scholarly journals Electrical Posterior Box Isolation in Persistent Atrial Fibrillation Changed to Paroxysmal Atrial Fibrillation

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Hui-Nam Pak ◽  
Junbeom Park ◽  
Je-Wook Park ◽  
Song-Yi Yang ◽  
Hee Tae Yu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Unique Identifier ◽  
Clinical Recurrence ◽  
Ablation Time ◽  
Significant Difference

Background: Persistent atrial fibrillation (AF) can change to paroxysmal AF after antiarrhythmic drug medication and cardioversion. We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient groups. Methods: We prospectively randomized 114 patients with persistent AF to paroxysmal AF (men, 75%; 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). Primary end point was AF recurrence after a single procedure, and secondary end points were recurrence pattern, cardioversion rate, and response to antiarrhythmic drugs. Results: After a mean follow-up of 23.8±10.2 months, the clinical recurrence rate did not significantly differ between the CPVI alone and additional POBI group (31.6% versus 28.1%; P =0.682; log-rank P =0.729). The recurrences as atrial tachycardias (5.3% versus 12.3%; P =0.134) and cardioversion rates (5.3% versus 10.5%; P =0.250) were not significantly different between the CPVI and POBI groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% of CPVI group and 59.6% of POBI group ( P =0.450). No significant difference was found in major complication rates between the two groups (5.3% versus 1.8%; P =0.618), but the total ablation time was significantly longer in the POBI group (4187±952 versus 5337±1517 s; P <0.001). Conclusions: In patients with persistent AF converted to paroxysmal AF by antiarrhythmic drug, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation or influence overall safety, while leading to longer ablation time. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02176616.

scholarly journals Electrical posterior box isolation in persistent atrial fibrillation changed to paroxysmal atrial fibrillation: a multi-center, prospective, randomized study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.N Pak ◽  
J.B Park ◽  
H.T Yu ◽  
T.H Kim ◽  
J.S Uhm ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrence Rate ◽  
Antiarrhythmic Drug ◽  
Persistent Atrial Fibrillation ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
End Point ◽  
Significant Difference

Abstract Background Persistent atrial fibrillation (PeAF) can change to paroxysmal AF (PAF) after antiarrhythmic drug medication and cardioversion. Purpose We investigated whether electrical posterior box isolation (POBI) may improve rhythm outcome of catheter ablation in those patient group. Methods We prospectively randomized 114 patients with PeAF to PAF (male 75%, 59.8±9.9 years old) to circumferential pulmonary vein isolation (CPVI) alone group (n=57) and additional POBI group (n=57). The primary end-point was AF recurrence after a single procedure, and the secondary end-point was a recurrence pattern, cardioversion rate, and the response to antiarrhythmic drugs (AADs). Results After a mean follow-up of 22.5±9.4 months, the clinical recurrence rate did not significantly differ between the two groups (29.8% vs. 28.1%, p=0.836; log rank p=0.815) The recurrence rate for atrial tachycardias (17.6% vs. 43.8%, p=0.141) was higher in POBI group, but the cardioversion rates (13.5% vs. 8.5%, p=0.434) were not significantly different between two groups. At the final follow-up, sinus rhythm was maintained without antiarrhythmic drug in 52.6% in CPVI group and 59.7% of POBI group (p=0.452). No significant difference was found in the major complication rates between the two groups (5.3% vs. 1.8%, p=0.618), but the total ablation time was significantly longer in the POBI group (4397±842 sec vs. 5337±1517 sec, p&lt;0.001). Conclusion In patients with persistent AF converted to paroxysmal AF by AAD, the addition of POBI to CPVI did not improve the rhythm outcome of catheter ablation nor influence overall safety. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Yong-Soo Baek ◽  
Oh-Seok Kwon ◽  
Byounghyun Lim ◽  
Song-Yi Yang ◽  
Je-Wook Park ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Catheter Ablation ◽  
Computational Modeling ◽  
Controlled Trial ◽  
Dominant Frequency ◽  
Complication Rates ◽  
Clinical Recurrence ◽  
Significant Difference

