Atrial Tachyarrhythmia
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2021 ◽  
Vol 10 (21) ◽  
pp. 4863
Author(s):  
Denise Guckel ◽  
Khuraman Isgandarova ◽  
Leonard Bergau ◽  
Misagh Piran ◽  
Mustapha El Hamriti ◽  
...  

Diabetes mellitus (DM) plays a crucial role in the regulation of atrial fibrillation (AF). This study aimed to evaluate the outcome of pulmonary vein isolation (PVI) using a single-shot device in patients with AF and DM. A total of 531 consecutive patients undergoing initial cryoballoon (CB)-guided PVI were evaluated. Two hundred eighty-one patients (53%) suffered from paroxysmal AF (PAF; mean age 51 ± 23.2 years, 26% female), 250 patients (48%) from persistent AF (PERS; 64 ± 10.0 years old, 30% female) and 80 patients (15%) were diagnosed with coincidental DM (68 ± 19.6 years old, 30% female). Follow-up visits were performed at 3, 6 and 12 months including 7-day Holter ECGs. Primary endpoint was the first documented recurrence of atrial tachyarrhythmia. AF recurrence occurred in 26% (140 patients). PAF patients with DM presented with a significantly higher risk for arrhythmia recurrence (Kaplan Meier analysis; Log rank p < 0.001 *). Multivariate analyses found DM to be an independent predictor (IP) for AF recurrence (p = 0.009 *, hazard ratio (HR) 4.363, confidence interval (CI) 1.456–13.074). In PERS, DM was associated with a 43% increase in AF recurrence (p = 0.320, HR 1.427, CI 0.707–2.879). DM has relevant effects on AF recurrence after PVI-only ablation approaches for AF. Major differences were observed in PAF as DM seems to favor the development of individual arrhythmia substrate, which is usually not yet present in PAF. In PERS, DM effects are less pronounced as individual fibrosis has already developed. Thus, personalized paths addressing individual arrhythmia substrates are needed in this specific cohort of patients.


2021 ◽  
Author(s):  
Keisuke Suzuki ◽  
Koji Miyamoto ◽  
Akinori Wakamiya ◽  
Nobuhiko Ueda ◽  
Kenzaburo Nakajima ◽  
...  

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Zheng ◽  
Deling Zu ◽  
Keyun Cheng ◽  
Yunlong Xia ◽  
Yingxue Dong ◽  
...  

Abstract Background Catheter ablation is an established therapy for atrial fibrillation (AF), but recurrence after ablation remains a great challenge. Additionally, little is known about the effect of renal function on the efficiency of AF ablation. This study aimed to evaluate the predictors of the prognosis of catheter ablation for AF, especially the effect of renal function. Methods A total of 306 drug-refractory symptomatic patients with AF who underwent first-time catheter ablation were enrolled in the present study. Individuals underwent circumferential pulmonary vein isolation for paroxysmal AF and stepwise ablation for persistent AF. Results The follow-up time was 27.2 ± 19.5 months, 202 patients (66.01%) were free of atrial tachyarrhythmia (non-recurrence group), and the other 104 patients experienced recurrence (recurrence group). The recurrence group had a larger left atrial diameter (LAD) and left atrial volume (LAV), a higher LAV index (LAVI) (both, p < 0.01), and a lower estimated glomerular filtration rate (eGFR) (53.5 ± 14.4 vs. 65.5 ± 13.3 ml/min/1.732, p < 0.001) and creatinine clearance rate (CCr) (85.2 ± 26.1 vs. 101.5 ± 29.4 ml/min, p < 0.05). Multivariate logistic regression indicated both eGFR (p = 0.002) and LAVI (p < 0.001) as independent associated factors for long-term recurrence after single catheter ablation; multivariate Cox proportional hazard regression with backward feature selection identified both eGFR (HR: 0.93, 95% CI: 0.91–0.95, p < 0.001) and LAVI (HR: 1.32, 95% CI: 1.25–1.40, p < 0.001) as independent prognostic factors for recurrence when adjusting other clinical variables. Conclusions Decreased eGFR and elevated LAVI may facilitate the long-term recurrence of atrial tachyarrhythmia after catheter ablation for AF.


