Abstract 15733: Long-Term Follow-Up of Patients With Paroxysmal Atrial Fibrillation and Severe Left Atrial Scarring: Comparison Between Pulmonary Vein Antrum Isolation Only or PVAI Combined With Either Scar Homogenization or Trigger Ablation

Background: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF and severe LA scarring/fibrosis identified by 3D mapping undergoing ablation of the pulmonary veins (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI plus ablation of the non-PV triggers. Methods: One-hundred seventy seven consecutive patients with paroxysmal atrial fibrillation and severe left atrial scarring were included in this study. LA scarring was diagnosed by 3D voltage mapping. The degree of scar was described as severe when >60% of the LA area was involved. Non-PV triggers were defined as ectopic triggers originating from sites other than pulmonary veins such as interatrial septum, superior vena cava, left atrial appendage, ligament of Marshall, crista terminalis and coronary sinus. Patients underwent ablation of the pulmonary vein antrum (PVAI) only (n=45, group 1), PVAI extended to the entire scar areas (scar homogenization [n=66, group 2]) or PVAI plus ablation of non-PV triggers (n=66, group 3). Choice of ablation strategy was determined by the operator. Patients were followed up for arrhythmia recurrence with event recorders, ECG and Holter monitoring. Results: Baseline characteristics were not different between the groups (age 63±9 vs 58±10 vs. 60±11 years, p=0.23; male 71%, vs. 72% vs. 73% p= 0.91). After a single procedure, all patients were followed-up for a minimum of two years. The long-term success rate at the end of the follow up was 19% (12 pts) in group 1, 21% (14 pts) in group 2, and 61% (40 pts) in group 3. Kaplan-Meier log-rank test indicated that the cumulative probability of AF-free survival was significantly higher in group 3 (overall log-rank p <0.001, pairwise comparison 1 vs. 3 and 2 vs. 3 was significant at p<0.01). Conclusions: In patients with paroxysmal atrial fibrillation and severe left atrial scarring, PVAI plus ablation of non-PV triggers is associated with significantly better long-term outcome than PVAI alone or when PVAI is combined with scar homogenization.

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Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.18649 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Xue Zhao ◽

Jianqiang Hu ◽

Yan Huang ◽

Yawei Xu ◽

Yanzhou Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Holter Monitoring ◽

Pericardial Tamponade ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up ◽

One Year

Objectives: The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up. Background: The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF. Methods: The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients. Results: The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group ( P <0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group ( P= 0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade. Conclusions: PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms. Registration: ChiCTR-TRC-11001191

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P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz745.0627 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Dinshaw ◽

M Lemoine ◽

J Hartmann ◽

B Schaeffer ◽

N Klatt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrial ◽

High Density ◽

Term Outcome ◽

Long Term Outcome ◽

Density Mapping ◽

Ablation Success

Abstract Introduction Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain. Purpose The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems. Methods A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices. Results Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003). Conclusion Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.

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Impact of baseline left atrial function on long-term outcome after catheter ablation for paroxysmal atrial fibrillation

Journal of Cardiology ◽

10.1016/j.jjcc.2019.08.014 ◽

2020 ◽

Vol 75 (4) ◽

pp. 352-359

Author(s):

Takafumi Oka ◽

Koji Tanaka ◽

Yuichi Ninomiya ◽

Yuko Hirao ◽

Nobuaki Tanaka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Atrial Function ◽

Left Atrial Function ◽

Term Outcome ◽

Long Term Outcome

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Long term outcome of single ventricle physiology with pulmonary restriction not undergoing Fontan repair

European Heart Journal ◽

10.1093/ehjci/ehaa946.2205 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Buendia ◽

B Ramirez ◽

P Gallego ◽

J.M Oliver ◽

S Montserrat ◽

...

Keyword(s):

