scholarly journals Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Zheng ◽  
Meng Wang ◽  
Qun-feng Tang ◽  
Feng Xue ◽  
Ku-lin Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cerebrovascular Accident ◽  
Independent Risk Factor ◽  
Magnetic Navigation ◽  
Ablation Procedure ◽  
Af Ablation ◽  
History Of ◽  
Ischemic Attack ◽  
Risk Predictors ◽  
Low Ejection Fraction

Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates.Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X2 = 20.63 P < 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.Conclusions: Ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.Clinical Trial Registration: ChiCTR2100046505.

scholarly journals The Association of Pre-Existing Left Atrial Fibrosis with Clinical Variables in Patients Referred for Catheter Ablation of Atrial Fibrillation

2014 ◽  
Vol 8s1 ◽  
pp. CMC.S15036 ◽  
Author(s):  
Jane Dewire ◽  
Irfan M. Khurram ◽  
Farhad Pashakhanloo ◽  
David Spragg ◽  
Joseph E. Marine ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Af Ablation ◽  
Group 4 ◽  
Significant Difference ◽  
History Of ◽  
Group 2 ◽  
Magnetic Resonance Imaging Mri ◽  
Left Atrial Fibrosis

Introduction Atrial fibrillation (AF) recurrence after ablation is associated with left atrial (LA) fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI). We sought to determine pre-ablation, clinical characteristics that associate with the extent of LA fibrosis in patients undergoing catheter ablation for AF. Methods and Results Consecutive patients presenting for catheter ablation of AF were enrolled and underwent LGE-MRI prior to initial AF ablation. The extent of fibrosis as a percentage of total LA myocardium was calculated in all patients prior to ablation. The cohort was divided into quartiles based on the percentage of fibrosis. Of 60 patients enrolled in the cohort, 13 had <5% fibrosis (Group 1), 15 had 5-7% fibrosis (Group 2), 17 had 8-13% fibrosis (Group 3), and 15 had 14-36% fibrosis (Group 4). The extent of LA fibrosis was positively associated with time in continuous AF, and the presence of persistent or longstanding persistent AF. However, no statistically significant difference was observed in the presence of comorbid conditions, age, BMI, LA volume, or family history of AF among the four groups. After adjusting for diabetes and hypertension in a multivariable linear regression model, paroxysmal AF remained independently and negatively associated with the extent of fibrosis (-4.0 ± 1.8, P = 0.034). Conclusion The extent of LA fibrosis in patients undergoing AF ablation is associated with AF type and time in continuous AF. Our results suggest that the presence and duration of AF are primary determinants of increased atrial LGE.

scholarly journals Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What’s the Culprit?

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 505
Author(s):  
Francesco De Sensi ◽  
Gennaro Miracapillo ◽  
Luigi Addonisio ◽  
Marco Breschi ◽  
Alberto Cresti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Septal Defect ◽  
Femoral Vein ◽  
Global Evaluation ◽  
Thromboembolic Events ◽  
Ablation Procedure ◽  
Af Ablation ◽  
Vein Thrombosis ◽  
Iatrogenic Atrial Septal Defect

Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation.

P1000Aetiology and efficacy of atrial fibrillation ablation in young adults

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Zhang ◽  
I T Fazmin ◽  
A Porto ◽  
K Divulwewa ◽  
A Reddy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Young Adults ◽  
Family History ◽  
Sudden Cardiac Death ◽  
Pulmonary Vein ◽  
Cardiac Death ◽  
Univariate Analysis ◽  
Pulmonary Vein Stenosis ◽  
Af Ablation ◽  
History Of

