Left atrial diameter, CHA2DS2-VASc score and type of atrial fibrillation predict pulmonary vein isolation outcome

Abstract Purpose Pulmonary vein isolation (PVI) is the most effective treatment strategy for atrial fibrillation (AF). This study evaluated Pulmonary Vein Isolation Outcome Degree (PVIOD) as a new semi-quantitative measure for PVI success after a 7-year follow-up and determined predictors associated with PVIOD.Methods We enrolled 117 patients with symptomatic AF who underwent PVI and after a 7-year follow-up applied PVIOD with 4 possible outcomes. PVIOD 1 group included patients with successful single PVI. PVIOD 2 group included patients with efficacy after ≥ 2 re-PV isolation and/or additional substrate modification (ASM). PVIOD 3 group contained subjects with clinical success after PVI±ASM. Patients with procedural and clinical failure were in PVIOD 4 group.Results In multivariate ordinal logistic regression analysis PVIOD was independently associated with longstanding persistent AF with paroxysmal AF as referent category: odds ratio (OR) 4.1, 95% confidence interval (95% CI) 1.3-12.8 (P=0.014), left atrial (LA) diameter: OR 1.2, 95% CI 1.1-1.3 (P<0.001) and CHA2DS2-VASc score: OR 1.5, 95% CI 1.0-2.2 (P=0.039). LA size, CHA2DS2-VASc score and AF type predicted 7-year probability for procedural and procedural with clinical failure. LA diameter >41mm (AUC 0.741, 95% CI 0.6-0.8, P<0.001) and CHA2DS2-VASc score ≥2 (AUC 0.718, 95% CI 0.6-0.8, P<0.001) predicted long-term procedural and clinical failure. Conclusion PVIOD is a new classification for PVI success. LA diameter, CHA2DS2-VASc score and AF type are independently associated with PVIOD and predict procedural and procedural with clinical failure after the 7-year follow-up. LA diameter >41mm and CHA2DS2-VASc score ≥2 predict long-term PVI failure.

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Long-term follow-up of patients with paroxysmal atrial fibrillation and severe left atrial scarring: comparison between pulmonary vein antrum isolation only or pulmonary vein isolation combined with either scar homogenization or trigger ablation

EP Europace ◽

10.1093/europace/euw338 ◽

2016 ◽

Vol 19 (11) ◽

pp. 1790-1797 ◽

Cited By ~ 26

Author(s):

Sanghamitra Mohanty ◽

Prasant Mohanty ◽

Luigi Di Biase ◽

Chintan Trivedi ◽

Eli Hamilton Morris ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Long Term Follow Up ◽

Pulmonary Vein Antrum Isolation

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Pulmonary Vein Isolation Outcome Degree Is a New Score for Efficacy of Atrial Fibrillation Catheter Ablation

Journal of Clinical Medicine ◽

10.3390/jcm10245827 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5827

Author(s):

Ruzica Jurcevic ◽

Lazar Angelkov ◽

Nebojsa Tasic ◽

Milosav Tomovic ◽

Dejan Kojic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Clinical Success ◽

Quantitative Measure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Ordinal Logistic Regression Analysis

This study introduces the pulmonary vein isolation outcome degree (PVIOD) as a new semiquantitative measure for the efficacy of atrial fibrillation (AF) catheter ablation and reports the determination of predictors associated with PVIOD. The median follow-up periods of 117 patients after the first and last ablation were, respectively, 82 (IQR 15) and 72 (IQR 30) months. PVIOD 1 included 32.5% of patients, those with successful single pulmonary vein isolation (PVI); PVIOD 2 included 29.1% of subjects, those with success after multiple procedures; PVIOD 3 comprised 14.5% of patients, those with clinical success; and PVIOD 4 included 23.9% of cases, those with procedural and clinical failure. In the multivariate ordinal logistic regression analysis, PVIOD 1–4 were independently associated with longstanding persistent AF with paroxysmal AF as the referent category (odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.1–10.7 (p = 0.031)), left atrial (LA) diameter (OR, 1.2; 95% CI, 1.1–1.3 (p = 0.001)) and left ventricular ejection fraction (LVEF) (OR, 0.9; 95% CI, 0.86–1.0 (p = 0.038)). LA size > 41 mm, LVEF ≤ 50% and longstanding persistent AF are strong predictors of AF recurrence. PVIOD 1–4 offer the most exact long-term prognosis of PVI. The purpose of the present article is to expand the quantitative measure of procedural success in the medical and biological fields.

