scholarly journals Ablation of complex fractionated electrograms improves outcome in long standing persistent atrial fibrillation

2017 ◽  
Author(s):  
Claire A Martin ◽  
James P Curtain ◽  
Parag R Gajendragadkar ◽  
David A Begley ◽  
Simon P Fynn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Persistent Atrial Fibrillation ◽  
Atrial Arrhythmia ◽  
General Anaesthetic ◽  
Procedure Time ◽  
Substrate Modification ◽  
Linear Ablation ◽  
Complex Fractionated Electrogram ◽  
One Year

AbstractPurposeThere is controversy and sparse data on whether substrate based techniques in addition to pulmonary vein isolation (PVI) confer benefit in the catheter ablation of persistent atrial fibrillation (AF), especially if long standing. We performed an observational study to assess whether substrate based ablation improved freedom from atrial arrhythmia.Methods286 patients undergoing first ablation procedures for persistent AF with PVI only, PVI plus linear ablation, or PVI plus complex fractionated electrogram (CFAE) and linear ablation were followed. Primary end point was freedom from atrial arrhythmia at one year.ResultsMean duration of pre-procedure time in AF was 28+/-27 months. Freedom from atrial arrhythmia was higher with a PVI+CFAE+lines strategy then for PVI alone (HR 1.56, 95% CI: 1.04-2.34, p=0.032) but was not higher with PVI+lines. Benefit of substrate modification was conferred for pre-procedure times in AF of over 30 months. The occurrence of atrial tachycardia was higher when lines were added to the ablation strategy (HR 0.08, 95% CI: 0.01-0.59, p=0.014). Freedom from atrial arrhythmia at 1 year was higher with lower patient age, use of general anaesthetic (GA), normal or mildly dilated left atrium and decreasing time in AF.ConclusionsIn patients with long standing persistent AF of over 30 months duration, CFAE ablation resulted in improved freedom from atrial arrhythmia. Increased freedom from atrial arrhythmia occurs in patients who are younger and have smaller atria, and with GA procedures. Linear ablation did not improve outcome and resulted in a higher incidence of atrial tachycardia.

scholarly journals Long-term outcomes of empirical extra-pulmonary vein linear ablation in patients with persistent atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T Hwang ◽  
M Kim ◽  
H Yu ◽  
T Kim ◽  
J Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Clinical Recurrence ◽  
Linear Ablation ◽  
Extra Pulmonary

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by grants [HI18C0070] and [HI19C0114] from the Korea Health 21 R&D Project, Ministry of Health and Welfare, and a grant [NRF-2020R1A2B01001695] from the Basic Science Research Program run by the National Research Foundation of Korea (NRF). Background Although extra-pulmonary vein (PV) left atrial (LA) linear ablation has been performed during catheter ablation (CA) of persistent atrial fibrillation (PeAF), the long-term efficacy and safety of this procedure have not yet been verified. Purpose We investigated whether an anterior line (AL) and posterior box ablation (POBA) in addition to circumferential PV isolation (CPVI) improves the rhythm without worsening the LA function in PeAF patients. Methods We retrospectively compared the additional AL + POBA and CPVI alone groups in 604 patients with PeAF who underwent regular rhythm follow-ups (16.9%; males 79.3%, 58.5 ± 10.7 years of age) after propensity score matching. The primary endpoint was AF recurrence after single procedures and secondary endpoints were the cardioversion rate, response to anti arrhythmic drugs, LA changes, and re-conduction rates of the de-novo ablation lesion set. Results After a mean follow-up of 45.2 ± 33.6 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank p = 0.554) despite longer procedure times in the AL + POBA group (p < 0.001). Atrial tachycardia recurrences (p = 0.001) and the cardioversion rates after ablation (p < 0.001) were higher in the AL + POBA group than CPVI group. AL + POBA was associated with better rhythm outcomes in patients with large anterior LA volume indices (p for interaction 0.037) and low mean LAA(left atrial appendage) voltages (p for interaction 0.019). In repeat procedures, the LA pulse pressure elevation was significant after the AL + POBA. Conclusion In patients with PeAF, an AL + POBA in addition to the CPVI did not improve the rhythm outcomes nor influence the long-term safety, and lead to more extended procedures. Procedure outcomes OverallAL + POBACPVIp-value(n = 604)(n = 302)(n = 302)Procedure time, min190.8 ± 62.6226.9 ± 49.4154.6 ± 52.8<0.001Ablation time, sec5079 ± 19566420 ± 13723738± 1475<0.001Overall complications24 (4.0)13 (4.3)11 (3.6)0.835Early recurrence, n (%)277 (45.9)129 (42.7)148 (49.0)0.142Recurrence type AT, n (% in early recur)77 (27.8)51 (39.5)26 (17.6)<0.001Clinical recurrence within 1-year, n(%)116 (19.2)52 (17.2)65 (21.5)0.256Recurrence type AT, n (% in clinical recur)60 (23.1)46 (30.7)14 (12.7)0.001Cardioversion, n (% in total recur/ % overall)105 (40.4/17.4)74 (49.3/24.5)31 (28.1/10.3)<0.001POBA, posterior box ablation; AL, anterior line; CPVI, circumferential pulmonary vein isolation; AT, atrial tachycardia;Abstract Figure. Long term ablation outcome

scholarly journals Improved outcome and cost effectiveness in ablation of persistent atrial fibrillation under general anaesthetic

