmal) and control (N=94, Age=65.1 ± 9.9, 72.3% male, 50% paroxysmal) group. Non-PV triggers were detected and ablated in 51 (54.3%) and 56 (59.6%) patients in fluoroless and control group respectively (p=0.5). Average fluoro time in control group was 10.1 ± 4.7 minutes. Procedure duration was comparable (120.4 ± 25.8 vs. 122.2 ± 28.7, p =0.6). After the short term median follow-up of 4.5 (4 – 6.5) months, 10 (10.6 %) patients in flourless and 9 (9.6%) patients in control group experienced recurrences (p=0.8).One pericardial effusion requiring pericardiocenteis occurred in the fluoroless group. Conclusions: Our series show that zero fluoroscopy ablation of atrial fibrillation with the use of newer technologies is feasible, safe and efficacious at the short term follow up. Importantly in our series the double transeptal was performed without fluoroscopy and the ablation was not limited to the pulmonary veins only but included ablation of the posterior wall, the coronary sinus and the left atrial appendage.

scholarly journals 96-08: Short-term amiodarone treatment for atrial fibrillation after catheter ablation induces a transient thyroid dysfunction: Results from the placebo-controlled randomized AMIO-CAT trial

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i61-i61 ◽  
Author(s):  
Søren Zöga Diederichsen ◽  
Stine Darkner ◽  
Xu Chen ◽  
Arne Johannessen ◽  
Steen Pehrson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Thyroid Dysfunction ◽  
Short Term ◽  
Amiodarone Treatment

scholarly journals Impact of Sinus Rhythm Maintenance on Major Adverse Cardiac and Cerebrovascular Events after Catheter Ablation of Atrial Fibrillation: Insights from AF Frontier Ablation Registry

2021 ◽  
Author(s):  
Keisuke Usuda ◽  
Takeshi Kato ◽  
Toyonobu Tsuda ◽  
Hayato Tada ◽  
Satoru Niwa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Af Ablation ◽  
Multicenter Cohort ◽  
Cerebrovascular Events ◽  
The Impact ◽  
Sinus Rhythm Maintenance

Introduction: The impact of catheter ablation for atrial fibrillation (AF) on cardiovascular events and mortality is controversial. We investigated the impact of sinus rhythm maintenance on major adverse cardiac and cerebrovascular events after AF ablation from a Japanese multicenter cohort of AF ablation. Methods and Results: We investigated 2737 consecutive patients (25.6% female, mean age 63.4 ± 10.3 years) who underwent a first catheter ablation for AF from the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry). The primary endpoint was a composite of stroke, transient ischemic attack, cardiovascular events, and all-cause death. During a mean follow-up of 25.2 months, 2070 (75.6%) patients were free from AF after catheter ablation, and the primary composite endpoint occurred in 122 (4.5%) patients. The AF nonrecurrence group had a significantly lower incidence of the primary endpoint (1.7 per 100 person-years) compared with the AF recurrence group (3.2 per 100 person-years; P = 0.001). The multivariate analysis revealed that freedom from AF (hazard ratio 0.57; 95% confidence interval 0.39–0.83; P = 0.003) was independently associated with the incidence of the composite event.¬¬ Conclusion: In the multicenter cohort of AF ablation, sinus rhythm maintenance after catheter ablation was independently associated with lower rates of major adverse cardiac and cerebrovascular events.

scholarly journals Clinical Significance of B-Type Natriuretic Peptide Levels at 3 Months after Atrial Fibrillation Ablation

Diseases ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 49
Author(s):  
Sen Matsumoto ◽  
Yasuharu Matsunaga-Lee ◽  
Masashi Ishimi ◽  
Mamoru Ohnishi ◽  
Nobutaka Masunaga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Natriuretic Peptide ◽  
Roc Curve ◽  
Cox Regression ◽  
Significant Prognostic Factor ◽  
Cox Regression Analysis ◽  
Af Ablation ◽  
Increased Risk ◽  
The Impact

