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 Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Katbeh ◽  
T De Potter ◽  
P Geelen ◽  
E Stefanidis ◽  
K Iliodromitis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Time Course ◽  
Public Institution ◽  
P Value ◽  
Funding Source ◽  
Functional Changes ◽  
Af Recurrence

Abstract Background Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR). Methods We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up. Results During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group. Conclusion LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration. Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value <0.05 (baseline vs. follow-up). Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).

scholarly journals Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after catheter ablation in patients with obstructive sleep apnea: A randomized controlled trial

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T-E Hunt ◽  
GM Traaen ◽  
L Aakeroy ◽  
C Bendz ◽  
B Oeverland ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Randomized Study ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority OnBehalf OUH Background Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Studies have reported an association between OSA and increased AF burden, as well as increased recurrence of AF after catheter ablation. However, whether treatment with positive airway pressure (CPAP) can reduce the risk of AF recurrence after pulmonary vein isolation has still not been established. Purpose This is the first randomized study evaluating the effect of CPAP treatment on AF recurrence after pulmonary vein isolation in patients with AF and OSA. Methods Consecutive patients with AF referred for catheter ablation were included after being screened positive for OSA (apnea-hypopnea index [AHI] ≥ 15 events/h). All patients received an implantable loop recorder 6 months prior to ablation to quantify the arrhythmia burden. Patients were randomized to CPAP treatment or no treatment of OSA during five months before and 12 months after ablation. The primary end point was AF recurrence, defined as one episode of AF lasting longer than 30 seconds after catheter ablation, with an initial 90-day blanking period. We also compared AF burden measured in percent of time in AF and assessed five months before and 3-12 months after catheter ablation. Results We included 83 patients (65% male, age 61 ± 7.3 years), of which 37 patients were treated with CPAP and 46 controls. The mean baseline AHI in patients with CPAP was 26.7 ± 14.7 and in patients with usual care 26.3 ± 12.3. AF-burden prior to catheter ablation expressed as median [IQR] percent of time was 2.7 [0.9-9.1] in the CPAP-group compared to 1.8 [0.2-6.4] in the control group (p = 0.24). There was no signal to a difference in AF recurrence rate between patients with or without CPAP treatment. As shown in figure, we found overlapping curves with a final 21 patients [57%] vs. 26 patients (57%) presenting at least 30 seconds of AF. After catheter ablation and blanking period, patients with CPAP treatment had an AF burden of 0.0 [0.0-0.3] % compared to 0.0 [0.0-0.3] % in patients without CPAP (p = 0.64). Conclusion In this randomized study concomitant treatment with CPAP on top of pulmonary vein isolation had no added effect on the risk of AF recurrence in patients with OSA. Although several patients revealed at least 30 seconds of AF 3-12 months after ablation, there was a great reduction in percent AF burden after catheter ablation independent of CPAP treatment. Abstract Figure

P985The long-term impact of maintaining sinus rhythm on the risk for death or heart failure after catheter ablation for atrial fibrillation in a real world clinical practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yoshizawa ◽  
H Shiomi ◽  
M Tanaka ◽  
T Aizawa ◽  
S Yamagami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
P Value ◽  
Af Ablation ◽  
Risk Of Death ◽  
The Impact ◽  
Af Recurrence

Abstract Background Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated. Purpose To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization. Methods The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation. Results Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P<0.001). After adjusting for baseline confounders, the lower risk of SR-group relative to AF-group for death or HF was still statistically significant (HR: 2.05, 95% CI: 1.11–3.58, P=0.02). Risks for a Composite of Death or HF Hazard Ratio (95% CI) Crude HR P value Adjusted HR P value AF recurrence 2.59 (1.43–4.43) 0.002 2.05 (1.11–3.58) 0.02 Age>75 years old 2.55 (1.56–4.10) <0.001 2.32 (1.39–3.81) 0.002 Female 0.85 (0.49–1.43) 0.56 0.73 (0.40–1.25) 0.26 PeAF 1.25 (0.68–2.16) 0.45 0.98 (0.52–1.75) 0.94 LSAF 1.10 (0.46–2.23) 0.82 0.70 (0.28–1.53) 0.39 LVEF>50% 0.27 (0.16–0.48) <0.001 0.57 (0.31–1.09) 0.09 Past history of HF 7.06 (4.18–11.6) <0.001 4.67 (2.51–8.41) <0.001 CKD 4.74 (2.08–9.39) <0.001 2.23 (0.94–4.69) 0.07 AF, Atrial fibrillation; PeAF, Persistent AF; LSAF; Long standing AF; HF, Heart failure; CKD, Chronic kidney disease. Figure 1 Conclusions Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.

