A novel predictive model of recurrence after surgical ablation of valvular atrial fibrillation

Background: Radiofrequency ablation(RFA) has emerged as a common approach to treatment of atrial fibrillation(AF) coupled with valve surgery. However, risk factors were rarely reported on recurrence after RFA of valvular atrial fibrillation . Methods: Retrospective study of a single-center database was performed in patients underwent valvular surgery combined with radiofrequency ablation. Follow-up was conducted from 3 months to 1 year after procedure. AF recurrence was defined as any episode of atrial arrhythmia lasting more than 30 seconds. Risk factors were analysis using Logistic regression and a predictive model was established. Results: 3-month follow-up was completed in 319 patients, 195 patients (61.1%) had AF recurrence. During the 1-year follow-up, 74 /166 patients(44.6%) had AF recurrence. Compared with sinus rhythm maintenance group, overweight(p=0.022), high BMI(p=0.024), large preoperative LAD(p<0.001), small MI area(p=0.019), large MI diameter(p<0.001) and other liver function parameter like low ALT level(p=0.023), high total bilirubin(p=0.013) and direct bilirubin level(p=0.033) were significantly correlated with AF recurrence after RF. In multivariate analysis, BMI(OR 1.12, 95% CI 1.04-1.21, p=0.003), LAD(OR 1.49, 95% CI 1.09-2.07, p=0.015), MI area(OR 0.41, 95% CI 0.18-0.85, p=0.023), MI diameter(OR 2.45, 95% CI 1.16-5.34, p=0.021), ALT(OR 0.98, 95% CI 0.97-0.99, p=0.002) and eGFR(OR 1.01, 95% CI 1.09-1.02, p=0.042) were significantly independent risk predictors of AF early recurrence. A predictive model was created with AUC of 0.720. Conclusions: BMI、LAD、MI area、MI diameter、ALT and eGFR were risk predictors of AF early recurrence. We established a predictive model and it devote to preoperative clinical health management of individual with valvular AF.

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The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01670-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

She-an Chen ◽

Man-man Zhang ◽

Meifang Zheng ◽

Fei Liu ◽

Lei Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

High Density Lipoprotein ◽

Predictive Value ◽

Density Lipoprotein ◽

Late Recurrence ◽

High Density ◽

Significant Difference ◽

Af Recurrence

Abstract Background The monocyte/high-density lipoprotein ratio (MHR) has emerged as a promising alternative biomarker in the fields of cardiovascular disease and atrial fibrillation (AF). This retrospective study was aimed to explore the predictive value of the MHR for the late recurrence of AF after radiofrequency ablation. Methods From April 2015 to October 2018, patients with paroxysmal AF who had undergone radiofrequency catheter ablation at Subei People’s Hospital of Jiangsu Province were enrolled in our study. All the participants were observed until November 2019 after the procedure. During the postoperative follow up, the patients were categorized into the recurrence group and maintenance of sinus rhythm group based on who had experienced AF recurrence. Results One hundred twenty-five patients were diagnosed with paroxysmal AF, with an average age of 61.2 ± 9.3 years. Forty-seven patients had developed late recurrence during a mean follow up of 25.1 ± 12.0 months. The AF recurrence event rates were significantly increased in the highest MHR tertile compared with those in the lowest MHR tertile (22.0% vs. 57.1%; P < 0.05). On multivariate logistic regression analysis, the preablation MHR (OR = 1.34; 95% CI = 1.12 ~ 1.60; P = 0.001) and left atrial diameter (LAD) (OR = 1.21, 95% CI = 1.08 ~ 1.35; P = 0.001) were independent risk factors predicting the recurrence of AF after radiofrequency ablation. Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the MHR was 0.712 (95% CI = 0.618 ~ 0.806; P = 0.000) and that of LAD was 0.739 (95% CI = 0.653 ~ 0.814; P = 0.000). Z-test found no significant difference between the MHR and LAD regarding the AUC (Z = 0.451; P = 0.652). Conclusion An elevated preablation MHR was associated with an increased risk of the postoperative recurrence of AF. Additionally, the MHR independently predicted the late recurrence of paroxysmal AF after radiofrequency ablation, with the same predictive value as LAD.