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P &lt; 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

scholarly journals Radiofrequency Ablation versus Cryoablation in the Treatment of Paroxysmal Atrial Fibrillation: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Ali H. Hachem ◽  
Joseph E. Marine ◽  
Housam A. Tahboub ◽  
Sana Kamdar ◽  
Shaffi Kanjwal ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Meta Analysis ◽  
Fluoroscopy Time ◽  
Radiofrequency Energy ◽  
Cryoballoon Ablation ◽  
Complication Rates ◽  
Ablation Time ◽  
Significant Difference

Background. Pulmonary vein isolation is commonly performed using radiofrequency energy with cryoablation gaining acceptance. We performed a meta-analysis of randomized controlled trials which compared radiofrequency versus cryoablation for patients with atrial fibrillation. Methods. A systematic search strategy identified both published and unpublished articles from inception to November 10, 2016, in multiple databases. The primary outcomes for this meta-analysis were long-term freedom from atrial fibrillation at 12-month follow-up and overall postoperative complication rates. For all included studies, the methodological quality was assessed through the Cochrane Collaboration’s tool for risk of bias. Results. A total of 247 articles were identified with eight being included in this review as they satisfied the prespecified inclusion criteria. Overall, there was no significant difference in freedom from atrial fibrillation at ≥12-month follow-up between those receiving cryoballoon and radiofrequency ablation, respectively (OR = 0.98, CI = 0.67–1.43, I2 = 56%, p=0.90). Additionally, the secondary outcomes of duration of ablation, fluoroscopy time, and ablation time failed to reach significance. Cryoballoon ablation had significantly greater odds of postoperative phrenic nerve injury at 12-month follow-up. Conclusions. Our meta-analysis suggests that cryoballoon ablation provides comparable benefits with regard to freedom from atrial fibrillation at medium-term follow-up, fluoroscopy time, ablation time, operative duration, and overall complication rate in comparison to radiofrequency ablation.

scholarly journals Evaluation of proarrythmogenic effects after different techniques of radiofrequency catheter ablation of atrial fibrillation

2015 ◽  
Vol 17 (1) ◽  
pp. 33 ◽  
Author(s):  
S. N. Artemenko ◽  
A. B. Romanov ◽  
V. V. Shabanov ◽  
I. G. Stenin ◽  
D. A. Yelesin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Linear Lesions ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

To assess proarrythmogenic effects after different techniques of radiofrequency catheter ablation, 427 patients with paroxysmal, persistent, and long-standing persistent atrial fibrillation (AF) were examined. The patients were randomized into four groups: antral pulmonary vein isolation (PVI) (Group I), PVI plus roof line and mitral isthmus ablation (Group II), anatomic ablation of ganglionated plexuses (GP) of the left atrium (Group III) and GP plus PVI (Group IV). At the end of follow up (34,43,2 months) the largest number of proarrythmogenic effects was observed in Group II, 24,8% (26 patients). In the remaining groups the percentage of proarrythmogenic effects did not exceed 11%, neither was there any significant difference among Groups I, III and IV. Thus, the creation of additional linear lesions in the left atrium is a predictor of proarrythmogenic effects during follow up.

Abstract 15258: The Association of Genetic Polymorphism of rs2106261 in ZFHX3 and ‘Super-responder’ to Catheter Ablation Among the Patients With Long-standing Persistent Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jin kyu Park ◽  
Junbeom Park ◽  
Jae-Sun Uhm ◽  
Boyoung Joung ◽  
Moon-Hyong Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Genetic Polymorphism ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
P Wave ◽  
Volume Index ◽  
Genome Wide Association Studies ◽  
Clinical Recurrence

