scholarly journals Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

2015 ◽  
Vol 42 (4) ◽  
pp. 341-347 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Fabrizio Veglia ◽  
Claudia Galli ◽  
Alessandro Parolari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P <0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

Abstract 17223: Castle of Stone or Straw, Radiofrequency Ablation of Atrial Fibrillation in Heart Failure?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Brian D McCauley ◽  
Esseim Sharma ◽  
John Dudley ◽  
Antony Chu
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Prospective Trials

Introduction: Based on the data from CASTLE-AF trial, in patient with Atrial Fibrillation (AF) and heart failure (HF) catheter ablation may offer a significant reduction in both death, and hospitalization, while promoting maintenance of sinus rhythm as well as improvement in left ventricular ejection fraction (LVEF). This multi-center randomized trial is hailed as a paradigm shifting study in catheter ablation, however it is not without fault. One of the critiques of the CASTLE-AF trial was the high frequency of crossover between the treatment arms. To help sort out this potential source of confounding, we performed a systematic meta-analysis of prospective trials for catheter ablation in AF in patients with Class II through IV heart failure. Hypothesis: The reduction in death, and hospitalization, as well as the maintenance in sinus rhythm and improvement in LVEF seen CASTLE-AF trial are support by other similarly designed AF ablation trials. Methods: Using the inclusion/exclusion criteria from the CASTLE-AF trial, we performed a systematic meta-analysis of 28 published studies. Randomized and non-randomized observational studies comparing the impact of catheter ablation of AF in HF. Studies were identified using the Cochrane Library, EMBASE, and PubMed. Results: A total of 29 studies were identified (n =2,339). Mean follow-up was 25 (95% confidence interval, 18-40) months. Efficacy in maintaining sinus rhythm at follow-up end was 60% (43%-76%). Left ventricular ejection fraction improved significantly during follow-up by 15% (P<0.001). Conclusions: Following our meta-analysis, we found data to support the findings of improved LVEF and maintenance of sinus rhythm reported in the CASTLE-AF trial. However, due to differences in study design, we were unable to further validate the reduction in both hospitalization and death seen in CASTLE-AF. We recommend future prospective trials be conducted without cross over to further explore this topic.

scholarly journals Overweight and Aging Increase the Risk of Atrial Fibrillation After Cardiac Surgery Independently of Left Atrial Size and Left Ventricular Ejection Fraction

2020 ◽  
Author(s):  
Pier Luigi Stefano ◽  
Marco Bugetti ◽  
Guido Del Monaco ◽  
Gloria Popescu ◽  
Paolo Pieragnoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Aortic Surgery ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background: Body mass index (BMI), age, left atrium (LA) dimensions and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim was to better define the role of these risk factors. Methods: This study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery . Prior to surgery the following data were collected: age (yrs), BMI (kg/m2), LA diameter (cm), LA area (cm2), LVEF (%), the presence of arterial hypertension (AH) and of diabetes, tyroid stimulating hormone (TSH, mU/L) and, creatinine (mg/dL). Results: Patients with (n. 127, 51%) and without POAF (n. 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH and diabetes. Instead, patients with PoAF had higher values of age, BMI, creatinine and a greater prevalence of AH and Bentall procedures. Multivariable analysis showed that the only independent predictors of PoAF were: age (OR = 1,05, CI 95% 1,025-1,076, p= 0,0001) and BMI (OR=1,095, CI 95% 1,015-1,182, p= 0,019). Conclusions: Results suggest that advanced age and a higher value of BMI are strong risk factors for POAF in patients without previous AF. This even in the presence of comparable LA dimensions and LVEF.

scholarly journals Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Pier Luigi Stefàno ◽  
Marco Bugetti ◽  
Guido Del Monaco ◽  
Gloria Popescu ◽  
Paolo Pieragnoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pleural Effusion ◽  
Left Ventricular Ejection Fraction ◽  
Operation Time ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. Methods This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. Results Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2,p = 0.006). Conclusions These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

scholarly journals Early assessment of left atrial function after cardioversion predicts recurrence of atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Kupczynska ◽  
BW Michalski ◽  
E Trzos ◽  
D Miskowiec ◽  
L Szyda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Early Assessment ◽  
Ventricular Ejection Fraction ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background The restoration of sinus rhythm (SR) improves the mechanical function of the heart. Purpose To assess left atrial (LA) function before and within 24 hours after successful electrical cardioversion (EC) and its prognostic value for atrial fibrillation (AF) recurrence during 24 months follow-up. Methods Prospective study involved 71 patients with non-valvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echocardiography before and after EC. We analysed standard parameters in two-dimensional echo, pulse-wave Doppler and tissue Doppler echocardiography. Using speckle-tracking method we assessed peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). Results During follow-up we noticed AF recurrence in 48 (68%) patients. Median time to AF recurrence was 2.4 (IQR 1 to 6.9) months. Left ventricular ejection fraction as well as E/E’ and PALS assessed during AF were statistically insignificant as potential predictors in univariate regression model. Receiver operating characteristic curve analysis revealed that left atrial volume index &gt;37 ml/m² (AUC = 0.811, p &lt; 0.0001), E/A ratio &gt;2.1 (AUC = 0.828, p &lt; 0.0001), A wave ≤0.4 m/s (AUC = 0.662, p = 0.01), mean E/E’ ratio during sinus rhythm &gt;8.5 (AUC = 0.815, p &lt; 0.0001), mean A’ wave of ≤5.5 cm/s (AUC = 0.848, p &lt; 0.0001), PALS-SR ≤14.1% (AUC = 0.767, p &lt; 0.0001), PACS ≤4.3% (AUC = 0.883, p &lt; 0.0001) were the optimal cut-off values for predicting AF recurrence. Conclusions The assessment of LA and diastolic function conducted within 24 hours after successful cardioversion predicts long-term maintenance of sinus rhythm.