Abstract Introduction Little is known regarding the aetiology or outcome of atrial fibrillation (AF) occurring in young adults. This retrospective analysis was performed to explore the demographics and efficacy of AF ablation in this population. Methods Patients were included who had undergone ≥1 AF ablation under the age of 40 between 2006-2018. Recurrence was defined as return of either documented AF or previous symptoms for &gt;30s following a 3-month blanking period. Initial exploratory co-variates were included in a univariate analysis and those terms with P-value of &lt;0.1 were then used to generate a Cox proportional-hazards multivariate model. Results 124 patients (33.6 ± 4.7 yrs, 77% men), initially presenting with paroxysmal AF (pAF; n = 97) or persistent AF (n = 27), underwent 175 AF ablation procedures. 22.6% (n = 28) also had atrial flutter. Time from symptom onset to first ablation was 50.7 ± 46.2 months. Relevant cardiovascular-related demographics were analysed: hypertension in 8.9% (n = 11); diabetes in 1.6% (n = 2); positive family history of AF in 12.9% (n = 16); and family history of sudden cardiac death in 2.4% (n = 3). Mean CHA2DS2-VASc score was 0.35. Of those patients with documented echocardiogram imaging (n = 91), 26.4% (n = 24) had LA dilatation and 6.6% (n = 6) had LV dysfunction. Patients with LA dilatation underwent more ablations (2.3 ± 0.3) compared to controls (1.5 ± 0.1; p &lt; 0.001). Ablation strategy was pulmonary vein isolation (PVI) only in 67.2% (n = 119), with additional ablation in the remaining: roof line in 18.9% (n = 33); cavotricuspid isthmus line in 13.1% (n = 23); mitral isthmus line in 2.3% (n = 4); superior vena cava isolation in 2.3% (n = 4); complex fractionated atrial electrograms in 14.9% (n = 26). Mean procedure time was 155 ± 41 min, mean ablation time was 1657 ± 991 s and mean fluoroscopy time was 32.6 ± 23.4 min. General anaesthesia was used in 43.4% (n = 76). Complications included femoral haematoma (n = 2), tamponade (n = 1) and pulmonary vein stenosis (n = 2). 90 days of follow-up was available for 137 procedures performed for pAF (n = 105) and persistent AF (n = 32). For pAF, overall recurrence was 61.9% for first ablations and 62.9% overall. Recurrence was 56.3% for persistent AF. Factors significantly associated with increased AF recurrence in univariate analysis were male gender (hazard ratio (HR) 2.3, 95% confidence interval (CI): 1.2-4.4, p = 0.011), hypertension (HR 0.5, CI: 0.2-1.1, p = 0.067), family history of sudden cardiac death (HR 6.8, CI: 1.6-29.0 , p = 0.010) and enlarged LA size (HR 2.2, CI: 1.3-3.6, p = 0.003). In multivariate analysis, the only significant predictor of poor outcome was enlarged LA size (HR 2.0, 95% CI: 1.2-3.5, p = 0.011). Conclusions Young patients with AF may have structurally abnormal hearts, and therefore do not only present with lone AF. LA size may be used as a predictor for success. Surveillance imaging may be useful to detect future structural change, which will be the subject of future prospective studies. Abstract Figure. AF ablation recurrence in young adults

scholarly journals 12-Month Single-Procedure Outcomes after Atrial Fibrillation Catheter Ablation in Phramongkutklao Hospital: A Single Center 10-Year Experience

2021 ◽  
Vol 72 (2) ◽  
pp. 114-120
Author(s):  
Sarawuth Limprasert
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Posterior Wall ◽  
Efficacy And Safety ◽  
Related Complication ◽  
Single Procedure ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack ◽  
First Time

Objective: This study aimed to report the efficacy and safety of 1-year outcome for single-procedure radiofrequency catheter ablation (RFCA) at Phramongkutklao Hospital. Methods: Review of medical records was carried out on consecutive patients with symptomatic atrial fibrillation (AF) who had undergone first-time RFCA in Phramongkutklao Hospital between January 2009 and December 2018. The efficacy and safety of outcomes after 1 year of RFCA were collected, analyzed, and validated using descriptive data. Results: 61 patients underwent RFCA for the first time. 77.05% were male, with a mean age of 58.31 ± 10.83 years. Paroxysmal AF presented in 65.57%. 49.18% had hypertension, 9.84% had a history of ischemic stroke or transient ischemic attack, 6.56% had diabetes, 6.56% had coronary artery disease, and 4.92% had heart failure. 96.72% of RFCA procedures were performed under local anesthesia and conscious sedation. Pulmonary vein isolation was performed in all patients. Roofline, mitral isthmus line, and posterior wall isolation were created in 27.87%, 13.11%, and 3.28%, respectively. Additional complex fractionated atrial electrograms (CFAEs) were targeted in 19.67%. After 12 months, 45.45% remained in sinus rhythm, with only one patient experiencing a procedure-related complication with cardiac tamponade. Conclusion: The 1-year results of single-procedure RFCA for treating AF at our center, while not highly successful in our first decade, were comparable to other series. Notably, there was a relatively low rate of complications.