Introduction: The radiofrequency catheter ablation (RFCA) is challenging in patients with long-standing persistent atrial fibrillation (PeAF) and its clinical outcome is highly variable. Genome-wide association studies (GWAS) have identified that the rs2106261 polymorphism in ZFHX3 is associated with non-valuvluar AF. Hypothesis: We tested the association between the “super-responder” to the radiofrequency catheter ablation (RFCA) and the rs2106261 polymorphism among the patients with long-standing persistent AF. Methods: We included consecutive 207 patients with long-standing PeAF (79.2% male, age 58.0±9.7 years and follow-up interval 21 (16-34) months) who underwent RFCA for symptomatic long-standing PeAF. The super-responders were defined as the patients without early or clinical recurrence of AF at least for 12 months of post-procedural follow-up period without taking anti-arrhythmic drug. We looked for the characteristics of super-responders in clinical profiles, ECG in sinus rhythm, 3D-left atrial (LA) CT, or genotypes of the rs2106262. Results: 1. Fifty two patients (25.1%) were categorized as super-responders. Super-responders were younger (55.5±9.6 vs. 58.9±9.6 years old, p=0.028) and had shorter AF duration (44.9 [25.4-73.1] vs. 65.1 [34.1-113.6] month, p=0.010), shorter QTc (435.1±27.8 vs. 447.3±29.1 msec, p=0.007), lower negative P wave amplitude in lead V1 (0.07±0.03 vs. 0.08±0.04, p=0.034), and smaller LA volume index (CT) (75.2±21.0 vs. 88.2±24.1, p=0.001) than recurred patient group. 2. In additive model, the minor allele frequency of the rs2106261 was higher in super-responders (52.2%) than in recurred group (40.9%, p=0.058). 3. In multivariate analyses, LA volume index (adjusted OR=0.973, 95% CI 0.955-0.992, p=0.006) and genetic polymorphism of the rs2106261 (adjusted OR=1.808, 95% CI 1.034-3.163, p=0.038) were independently associated with super-responder to RFCA among the patients with long-standing persistent AF. Conclusion: Although the recurrence rate after catheter ablation for long-standing persistent AF is still high, pre-procedural LA volume index or the rs2106261 polymorphism may be helpful for the selection of good candidate for RFCA.

Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: the EARNEST-PVI trial

EP Europace ◽  
2020 ◽  
Author(s):  
Koichi Inoue ◽  
Shungo Hikoso ◽  
Masaharu Masuda ◽  
Yoshio Furukawa ◽  
Akio Hirata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Primary Endpoint ◽  
Persistent Atrial Fibrillation ◽  
Hazard Ratio ◽  
Complication Rates ◽  
Inferior Margin ◽  
Linear Ablation

Abstract Aims Previous studies could not demonstrate any benefit of more intensive ablation in addition to pulmonary vein isolation (PVI) including complex fractionated atrial electrogram (CFAE) and linear ablation for recurrence in the initial catheter ablation of persistent atrial fibrillation (AF). This study aimed to establish the non-inferiority of PVI alone to PVI plus these additional ablation strategies. Methods and results Patients with persistent AF who underwent an initial catheter ablation (n = 512, long-standing persistent AF; 128 cases) were randomly assigned in a 1:1 ratio to either PVI alone (PVI-alone group) or PVI plus CFAE and/or linear ablation (PVI-plus group). After excluding 15 cases who did not receive procedures, we analysed 249 and 248 patients, respectively. The primary endpoint was recurrence of AF, atrial flutter, and/or atrial tachycardia, and the non-inferior margin was set at a hazard ratio of 1.43. In the PVI-plus group, 85.1% of patients had linear ablation and 15.3% CFAE ablation. After 12 months, freedom from the primary endpoint occurred in 71.3% of patients in the PVI-alone group and in 78.3% in the PVI-plus group [hazard ratio = 1.56 (95% confidence interval: 1.10–2.24), non-inferior P = 0.3062]. The procedure-related complication rates were 2.0% in the PVI-alone group and 3.6% in the PVI-plus group (P = 0.199). Conclusion This randomized trial did not establish the non-inferiority of PVI alone to PVI plus linear ablation or CFAE ablation in patients with persistent AF, but implied that the PVI plus strategy was promising to improve the clinical efficacy (NCT03514693).

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