The role of B-type natriuretic peptide (BNP) levels as a predictor of arrhythmia recurrence (AR) after atrial fibrillation (AF) ablation remains unclear. In this study, we investigated the association of BNP levels before and 3 months after ablation with the risk of AR. A total of 234 patients undergoing their first session of AF ablation were included (68% male, mean age of 69 years). The cut-off value for discriminating AR was determined based on the maximum value of the area under the receiver operating characteristic (ROC) curve. The impact of BNP levels on AR was evaluated using Cox regression analysis. ROC curve analysis showed that the area under the curve for BNP at 3 months after the procedure was larger (0.714) compared to BNP levels before ablation (0.593). Elevated levels of BNP 3 months after the procedure (>40.5 pg/mL, n = 96) was associated with a higher risk of AR compared to those without elevated levels (34.4% vs. 10.9%, p < 0.01). Multivariate Cox regression analysis revealed that elevated BNP levels were associated with an increased risk of AR (hazard ratio 2.43; p = 0.014). Elevated BNP levels 3 months after AF ablation were a significant prognostic factor in AR, while baseline BNP levels were not.

Abstract 9955: Outcomes of Catheter Ablation of Atrial Fibrillation in Hypertrophic Cardiomyopathy Patients - A Pooled Analysis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Vivek Yarlagadda ◽  
Arun Kanmanthareddy ◽  
Parinita A Dherange ◽  
Pradyumna Agasthi ◽  
Arun Raghav Mahankhali Sridhar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Catheter Ablation ◽  
Pooled Analysis ◽  
High Rate ◽  
Af Ablation ◽  
Procedural Time ◽  
Ischemic Attack ◽  
Adjusted Incidence ◽  
The Impact

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM.) Aggressive rhythm control is recommended for this group of patients and radiofrequency catheter ablation is emerging as a frontline strategy. This pooled analysis aims to study the efficacy and outcomes of AF ablation in HCM patients Methods: PubMed, EMBASE and Google Scholar databases were searched to identify all studies describing the outcomes of catheter ablation of AF in HCM. Data from identified studies was extracted and pooled analysis was carried out using CMA 2 software. Pooled adjusted procedure duration and incident rates of recurrence and adverse events were calculated using random effects model. Results: A total of 11 studies with 384 patients were included in this study. For the index procedure, mean procedural time, radio frequency ablation and fluoroscopy times were 207.3 minutes, 39.7 minutes and 62.4 minutes respectively. The adjusted incidence of major ablation-related complications (death, stroke, transient ischemic attack, peripheral embolism, cardiac tamponade or perforation, valvular damage, arteriovenous fistula requiring surgical intervention, and a large vascular access site hematoma resulting in a drop of hemoglobin level by 2 g/dL) was 4 per 100 procedures (95% CI 2.1 - 7.5%). The recurrence of AF after index ablation during the mean follow up period of 14.5 months occurred in 58% (95% CI 50 -66%) of the patients (Figure1). Conclusion: The results of our analysis suggest that there is a high rate of recurrence of AF in HCM patients who undergo single AF ablation. The risk of complications with AF ablation appears to be low in this group of patients. Further studies are needed to assess the impact of multiple ablations on long term outcomes in these patients.

P5650Improvement in ejection fraction predicts heart failure after catheter ablation for atrial fibrillation in patients with left ventricular systolic dysfunction: from the KPAF registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Fujimoto ◽  
N Doi ◽  
K Hirai ◽  
M Naito ◽  
S Shizuta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Af Ablation ◽  
Study Population ◽  
The Impact