scholarly journals Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

2021 ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
P Value ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Association of the CHA2D(S2)-VASc Score and Its Components With Overt and Silent Ischemic Brain Lesions in Patients With Atrial Fibrillation

2021 ◽  
Vol 11 ◽  
Author(s):  
Fabienne Steiner ◽  
Pascal B. Meyre ◽  
Stefanie Aeschbacher ◽  
Michael Coslovsky ◽  
Tim Sinnecker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Transient Ischemic Attack ◽  
Brain Lesion ◽  
Brain Lesions ◽  
Multicenter Cohort Study ◽  
Clinical Trial Registration ◽  
Cross Sectional ◽  
Ischemic Brain ◽  
History Of ◽  
Ischemic Attack

Background: Silent and overt ischemic brain lesions are common and associated with adverse outcome. Whether the CHA2DS2-VASc score and its components predict magnetic resonance imaging (MRI)-detected ischemic silent and overt brain lesions in patients with atrial fibrillation (AF) is unclear.Methods: In this cross-sectional analysis, patients with AF were enrolled in a multicenter cohort study in Switzerland. Outcomes were clinically overt, silent [in the absence of a history of stroke/transient ischemic attack (TIA)] and any MRI-detected ischemic brain lesions. Logistic regression analyses were performed to assess the relationship of the CHA2DS2-VASc score and its components with ischemic brain lesions. An adapted CHA2D-VASc score (excluding history of stroke/TIA) for the analyses of clinically overt and silent ischemic brain lesions was used.Results: Overall, 1,741 patients were included in the analysis (age 73 ± 8 years, 27.4% female). At least one ischemic brain lesion was observed in 36.8% (clinically overt: 10.5%; silent: 22.9%; transient ischemic attack: 3.4%). The CHA2D-VASc score was strongly associated with clinically overt and silent ischemic brain lesions {odds ratio (OR) [95% confidence interval (CI)] 1.32 (1.17–1.49), p &lt; 0.001 and 1.20 (1.10–1.30), p &lt; 0.001, respectively}. Age 65–74 years (OR 2.58; 95%CI 1.29–5.90; p = 0.013), age ≥75 years (4.13; 2.07–9.43; p &lt; 0.001), hypertension (1.90; 1.28–2.88; p = 0.002) and diabetes (1.48; 1.00–2.18; p = 0.047) were associated with clinically overt brain lesions, whereas age 65–74 years (1.95; 1.26–3.10; p = 0.004), age ≥75 years (3.06; 1.98–4.89; p &lt; 0.001) and vascular disease (1.39; 1.07–1.79; p = 0.012) were associated with silent ischemic brain lesions.Conclusions: A higher CHA2D-VASc score was associated with a higher risk of both overt and silent ischemic brain lesions.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02105844.

Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Haemmerle ◽  
C Eick ◽  
A Bauer ◽  
K.D Rizas ◽  
M Coslovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Transient Ischemic Attack ◽  
Brain Mri ◽  
Binary Logistic Regression ◽  
Funding Source ◽  
Logistic Regression Models ◽  
History Of ◽  
Ischemic Attack

Abstract Introduction The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system. Purpose We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes. Methods We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes. Results At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI &lt;15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI&lt;15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN&lt;70ms and MHR&lt;80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure). Conclusions Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation

scholarly journals Sex differences in catheter ablation of atrial fibrillation: results from AXAFA-AFNET 5

EP Europace ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1026-1035 ◽  
Author(s):  
Mariëlle Kloosterman ◽  
Winnie Chua ◽  
Larissa Fabritz ◽  
Hussein R Al-Khalidi ◽  
Ulrich Schotten ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sex Differences ◽  
Primary Outcome ◽  
Short Form ◽  
Medical Attention ◽  
Bleeding Events ◽  
Af Ablation ◽  
History Of ◽  
Ischaemic Attack

