Characterization of “Super-Responders” to Cryoballoon Ablation

Background: Pulmonary Veins Isolation (PVI) is the cornerstone in the treatment of atrial fibrillation. Recurrence rate is common in the long-term followup (FU); nevertheless, some patients maintain Sinus Rhythm (SR) for more than 5 years after the index ablation. The aim of this study is characterize this kind of patients so called “super-responders”. Methods: This is a retrospective single-center study including all patients summited for cryo-balloon ablation in our hospital from January 2011 to September 2020. We investigated clinical, electrocardiographic, echocardiographic variables and those linked to the ablation procedure. A univariate and multivariate logistic regression was performed. Results: During this period, 422 patients underwent PVI; however, 193 were excluded: 21 lost in the FU, 30 got radiofrequency ablation and 142 did not reach a minimum 5 years FU. Of the 229 finally included, 85 (group 1) did not have any recurrence during the follow-up, in front of 144 (group 2) with AF recurrences. In the multivariate analysis the p wave duration: OR: 0.92; 95% CI (0.89-0.94); p <0.001, BMI kg/m²: OR: 0.74; 95% CI (0.65-0.85); p <0.001, a temperature <-40°C in all the targeted veins: OR: 3.52; 95% CI (1.45-8.54); p=0.005 and SR on the ablation index day OR: 7.29; 95% CI (1.53-34.71); p=0.012, maintained statistical significance. Conclusions: In our series the p wave duration, BMI, the presence of SR the ablation index day and achieving a temperature <-40°C in all the targeted veins, resulted as protective factors to maintain SR in the long term follow-up. An adequate selection of patients probably could improve results and optimize resources.

Download Full-text

Characterization of superresponders to cryoballoon ablation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0348 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J Marti Almor ◽

B Casteigt ◽

J Jimenez-Lopez ◽

J Conejos ◽

E Valles ◽

...

Keyword(s):

Pulmonary Veins ◽

Left Ventricular ◽

P Wave ◽

Left Ventricular Ejection ◽

Cryoballoon Ablation ◽

Ventricular Ejection Fraction ◽

Wave Duration ◽

P Wave Duration ◽

Ablation Index

Abstract Background Isolation of pulmonary veins is the cornerstone in the treatment of symptomatic atrial fibrillation rather with radiofrequency or cryo balloon. Recurrence rate is quite common in the long term follow up, clearly related to previosly described factors. Nevertheless some patients maintain sinus rhythm forever after the index ablation. The aim of this study is characterize this kind of patients (so called superresponders). Methods This is a Unicentric, retrospective, consecutive study including all patients summited for cryoablation in our hospital from January 2011 to September 2020. We looked for clinical, electrical, echocardiographic variables and those linked to the ablation procedure. A transversal FU to discard recurrences was done. A univariate and multivariate logistic regression was performed. Results We included 422 patients, 193 of them were finally excluded: 21 lost in the FU, 30 got radiofrequency ablation and 142 did not reach a minimum 5 years FU. About the 229 finally included, 85 (group 1) didn't have any recurrence during the FU, in front of 144 (group2) with recurrences. The univariate analysis showed that grup 1 patients were younger, the rate of hypertension, CHA2DS2VASc score, moderate sleep apnea, body mass index (BMI), p wave duration, and the size of left atrial was lower in grup 1 in front of patients of grup 2. Left ventricular ejection fraction was higher and the number of pulmonary veins in whom the temperature was lower than −40°C in grup 1 in front to grup 2. In the multivariate analysis the p wave duration: OR 0.92; 95% CI [0.89–0.94]; p<0.001, BMI kg/m2: OR 0.74; 95% CI [0.65–0.85]; p<0.001, a temperature <−40°C in all the targeted veins: OR 3.52 95% CI [1.45–8.54]; p=0.005 and SR on the ablation index day OR: 7.29; 95% CI [1.53–34.71]; p=0.012, maintained statistical significance. Conclusions In our series patients with a p wave duration, BMI, SR the ablation index day and achieving a temperature <−40°C in all the targeted veins, resulted as protective factors to maintain SR in the long term FU. An adequate selection of patients can improve results and optimize resources. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Long-term Follow-up of P-wave Duration and Dispersion in Patients with Mitral Stenosis

