The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring

Abstract Background Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA). Objective We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder. Methods This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months. Results 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32–8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008–1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67–9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007–1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42–35.99; p = 0.019). Conclusions ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF’s early and late recurrence.

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Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: Predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences

Heart Rhythm ◽

10.1016/j.hrthm.2015.12.034 ◽

2016 ◽

Vol 13 (4) ◽

pp. 845-851 ◽

Cited By ~ 34

Author(s):

Giacomo Mugnai ◽

Carlo de Asmundis ◽

Burak Hünük ◽

Erwin Ströker ◽

Vedran Velagic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Second Generation ◽

Cryoballoon Ablation ◽

Atrial Arrhythmias ◽

Predictive Role

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Role of the burden of premature atrial contractions during the blanking period following second-generation cryoballoon ablation in predicting late recurrences of atrial arrhythmias

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-017-0270-6 ◽

2017 ◽

Vol 49 (3) ◽

pp. 329-335 ◽

Cited By ~ 2

Author(s):

Hugo-Enrique Coutiño ◽

Juan-Pablo Abugattas ◽

Moisés Levinstein ◽

Giacomo Mugnai ◽

Darragh Moran ◽

...

Keyword(s):

Second Generation ◽

Cryoballoon Ablation ◽

Atrial Arrhythmias

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Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolation

Heart Rhythm ◽

10.1016/j.hrthm.2014.12.026 ◽

2015 ◽

Vol 12 (4) ◽

pp. 673-680 ◽

Cited By ~ 125

Author(s):

Giuseppe Ciconte ◽

Carlo de Asmundis ◽

Juan Sieira ◽

Giulio Conte ◽

Giacomo Di Giovanni ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Cryoballoon Ablation ◽

One Year

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Long-term follow-up of thoracoscopic ablation for long-standing persistent atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0625 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N Harlaar ◽

M.A.P Oudeman ◽

S.A Trines ◽

G.S De Ruiter ◽

M Khan ◽

...

Keyword(s):

Sinus Rhythm ◽

Pulmonary Vein ◽

Atrial Arrhythmia ◽

Wilcoxon Test ◽

Continuous Group ◽

Loop Recorder ◽

Long Term Follow Up ◽

Rhythm Monitoring

Abstract Background Catheter ablation in patients with long-standing persistent AF (LSPAF) remains challenging and often requires repeated procedures with variable results. We report long-term outcomes of a bipolar thoracoscopic pulmonary vein and left atrial posterior wall ablation for LSPAF, and compare continuous and interval rhythm monitoring. Methods Seventy-seven LSPAF patients who underwent thoracoscopic pulmonary vein and box isolation between 2009–2017 in two Dutch centers were included. Follow-up consisted of continuous rhythm monitoring using an implanted loop recorder or 24-h Holter at 3/6/12/24/60 months. Results Mean age was 59±8 years with a median AF duration of 3.8 [1.2–6.3] years. In the total cohort, at 2-year follow-up, 86.0% of patients were in sinus rhythm, 12.3% were in paroxysmal AF and 1.6% in persistent AF. At 5 years, 62.9% of patients were in sinus rhythm, 20.0% in paroxysmal AF, 14.3% in persistent AF and 2.9% was experiencing atrial flutter. Continuous rhythm monitoring was performed in 46% of patients. Comparing continuous and interval rhythm monitoring, freedom from any atrial arrhythmia episode at 2- and 5 years was 60.0% and 49.9% in the continuous group and 93.8% and 51.9% in the interval monitoring group, respectively (p=0.02, Breslow-Wilcoxon test). In patients with continuous rhythm monitoring the mean atrial arrhythmia burden was reduced from 99.1% preoperatively to 0.1% at the end of the blanking period and 7.3% at 2-year follow-up. Conclusions Thoracoscopic box ablation is highly effective in restoring sinus rhythm at medium term follow-up. However, it is not a curative treatment as demonstrated by the 50% arrhythmia-free survival at long-term follow-up. Whether this is due to the progressive nature of AF needs further investigation. Continuous rhythm monitoring shows earlier recurrence detection with a potential early treatment adaptation. Funding Acknowledgement Type of funding source: None

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Anatomic predictors of late right inferior pulmonary vein reconnection in the setting of second‐generation cryoballoon ablation

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14186 ◽

2019 ◽

Vol 30 (11) ◽

pp. 2294-2301

Author(s):

Muryo Terasawa ◽

Gian‐Battista Chierchia ◽

Ken Takarada ◽

Alessandro Rizzo ◽

Riccardo Maj ◽

...

