scholarly journals Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001718
Author(s):  
Bart A Mulder ◽  
Meelad I H Al-Jazairi ◽  
Federico T Magni ◽  
Hessel F Groenveld ◽  
Robert G Tieleman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Area Under The Curve ◽  
Holter Monitoring ◽  
Underlying Disease ◽  
Volume Index ◽  
Left Atrium Volume

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

Extended Pulmonary Vein Isolation: is it sufficient to achieve long-term sinus rhythm in octogenarian women with atrial fibrillation?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D.G Della Rocca ◽  
C Gianni ◽  
A Salwan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Office Visits ◽  
Increased Risk

Abstract Background Atrial fibrillation (AF) is a disease of the elderly and women typically present with AF at an older age than men do. Moreover, they tend to experience more symptoms and post-ablation recurrences, have worse quality of life and increased risk of stroke and mortality. Objective We evaluated long-term efficacy of our standard ablation approach of extended pulmonary vein isolation (PVI) in octogenarian women undergoing their first AF ablation. Methods Consecutive female AF patients aged ≥80 years receiving their first catheter ablation at our center were included in the analysis. Our standard ablation approach at the first procedure includes PVI + empirical isolation of left atrial posterior wall (LAPW) and superior vena cava (SVC). Complete abolition of all potentials rather than decrease in amplitudes was the procedural end point. Patients were prospectively monitored at regular intervals for 3 years after the index procedure with event recorders, 12-lead ECG, cardiology evaluation at office visits and 7-day Holter monitoring. Results A total of 194 patients with mean age of 84.2±1.4 years were included in the analysis. Of the 194, 120 (61.8%) had non-paroxysmal AF. All received PVI+ isolation of LAPW and SVC. Acute procedural success was achieved in 100% of cases. At 3 years of follow-up, 24 (12.4%) patients remained in sinus rhythm; 22 on- and 2 off-antiarrhythmic drugs (AAD). All of the 23 patients had paroxysmal AF as their initial diagnosis. Of the 170 patients experiencing recurrence, 147 underwent repeat ablation. PV/PW/SVC reconnection was noted in only 6 (4.1%) patients at redo. Triggers originating from non-PV sites were targeted for ablation in all. At 1.5 years after the repeat procedure, 136 (92.5%) patients were in sinus rhythm; 131 off-AAD and 5 patients on-AAD. Conclusion Extended PVI including isolation of posterior wall and SVC was not sufficient to maintain long-term sinus rhythm in majority of octogenarian women, regardless of AF type. Moreover, non-PV triggers rather than PV reconnection was the major cause of recurrence in this subset of AF population. Funding Acknowledgement Type of funding source: None

scholarly journals Persistent atrial fibrillation presenting in sinus rhythm: Pulmonary vein isolation versus pulmonary vein isolation plus electrogram-guided ablation

2013 ◽  
Vol 106 (10) ◽  
pp. 501-510 ◽  
Author(s):  
Frederic A. Sebag ◽  
Najia Chaachoui ◽  
Nick W. Linton ◽  
Sana Amraoui ◽  
James Harrison ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation

scholarly journals Recent advances in rhythm control for atrial fibrillation

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1796 ◽  
Author(s):  
Richard Bond ◽  
Brian Olshansky ◽  
Paulus Kirchhof
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Rate Control ◽  
Rhythm Control ◽  
Management Problem ◽  
Recent Trial ◽  
Control Therapy

Atrial fibrillation (AF) remains a difficult management problem. The restoration and maintenance of sinus rhythm—rhythm control therapy—can markedly improve symptoms and haemodynamics for patients who have paroxysmal or persistent AF, but some patients fare well with rate control alone. Sinus rhythm can be achieved with anti-arrhythmic drugs or electrical cardioversion, but the maintenance of sinus rhythm without recurrence is more challenging. Catheter ablation of the AF triggers is more effective than anti-arrhythmic drugs at maintaining sinus rhythm. Whilst pulmonary vein isolation is an effective strategy, other ablation targets are being evaluated to improve sinus rhythm maintenance, especially in patients with chronic forms of AF. Previously extensive ablation strategies have been used for patients with persistent AF, but a recent trial has shown that pulmonary vein isolation without additional ablation lesions is associated with outcomes similar to those of more extensive ablation. This has led to an increase in catheter-based technology to achieve durable pulmonary vein isolation. Furthermore, a combination of anti-arrhythmic drugs and catheter ablation seems useful to improve the effectiveness of rhythm control therapy. Two large ongoing trials evaluate whether a modern rhythm control therapy can improve prognosis in patients with AF.

scholarly journals P1518Early recurrence of atrial fibrillation is a negative predictor of long-term success after a first pulmonary vein isolation

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
T Mraz ◽  
H Keller ◽  
C Neuhold ◽  
T Yoshida ◽  
C Wegner-Siegmundt ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Negative Predictor

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

2019 ◽  
Vol 42 (7) ◽  
pp. 910-921 ◽  
Author(s):  
Ugur Canpolat ◽  
Duygu Kocyigit ◽  
Muhammed Ulvi Yalcin ◽  
Cem Coteli ◽  
Yusuf Ziya Sener ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Atrial Fibrillation Ablation ◽  
Long Term Outcomes
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