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2008.01235.x ◽

2008 ◽

Vol 31 (12) ◽

pp. 1620-1624 ◽

Cited By ~ 9

Author(s):

UNAL GUNTEKIN ◽

YILMAZ GUNES ◽

MUSTAFA TUNCER ◽

AHMET GUNES ◽

MUSA SAHIN ◽

...

Keyword(s):

Mitral Stenosis ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Long Term Follow Up

Download Full-text

The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of in-hospital and long-term atrial fibrillation in ischemic stroke

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2021.09.006 ◽

2021 ◽

Author(s):

Mert İlker Hayıroğlu ◽

Tufan Çınar ◽

Murat Selçuk ◽

Göksel Çinier ◽

Bryce Alexander ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Ecg Score

Download Full-text

Abstract 15360: Prolonged P Wave Duration is Not Associated With New Onset Atrial Fibrillation During 10-year Follow-up After First-ever Ischemic Stroke in Lund Stroke Register

Circulation ◽

10.1161/circ.130.suppl_2.15360 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Maria A Baturova ◽

Arne Lindgren ◽

Jonas Carlson ◽

Yuri V Shubik ◽

Bertil Olsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

P Wave ◽

Stroke Patients ◽

Wave Duration ◽

Control Subjects ◽

P Wave Duration ◽

Stroke Register ◽

New Onset

Introduction: Prolonged P-wave duration (PWD) is associated with paroxysmal atrial fibrillation (AF), which might be underdiagnosed in ischemic stroke patients, in whom it might be pivotal for initiation of secondary prevention oral anticoagulation therapy. We aimed to assess whether PWD predicts new-onset AF during 10-year follow-up in ischemic stroke patients compared to control subjects enrolled in the Lund Stroke Register (LSR). Methods: Study sample comprised of 227 first-ever ischemic stroke patients without AF (mean age 72±12 y, 92 female) and 1:1 age- and gender- matched control subjects without stroke and AF enrolled in LSR from Mar 2001 to Feb 2002. The date of new-onset AF during follow-up was assessed by the date of first AF ECG in the regional ECG database and by record linkage with the Swedish National Patient Register. The available standard snapshot 12-lead sinus rhythm ECGs at baseline were retrieved from electronic database and digitally processed. Results: Patients with ischemic stroke compared to controls more often had hypertension (57% vs 31%), diabetes (15% vs 7%) and vascular diseases (42% vs 13%, all p < 0.005). New-onset AF was detected in 39 (17%) stroke patients and in 30 (13%) controls, p=0.296. In the multivariate Cox regression analysis, new onset AF in the stroke group was associated with age>65 years (HR=3.78, 95%CI 1.32-10.85, p=0.013) and hypertension (HR=2.42, 95%CI 1.09-5.40, p=0.030), but not with PWD. On the contrary, PWD>120 ms was the only independent predictor of new onset AF in the control group after adjustment for age and cardiovascular risk factors (HR=3.36, 95%CI 1.41-8.01, p=0.006, Figure 1). Conclusions: Prolonged P-wave duration is the strongest predictor of AF incidence during 10-year follow-up in stroke-free population. However, in ischemic stroke patients the developing of AF is more likely associated with more advanced cardiovascular comorbidities than with electrical abnormalities in the heart.