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Aortic plaques in patients with atrial fibrillation: an often-forgotten risk factor for thromboembolism

European Heart Journal ◽

10.1093/eurheartj/ehab724.0429 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A.F Esteves ◽

L Parreira ◽

M Fonseca ◽

J.M Farinha ◽

J Ferreira ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Type 2 Diabetes ◽

P Value ◽

Af Ablation ◽

Aortic Plaques ◽

Af Recurrence

Abstract Background CHA2DS2-VASc risk score is the main determinant for maintaining anticoagulation after atrial fibrillation (AF) ablation, irrespective of the procedure outcome. The presence of aortic plaques is included in the score, but isn't regularly assessed previously to AF ablation. This way, risk factors for coronary artery disease (CAD) other than arterial hypertension and diabetes mellitus may influence stroke risk in patients with AF, albeit not being included in the CHA2DS2-VASc score. Purpose We sought to evaluate the prevalence of aortic plaques diagnosed during transesophageal echocardiography (TOE) in patients submitted to AF ablation and to assess its determinants and clinical impact on the CHA2DS2-VASc score. Methods Retrospective study of patients submitted to AF ablation that performed TOE prior to the procedure, with assessment of aortic plaques. CHA2DS2-VASc risk score was evaluated in the pre-ablation patient evaluation and reassessed after TOE. Demographic, clinical and echocardiographic data, including cardiovascular risk factors, were analyzed. We assessed AF recurrence rate, cerebrovascular events and death during follow-up. Results 120 patients were submitted to TOE prior to AF ablation from November 2015 to December 2020, mean age 66.6 (±9.55) years, 48% male. In 30 (25%) patients aortic plaques were identified in TOE. Mean CHA2DS2-VASc was 2.2 (±1.47) in pre-ablation evaluation and 2.5 (±1.69) post-TOE, increasing in all patients with aortic plaques and prompting beginning of oral anticoagulation in 5 patients. AF was paroxysmal in 74% and persistent in 26% of patients, mean duration of 6.28 (±3.76) years. Arterial hypertension was present in 79 (66%) of patients, type 2 diabetes mellitus in 24 (20%) and dyslipidemia in 67 (56%). 17 (14%) patients had a prior stroke. During a mean follow-up of 30 (±18.3) months, 32 (27%) patients had AF recurrence and 10 (8%) were submitted to redo procedures. 107 (89%) patients remained under oral anticoagulation, stroke occurred in 1 patient and 2 patients died. In univariate analysis, age, type 2 diabetes mellitus and dyslipidemia predicted an increase in CHA2DS2-VASc score after TOE (respectively, OR 1.113, 95% CI 1.041–1.190, p-value 0.002; OR 2.907, 95% CI 1.145–7.379, p-value 0.025; and OR 2.442, 95% CI 1.016–5.868, p-value 0.046). In multivariate analysis, age is the only independent predictor of increased CHA2DS2-VASc score after TOE (OR 1.095, 95% CI 1.013–1.185, p-value 0.023). No risk factor for CAD was independently associated with the presence of aortic plaques (Table 1). Conclusion In this population, single CAD risk factors were not independent predictors of aortic plaques. If TOE had not been performed prior to AF ablation, 25% of patients would have had an underestimated CHA2DS2-VASc score and would be off anticoagulation after the procedure, unprotected from thromboembolic events. FUNDunding Acknowledgement Type of funding sources: None. Table 1

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Left Atrial Appendage Circular RNAs Are New Predictors of Atrial Fibrillation Recurrence After Surgical Ablation in Valvular Atrial Fibrillation Patients

The Heart Surgery Forum ◽

10.1532/hsf.4125 ◽

2021 ◽

Vol 24 (6) ◽

pp. E968-E976

Author(s):

Xiyu Zhu ◽

Yali Wang ◽

Ran Mo ◽

Hoshun Chong ◽

Cailong Cao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Predictive Model ◽

Left Atrial Appendage ◽

Late Recurrence ◽

Circular Rnas ◽

Surgical Ablation ◽

Kaplan Meier ◽

Independent Risk Factors ◽

Af Recurrence

Background: Atrial fibrillation (AF) recurrence after ablation will increase mortality and morbidity during follow up. We attempted to evaluate the relationship between circular RNAs (circRNA) and AF recurrence to establish a predictive model for early intervention. Methods: Patients who received surgical ablation retrospectively were analyzed. The expression of circRNAs were detected in the left atrial appendage. The independent risk factors of late recurrence were analyzed by multivariate analysis. The predictive model was visualized by Nomogram and tested by receiver operating characteristic curve and calibration plot. Kaplan-Meier plot was used to compare the rate of freedom from AF recurrence after surgery. The relationships between circRNAs and clinical characteristics were detected by Spearman’s correlation analysis. Results: A total of 136 patients were enrolled from September 2018 to June 2019, 55 patients experienced late recurrence during one-year follow up. Increased age, longer AF duration and increased circ 81906-RYR2, circ 44782-LAMA2, circ 418-KCNN2 and circ 35880-ANO5 were detected in recurrent patients. Multivariate analysis revealed that increased age (odds ratio (OR)=1.072, P = 0.006), longer AF duration (OR=1.007, P = 0.036) and increased circ 81906-RYR2 (OR=2.210, P < 0.001) were independent risk factors for late recurrence. Area under the curve was 0.77, and the cut-off value was 70 points of the predictive model. Kaplan-Meier plots showed that patients over 70 points tended to experience AF recurrence. Conclusion: Circ 81906-RYR2 could be a new predictor of late recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration, and circ 81906-RYR2 was alternative for early intervention of AF recurrence.

