scholarly journals Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

2019 ◽  
Author(s):  
Hao Wang ◽  
Jindong Chen ◽  
Mengmeng Zhou ◽  
Liang Zhao
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Underlying Mechanism ◽  
Recurrence Rates ◽  
Pulmonary Vein Ablation ◽  
Second Procedure ◽  
Maintain Sinus Rhythm ◽  
Complex Fractionated Atrial Electrograms

Abstract Background: Many atrial fibrillation (AF) patients require more than one radiofrequency catheter ablation (RFCA) procedure to maintain sinus rhythm. This study aimed to evaluate risk and risk factors of atrial tachyarrhythmia (ATa) recurrence in patients undergoing multiple (≥3) RFCA procedures for AF. Methods: This single-center, retrospective, observational study enrolled 118 consecutive patients who underwent multiple ablation procedures for paroxysmal and non-paroxysmal AF with circumferential pulmonary vein ablation (CPVA), and bidirectional block of lines with disappearance of complex fractionated atrial electrograms (CFAEs) as index procedural endpoints, respectively. Results: At a median follow-up of 18 (range, 6-91) months after the last procedure (mean, 3.2 procedures), freedom from ATa recurrence was 40.7% (48/118). Initially diagnosed non-paroxysmal AF (P=0.039), baseline LA size (P=0.044), and recurrent AF after the second procedure (P=0.044) were univariate predictors of ATa recurrence, while only the latter (P=0.010) was an independent multivariate predictor (hazard ratio for ATa recurrence of 1.88 [95% CI, 1.16-3.05]. Conversion of recurrent types between AF and AFL/AT occurred in 52.9% (37/70) of patients with ATa recurrence, and 29.2% (14/48) of patients with sinus rhythm after last procedure. Few patients (7.8% [20/257]) recovered PV potential induced recurrent ATa during multiple procedures, and most (87.6% [141/161]) were bystanders of recurrent ATa. Conclusions: Multiple (>3) RFCA for paroxysmal or non-paroxysmal AF yielded unsatisfactory ATa recurrence rates with recurrent AF after the second procedure as multivariate predictor and recovered PV potential as a bystander commonly as underlying mechanism. Conversion of recurrent types between AF and AFL/AT was common.

Abstract 5665: Assessment of Noninducibility after Catheter Ablation for Atrial Fibrillation: High Dose Isoproterenol vs Rapid Atrial Pacing

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Thomas Crawford ◽  
Jean F Sarrazin ◽  
Michael Kuhne ◽  
Nagib Chalfoun ◽  
Darryl Wells ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drugs ◽  
High Dose ◽  
Atrial Pacing ◽  
Target Sites ◽  
Isoproterenol Infusion ◽  
Complex Fractionated Atrial Electrograms

Background: Noninducibility of atrial fibrillation (AF) after catheter ablation of paroxysmal AF (PAF) identifies patients who are more likely to remain in sinus rhythm (SR). However, it is not clear whether assessment of noninducibility by rapid atrial pacing (RAP) is incremental to high dose isoproterenol (ISO) infusion. Methods and Results: There were 65 patients (age=56±13 years) with PAF who presented in sinus rhythm for catheter ablation. ISO was administered in escalating doses of 5/10/15/20 μg/min every 2 minutes prior to ablation. AF (or frequent PACs in 4) was inducible in 61/65 patients (94%) at a mean dose of 15±6 μg/min. Antral pulmonary vein (PV) isolation (APVI) was performed in all patients with complete isolation of all PVs. If AF did not terminate during APVI, complex fractionated atrial electrograms (CFAEs) were targeted in the left atrium (16) or coronary sinus (2) until AF terminated or all target sites were ablated. AF terminated during ablation in 41/65 (63%). Following conversion to sinus rhythm, 54 of the 61 patients (89%) who were initially inducible with ISO became noninducible during ISO re-challenge. Among these 54 patients who were noninducible by ISO, rapid atrial pacing (RAP) down to a cycle length of 180 ms (≥5 times) induced sustained AF (>60 seconds) in 17 patients (31%). At a mean follow-up of 9±4 months after a single ablation procedure, 35/54 patients (65%) who were noninducible by ISO and 2/7 patients (29%) who were inducible were in sinus rhythm without antiarrhythmic drugs. However, 11/17 patients (65%) who were inducible by RAP and 26/37 (70%) who were noninducible by RAP were in sinus rhythm without antiarrhyhtmic drug therapy (P=0.8). Conclusions: Noninducibility of AF in response to high dose isoproterenol infusion identifies patients who are more likely to remain in sinus rhythm after catheter ablation. Rapid atrial pacing may still result in induction of AF in 30% of patients who are noninducible by isoproterenol. However, inducibility of AF by rapid atrial pacing in patients who are noninducible by isoproterenol appears to be a nonspecific observation.

