Abstract 5665: Assessment of Noninducibility after Catheter Ablation for Atrial Fibrillation: High Dose Isoproterenol vs Rapid Atrial Pacing

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thomas Crawford ◽  
Jean F Sarrazin ◽  
Michael Kuhne ◽  
Nagib Chalfoun ◽  
Darryl Wells ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drugs ◽  
High Dose ◽  
Atrial Pacing ◽  
Target Sites ◽  
Isoproterenol Infusion ◽  
Complex Fractionated Atrial Electrograms

Background: Noninducibility of atrial fibrillation (AF) after catheter ablation of paroxysmal AF (PAF) identifies patients who are more likely to remain in sinus rhythm (SR). However, it is not clear whether assessment of noninducibility by rapid atrial pacing (RAP) is incremental to high dose isoproterenol (ISO) infusion. Methods and Results: There were 65 patients (age=56±13 years) with PAF who presented in sinus rhythm for catheter ablation. ISO was administered in escalating doses of 5/10/15/20 μg/min every 2 minutes prior to ablation. AF (or frequent PACs in 4) was inducible in 61/65 patients (94%) at a mean dose of 15±6 μg/min. Antral pulmonary vein (PV) isolation (APVI) was performed in all patients with complete isolation of all PVs. If AF did not terminate during APVI, complex fractionated atrial electrograms (CFAEs) were targeted in the left atrium (16) or coronary sinus (2) until AF terminated or all target sites were ablated. AF terminated during ablation in 41/65 (63%). Following conversion to sinus rhythm, 54 of the 61 patients (89%) who were initially inducible with ISO became noninducible during ISO re-challenge. Among these 54 patients who were noninducible by ISO, rapid atrial pacing (RAP) down to a cycle length of 180 ms (≥5 times) induced sustained AF (>60 seconds) in 17 patients (31%). At a mean follow-up of 9±4 months after a single ablation procedure, 35/54 patients (65%) who were noninducible by ISO and 2/7 patients (29%) who were inducible were in sinus rhythm without antiarrhythmic drugs. However, 11/17 patients (65%) who were inducible by RAP and 26/37 (70%) who were noninducible by RAP were in sinus rhythm without antiarrhyhtmic drug therapy (P=0.8). Conclusions: Noninducibility of AF in response to high dose isoproterenol infusion identifies patients who are more likely to remain in sinus rhythm after catheter ablation. Rapid atrial pacing may still result in induction of AF in 30% of patients who are noninducible by isoproterenol. However, inducibility of AF by rapid atrial pacing in patients who are noninducible by isoproterenol appears to be a nonspecific observation.

scholarly journals Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

2019 ◽  
Author(s):  
Hao Wang ◽  
Jindong Chen ◽  
Mengmeng Zhou ◽  
Liang Zhao
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Underlying Mechanism ◽  
Recurrence Rates ◽  
Pulmonary Vein Ablation ◽  
Second Procedure ◽  
Maintain Sinus Rhythm ◽  
Complex Fractionated Atrial Electrograms

Abstract Background: Many atrial fibrillation (AF) patients require more than one radiofrequency catheter ablation (RFCA) procedure to maintain sinus rhythm. This study aimed to evaluate risk and risk factors of atrial tachyarrhythmia (ATa) recurrence in patients undergoing multiple (≥3) RFCA procedures for AF. Methods: This single-center, retrospective, observational study enrolled 118 consecutive patients who underwent multiple ablation procedures for paroxysmal and non-paroxysmal AF with circumferential pulmonary vein ablation (CPVA), and bidirectional block of lines with disappearance of complex fractionated atrial electrograms (CFAEs) as index procedural endpoints, respectively. Results: At a median follow-up of 18 (range, 6-91) months after the last procedure (mean, 3.2 procedures), freedom from ATa recurrence was 40.7% (48/118). Initially diagnosed non-paroxysmal AF (P=0.039), baseline LA size (P=0.044), and recurrent AF after the second procedure (P=0.044) were univariate predictors of ATa recurrence, while only the latter (P=0.010) was an independent multivariate predictor (hazard ratio for ATa recurrence of 1.88 [95% CI, 1.16-3.05]. Conversion of recurrent types between AF and AFL/AT occurred in 52.9% (37/70) of patients with ATa recurrence, and 29.2% (14/48) of patients with sinus rhythm after last procedure. Few patients (7.8% [20/257]) recovered PV potential induced recurrent ATa during multiple procedures, and most (87.6% [141/161]) were bystanders of recurrent ATa. Conclusions: Multiple (>3) RFCA for paroxysmal or non-paroxysmal AF yielded unsatisfactory ATa recurrence rates with recurrent AF after the second procedure as multivariate predictor and recovered PV potential as a bystander commonly as underlying mechanism. Conversion of recurrent types between AF and AFL/AT was common.