Author(s):  
Enida Rexha ◽  
Christian Heeger ◽  
Sabrina Maack ◽  
Laura Rottner ◽  
Peter Wohlmuth ◽  
...  

Background: Cryoballoon (CB) based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency (RF) based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze-cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA). Methods and Results: In 205 patients with ATA recurrence after previous CB-based PVI a total of 806 PVs were identified. One hundred-twenty-six out of 806 PVs (16%) were previously treated with a TTI guided ablation (protocol #1; TTI+120 sec.), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze-cycles were applied (protocol #2; mTTI) and in 588/806 (73%) a fixed freeze-cycle was applied without TTI-monitoring. There was no difference in the PV-reconduction rate between the groups (P=0.23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV – left inferior PV (LIPV) p<0.003, -left superior PV (LSPV) p<0.001, - right superior PV RSPV p<0.013). In 21 patients (10%) only for the RIPV reconduction was assessed. Conclusions: TTI based CB ablation did not show significant differences regarding PV-reconduction rates compared to the other protocols.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M.J Mulder ◽  
M.J.B Kemme ◽  
L.H.G.A Hopman ◽  
A.M.D Hagen ◽  
P.M Van De Ven ◽  
...  

Abstract Background Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is an important treatment option in symptomatic atrial fibrillation (AF) patients. Ablation Index (AI) has recently attracted considerable interest as a guide for PVI procedures and combines contact force, RF application time and ablation power into a single metric. A limitation of ablation strategies guided by AI is the impossibility to use a catheter dragging technique. Although comparative studies are sparse, ablation using a catheter dragging technique may shorten procedural duration and improve PVI durability by creating uninterrupted linear ablation lesions. These ablation lesions can be visualized by a grid (grid annotation), which may provide valuable information on both lesion depth and lesion contiguity. We compared an AF ablation approach guided by grid annotation, with a point-by-point AI annotation approach in a single-center randomized study. Methods Eighty-eight patients with paroxysmal or persistent AF were randomized 1:1 to undergo RF-PVI guided by either grid annotation or AI annotation. In the grid annotation arm, ablation was visualized using automatic generation of 1mm3 grid points projected on the electroanatomic map, with grid points coloring red after 15 seconds of ablation while meeting predefined stability and contact force criteria. Ablation was performed aiming for a continuous circle of red grid points. In the AI annotation arm, ablation was visualized using automatically generated lesion tags with a diameter of 3 mm. AI target values were set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Ablation lesions were created in a point-by-point fashion, aiming for a maximum interlesion distance of 6 mm. All study participants were followed up for 12 months after PVI using out-patient clinic visits, ECGs, 24-hour Holter monitoring and a mobile-based one-lead ECG device to assess heart rhythm when symptoms suggestive of an arrhythmia occurred. Results The primary endpoint of procedure time was not different between the two randomization arms (grid annotation 71±19 min, AI annotation 72±26 min, p=0.765, Figure 1A). RF time was significantly longer in the grid annotation arm compared with the AI annotation arm (49±8 min vs. 37±8 min, respectively, p&lt;0.001). Neither fluoroscopy time or radiation dose were different between the randomization arms. All patients completed 12 months of follow-up and recurrent atrial tachyarrhythmias were observed in 29 patients (33%). Recurrence of any atrial tachyarrhythmia was documented in 10 patients (23%) in the grid annotation arm compared with 19 patients (42%) in the AI annotation arm, which did not reach statistical significance by log-rank test (p=0.074, Figure 1B). Conclusions Findings from this randomized controlled study suggest that grid annotation may provide an alternative approach for RF-PVI using AI, allowing for ablation with the catheter dragging technique. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Biosense Webster, Inc. Figure 1


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Berkowitsch ◽  
J Hutter ◽  
S Zaltsberg ◽  
M Tomic ◽  
P Kahle ◽  
...  