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Long-term outcomes of cryoballoon-based left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation

EP Europace ◽

10.1093/europace/euz232 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1653-1662 ◽

Cited By ~ 10

Author(s):

Hikmet Yorgun ◽

Uğur Canpolat ◽

Metin Okşul ◽

Yusuf Ziya Şener ◽

Ahmet Hakan Ateş ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Persistent Atrial Fibrillation ◽

Atrial Appendage ◽

Left Atrial Appendage Isolation

Abstract Aims Pulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF. Methods and results We compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG’s, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81–5.03; P < 0.001). Conclusions Our findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.

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Clinical success of cryoballoon pulmonary vein isolation in patients with atrial fibrillation

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2018-7-4s-6-14 ◽

2019 ◽

Vol 7 (4S) ◽

pp. 6-14

Author(s):

T. Y. Chichkova ◽

S. E. Mamchur ◽

E. A. Khomenko

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Direct Current ◽

Clinical Success ◽

Persistent Atrial Fibrillation ◽

Cryoballoon Ablation ◽

Clinical Effects ◽

Rf Ablation

Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).Methods.230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.Results.77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).Conclusion.The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

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Significance of Late Recurrence of Atrial Fibrillation during Long-Term Follow-Up after Pulmonary Vein Isolation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2007.00617.x ◽

2007 ◽

Vol 30 (s1) ◽

Cited By ~ 4

Author(s):

EIVIND SOLHEIM ◽

PER IVAR HOFF ◽

MORTEN KRISTIAN OFF ◽

OLE-JØRGEN OHM ◽

JIAN CHEN

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Late Recurrence ◽

Long Term Follow Up

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Single-Ring Posterior Left Atrial (Box) Isolation Results in a Different Mode of Recurrence Compared With Wide Antral Pulmonary Vein Isolation on Long-Term Follow-Up

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.111.970293 ◽

2012 ◽

Vol 5 (5) ◽

pp. 968-977 ◽

Cited By ~ 39

Author(s):

Toon Wei Lim ◽

Choon Hiang Koay ◽

Valerie A. See ◽

Rebecca McCall ◽

William Chik ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Single Ring ◽

Long Term Follow Up

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Costs and long-term outcomes following pulmonary vein isolation for atrial fibrillation in elderly patients using second-generation cryoballoon vs. open-irrigated radiofrequency in China

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-019-00697-7 ◽

2019 ◽

Vol 59 (3) ◽

pp. 557-564 ◽

Cited By ~ 2

Author(s):

Chao-feng Chen ◽

Mei-jun Liu ◽

Chao-lun Jin ◽

Xiao-fei Gao ◽

Xiao-hua Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Length Of Stay ◽

Elderly Patients ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Dwell Time ◽

Second Generation ◽

Procedure Time

Abstract Purpose Limited comparative data are available regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) vs. radiofrequency (RF) ablation in elderly patients (> 75 years old). The present study aimed to compare the costs and clinical outcomes in elderly patients using these two strategies. Methods Elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients. Results A total of 324 elderly patients were included (RF,176; CB-2,148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure time and left atrial dwell time (112.9 ± 11.1 vs. 135.1 ± 9.9 min, P < 0.001; 53.7 ± 8.9 vs. 65.1.9 ± 9.0 min, P < 0.001) but marked fluoroscopy utilization (22.1 ± 3.3 vs. 18.5 ± 3.6 min, P < 0.001). Complications occurred in 3.3% (CB-2) and 6.2% (RF) of patients with no significant different (p = 0.307). The length of stay after ablation was shorter, but the costs were higher in the CB-2 group (1.94 vs. 2.53 days, P < 0.001 and 91,132.6 ± 3723.5 vs. 81,149.4 ± 6824.1 CNY, P < 0.001) compared to the RF group. Additionally, the rate of early recurrence of atrial arrhythmia (ERAA) was lower in the CB-2 group (14.2 vs. 23.3%, P = 0.047), but the long-term success rate was similar between two groups. Conclusions CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower ERAA, but its costs and fluoroscopy time are greater than the RF group. Moreover, the rate of complications and long-term success is similar between the two groups.

