Sex Differences in Ablation Strategy, Lesion Sets, and Complications of Catheter Ablation for Atrial Fibrillation: An Analysis From the GWTG-AFIB Registry

2021 ◽  
Author(s):  
Fahd N. Yunus ◽  
Alexander C. Perino ◽  
DaJuanicia N. Holmes ◽  
Roland A. Matsouaka ◽  
Anne B. Curtis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Patient Demographics ◽  
Linear Ablation ◽  
Mitral Isthmus ◽  
Get With The Guidelines ◽  
To Receive

Background: When presenting for atrial fibrillation (AF) ablation, women, compared with men, tend to have more nonpulmonary vein triggers and advanced atrial disease. Whether this informs differences in AF ablation strategy is not well described. We aimed to characterize ablation strategy and complications by sex, using the Get With The Guidelines-AF registry. Methods: From the Get With The Guidelines-AF registry ablation feature, we included patients who underwent initial AF ablation procedure between January 7, 2016, and December 27, 2019. Patients were stratified based on AF type (paroxysmal versus nonparoxysmal) and sex. We compared patient demographics, ablation strategy, and complications by sex. Results: Among 5356 patients from 31 sites who underwent AF ablation, 1969 were women (36.8%). Women, compared with men, were older (66.8±9.6 versus 63.4±10.6, P <0.0001) and were more likely to have paroxysmal AF (59.4% versus 49.5%, P <0.0001). In women with nonparoxysmal AF, left atrial linear ablation was more frequent (roof line: 53.9% versus 45.3%, P =0.0002; inferior mitral isthmus line: 10.2% versus 7.0%, P =0.01; floor line: 46.1% versus 40.6%, P =0.02) than in men. In multivariable analysis, the association between patient sex and complications from ablation was not statistically significant. Conclusions: In this US wide AF ablation quality improvement registry, women with nonparoxysmal AF were more likely to receive adjunctive lesion sets compared with men. These findings suggest that patient sex may inform ablation strategy in ways that may not be strongly supported by evidence and emphasize the need to clarify optimal ablation strategies by sex.

scholarly journals Atrial Tachycardias Arising from Ablation of Atrial Fibrillation: A Proarrhythmic Bump or an Antiarrhythmic Turn?

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Ashok J. Shah ◽  
Amir Jadidi ◽  
Xingpeng Liu ◽  
Shinsuke Miyazaki ◽  
Andrei Forclaz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Direct Function ◽  
Mapping Strategy ◽  
Linear Ablation ◽  
Mitral Isthmus ◽  
Focal Ablation

The occurrence of atrial tachycardias (AT) is a direct function of the volume of atrial tissue ablated in the patients with atrial fibrillation (AF). Thus, the incidence of AT is highest in persistent AF patients undergoing stepwise ablation using the strategic combination of pulmonary vein isolation, electrogram based ablation and left atrial linear ablation. Using deductive mapping strategy, AT can be divided into three clinical categories viz. the macroreentry, the focal and the newly described localized reentry all of which are amenable to catheter ablation with success rate of 95%. Perimitral, roof dependent and cavotricuspid isthmus dependent AT involve large reentrant circuits which can be successfully ablated at the left mitral isthmus, left atrial roof and tricuspid isthmus respectively. Complete bidirectional block across the sites of linear ablation is a necessary endpoint. Focal and localized reentrant AT commonly originate from but are not limited to the septum, posteroinferior left atrium, venous ostia, base of the left atrial appendage and left mitral isthmus and they respond quickly to focal ablation. AT not only represents ablation-induced proarrhythmia but also forms a bridge between AF and sinus rhythm in longstanding AF patients treated successfully with catheter ablation.