Single Ventricle ◽

Term Outcome ◽

Long Term Outcome ◽

Single Ventricle Physiology ◽

Pulmonary Flow ◽

Adult Congenital ◽

Group 3 ◽

Group 2

Abstract Background Patients with univentricular physiology who do not complete the palliation to Fontan are a heterogeneous group with unknown long term outcome. Aims This study aimed at describing the clinical course and long-term survival of patients with SV physiology with restricted pulmonary flow that had not undergone a Fontan type of repair. Methods From the prospectively maintained databases of the adult congenital cardiac units of five tertiary referral centers, data from all SV physiology patients were obtained. Patients completing a Fontan type palliation or developing Eisenmenger physiology and segmental pulmonary hypertension were excluded. Baseline data were recorded on the first visit at adult congenital heart disease (ACHD) unit. The primary end point was death. Results 101 patients (50.5% females) were identified. Mean age at end of follow up was 39.3±11.3 years. Of these, 45 (44.6%) were unoperated (group 1, restricted forward pulmonary flow with or without pulmonary banding), 38 (37.6%) had undergone a cavopulmonary shunt as a definitive palliation (group 2) and 18 (17.8%) had aortopulmonary shunts (group 3). The main diagnosis was double inlet left ventricle (DILV) (N: 52, 51.5%) and most of the ventricle was left (82.2%). The principal reason for not performing a Fontan repair was mean pulmonary artery pressure >18 mmHg. At initial visit at the ACHD unit patients were 32.2±11.1 years of age. 35% of the patients were in NYHA class III-IV, with no differences between groups. However, patients in group 2 had worse oxygen saturation (p=002) and higher haemoglobin (p=0.037). After a mean follow-up of 7.3±4.1 years, mortality was 20.8% (21 patients), being sudden death (7p, 6.9%) the most frequent cause. Patients in group 3 showed worse ventricular function (p=0.0001) and a trend to higher mortality that did not reach statistical significance (HR 2.7, CI 95% 0.91–8.14, P=0.07). Conclusions Patients with single ventricle physiology not undergoing Fontan repair are a population of high risk, with sudden death as main driver of mortality. Patients palliated with aortopulmonary shunts are prone to worse ventricular function and a trend to higher mortality. Funding Acknowledgement Type of funding source: Public hospital(s)

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Long-term outcome after second-generation cryoballoon ablation for paroxysmal atrial fibrillation - a 3-years follow-up

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-017-0237-7 ◽

2017 ◽

Vol 49 (1) ◽

pp. 93-100 ◽

Cited By ~ 19

Author(s):

Ken Takarada ◽

Ingrid Overeinder ◽

Carlo de Asmundis ◽

Erwin Stroker ◽

Giacomo Mugnai ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Second Generation ◽

Cryoballoon Ablation ◽

Term Outcome ◽

Long Term Outcome

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Long Term Outcome of Pulmonary Atresia with Major Aorto-Pulmonary Collaterals: Data from a Pooled Analysis

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.02.08 ◽

2020 ◽

pp. 1-9

Author(s):

Paolo Ferrero ◽

Isabelle Piazza ◽

Matteo Ciuffreda ◽

Paolo Ferrero ◽

Youcef Sadou

Keyword(s):

Full Text ◽

Pulmonary Atresia ◽

Pooled Analysis ◽

High Rate ◽

Term Outcome ◽

Long Term Outcome ◽

Group 3 ◽

Group 2

Prognosis of Tetralogy of Fallot and Pulmonary atresia with MAPCAs is variable. We aimed to assess the outcome of patients who had undergone repair of TOF and PA with MAPCAs by different institutions and approaches, pooling together data on mortality and reinterventions. Abstracts were screened and full text papers were examined retrieving data on mortality, reinterventions and percentage of complete repair. Variables abstracted from the studies were pooled together and compared among different strategies. 28 papers out of 124 were selected, accounting for 1983 patients. 704 patients had undergone single stage unifocalization, 544 recruitment of PAs, 645 patients multistage and combined approaches. Median follow up was 49 months (36-70). 93 deaths occurred in the first month (5.4 %): 38 in group one (5.8%), 10 in group 2 (2.3%) and 45 in group 3 (8.6%), p<0.0001. At last follow up a total of 305 deaths occurred (16%) and did not differ among the three groups: 0.21 (0.15-0.25), 0.18 (0.07-0.26), 0.32 (0,13-0.38) deaths/100patients year, respectively p=0.43. 465 out of 969 patients, underwent at least one re-intervention (47.9%). Reintervention rate was similar among the three subsets and inversely correlated with the volume of institution (r= -0.45, p= 0.04). Although strategies of pulmonary atresia with MAPCAs repair are based on contrasting philosophies and extreme anatomic varibility, pooling together data from different studies, outcomes do not differ significantly and are characterized by a high rate of reinterventions. The latter appears to be significantly influenced by the volume of patients.

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The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.011 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

YR Kim

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Volume Estimation ◽

Term Outcome ◽

Long Term Outcome ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF). Methods We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration. Results The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p < 0.0001) but LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1 (LA volume < 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group 1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume >160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045) Conclusion Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.

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