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The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shiyu Gong ◽

Jian Zhou ◽

Bingyu Li ◽

Sheng Kang ◽

Xiaoye Ma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Recurrence Rate ◽

Morphological Feature ◽

Left Atrial ◽

Left Atrial Appendage ◽

Recurrence Risk ◽

Atrial Appendage ◽

Af Recurrence

Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA.Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed.Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002).Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.

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Forecasting of recurrent atrial fibrillation after radiofrequency ablation of pulmonary veins using preoperative characteristics

Translational Medicine ◽

10.18705/2311-4495-2020-7-5-6-16 ◽

2020 ◽

Vol 7 (5) ◽

pp. 6-16

Author(s):

B. B. Bondarenko ◽

A. V. Grigoryeva ◽

L. A. Sokolova ◽

V. A. Bart ◽

I. A. Gorlova ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Pulmonary Veins ◽

First Year ◽

Recurrent Atrial Fibrillation ◽

Design And Methods ◽

Preoperative Predictors ◽

Af Recurrence

Background. Atrial fibrillation (AF) is the most frequent arrhythmia. The method of catheter radiofrequency ablation (CRA) of pulmonary veins (PV) does not guarantee the preservation of sinus rhythm. Determination of predictors of AF relapses dictates the need in systemic approach taking into account demographic and clinical-instrumental characteristics of patients. Objective. Determination of preoperative predictors of AF recurrence within 3 year after follow-up CRA PV.Design and methods. The study included 89 patients (50 men, 39 women; mean age 58 and 62 years respectively) followed during 3 years after CRA PV. The methods of principal components and discriminant analysis were used for analytical purposes. Results. The recurrence of AF was observed in 43 patients (48 %): during the first year — in 18 (43 %), during the second — in 16 (37 %), during the third — in 9 (20 %) cases. By consistently using the methods of descriptive and multivariant statistics a set of the preoperative indicators has been identified that distinguishes patients with AF relapses undergone CRA PV. It consists of the longivity of AF, the state of contractive myocardial function, the presence of ICD, cardioversion in the past and thyroid pathology. The contribution of modified risk factors: SBP level, BMI, tobacco smoking also are valued. Conclusion. Using of multivariant statistics allows to determine preoperative characteristics, which provide optimization of management of patients with AF.

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Risk factors of atrial fibrillation recurrence despite successful radiofrequency ablation of accessory pathway: At 11 years of follow-up

Cardiology Journal ◽

10.5603/cj.a2017.0055 ◽

2017 ◽

Vol 24 (6) ◽

pp. 597-603 ◽

Cited By ~ 3

Author(s):

Michał Orczykowski ◽

Piotr Urbanek ◽

Robert Bodalski ◽

Paweł Derejko ◽

Grzegorz Warmiński ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Accessory Pathway ◽

Atrial Fibrillation Recurrence

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Predictive role of early recurrence of atrial fibrillation after cryoballoon ablation

EP Europace ◽

10.1093/europace/euaa239 ◽

2020 ◽

Vol 22 (12) ◽

pp. 1798-1804 ◽

Cited By ~ 1

Author(s):

Giuseppe Stabile ◽

Saverio Iacopino ◽

Roberto Verlato ◽

Giuseppe Arena ◽

Paolo Pieragnoli ◽

...

Keyword(s):

Atrial Fibrillation ◽

Strong Predictor ◽

Early Recurrence ◽

Cryoballoon Ablation ◽

Term Outcome ◽

Long Term Outcome ◽

Group B ◽

Af Recurrence

Abstract Aims The aims of this study were to determine the rate and the predictors of early recurrences of atrial fibrillation (ERAF) after cryoballoon (CB) ablation and to evaluate whether ERAF correlate with the long-term outcome. Methods and results Three thousand, six hundred, and eighty-one consecutive patients (59.9 ± 10.5 years, female 26.5%, and 74.3% paroxysmal AF) were included in the analysis. Atrial fibrillation recurrence, lasting at least 30 s, was collected during and after the 3-month blanking period. Three-hundred and sixteen patients (8.6%) (Group A) had ERAF during the blanking period, and 3365 patients (Group B) had no ERAF. Persistent AF and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of ERAF. After a mean follow-up of 16.8 ± 16.4 months, 923/3681 (25%) patients had at least one AF recurrence. The observed freedom from AF recurrence, at 24-month follow-up from procedure, was 25.7% and 64.8% in Groups A and B, respectively (P < 0.001). ERAF, persistent AF, and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of AF. In a propensity score matching, the logistic model showed that ERAF 1 month after ablation are the best predictor of long-term AF recurrence (P = 0.042). Conclusion In patients undergoing CB ablation for AF, ERAF are rare and are a strong predictor of AF recurrence in the follow-up, above all when occur >30 days after the ablation.