Linear ablation of the mitral isthmus during atrial fibrillation ablation increases the incidence of left atrial tachycardia

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S16 ◽  
Author(s):  
Jesse S. Sethi ◽  
Bryan T. Piedad ◽  
John R. Bullinga ◽  
Douglas S. Holmes ◽  
Neil E. Bernstein ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
Linear Ablation ◽  
Mitral Isthmus

Abstract 3369: Association Between Bi-directional Mitral Isthmus Block and Atypical Flutter Following Left Atrial Linear Ablation in Patients with Symptomatic Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ramtin Anousheh ◽  
Navinder Sawhney ◽  
Charles Tate ◽  
Michael Panutich ◽  
Wayne Whitwam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
List Type ◽  
Additional Line ◽  
Linear Ablation ◽  
Mitral Isthmus ◽  
Isthmus Block ◽  
The Right

Background: Incomplete or unidirectional mitral isthmus block (MIB) during left atrial linear ablation (LALA) for atrial fibrillation (AF) may be proarrhythmic, and is the most common target for repeat ablation in patients with atypical atrial flutter (AAFL) after LALA. Objective: To determine if achieving bidirectional MIB during LALA will reduce occurrence post-ablation AAFL and/or recurrence of AF. Methods and Results: Fifty-six consecutive patients (pts), 49 males and 7 females, mean age 59±8 years, who underwent LALA for symptomatic, persistent (61%) or paroxysmal (39%) AF were evaluated. Thirty-four pts had been previously ablated, none had MIB from the first ablation. All pts underwent LALA including two encircling lesions around the right and left pulmonary veins, a line at the roof of the left atrium between the two circles, and a line from the lateral mitral valve annulus (MVA) to the left circle with adjunctive coronary sinus ablation as needed to achieve MIB. Thirty pts had an additional line from the septal MVA to the right circle. Bi-directional MIB was documented by pacing from the left atrial appendage and proximal coronary sinus. Bi-directional MIB was achieved in 38 pts (68%), with ablation in the coronary sinus required in 87.5% of pts. Thirty-seven pts underwent LALA with a standard 8 mm tip (Blazer™ or Navistar™) catheter and 19 pts with saline-irrigated catheters (ThermoCool™, Chili™). Patients were followed for 6±2 months. AAFL occurred in 15 pts (27%), and 17 pts (30%) had recurrence of AF. In pts with AAFL, 8 had documented bi-directional MIB during ablation and 7 did not. The odds of AAFL was 7.6 times higher in pts without MIB compared those with MIB (p=0.02); adjusting for age, gender, diagnosis, type of catheter, coronary sinus ablation and history of previous ablation. This study did not show similar association between recurrence of AF and MIB (p=0.5). Conclusions: Achieving bi-directional MIB will reduce incidence of post-ablation AAFL significantly. Recurrence of AF is not reduced by achieving bi-directional MIB.

High incidence of left atrial dysfunction and low voltage zone in patients requiring multiple atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Oka ◽  
I Yoshimoto ◽  
Y Koyama ◽  
K Tanaka ◽  
Y Hirao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Recurrence Rate ◽  
Left Atrial ◽  
Low Voltage ◽  
Peak Voltage ◽  
Af Ablation ◽  
Recurrent Atrial Fibrillation ◽  
Linear Ablation ◽  
Left Atrial Dysfunction