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P1913Implantable Loop Recorder Detected Pattern of Atrial Fibrillation Recurrence Following Cryoballoon Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0660 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Musat ◽

N Milstein ◽

R Shaw ◽

A Bhatt ◽

M Preminger ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Persistent Atrial Fibrillation ◽

Limited Data ◽

Loop Recorder ◽

Long Term Follow Up ◽

Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is increasingly being used in patients (pts) with persistent atrial fibrillation (AF). However, there are limited data about the pattern of atrial fibrillation (AF) recurrence in these pts. Objective To assess, using an implantable loop recorder (ILR), the patterns of AF recurrence following CB PVI in pts with persistent atrial fibrillation. Methods We enrolled consecutive pts with persistent AF ablation undergoing their first CB ablation. Other cavotricuspid isthmus ablation when indicated, no other ablation was performed. A Reveal LINQ ILR (Medtronic) was implanted <3 months following ablation; all pts had a minimum of 1-year follow-up. The recurrence of any atrial arrhythmia was determined and adjudicated; 4 distinct AF patterns were characterized (Figure). Results We studied 64 pts (66±9 years; 50 [78%] male; CHA2DS2-VASc 2.6±1.9) with persistent AF; 52 (81%) pts were on an antiarrhythmic drug (AAD) peri-ablation. During 803±361 days of follow-up, 33 (52%) pts had their 1st AF recurrence 91–365 days post-ablation and another 17 (27%) pts had their 1st AF recurrence >365 days post-ablation. No AF was seen in 14 (31%) pts. Most pts (33 of 50, 66%) with AF recurrence presented with 1 of 3 distinct patterns of paroxysmal AF (Figure), which ranged from 22 min to 124 hours. In 2/3 of these pts, all AF recurrences lasted <24 hours. Only 17 (34%) pts recurred with persistent AF. Conclusion Following single CB PVI, most pts with persistent AF remained free of persistent AF during long-term follow-up. Most pts with recurrent AF have 1 of 3 distinct patterns with episodes commonly last <24 hours. These data suggest that CB PVI ablation may halt AF progression in pts initially presenting with persistent AF.

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Abstract 2752: Pulmonary Vein Isolation With And Without Additional Ablation Of Complex Fractionated Electrograms In Paroxysmal Atrial Fibrillation: Long-term Results Of A Prospective Randomized Study

Circulation ◽

10.1161/circ.118.suppl_18.s_771-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Isabel Deisenhofer ◽

Tilko Reents ◽

Heidi L Estner ◽

Stephanie Fichtner ◽

Christian von Bary ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Paroxysmal Atrial Fibrillation ◽

Randomized Study ◽

Intention To Treat ◽

Long Term Follow Up ◽

Treat Analysis

Introduction: Segmental pulmonary vein isolation (PVI) leads to elimination of paroxysmal atrial fibrillation (AF) in approximately 75% of patients. Ablation of complex fractionated atrial electrograms (CFAE) is an alternative ablation strategy. In this prospective randomized study the long-term effect of PVI alone is compared to the effect of combined PVI and CFAE ablation in paroxysmal AF. Methods: 98 patients with paroxysmal AF (57±10 years, 74 male) were randomly assigned to PVI (48 patients) or PVI+CFAE ablation (50 patients). Additional CFAE ablation was performed in the PVI+CFAE group if AF was still inducible after PVI. Follow-up results were assessed with repetitive 7 days Holter ECG and clinical evaluation including repeat ablations. Results: Additional CFAE ablation was performed in 30/50 (60%) patients of the PVI+CFAE group with still inducible AF after PVI. In each group, 2 patients were lost to long term follow-up. In the intention-to-treat analysis at 3 months and after 19±8 months, there was no significant difference between both groups (36/48 [75%] and 34/46 [74%] patients in the PVI and 37/50 [73%] and 40/48 [83%] of patients in the PVI+CFAE ablation group in sinus rhythm [p=0.32]). In subgroup analysis, patients actually treated with the combined PVI+CFAE ablation approach had a significantly better long-term success (25/28; 89%) than patients with still inducible AF who underwent PVI only (22/30;73%; p=0.02). In both groups repeat ablations were performed in 31% (PVI group; 15/48 patients) and 35% (PVI+CFAE group; 17/48 patients) (p=n.s). After 9 months, significantly more patients in the PVI+CFAE group experienced sustained regular atrial tachycardia than in the PVI group (6/44 versus 1/39 patients, P=0.02). Conclusion: The combination of PVI and CFAE ablation was equally effective than PVI alone in reaching freedom of AF in the intention-to-treat analysis. During long-term follow-up, patients actually treated with combined PVI+CFAE ablation had a significantly better outcome (89% vs. 73%). However, the rate of ablation-induced regular atrial tachycardias is inreased.

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