Abstract Introduction The presence of atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF) is associated with increased risks of mortality and hospitalization for heart failure (HF). Although prior studies reported that catheter ablation (CA) for AF in low LVEF patients reduced risks of all-cause mortality and HF hospitalization, the predictors of worsening HF after ablation has not been adequately evaluated. Purpose The purpose of this study was to investigate the impact of improvement in LVEF after AF ablation on the incidence of subsequent HF hospitalization in patients with low LVEF. Methods The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multicenter registry enrolling 5,013 consecutive patients undergoing first-time ablation for AF. The current study population consisted of 1,031 patients with reduced LVEF of <60%. We divided the study population into 3 groups according to LVEF at follow-up; 678 patients (65.8%) with improved LVEF (≥5 U change in LVEF), 288 patients (27.9%) with unchanged LVEF (−5 U ≤ change in LVEF <5 U) and 65 patients (6.3%) with worsened LVEF (<−5 U change in LVEF). Results During the median follow-up of 1067 [879–1226] days, patients improved LVEF had lower rate of HF hospitalization, compared with those with unchanged and worsened LVEF (2.1%, 8.0%, and 21.5%, respectively, P<0.0001). Recurrent atrial tachyarrhythmias were documented in 43.5%, 47.2% and 67.7%, respectively (P=0.0008). Figure 1 Conclusion Among patients with reduced LVEF undergoing AF ablation, patients with subsequently improved LVEF in association with maintained sinus rhythm had markedly lower risk of HF hospitalization during follow-up as compared with those with unchanged or worsened LVEF.

P985The long-term impact of maintaining sinus rhythm on the risk for death or heart failure after catheter ablation for atrial fibrillation in a real world clinical practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yoshizawa ◽  
H Shiomi ◽  
M Tanaka ◽  
T Aizawa ◽  
S Yamagami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
P Value ◽  
Af Ablation ◽  
Risk Of Death ◽  
The Impact ◽  
Af Recurrence

Abstract Background Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated. Purpose To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization. Methods The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation. Results Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P<0.001). After adjusting for baseline confounders, the lower risk of SR-group relative to AF-group for death or HF was still statistically significant (HR: 2.05, 95% CI: 1.11–3.58, P=0.02). Risks for a Composite of Death or HF Hazard Ratio (95% CI) Crude HR P value Adjusted HR P value AF recurrence 2.59 (1.43–4.43) 0.002 2.05 (1.11–3.58) 0.02 Age>75 years old 2.55 (1.56–4.10) <0.001 2.32 (1.39–3.81) 0.002 Female 0.85 (0.49–1.43) 0.56 0.73 (0.40–1.25) 0.26 PeAF 1.25 (0.68–2.16) 0.45 0.98 (0.52–1.75) 0.94 LSAF 1.10 (0.46–2.23) 0.82 0.70 (0.28–1.53) 0.39 LVEF>50% 0.27 (0.16–0.48) <0.001 0.57 (0.31–1.09) 0.09 Past history of HF 7.06 (4.18–11.6) <0.001 4.67 (2.51–8.41) <0.001 CKD 4.74 (2.08–9.39) <0.001 2.23 (0.94–4.69) 0.07 AF, Atrial fibrillation; PeAF, Persistent AF; LSAF; Long standing AF; HF, Heart failure; CKD, Chronic kidney disease. Figure 1 Conclusions Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.

scholarly journals Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage?

2020 ◽  
Vol 9 (2) ◽  
pp. 54-60
Author(s):  
Yuan Hung ◽  
Shih-Ann Chen ◽  
Shih-Lin Chang ◽  
Wei-Shiang Lin ◽  
Wen-Yu Lin
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Medical Therapy ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
Pharmacological Management ◽  
Af Ablation ◽  
Density Mapping ◽  
The Past ◽  
Atrial Remodelling

With catheter ablation becoming effective for non-pharmacological management of AF, many cases of atrial tachycardia (AT) after AF ablation have been reported in the past decade. These arrhythmias are often symptomatic and respond poorly to medical therapy. Post-AF-ablation ATs can be classified into the following three categories: focal, macroreentrant and microreentrant ATs. Mapping these ATs is challenging because of atrial remodelling and its complex mechanisms, such as double ATs and multiple-loop ATs. High-density mapping can achieve precise identification of the circuits and critical isthmuses of ATs and improve the efficacy of catheter ablation. The purpose of this article is to review the mechanisms, mapping and ablation strategy, and outcome of ATs after AF ablation.

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