Abstract Background While multiple catheter ablation for recurrent atrial fibrillation (AF) is effective for the maintenance of sinus rhythm, some of patients have ablation-refractory AF. Left atrial (LA) dysfunction and the presence of low voltage zone (LVZ) are associated with recurrence after AF ablation. The association between recurrence and LA dysfunction/ LVZ among patients undergoing multiple AF ablation remains unclear. Purpose We aimed to compare (i)LA function, (ii)the prevalence of LVZ among patients undergoing first, second and third or more AF ablation procedures. Further, we investigated whether LA dysfunction and LVZ are associated with recurrence after multiple procedures. Methods We retrospectively analyzed 460 patients undergoing AF ablation procedures including first, second and third or more sessions from January 2017 to October 2019 in our institute. Before each session, 256-slice MDCT was performed under sinus rhythm to measure pre-ablation LA emptying fraction (LAEF) as the representative of LA function. At the end of each session, we checked the presence of LVZ, which was defined as regions where bipolar peak-to-peak voltage was &lt;0.5mV. All patients underwent pulmonary vein isolation (PVI). If necessary, additional ablation (e.g. linear ablation, non-PV foci ablation and LVZ ablation) was performed. Results Out of 460 sessions, 295 were first (follow-up years: 1.5 [0.8, 2.0]), 134 were second (1.0 [0.5, 1.8]), and 31 were third or more sessions (1.2 [0.7, 2.0]). As the number of sessions increased, the recurrence rate was increased (19% vs. 31% vs. 61%, first vs. second vs. ≥third, P&lt;0.0001), LAEF decreased (39.7±10.5% vs. 32.6±10.1% vs. 25.3±11.8%, P&lt;0.0001) and the incidence of LVZ increased (18% vs. 34% vs. 68%, P&lt;0.0001) (Figure 1). In patients with recurrence (N=104) after multiple ablation (second or more sessions), LAEF was lower and the prevalence of LVZ was higher than those without recurrence (N=61) (LAEF: 27.3±10.3% vs. 33.5±10.5%, with vs. without, P=0.0003; LVZ: 57% vs. 31%, P=0.0014). Conclusions As the number of sessions increased, the recurrence rate was increased. The prevalence of LA dysfunction and LVZ was high in patients requiring multiple ablation procedure. LA dysfunction and LVZ possibly reflect arrhytmogenic substrate causing recurrence of ablation-refractory AF. We should carefully consider repeated AF ablation in patients with severe LA dysfunction and extensive LVZ. Figure 1 Funding Acknowledgement Type of funding source: None

P430Antiarrhythmic drug therapy in Russian patients undergoing atrial fibrillation ablation: a sub-analysis of the ESC-EHRA EORP registry

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Korobchenko ◽  
S Bayramova ◽  
V Kharats ◽  
R Batalov ◽  
I Silin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Class Iii ◽  
Left Atrial Size ◽  
Related Factors ◽  
Factors Associated ◽  
Af Ablation ◽  
Atrial Size ◽  
Number Of Patients ◽  
To Receive

Abstract OnBehalf EHRA-ESC EORP AFA LT registry Introduction Despite the effectiveness of atrial fibrillation (AF) catheter ablation (CA), antiarrhythmic therapy (AAT) remains an important part of the complex treatment. Purpose To analyze AAT dynamics in Russian patients undergoing AF ablation, and to reveal potential factors associated with ongoing AAT in patients without arrhythmia recurrence. Methods The ESC-EHRA AF ablation registry was conducted in 2012-2016 in EHRA countries. The current analysis included 476 patients (57.1 male; 57.1 ± 8.7 years) who underwent AF ablation in 13 Russian clinics. AAT before, during and at 12-month follow-up (12-FU) was assessed. At baseline, paroxysmal AF was present in 320 (67.2%) patients, persistent AF - in 94 (19.7%), long-standing persistent AF- in 53 (11,1%), in 9 (1.9%) AF type was unknown. Hypertension (H) was present in 355 (74.6%) patients; congestive heart failure (CHF) (NYHA≥2) in 184 (38.7%) patients; coronary artery disease (CAD) in 132 (27.7%) patients. The CA was the first in 396 (83.2%) cases, redo ablation was performed in 80 (16.8%) cases. AF recurrences were registered according to local clinical practice. Any atrial tachyarrhythmia &gt;30s was considered as a recurrence. Results A three-month FU (3-FU) visit was performed in 476 (100%) patients, 12-FU - in 390 (81.9%). Prior to PV isolation 439 (92.2%) patients received AAT, while after ablation there was an increase in the number of patients on AAT - 459 (96.4%). The highest number of patients on AAT was detected at 3-FU - 463 (97.3%). During 12 months at least one episode of arrhythmia recurrence was documented in 203 (52.1%) patients, and 370 (94.8%) patients were on AAT at the 12-month visit. After the 12-month visit 307 (78.7%) patients continued to receive AAT, and in 187 (47.9%) of them there was no arrhythmia recurrence after the index ablation. Five (2.7%) of these patients continued a Ic class AAT drug, 35 (18.7%) patients - class III, 129 (69.0%) patients - β-blockers (BB) and 18 (9.6%) patients - calcium channel blockers (CCB). All 187 patients had co-morbidities (75.4% - H; 41.7% - CHF (NYHA≥2; 31.6% - CAD). There were no statistically significant predictors of AAT use in patients without arrhythmia reccurence. According to the univariant regression analysis, the use of AAT III class (mainly-sotalol) at 12 months had a small but statistically significant negative association with left atrial size enlargement (OR = 0.917; 0.860-0.997); class III AAT was negatevely associated with BB therapy (OR = 0.057; 0.016-0.198); CCB therapy was associated with an older age (OR = 1.073; 1.053-1.151). Conclusions About one-half of patients without apparent arrhythmia recurrence following AF ablation do receive AAT. There were no clinical or procedure-related factors associated with AAT after effective AF ablation. Paradoxically, patients with a smaller left atrial size and without arrhythmia recurrence had more chances to receive class III AAT, what requires further analysis.

