scholarly journals Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA)

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Euijae Lee ◽  
Hyoung-Seob Park ◽  
Seongwook Han ◽  
Gi-Byung Nam ◽  
Jong-Il Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Catheter Ablation ◽  
Demographic Data ◽  
Heart Rhythm ◽  
Current Status ◽  
Procedural Complication ◽  
Acute Success ◽  
One Year ◽  
Af Recurrence

Abstract Background This study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea. Methods The patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed. Results A total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence. Conclusions Additional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.

Catheter ablation for atrial fibrillation – more effectively and safely

2020 ◽  
Vol 1 (54) ◽  
pp. 15-22
Author(s):  
Piotr Kułakowski ◽  
Agnieszka Sikorska ◽  
Tomasz Kryński ◽  
Roman Piotrowski ◽  
Jakub Baran
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Similar Efficacy ◽  
Current Status ◽  
Cryoballoon Ablation ◽  
Efficacy And Safety ◽  
Future Perspectives ◽  
Significant Progress ◽  
One Year

During past twenty years a significant progress in efficacy and safety of ablation for atrial fibrillation (AF) has been made. Data from literature and our own experience suggest that success rate during one-year follow-up exceeds 80%, especially in patients with paroxysmal AF. Both, radiofrequency (RF) and cryoballoon ablation have similar efficacy whereas learning curve is much shorter when using the latter technique. Summary of current status of AF ablation and future perspectives are presented.

scholarly journals Viable Prediction for Atrial Fibrillation Recurrence After Catheter Ablation

2021 ◽  
Vol 11 ◽  
Author(s):  
Vinila Baljepally ◽  
Jesse Raffa ◽  
Xiaopeng Zhao
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Catheter Ablation ◽  
Heart Rhythm ◽  
P Wave ◽  
P Value ◽  
Tree Model ◽  
Repeat Procedure ◽  
Obstructive Sleep ◽  
Af Recurrence

Introduction: Atrial fibrillation (AF) is the most common heart rhythm abnormality and the leading cause of stroke. Radiofrequency catheter ablation is used to treat AF but recurrence can occur after the ablation procedure, requiring repeat procedure. A new model to predict AF recurrence after ablation was developed through multivariate analysis. Methods: The variables include demographic, electrocardiographic, echocardiographic, and clinical parameters. In a retrospective review (n=82), 41 patients who underwent repeat ablation for recurrent AF were compared to 41 controls that underwent ablation only once. Results: Of the analyzed parameters, age, female gender and left atrial enlargement were not predictive, but P wave duration (PWD) and obstructive sleep apnea (OSA) were significant predictors of repeat ablation (p-value = 0.0003 and 0.0023, respectively). Based on the analyses, a simple decision tree model was developed, achieving a prediction accuracy of 87% (sensitivity=83%, specificity=90%). Conclusion: The developed PWD and OSA 2-predictor model has good accuracy and sensitivity, both of which make it a viable prediction model for AF recurrence after catheter ablation. The developed model will help doctors: 1) Avoid repeat procedure in patients at high risk of recurrence by exploring alternative treatments (2) Reduce costs by avoiding repeat procedure (3) Correct underlying issues prior to procedure in those at high risk (4) Objectively inform patients about recurrence so they can make an informed decision about whether to undergo the procedure. Adopting predictive models such as ours may therefore improve quality care and reduce costs for AF patients undergoing ablation.

scholarly journals Autonomic nervous modulation after cryoballoon ablation for paroxysmal atrial fibrillation

2021 ◽  
Vol 28 (1) ◽  
pp. 38-46
Author(s):  
I. A. Novikov ◽  
P. S. Novikov ◽  
N. U. Mironov ◽  
M. A. Shariya ◽  
S. F. Sokolov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Heart Rhythm ◽  
Holter Monitoring ◽  
Early Recurrence ◽  
Cryoballoon Ablation ◽  
Autonomic Nervous ◽  
One Year ◽  
Af Recurrence