2017 ◽  
Author(s):  
Claire A Martin ◽  
James P Curtain ◽  
Parag R Gajendragadkar ◽  
David A Begley ◽  
Simon P Fynn ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Persistent Atrial Fibrillation ◽  
Atrial Arrhythmia ◽  
General Anaesthetic ◽  
List Type ◽  
Single Shot ◽  
Af Ablation ◽  
Improved Outcome

AbstractAimsOutcome of persistent atrial fibrillation (AF) ablation remains suboptimal. Techniques employed to reduce arrhythmia recurrence rate are more likely to be embraced if cost-effectiveness can be demonstrated. A single-centre observational study assessed whether use of general anaesthesia (GA) in persistent AF ablation improved outcome and was cost-effective.Methods292 patients undergoing first ablation procedures for persistent AF under conscious sedation or GA were followed. End points were freedom from listing for repeat ablation at 18 months and freedom from recurrence of atrial arrhythmia at one year.ResultsFreedom from atrial arrhythmia was higher in patients who underwent ablation under GA rather than sedation (63.9% vs 42.3%, HR 1.87, 95% CI: 1.23 to 2.86, p = 0.002). Significantly fewer GA patients were listed for repeat procedures (29.2% vs 42.7%, HR 1.62, 95% CI: 1.01 to 2.60, p = 0.044). Despite GA procedures costing slightly more, a saving of £177 can be made per patient in our centre for a maximum of 2 procedures if all persistent AF ablations are performed under GA.ConclusionsIn patients with persistent AF, it is both clinical and economically more effective to perform ablation under GA rather than sedation.What’s New?There is very little known regarding the clinical outcome of catheter ablation of AF under GA compared with sedation; to our knowledge there is one study only in paroxysmal AF and no studies examining cost effectiveness.This study shows that in patients with persistent AF, it is both clinical and economically more effective to perform ablation under GA rather than sedation.This study leads us to recommend the use of GA for the ablation of persistent AF. As PAF ablation is now increasingly being undertaken by single shot techniques which do not have the same requirements for analgesia and immobility, GA resources may be allocated for persistent AF ablation.

Prevalence of atrial arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Rujirachun ◽  
P Wattanachayakul ◽  
N Charoenngam ◽  
A Winijkul ◽  
P Ungprasert
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Studies ◽  
Right Ventricular ◽  
Atrial Tachycardia ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Meta Analysis ◽  
Atrial Arrhythmia ◽  
Funding Source ◽  
Ventricular Cardiomyopathy ◽  
Pooled Prevalence

Abstract Background and objectives Little is known about atrial involvement in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Recent studies have suggested that atrial arrhythmia (AA), including atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), was common among these patients although the reported prevalence varied considerably across the studies. Methods We searched for published articles indexed in MEDLINE and EMBASE databases from inception through Sep 22, 2019 to identify cohort studies of patients with ARVC that described the prevalence of atrial arrhythmia among the participants. The pooled prevalence across studies was calculated. Results A total of 16 cohort studies with 1,986 patients with ARVC were included into this meta-analysis. The pooled prevalence of overall AA among patients with ARVC was 17.9% (95% CI, 13.0%–24.0%; I2 88%), the pooled prevalence of AF of 12.9% (95% CI, 9.6%–17.0%; I2 78%), the pooled prevalence of AFL of 5.9% (95% CI, 3.7%–9.2%; I2 70%), and the pooled prevalence of AT of 7.1% (95% CI, 3.7%–13.0%; I2 49%). Conclusions AA is common among patient with ARVC with the pooled prevalence of approximately 18%, which is substantially higher than the reported prevalence of AA in general population. Funding Acknowledgement Type of funding source: None

Atrial Tachycardia Transition During Ablation of Persistent Atrial Fibrillation: What is the Mechanism?

2007 ◽  
Vol 18 (10) ◽  
pp. 1109-1111 ◽  
Author(s):  
LEONARDO BANDEIRA ARANTES ◽  
GEORGE J. KLEIN ◽  
PIERRE JAIS ◽  
SEIISCHIRO MATSUO ◽  
KANG TENG LIM ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Persistent Atrial Fibrillation
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