scholarly journals Recovery of Mitral Isthmus Conduction Leads to the Development of Macro-Reentrant Tachycardia After Left Atrial Linear Ablation for Atrial Fibrillation

2011 ◽  
Vol 4 (6) ◽  
pp. 832-837 ◽  
Author(s):  
Navinder Sawhney ◽  
Kislay Anand ◽  
Clare E Robertson ◽  
Taylor Wurdeman ◽  
Ramtin Anousheh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Reentrant Tachycardia ◽  
Linear Ablation ◽  
Mitral Isthmus

scholarly journals The Association of Pre-Existing Left Atrial Fibrosis with Clinical Variables in Patients Referred for Catheter Ablation of Atrial Fibrillation

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15036 ◽  
Author(s):  
Jane Dewire ◽  
Irfan M. Khurram ◽  
Farhad Pashakhanloo ◽  
David Spragg ◽  
Joseph E. Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Af Ablation ◽  
Group 4 ◽  
Significant Difference ◽  
History Of ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Left Atrial Fibrosis

Introduction Atrial fibrillation (AF) recurrence after ablation is associated with left atrial (LA) fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI). We sought to determine pre-ablation, clinical characteristics that associate with the extent of LA fibrosis in patients undergoing catheter ablation for AF. Methods and Results Consecutive patients presenting for catheter ablation of AF were enrolled and underwent LGE-MRI prior to initial AF ablation. The extent of fibrosis as a percentage of total LA myocardium was calculated in all patients prior to ablation. The cohort was divided into quartiles based on the percentage of fibrosis. Of 60 patients enrolled in the cohort, 13 had <5% fibrosis (Group 1), 15 had 5-7% fibrosis (Group 2), 17 had 8-13% fibrosis (Group 3), and 15 had 14-36% fibrosis (Group 4). The extent of LA fibrosis was positively associated with time in continuous AF, and the presence of persistent or longstanding persistent AF. However, no statistically significant difference was observed in the presence of comorbid conditions, age, BMI, LA volume, or family history of AF among the four groups. After adjusting for diabetes and hypertension in a multivariable linear regression model, paroxysmal AF remained independently and negatively associated with the extent of fibrosis (-4.0 ± 1.8, P = 0.034). Conclusion The extent of LA fibrosis in patients undergoing AF ablation is associated with AF type and time in continuous AF. Our results suggest that the presence and duration of AF are primary determinants of increased atrial LGE.

scholarly journals Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium

2021 ◽  
Author(s):  
Jolien Neefs ◽  
Robin Wesselink ◽  
Nicoline W. E. van den Berg ◽  
Jonas S. S. G. de Jong ◽  
Femke R. Piersma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Antiarrhythmic Drugs ◽  
Primary Outcome ◽  
Volume Index ◽  
Substantial Part ◽  
Atrial Tachyarrhythmia ◽  
Af Ablation ◽  
Male Patients

Abstract Purpose Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA. Methods Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m2. Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up. Results At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4–62.8] ml/m2), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m2). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8–49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8–47.4 in a combined group of GLA and/or female sex(log rank p = 0.02). Conclusion Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.

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