Aim. Aim of our study was the assessment of autonomic nervous system (ANS) modulation by assessment of heart rhythm variation (HRV) using Holter monitoring after single second generation cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF).Methods. Patients who underwent the CBA for paroxysmal AF were include in this study. At the baseline the Holter monitoring after withdrawal of antiarrhythmic therapy (AAT) with assessment of HRV: SDNN, RMSSD, ln LF, ln LH, LH/HF, mean, minimal and maximal beats per minute (BPM) was perform. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months including Holter monitoring.Results. Among 80 patients underwent CBA, HRV was assessed in 55 patients (65.5% male, age median 61 years, 97.7% of pulmonary vein have been successful isolated). One year after CBA all HRV parameters and the mean, minimal and maximal BPM was significantly different from baseline parameters (p<0.05). In the AF recurrence group ln LF was lower at 3-, 6and 12-month visits (p<0.05) and minimal HR was higher at 3 months (median 58 vs 55.5, p=0.033). Multivariate analysis demonstrated that early recurrence of AF was independent predictor of AF recurrence after CBA (HR 7,44, 95% CI 2,19-25,25, р=0,001).Conclusion. Our study demonstrated that CBA leads to modulation of ANS which persists for at least 12 months. The early recurrence of AF was only predictor of AF recurrence after CBA.

scholarly journals Is There an Association between Epicardial Adipose Tissue and Outcomes after Paroxystic Atrial Fibrillation Catheter Ablation?

2021 ◽  
Vol 10 (14) ◽  
pp. 3037
Author(s):  
Néfissa Hammache ◽  
Hugo Pegorer-Sfes ◽  
Karim Benali ◽  
Isabelle Magnin Poull ◽  
Arnaud Olivier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adipose Tissue ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Epicardial Adipose Tissue ◽  
University Hospital ◽  
One Year ◽  
Af Recurrence

Background: In patients undergoing paroxysmal atrial fibrillation (PAF) ablation, pulmonary vein isolation (PVI) alone fails in maintaining sinus rhythm in up to one third of patients after a first catheter ablation. Epicardial adipose tissue (EAT), as an endocrine-active organ, could play a role in the recurrence of AF after catheter ablation. Objective: To evaluate the predictive value of clinical, echocardiographic, biological parameters and epicardial fat density measured by computed tomography scan (CT-scan) on AF recurrence in PAF patients who underwent a first pulmonary vein isolation procedure using radiofrequency (RF). Methods: This monocentric retrospective study included all patients undergoing first-time RF PAF ablation at the Nancy University Hospital between March 2015 and December 2018 with one-year follow-up. Results: 389 patients were included, of whom 128 (32.9%) had AF recurrence at one-year follow-up. Neither total-EAT volume (88.6 ± 37.2 cm3 vs. 91.4 ± 40.5 cm3, p = 0.519), nor total-EAT radiodensity (−98.8 ± 4.1 HU vs. −98.8 ± 3.8 HU, p = 0.892) and left atrium-EAT radiodensity (−93.7 ± 4.3 HU vs. −93.4 ± 6.0 HU, p = 0.556) were significantly associated with AF recurrence after PAF ablation. In multivariate analysis, previous cavo-tricuspid isthmus (CTI) ablation, ablation procedure duration, BNP and triglyceride levels remained independently associated with AF recurrence after catheter ablation at 12-months follow-up. Conclusion: Contrary to persistent AF, EAT parameters are not associated with AF recurrence after paroxysmal AF ablation. Thus, the role of the metabolic atrial substrate in PAF pathophysiology appears less obvious than in persistent AF.