Abstract Aims Study sex-differences in efficacy and safety of atrial fibrillation (AF) ablation. Methods and results We assessed first AF ablation outcomes on continuous anticoagulation in 633 patients [209 (33%) women and 424 (67%) men] in a pre-specified subgroup analysis of the AXAFA-AFNET 5 trial. We compared the primary outcome (death, stroke or transient ischaemic attack, or major bleeding) and secondary outcomes [change in quality of life (QoL) and cognitive function] 3 months after ablation. Women were older (66 vs. 63 years, P &lt; 0.001), more often symptomatic, had lower QoL and a longer history of AF. No sex differences in ablation procedure were found. Women stayed in hospital longer than men (2.1 ± 2.3 vs. 1.6 ± 1.3 days, P = 0.004). The primary outcome occurred in 19 (9.1%) women and 26 (6.1%) men, P = 0.19. Women experienced more bleeding events requiring medical attention (5.7% vs. 2.1%, P = 0.03), while rates of tamponade (1.0% vs. 1.2%) or intracranial haemorrhage (0.5% vs. 0%) did not differ. Improvement in QoL after ablation was similar between the sexes [12-item Short Form Health Survey (SF-12) physical 5.1% and 5.9%, P = 0.26; and SF-12 mental 3.7% and 1.6%, P = 0.17]. At baseline, mild cognitive impairment according to the Montreal Cognitive Assessment (MoCA) was present in 65 (32%) women and 123 (30%) men and declined to 23% for both sexes at end of follow-up. Conclusion Women and men experience similar improvement in QoL and MoCA score after AF ablation on continuous anticoagulation. Longer hospital stay, a trend towards more nuisance bleeds, and a lower overall QoL in women were the main differences observed.

scholarly journals Short coupling with high burden of atrial ectopy in twenty-four hour holter recording predicts recurrence of atrial arrhythmia after atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Okajima ◽  
H Imai ◽  
Y Murase ◽  
N Kano ◽  
Y Ogawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Arrhythmia ◽  
Controlled Study ◽  
Ablation Procedure ◽  
High Burden ◽  
Af Ablation ◽  
Atrial Ectopy ◽  
Holter Recordings

Abstract Background Atrial arrhythmia recurrence is experienced in up to 20% of patients after initially receiving a catheter ablation for atrial fibrillation (AF). Therefore, it is important to define predictors of atrial arrhythmia recurrence. Atrial ectopy (AE) with short coupling interval (S-AE) has been reported to be a trigger of AF. On the other hand, high burden of AE has been reported to be a useful predictor of atrial arrhythmia recurrences after AF ablation. Thus, the combination of the incidence of S-AE and AE burden during a 24-hour Holter recording could be a useful predictor of atrial arrhythmia recurrence after AF ablation. Purpose To investigate this hypothesis, we performed a retrospective case-controlled study. Methods We enrolled 180 patients who underwent their first catheter ablation procedure for AF and performed a 24-hour Holter recording between 90 to 365 days after their ablation procedure. Patients who performed an additional ablation procedure before the Holter recording were excluded. Finally, we analyzed 173 patients (age: 65±10 years, female: 28.3%, non-paroxysmal: 27.7%). The Holter recordings were analyzed by the same experienced technicians. We defined AE as a narrow QRS complex occurring &gt;25% than prior R-R interval, and S-AE as AE occurring &gt;55% earlier than expected. The relationship between the characteristics of AE during the Holter recording and atrial arrhythmia recurrences was investigated. Results The Holter recordings were performed at a median of 103 (IQR: 98–138) days after ablation. The median number of AE were 144 (IQR: 54–699) beats per day, and S-AE was recorded in 49 patients (28.3%). Forty-two patients (24.3%) had a recurrence of atrial arrhythmia during a median 488-day follow up period. Patients with S-AE had a recurrence of atrial arrhythmia more frequently than those without S-AE (44.9% vs 16.1%, p&lt;0.001). We found the cut-off point of AE burden as 241 beats per day by the receiver operating characteristic curve with 74% sensitivity and 70% specificity to predict atrial arrhythmia recurrence. We divided the patients into four groups according to the presence or absence of S-AE and high AE burden. In the Kaplan-Meier analysis, patients with S-AE and high AE burden had the highest atrial arrhythmia recurrence rate (Log-rank test: p&lt;0.001). In the Cox multivariate analysis, S-AE with high AE burden was an independent predictor of atrial arrhythmia recurrence (HR: 4.27, 95% CI: 2.32–7.85, p&lt;0.001). Conclusion For AF patients who underwent their first catheter ablation, S-AE (&gt;55% earlier than expected) with high AE burden (&gt;241 beats per day) during the 24-hour Holter recording predicted recurrences of atrial arrhythmia. These results can help to develop follow-up strategies after AF ablation. Funding Acknowledgement Type of funding source: None

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