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The influence of iatrogenic atrial septal defect on the prognosis of patients with atrial fibrillation between cryoablation and radiofrequency ablation

Bioscience Reports ◽

10.1042/bsr20193128 ◽

2020 ◽

Vol 40 (2) ◽

Author(s):

Ying Yang ◽

Jinglan Wu ◽

Lixia Yao ◽

Yue Liu ◽

Chenfeng Zhang ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Left Atrial ◽

Septal Defect ◽

Enzyme Inhibitor ◽

Operation Time ◽

Left Ventricular ◽

Left Atrial Ejection Fraction ◽

Af Recurrence

Abstract Objective: The present study was to compare the incidence of septal defect (SD) in patients with atrial fibrillation (AF) who received radiofrequency ablation or cryoablation. Methods: A total of 293 AF patients were performed with radiofrequency ablation and cryoablation. Cardiac ultrasonography was performed to calculate left atrial diameter (LAD), left atrial ejection fraction (LAEF%), strain rate (SR), left ventricular systolic (SRs), left ventricular diastolic (SRe), and left atrial systole (SRa) before surgery, 3 months and 1 year after surgery. The patients were followed up to observe statin and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) medication, AF recurrence, 6-min walk test, stroke, any symptoms caused by arrhythmia, and re-hospitalization. Results: The levels of LAD and SD were higher, while SRe and SRa were lower in the cryoablation group in the comparison with the radiofrequency ablation group after surgery (P<0.05). LAEF was lower in the cryoablation group than the radiofrequency ablation group after 3 months (P<0.05). After 1-year follow-up, no right-to-left shunt occurred in all patients with SD. The AF recurrence rate in SD group was higher than that in the normal group (P<0.05). The use of statin and the application of ACEI/ARB were protective factors, whereas hypertension, LAD, left atrial operation time, and surgical plan were risk factors. Conclusion: SD affects left atrial function and increases the risk of AF recurrence. Hypertension, LAD, and left atrial operation time are risk factors for SD, whereas statin and ACEI/ARB drugs can reduce SD.

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Steroids prevent early recurrence of atrial fibrillation following catheter ablation: a systematic review and meta-analysis

Bioscience Reports ◽

10.1042/bsr20180462 ◽

2018 ◽

Vol 38 (5) ◽

Cited By ~ 2

Author(s):

Ming Lei ◽

Mengqi Gong ◽

George Bazoukis ◽

Konstantinos P. Letsas ◽

Panagiotis Korantzopoulos ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Observational Studies ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Early Recurrence ◽

Steroid Use ◽

Random Effects Models ◽

Af Recurrence

Previous studies have reported that steroids may reduce the risk of atrial fibrillation (AF) recurrence after catheter ablation, but data regarding this issue have been controversial. Therefore, we conducted a meta-analysis of randomized clinical trials (RCTs) and observational studies to ascertain the association of steroids and AF recurrence after ablation. PubMed, Embase, and Cochrane online databases were searched from inception to December 2017. The primary outcome of the meta-analysis was short-term or long-term AF recurrence following a single ablation procedure with or without the use of steroids. Both fixed- and random-effects models were used to calculate the overall effect estimates. Eight studies (four RCTs and four observational studies), with a total 992 patients, were included in the present study. Our meta-analysis shows that steroid use was associated with reduced AF occurrence at 3 months (odd ratio (OR) = 0.53, 95% confidence interval (CI) = 0.31–0.90, P=0.02) and 12–14 months (OR = 0.67, 95% CI = 0.47–0.95, P=0.02) after radiofrequency (RF) catheter ablation (RFCA). No clear benefit was observed for AF recurrence at 2–3 days, 1 or 24 months of follow-up. Steroid use was associated with decreased risk of early AF recurrence 3 and 12–14 months after ablation. No clear relationship was observed for 2–3 days, 1 and 24 months of follow-up and further data are needed to clarify these results.

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Autonomic nervous modulation after cryoballoon ablation for paroxysmal atrial fibrillation

Jounal of arrhythmology ◽

10.35336/va-2021-1-38-46 ◽

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.

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