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O.M Aldaas ◽  
F Lupercio ◽  
C.L Malladi ◽  
P.S Mylavarapu ◽  
D Darden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear. Purpose To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF. Methods We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR&lt;1.0 favors the HFpEF group. Results Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up. Conclusion Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF. Funding Acknowledgement Type of funding source: None

Abstract P172: Circulating Heat Shock Protein 70 and Antiheat Shock Protein 70 Antibodies in Atrial Fibrillation: Relation with Atrial Fibrillation Type and Response to Catheter Ablation

2011 ◽  
Vol 109 (suppl_1) ◽  
Author(s):  
Jelena Kornej ◽  
Claudia Reinhardt ◽  
Jedrzej Kosiuk ◽  
Arash Arya ◽  
Gerhard Hindricks ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Catheter Ablation ◽  
Heat Shock ◽  
Heat Shock Protein ◽  
Heat Shock Protein 70 ◽  
Recurrence Rates ◽  
Multivariable Regression Analysis ◽  
Multivariable Regression ◽  
Af Recurrence

Background: HSP and anti-HSP antibodies have been associated with AF development and progression. This study investigated the possible association between circulating heat shock protein 70 (HSP70) and anti-HSP70 antibodies as well their changes and rhythm outcome after atrial fibrillation (AF) catheter ablation. Methods: In 67 patients with AF (59±11 years, 66 % male, 66 % lone AF) undergoing catheter ablation, circulating HSP70 and anti-HSP70 antibodies levels were quantified before and 6 months after catheter ablation. Serial 7-day Holter ECGs were used to detect AF recurrences. Results: At baseline, HSP70 was detectable in 14 patients (21 %), but there was no correlation between clinical or echocardiographic variables and the presence or the level of HSP70. Patients with paroxysmal AF (n=39) showed lower anti-HSP70 antibodies (median 43, IQR 28 - 62 µg/ml) than patients with persistent AF (n=28; 53, 41 - 85 µg/ml, p=.035). Using multivariable regression analysis, AF type was the only variable associated with anti-HSP70 antibodies (Beta=.342, p=.008). At 6 months, HSP70 was present in 27 patients (41 %, p<.001 vs. baseline) with an overall increase (median 0, IQR 0 - 0 vs. 0, 0 - 0.09 ng/ml, p=.029). Similarly, there was an increase of anti-HSP70 antibodies (48, 36 - 72 vs. 57, 43 - 87 µg/ml, p<.001). AF recurrence rates were higher in patients with HSP70 increase >0.025 ng/ml (32 vs. 11 %, p=.038) or anti-HSP70 antibodies increase >2.5 µg/ml (26 vs. 4 %, p=.033). Conclusion: HSP70 and anti-HSP70 antibodies may be involved in the progression of AF and AF recurrence after catheter ablation.

Abstract 13793: Role of Cardiac Autoantibodies for the Prediction of Recurrence Following Cryoballoon-based Lone Atrial Fibrillation Ablation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Muhammed U Yalcin ◽  
Kadri M Gurses ◽  
Duygu Kocyigit ◽  
Sacit A Kesikli ◽  
Hikmet Yorgun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Predictive Value ◽  
Cox Regression ◽  
Muscarinic Acetylcholine Receptor ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Lone Atrial Fibrillation ◽  
Left Atrial Volume Index ◽  
One Year ◽  
Af Recurrence