Download Full-text

Signal-averaged P wave duration and the long-term risk of permanent atrial fibrillation

Scandinavian Cardiovascular Journal ◽

10.1080/14017430701652282 ◽

2008 ◽

Vol 42 (1) ◽

pp. 31-37 ◽

Cited By ~ 10

Author(s):

Ulrik Dixen ◽

Mette Vang Larsen ◽

Lasse Ravn ◽

Jan Parner ◽

Gorm B. Jensen

Keyword(s):

Atrial Fibrillation ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Permanent Atrial Fibrillation

Download Full-text

P5350Atrial fibrillation prediction using P wave signal-averaged ECG in patients with embolic stroke of undetermined source

European Heart Journal ◽

10.1093/eurheartj/ehz746.0317 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Shin ◽

M Jung ◽

J Song ◽

J Kim ◽

K Park ◽

...

Keyword(s):

Atrial Fibrillation ◽

Odds Ratio ◽

Unknown Origin ◽

Embolic Stroke ◽

P Wave ◽

Stroke Recurrence ◽

Wave Duration ◽

P Wave Duration ◽

Potential Association

Abstract Background Approximately 10–25% of ischemic strokes are of unknown origin. Determining their potential association with subclinical atrial fibrillation (SCAF) is important for proper secondary prevention. We investigated whether SCAF can be predicted by assessing the atrial substrate with signal-averaged electrocardiography (SAECG). Methods Between April 2015 and February 2018, we recruited 125 consecutive patients with embolic stroke of undetermined source (ESUS) and 125 patients with paroxysmal atrial fibrillation (AF) patients as control. All participants underwent P wave SAECG at baseline and ESUS patients were followed up with ECG and Holter ECG, at baseline, 3, 6, and 12 months after discharge, and every 12 months thereafter. Results In the ESUS group (69 males, 68.4±12.1 years), 32 (25.6%) patients were diagnosed with SCAF during follow-up. There were no significant differences between both groups in terms of P wave duration [PWD] (ESUS vs. AF, P=0.321). PWD demonstrated a significant predictive efficacy for SCAF detection during follow-up (C-index of standard PWD=0.657, 95% confidence interval (CI) 0.552–0.761, P=0.008). Stroke recurrence occurred in 22 patients (17.6%) and was significantly associated with PWD but not SCAF (odds ratio 2.756, 95% CI 1.061–7.161, P=0.037). Conclusion PWD, an ECG biomarker associated with atrial substrate directly contributes to AF and ESUS, is useful for predicting SCAF. The potential for using this simple ECG biomarker for screening for SCAF amongst ESUS patients merits further exploration.

Download Full-text

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Cardiology ◽

10.1159/000499501 ◽

2019 ◽

Vol 142 (2) ◽

pp. 109-115 ◽

Cited By ~ 8

Author(s):

Vanesa Bruña ◽

Jesús Velásquez-Rodríguez ◽

María Jesús Valero-Masa ◽

Beatriz Pérez-Guillem ◽

Lourdes Vicent ◽

...

Keyword(s):

Myocardial Infarction ◽

Sinus Rhythm ◽

P Wave ◽

St Segment Elevation ◽

Acute Stemi ◽

Wave Duration ◽

Segment Elevation Myocardial Infarction ◽

P Wave Duration ◽

St Segment

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

Download Full-text

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation

EP Europace ◽

10.1093/europace/euaa132 ◽

2020 ◽

Vol 22 (9) ◽

pp. 1337-1344

Author(s):

Matthias Daniel Zink ◽

Winnie Chua ◽

Stef Zeemering ◽

Luigi di Biase ◽

Bayes de Luna Antoni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Vitamin K Antagonists ◽

P Wave ◽

Interventional Treatment ◽

Wave Duration ◽

P Wave Duration ◽

History Of ◽

Artery Disease

Abstract Aims Freedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation. Methods and results We retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03). Conclusion Half of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF. Trial registration Clinicaltrials.gov identifier NCT02227550

Download Full-text

Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽

10.1093/qjmed/hcaa041.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O H M A Riad ◽

T Wong ◽

A N Ali ◽

M T Ibrahim ◽

M A Abdelhamid ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Cryoballoon Ablation ◽

The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p < 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

Download Full-text