Abstract 5659: Regular Atrial Tachycardias After Ablation Of Complex Fractionated Atrial Electrograms (CFAE) For Atrial Fibrillation: Acute Incidence And Recurrence In Clinical Follow-up

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tilko Reents ◽  
Gabriele Hessling ◽  
Stephanie Fichtner ◽  
Jinjin Wu ◽  
Heidi L Estner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Successful Ablation ◽  
Atrial Electrograms ◽  
Initial Procedure ◽  
The Impact ◽  
External Cardioversion ◽  
Complex Fractionated Atrial Electrograms

Background: The catheter ablation of atrial fibrillation (AF) can be performed by ablation of complex fractionated atrial electrograms (CFAE). Endpoint of CFAE ablation is the regularisation or termination of AF. However, the impact of regular atrial tachycardia (AT) occurring during CFAE ablation on long term outcome has not been investigated. Thus, it is not clear whether these tachycardias should be acutely targeted for ablation. Methods: In 43 patients (31 male, age 62±9 years with paroxysmal (15 patients), persistent (25 patietns) or permanent AF (3 patients) organisation of AF to regular AT was achieved by ablation of CFAE. Mapping of AT with subsequent successful ablation was performed in 14/43 patients (33%), in the remaining 29/43 patients (67%) AT was terminated with external cardioversion or pace overdrive. After ablation procedure, patients were seen in our out-patient clinic with repetitive Holter ECG after 1, 3, and subsequently every 3 months and were intensively screened for the occurrence of regular AT. Results: In follow-up 22/43 patients (51%) developed sustained AT necessitating in 20 patients repeat catheter ablation (12 patients) or external cardioversion (8 patients). AF had been paroxysmal in 7/22 and persisten in 15/22 patients with AT in follow-up. In 14/22 patients (63%), no attempt for ablation of AT had been made during the initial procedure, in 8/22 AT (36%) had been mapped and initially successful ablated. Of 21 patients without AT occurrence during follow-up, AF had been paroxysmal in 8/21 and persistent or permanent in 13/21 patients. AT had been mapped and ablated in 6 (29%) whereas in 15/21 patients (71%), AT had not been targeted. Ablation of AT during initial procedure, number of ablation applications, procedure and fluoroscopy duration were not predictive for freedom of AT in follow-up. Conclusion: In our study, mapping and successful ablation of new onset regular atrial tachycardias (AT) occurring during ablation of CFAE for atrial fibrillation was not predictive for the occurrence of AT in follow-up. Thus, results after termination of AT by cardioversion was in long-term comparable to sometimes time-consuming mapping/ablation for AT.

scholarly journals Oral Class I and III antiarrhythmic drugs for maintaining sinus rhythm after catheter ablation of atrial fibrillation

2020 ◽  
Author(s):  
Mazhar Warraich ◽  
Christina Peter ◽  
Mahmood Ahmad ◽  
Shazaib Sheikh ◽  
George R Abraham ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drugs ◽  
Class I

scholarly journals Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

2021 ◽  
Author(s):  
Miruna A. Popa ◽  
Marc Kottmaier ◽  
Elena Risse ◽  
Marta Telishevska ◽  
Sarah Lengauer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Transient Phenomenon ◽  
Future Studies

Abstract Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. Conclusion ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies. Graphic abstract

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

Abstract 17261: Maintenance of Sinus Rhythm After His Bundle Pacing and AV Nodal Ablation in Patients With Recurrent Atrial Fibrillation After Catheter Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Amrish Deshmukh ◽  
Puspha Khanal ◽  
Amlish Gondal ◽  
Mary Romanyshyn ◽  
Pramod Deshmukh
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Cardiac Resynchronization ◽  
Atrial Remodeling ◽  
Clinical Recurrence ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Recurrent Atrial Fibrillation

Background: Catheter ablation (CA) is the most effective means of rhythm control for atrial fibrillation (AF) but is not curative. Irregular and rapid ventricular activation by AF begets AF. Cardiac resynchronization and atrioventricular nodal (AVN) ablation have been associated with favorable atrial remodeling and spontaneous reversion to sinus rhythm in patients with longstanding atrial fibrillation. Hypothesis: We hypothesized that in patients with longstanding persistent AF who had failed CA, AVN ablation and His bundle pacing (HBP) may improve maintenance of sinus rhythm. Methods and Results: A total of 13 patients (5 female, age 69±8.7 years, 8 with HFrEF, BMI 29 ±5 kg/m 2 ,LVEF 38±15%, NYHA 3±0.6) underwent simultaneous AVN ablation and HBP an average of 531 days (Range 1-2158 days) after CA for AF with recurrent AF. Prior to AVN ablation and HBP these patients had a median 9-year history of AF (IQR: 5-15 years) with a median of 2 prior cardioversions (IQR: 1-4) and 2 prior CA. All patients had failed at least 1 antiarrhythmic drug. In 3 patients HBP induced cardiac resynchronization of pre-existing bundle branch block and in 8 patients HBP was fused with ventricular pacing to optimize QRS duration. 12 of 13 patients had an atrial lead. All patients underwent cardioversion at the time of the procedure. In a median of follow up of 21 months (IQR:4-74 months), 7 of the 13 patients (54%) had no device detected or clinical recurrence of AF. In follow up LVEF increased to 46±12.7% and NYHA class to 2 ±0.2. Of patients with recurrence, 3 underwent CA and had no recurrence of AF in subsequent follow up. Conclusion: In patients with advanced longstanding persistent AF, a strategy of AVN ablation and HBP allowed for ventricular rate control with a narrow QRS. This approach resulted in a lower than expected rate of AF recurrence.

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