Introduction: Recent evidence have suggested that autoantibodies may play an important role in the development of atrial fibrillation (AF). Predictive value of pre-procedural autoantibodies against beta-1 adrenergic receptor (anti-β1-R) and M2-muscarinic acetylcholine receptor (anti-M2-R) for AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) is still unclear. We aimed to determine the predictive value of pre-procedural anti-β1-R and anti-M2-R levels for AF recurrence in lone AF patients following cryoballoon-based PVI. METHODS: 80 patients (mean age 54.25±7.7 years; 40% males) with lone AF who underwent cryoballoon-based PVI were included in the study. Pre-procedural anti-M2-R and anti-β1-R levels were measured with ELISA. RESULTS: At one-year follow-up after ablation, late AF recurrence was observed in 17 (21.25%) patients. In the Cox regression model including number of antiarrhythmic drugs, early AF recurrence, anti-β1-R levels >159.88 ng/mL, anti-M2-R levels >277.65 ng/mL, AF duration and left atrial volume index; only anti-β1-R levels >159.88 ng/mL (HR: 4.281, p=0.039) and anti-M2-R levels >277.65 ng/mL (HR: 4.313, p=0.030) were found to be independent predictors of late AF recurrence. Anti-β1-R level >159.88 ng/mL was shown to predict late AF recurrence with a sensitivity of 70.59% and specificity of 90.48%. A cut-off value of 277.65 ng/mL for anti-M2-R level predicted AF recurrence with a sensitivity of 70.59% and specificity of 95.24%. CONCLUSION: Pre-procedural serum anti-β1-R and anti-M2-R levels are independent predictors of late AF recurrence following cryoballoon-based PVI in lone AF patients. Detection of pre-procedural anti-β1-R and anti-M2-R levels may serve as a novel method for determination of lone AF patients who may not benefit from cryoballoon-based PVI.

scholarly journals Cost-effectiveness of catheter ablation versus medical therapy for the treatment of atrial fibrillation in the United Kingdom

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
L Leung ◽  
RJ Imhoff ◽  
D Frame ◽  
PJ Mallow ◽  
L Goldstein ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Catheter Ablation ◽  
Medical Therapy ◽  
Rhythm Control ◽  
Uk National Health Service ◽  
The Uk ◽  
The Cost ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This research study was funded by Biosense Webster, Inc. Dr Leung has received research support from Attune Medical (Chicago, IL) towards a research fellowship at St. George"s University of London. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Background Randomised data on patient-related outcomes comparing catheter ablation to medical therapy for the treatment of atrial fibrillation (AF) have shown the effectiveness of catheter ablation. Ablation versus medical therapy should also be analysed from a health economics perspective to achieve optimal healthcare resource allocation. Purpose To determine the cost effectiveness of catheter ablation compared to medical therapy for the treatment of atrial fibrillation, from the perspective of the UK National Health Service. Methods A patient-level Markov health-state transition model was used to conduct a cost utility analysis comparing catheter ablation and medical therapy for the treatment of AF. A systematic review and meta-analysis of catheter ablation treatment versus medical therapy (rhythm and/or rate control drugs) was conducted to enable comparison of AF recurrence between treatment groups utilising the model. Additional model parameters were established based upon a best-evidence review of the literature. The model simulated care delivered from a secondary care perspective. Total patients simulated in this model over a lifetime were 250,000, with patients entering the model at age 64. Only previously treated AF patients were included, including those with concomitant heart failure. A separate scenario analysis was conducted to determine the cost effectiveness specifically in the cohort of patients with AF and heart failure. Main outcomes measures Incremental cost-effectiveness ratio (ICER) and average total expected costs and quality-of-life years (QALYs) incurred over the lifetime of a patient. AF recurrence, complications and cardiovascular adverse events were compared over the total duration inside the model. Results In the base case analysis, catheter ablation resulted in a favourable ICER of £8,614 per additional QALY gained when compared to medical therapy, well below the national Willingness-to-Pay threshold of £20,000. Catheter ablation was associated with an expected increase of 1.01 QALYs, while adding an additional cost £8,742 over a patient’s lifetime. The cost-effectiveness of catheter ablation was improved in the heart failure sub-group analysis, with an ICER of £6,438. A significantly greater proportion of patients in the medical therapy group failed rhythm control at any stage compared to catheter ablation (72% vs 24%) and at a faster rate (median time to treatment failure: 3.8 vs 10 years). Conclusion Catheter ablation appears to be a highly cost-effective treatment for atrial fibrillation, compared to medical therapy, from the perspective of the UK National Health Service. With low rates of adverse events and superiority in achieving rhythm control, AF ablation services should be prioritised with appropriate allocation of healthcare resources.

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