Are body mass index and age independent risk factors for new-onset atrial fibrillation after cardiac surgery regardless of left atrial size and left ventricular ejection fraction value?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Stefano ◽  
M Bugetti ◽  
A Michelucci ◽  
G Del Monaco ◽  
G Popescu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Valve Repair ◽  
Ventricular Ejection Fraction

Abstract Background Obesity, advanced age and left atrium dimensions have been linked to atrial fibrillation (AF). Purpose This study aimed at evidencing if the above mentioned risk factors have a role among the others in conditioning the onset of post operative AF (PoAF) in patients undergoing cardiac surgery without previous AF. Methods This study evaluated 249 consecutive patients undergoing coronary artery by-pass surgery either isolated or in combination with aortic or mitral valve repair/replacement, or isolated valve repair/replacement. Prior to surgery, in all patients the following data were collected: age (yrs), body mass index (BMI, kg/m2), left atrium (LA) diameter (cm), LA area (cm2), left ventricular ejection fraction (LVEF, %), the presence/absence of arterial hypertension (AH) and diabetes, creatinine (mg/dL). To detect the presence of PoAF, cardiac rhythm was continouosly recorded during the first seven postoperative days. Results PoAF occurred in 127 patients (51%). We compared patients with and without PoAF. Mean values (±1 SD) of continuous variables and the frequency of dicothomic ones are reported in the table. No difference was observed for sex, LA diameter, LA area, LVEF and diabetes. Instead, patients with PoAF had higher values of age, BMI, creatinine and a greater prevalence of AH. According to multivariable binary logistic analysis the independent predictors of PoAF were: age (OR = 1.05, CI 95%: 1.026–1.074, p=0.018) and BMI (OR = 1.09, CI 95%: 1.015–1.171, p=0.0001). Conclusions Results suggest that advanced age and a higher value of BMI could be strong risk factors for PoAF in patients who undergo cardiac surgery without previous AF. This considering that in the present population the values of LA diameter, LA area and LVEF showed no statistically significant difference between patients with and without PoAF. Funding Acknowledgement Type of funding source: None

Peak Oxygen Consumption and Resting Left Ventricular Ejection Fraction Changes After Cardiomyoplasty at 6-Month Follow-up

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 216-222 ◽  
Author(s):  
Edimar Alcides Bocchi ◽  
Guilherme Veiga Guimarães ◽  
Luiz Felipe P. Moreira ◽  
Fernando Bacal ◽  
Alvaro Vilela de Moraes ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

scholarly journals The relationship between diastolic blood pressure and the risk of cardiovascular events in patients with atrial fibrillation: the Fushimi AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ikeda ◽  
M Iguchi ◽  
H Ogawa ◽  
Y Aono ◽  
K Doi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background Hypertension is one of the major risk factors of cardiovascular events in patients with atrial fibrillation (AF). However, relationship between diastolic blood pressure (DBP) and cardiovascular events in AF patients remains unclear. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in Japan. Follow-up data were available in 4,466 patients, and 4,429 patients with available data of DBP were examined. We divided the patients into three groups; G1 (DBP&lt;70 mmHg, n=1,946), G2 (70≤DBP&lt;80, n=1,321) and G3 (80≤DBP, n=1,162), and compared the clinical background and outcomes between groups. Results The proportion of female was grater in G1 group, and the patients in G1 group were older and had higher prevalence of heart failure (HF), diabetes mellitus (DM), chronic kidney disease (CKD). Prescription of beta blockers was higher in G1 group, but that of renin-angiotensin system-inhibitors and calcium channel blocker was comparable. During the median follow-up of 1,589 days, in Kaplan-Meier analysis, the incidence rates of cardiovascular events (composite of cardiac death, ischemic stroke and systemic embolism, major bleeding and HF hospitalization during follow up) were higher in G1 group and G3 group than G2 group (Figure 1). When we divided the patients based on the systolic blood pressure (SBP) at baseline (≥130 mmHg or &lt;130 mmHg), the incidence of rates of cardiovascular events were comparable among groups. Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), higher SBP (≥130 mmHg), DM, pre-existing HF, CKD, low left ventricular ejection fraction (&lt;40%) and DBP (G1, G2, G3) revealed that DBP was an independent determinant of cardiovascular events (G1 group vs. G2 group; hazard ratio (HR): 1.40, 95% confidence intervals (CI): 1.19–1.64, G3 group vs. G2 group; HR: 1.23, 95% CI: 1.01–1.49). When we examined the impact of DBP according to 10 mmHg increment, patients with very low DBP (&lt;60 mmHg) (HR: 1.50,95% CI:1.24–1.80) and very high DBP (≥90 mmHg) (HR: 1.51,95% CI:1.15–1.98) had higher incidence of cardiovascular events than patients with DBP of 70–79 mmHg (Figure 2). However, when we examined the impact of SBP according to 20 mmHg increment, SBP at baseline was not associated with the incidence of cardiovascular events (Figure 3). Conclusion In Japanese patients with AF, DBP exhibited J curve association with higher incidence of cardiovascular events. Funding Acknowledgement Type of funding source: None

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