Keyword(s):

Pulmonary Vein ◽

Second Generation ◽

Cryoballoon Ablation ◽

Inferior Pulmonary Vein ◽

Pulmonary Vein Reconnection

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Prognostic role of neoplastic markers in Takotsubo syndrome

Scientific Reports ◽

10.1038/s41598-021-95990-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Francesco Santoro ◽

Tecla Zimotti ◽

Adriana Mallardi ◽

Alessandra Leopizzi ◽

Enrica Vitale ◽

...

Keyword(s):

Serum Levels ◽

Takotsubo Syndrome ◽

Ca 15.3 ◽

Risk Of Death ◽

Increased Risk ◽

Ca 19.9 ◽

Long Term Follow Up

AbstractTakotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9–14.8, HR = 7.8 95% CI 2.4–25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6–52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE.

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P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women

European Heart Journal ◽

10.1093/eurheartj/ehz748.0570 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

O L Rueda Ochoa ◽

L R Bons ◽

S Rohde ◽

K E L Ghoud ◽

R Budde ◽

...

Keyword(s):

Heart Failure ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Total Mortality ◽

Population Based ◽

Cardiovascular Outcomes ◽

Increased Risk ◽

Almost All

Abstract Background Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist. Purpose To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk. Methods and results 2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up. Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women. Conclusions Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.

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Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation

EP Europace ◽

10.1093/europace/euu350 ◽

2015 ◽

Vol 17 (4) ◽

pp. 559-565 ◽

Cited By ~ 76

Author(s):

G. Ciconte ◽

G. Baltogiannis ◽

C. de Asmundis ◽

J. Sieira ◽

G. Conte ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Radiofrequency Catheter Ablation ◽

Second Generation ◽

Persistent Atrial Fibrillation ◽

Cryoballoon Ablation ◽

Index Procedure ◽

Circumferential Pulmonary Vein Isolation

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The Predictive Role of Tooth Extractions, Oral Infections, and hs-C-Reactive Protein for Mortality in Individuals with and without Diabetes: A Prospective Cohort Study of a 12 1/2-Year Follow-Up

Journal of Diabetes Research ◽

10.1155/2017/9590740 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Lise Lund Håheim ◽

Kjersti S. Rønningen ◽

Morten Enersen ◽

Ingar Olsen

Keyword(s):

Blood Pressure ◽

Cohort Study ◽

C Reactive Protein ◽

Oral Infections ◽

Reactive Protein ◽

Predictive Role ◽

Hs Crp ◽

Tooth Extractions

The predictive role of high-sensitivity C-reactive protein (hs-CRP), number of tooth extractions, and oral infections for mortality in people with and without diabetes is unclear. This prospective cohort study is a 12 1/2-year follow-up of the Oslo II study, a health survey in 2000. In all, 12,764 men were invited. Health information was retrieved from 6434 elderly men through questionnaire information, serum measurements, and anthropometric and blood pressure measurements. Diabetes was reported by 425 men. Distinct differences were observed in baseline characteristics in individuals with and without diabetes. In the diabetes group, age and hs-CRP were statistically significant whereas in the nondiabetes group, age, hs-CRP, number of tooth extractions, tooth extractions for infections and oral infections combined, nonfasting glucose, systolic blood pressure, total cholesterol, regular alcohol drinking, daily smoking, and level of education were independent risk factors. The number of tooth extractions <5 was inversely related whereas more extractions increased the risk. Multivariate analyses showed that hs-CRP was a significant predictor in persons with diabetes and tooth extractions and oral infections combined; the number of teeth extracted and hs-CRP were for persons without diabetes. Infection and inflammation were associated with mortality in individuals both with and without diabetes.

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