Abstract 5659: Regular Atrial Tachycardias After Ablation Of Complex Fractionated Atrial Electrograms (CFAE) For Atrial Fibrillation: Acute Incidence And Recurrence In Clinical Follow-up

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Tilko Reents ◽  
Gabriele Hessling ◽  
Stephanie Fichtner ◽  
Jinjin Wu ◽  
Heidi L Estner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Successful Ablation ◽  
Atrial Electrograms ◽  
Initial Procedure ◽  
The Impact ◽  
External Cardioversion ◽  
Complex Fractionated Atrial Electrograms

Background: The catheter ablation of atrial fibrillation (AF) can be performed by ablation of complex fractionated atrial electrograms (CFAE). Endpoint of CFAE ablation is the regularisation or termination of AF. However, the impact of regular atrial tachycardia (AT) occurring during CFAE ablation on long term outcome has not been investigated. Thus, it is not clear whether these tachycardias should be acutely targeted for ablation. Methods: In 43 patients (31 male, age 62±9 years with paroxysmal (15 patients), persistent (25 patietns) or permanent AF (3 patients) organisation of AF to regular AT was achieved by ablation of CFAE. Mapping of AT with subsequent successful ablation was performed in 14/43 patients (33%), in the remaining 29/43 patients (67%) AT was terminated with external cardioversion or pace overdrive. After ablation procedure, patients were seen in our out-patient clinic with repetitive Holter ECG after 1, 3, and subsequently every 3 months and were intensively screened for the occurrence of regular AT. Results: In follow-up 22/43 patients (51%) developed sustained AT necessitating in 20 patients repeat catheter ablation (12 patients) or external cardioversion (8 patients). AF had been paroxysmal in 7/22 and persisten in 15/22 patients with AT in follow-up. In 14/22 patients (63%), no attempt for ablation of AT had been made during the initial procedure, in 8/22 AT (36%) had been mapped and initially successful ablated. Of 21 patients without AT occurrence during follow-up, AF had been paroxysmal in 8/21 and persistent or permanent in 13/21 patients. AT had been mapped and ablated in 6 (29%) whereas in 15/21 patients (71%), AT had not been targeted. Ablation of AT during initial procedure, number of ablation applications, procedure and fluoroscopy duration were not predictive for freedom of AT in follow-up. Conclusion: In our study, mapping and successful ablation of new onset regular atrial tachycardias (AT) occurring during ablation of CFAE for atrial fibrillation was not predictive for the occurrence of AT in follow-up. Thus, results after termination of AT by cardioversion was in long-term comparable to sometimes time-consuming mapping/ablation for AT.

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.

MO749CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND ON DIALYSIS - A META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Isaac Chung ◽  
Yasir Khan ◽  
Rao Kondapally ◽  
Manav Sohal ◽  
Debasish Banerjee
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Catheter Ablation ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Recurrence Rates ◽  
Ablation Therapy ◽  
Abnormal Metabolism ◽  
Af Recurrence

Abstract Background and Aims Atrial fibrillation (AF) is common in chronic kidney disease (CKD) patients and is difficult to treat with antiarrhythmics and anticoagulants due to abnormal metabolism and increased side effects. Catheter ablation if successful may be a safer alternative. This review evaluates the efficacy of catheter ablation therapy in CKD and haemodialysis (HD) patients. Method MEDLINE and Embase databases were searched with the following search terms: “(atrial fibrillation AND (chronic kidney disease OR renal failure OR renal function OR dialysis) AND ablation)” for journal articles of any language until December 2020. Two authors abstracted the data independently. Risk ratios were derived using random-effects meta-analysis. Results Of the initially identified 520 studies, 5 and 3 observational studies on CKD and HD patients respectively were found reporting AF recurrence rates. During a mean (SD) follow-up of 25.5 (9.8) months, CKD patients had a higher risk of AF recurrence compared to patients without CKD (RR 2.34, 95% CI 1.36-4.02, p&lt;0.01). The heterogenicity test showed there were significant differences between individual studies (I2 = 91%, 95% CI 82.2%-95.6%, p&lt;0.01). In a mean (SD) follow-up of 40.3 (20.8) months, HD patients may be at a higher risk of AF recurrence compared to healthy non-dialysis AF patients (RR 1.21, 95% CI 0.64-2.30, p=0.55). Heterogeneity analysis showed the studies were heterogeneous (I2 92.3%, 95% CI 80.8%-96.9%, p &lt;0.01). Conclusion Our meta-analysis suggests patients with CKD and patients on HD are more likely to have AF recurrences after catheter ablation compared to AF patients who are otherwise healthy. However, more robust evidence from randomized controlled trials comparing catheter ablation and pharmaceutical rhythm therapy are urgently needed to guide therapy in this difficult to treat population.