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.

scholarly journals Modified STOP-Bang for predicting perioperative adverse events in the Thai population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Sangkum ◽  
Chama Wathanavaha ◽  
Visasiri Tantrakul ◽  
Munthana Pothong ◽  
Cherdkiat Karnjanarachata
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Oxygen Therapy ◽  
Elective Surgery ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
P Value ◽  
Icu Admission ◽  
Obstructive Sleep ◽  
Postanesthetic Care Unit

Abstract Background Undiagnosed obstructive sleep apnea (OSA) is associated with adverse perioperative outcomes. The STOP-Bang questionnaire is a validated screening tool for OSA. However, its precision may vary among different populations. This study determined the association between high-risk OSA based on the modified STOP-Bang questionnaire and perioperative adverse events. Methods This cross-sectional study included patients undergoing elective surgery from December 2018 to February 2019. The modified STOP-Bang questionnaire includes a history of Snoring, daytime Tiredness, Observed apnea, high blood Pressure, Body mass index > 30 kg/m2, Age > 50, Neck circumference > 40 cm, and male Gender. High risk for OSA was considered as a score ≥ 3. Results Overall, 400 patients were included, and 18.3% of patients experienced perioperative adverse events. On the basis of modified STOP-Bang, the incidence of perioperative adverse events was 23.2 and 13.8% in patients with high risk and low risk (P-value 0.016) (Original STOP-Bang: high risk 22.5% vs. low risk 14.7%, P-value 0.043). Neither modified nor original STOP-Bang was associated with perioperative adverse events (adjusted OR 1.91 (95% CI 0.99–3.66), P-value 0.055) vs. 1.69 (95%CI, 0.89–3.21), P-value 0.106). Modified STOP-Bang ≥3 could predict the incidence of difficult ventilation, laryngoscopic view ≥3, need for oxygen therapy during discharge from postanesthetic care unit and ICU admission. Conclusions Neither modified nor original STOP-Bang was significantly associated with perioperative adverse events. However, a modified STOP-Bang ≥3 can help identify patients at risk of difficult airway, need for oxygen therapy, and ICU admission. Trial registrations This study was registered on Thai Clinical Trials Registry, identifier TCTR20181129001, registered 23 November 2018 (Prospectively registered).

scholarly journals B-AB16-03 P WAVE PARADOX: CAN THE P WAVE DURATION ON 12 LEAD ELECTROCARDIOGRAPHY INFORM ATRIAL FIBRILLATION RECURRENCE AFTER CATHETER ABLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S31-S32
Author(s):  
Michael Gardner ◽  
Shruti Bidani ◽  
Muzammil Khan ◽  
Jianhui Zhu ◽  
William W. Barrington ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
P Wave ◽  
Atrial Fibrillation Recurrence ◽  
Wave Duration ◽  
P Wave Duration

Signal-averaged P wave duration in patients with atrial fibrillation treated with radiofrequency catheter ablation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S182-S183
Author(s):  
Brian Nilsson ◽  
Ulrik Dixen ◽  
Xu Chen ◽  
Steen Pehrson ◽  
Jesper H. Svendsen
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
P Wave ◽  
Wave Duration ◽  
P Wave Duration

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.

scholarly journals Beat-to-Beat P-Wave Analysis Outperforms Conventional P-Wave Indices in Identifying Patients with a History of Paroxysmal Atrial Fibrillation during Sinus Rhythm

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1694
Author(s):  
Dimitrios Tachmatzidis ◽  
Dimitrios Filos ◽  
Ioanna Chouvarda ◽  
Anastasios Tsarouchas ◽  
Dimitrios Mouselimis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Paroxysmal Atrial Fibrillation ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
P Wave ◽  
P Value ◽  
Wave Analysis ◽  
P Waves ◽  
History Of

Early identification of patients at risk for paroxysmal atrial fibrillation (PAF) is essential to attain optimal treatment and a favorable prognosis. We compared the performance of a beat-to-beat (B2B) P-wave analysis with that of standard P-wave indices (SPWIs) in identifying patients prone to PAF. To this end, 12-lead ECG and 10 min vectorcardiogram (VCG) recordings were obtained from 33 consecutive, antiarrhythmic therapy naïve patients, with a short history of low burden PAF, and from 56 age- and sex-matched individuals with no AF history. For both groups, SPWIs were calculated, while the VCG recordings were analyzed on a B2B basis, and the P-waves were classified to a primary or secondary morphology. Wavelet transform was used to further analyze P-wave signals of main morphology. Univariate analysis revealed that none of the SPWIs performed acceptably in PAF detection, while five B2B features reached an AUC above 0.7. Moreover, multivariate logistic regression analysis was used to develop two classifiers—one based on B2B analysis derived features and one using only SPWIs. The B2B classifier was found to be superior to SPWIs classifier; B2B AUC: 0.849 (0.754–0.917) vs. SPWIs AUC: 0.721 (0.613–0.813), p value: 0.041. Therefore, in the studied population, the proposed B2B P-wave analysis outperforms SPWIs in detecting patients with PAF while in sinus rhythm. This can be used in further clinical trials regarding the prognosis of such patients.

Sign in / Sign up

Export Citation Format

Share Document