Entropy at the right atrium as a predictor of atrial fibrillation recurrence outcome after pulmonary vein ablation

2016 ◽  
Vol 61 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Raquel Cervigón ◽  
Javier Moreno ◽  
Jorge García-Quintanilla ◽  
Julián Pérez-Villacastín ◽  
Francisco Castells
Keyword(s):  
Atrial Fibrillation ◽  
Right Atrium ◽  
Sample Entropy ◽  
Ablation Procedure ◽  
Recurrence Rates ◽  
High Entropy ◽  
Pulmonary Vein Ablation ◽  
The Right ◽  
Af Recurrence

Abstract Atrial fibrillation (AF) recurrence rates after successful ablation procedures are still high and difficult to predict. This work studies the capability of entropy measured from intracardiac recordings as an indicator for recurrence outcome. Intra-atrial recordings from 31 AF patients were registered previously to an ablation procedure. Four electrodes were located at the right atrium (RA) and four more at the left atrium (LA). Sample entropy measurements were applied to these signals, in order to characterize different non-linear AF dynamics at the RA and LA independently. In a 3 months follow-up, 19 of them remained in sinus rhythm, whereas the other 12 turned back to AF. Entropy values can be associated to a proarrhythmic indicator as they were higher in patients with AF recurrence (1.11±0.15 vs. 0.91±0.13), in persistent patients (1.03±0.19 vs. 0.96±0.15), and at the LA with respect to the RA (1.03±0.23 vs. 0.89±0.15 for paroxysmal AF patients). Furthermore, entropy values at the RA arose as a more reliable predictor for recurrence outcome than at the LA. Results suggest that high entropy values, especially at the RA, are associated with high risk of AF recurrence. These findings show the potential of the proposed method to predict recurrences post-ablation, providing additional insights to the understanding of arrhythmia.

scholarly journals Novel Pharmacological Interventions to Maintain Sinus Rhythm after DC Cardioversion

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
D. E. Thomas ◽  
Z. Yousef ◽  
R. A. Anderson
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Direct Current ◽  
Mechanisms Of Action ◽  
Novel Therapies ◽  
Pharmacological Interventions ◽  
Recurrence Rates ◽  
Direct Current Cardioversion ◽  
Dc Cardioversion ◽  
Maintain Sinus Rhythm

Despite the availability of potentially curative interventions for atrial fibrillation, there remains an important role for conventional anti-arrhythmic therapy and anti-coagulation combined with direct current cardioversion. Unfortunately, the latter approach is disturbed by high recurrence rates of atrial fibrillation. In recent years, several adjunctive therapies have emerged which may facilitate the maintenance of sinus rhythm. These novel therapies and their potential mechanisms of action are reviewed in this article.

P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Pulmonary Vein Ablation ◽  
Group A ◽  
Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

scholarly journals Catheter Ablation of Atrial Fibrillation – Techniques and Technology

2012 ◽  
Vol 1 ◽  
pp. 29 ◽  
Author(s):  
George Katritsis ◽  
Hugh Calkins ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
The Elderly ◽  
Late Recurrence ◽  
Aged Patients ◽  
Antiarrhythmic Drug Therapy ◽  
Patient Groups ◽  
Maintain Sinus Rhythm

For certain patients with atrial fibrillation (AF) catheter ablation is now an important, therapeutic, intervention. It is established that catheter ablation is more effective than antiarrhythmic drug therapy at maintaining middle-aged patients with paroxysmal AF in sinus rhythm. However, the role of catheter ablation in other patient groups is not yet well defined. Particularly in patients with long-standing persistent AF, heart failure and the elderly, the efficacy of catheter ablation remains uncertain. At experienced centers catheter ablation for AF can be performed with reasonable safety and efficacy. However, major complications can occasionally occur. Late recurrence of AF is not uncommon and many patients will require a further procedure to maintain sinus rhythm. Fortunately, there are promising developments in the techniques and technology used for AF ablation that are likely to improve the outcomes of the procedure.

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