Abstract Background Presence of several comorbidities in patients with atrial fibrillation is well known, but impact of them on outcome after pulmonary vein isolation with cryo-balloon is not enough investigated. First aim of the study was analysis of the impact of comorbidities on long term outcome after PVI with cryo-balloon new generation (CBA) and secondary goal was evaluation of the impact of additional posterior roof ablation (PRA) in these patients. Methods Patients with non-paroxysmal AF ablated with CBA in our institution since May 2012 and completed follow up &gt;3 months were enrolled in the study. The history of AF, cardiac comorbidities (CAD, Non ischemic-cardiomyopathy, heart insufficiency, right ventricular dysfunction) diabetes mellitus, and renal failure were assessed at admission, all patients received echocardiographic examination and blood test. After a single trans-septal access and PV angiography PVI was performed using a 28-mm CBA. Mapping of PV signals before, during, and after each cryo application was performed with a 3F lasso catheter. The procedural endpoint after PVI was defined as complete elimination of all fragmented signals at the PV antrum with verification of entrance and exit block. In some patients PRA was performed additionally to PVI at discretion of physician. The primary endpoint of this study was the first documented recurrence of atrial tachyarrhythmia (&gt;30 sec.), hospitalization due to cardio-vascular cause, re-do procedure or re-administration of anti-arrhythmic drugs. Results Among 560 patients 78 (13.9%) had no comorbidity and 299 (53.4%) were lasted with &gt;1 comorbidity. A total of 260 (46.4%) recurrences were obtained within median follow up of 28 (12–57) months. Female gender, long time from first diagnosis &gt;12 months and cardiac comorbidity were revealed to be independent predictors for long term recurrences whereas additional PRA performed in 176 pts independently improved outcome (61.9% vs 49.7%). Conclusion Cardiac comorbidities increased probability of post ablation recurrences, but performing of additional posterior roof ablation improved outcome in our cohort. These results should be confirmed in multi-center randomized study FUNDunding Acknowledgement Type of funding sources: None.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed I Elbatran ◽  
Mervat Abou- Elmaaty Nabih ◽  
Magdi M Saba ◽  
Rania Samir ◽  
Mazen Tawfik ◽  
...  

Abstract Background Left atrial posterior wall (LAPW) isolation is an adjunct to pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF). Objective To compare the effect of LAPW box isolation with LAPW point-by-point ablation and PVI in persistent AF on 12-month arrhythmia-free survival and procedure complications. Methods 77 consecutive patients who underwent LAPW box isolation, 24 patients who underwent LAPW point-by-point ablation and 101 patients who underwent PVI for persistent AF were compared. All patients had undergone no prior ablation for AF and were followed up for one year. Results Mean time to atrial tachyarrhythmia recurrence was similar with LAPW box isolation (9.8 months, 95% CI = 9-10.7) and LAPW point-by-point ablation (10 months, 95% CI = 8.6-11.3), both were longer than PVI (8.2 months, 95% CI = 7.4-9.1, log-rank p = 0.003). There was no difference in peri-procedural complications (LAPW box isolation: 5/77, LAPW point-by-point ablation: 1/24, PVI: 6/101, p = 0.91). At 12 months, no difference in atrial tachyarrhythmia recurrence was observed between box isolation (23/77, 30%) and point-bypoint ablation (11/24, 46%, p = 0.15), but significantly higher recurrence occurred with PVI alone (58/101, 57%, p &lt; 0.001). Procedure time was similar with both approaches, with longer fluoroscopy with point-by-point ablation (median: 38 min, IQR: 29-47.75) vs box isolation (median: 28 min, IQR: 7.5-39.5, p = 0.2). Conclusion In persistent AF, there was no difference between LAPW box isolation and point-by-point ablation in terms of mean arrhythmia-free survival, 12-month recurrence or procedure complications. Arrhythmia-free survival with either technique was longer than PVI alone, with no increase in complications.


Author(s):  
Hee-jin Kwon ◽  
Dong Seop Jeong ◽  
Hye Ree Kim ◽  
Seung-Jung Park ◽  
Kyoung-Min Park ◽  
...  

Introduction: In patients with non-paroxysmal AF, various ablation strategies have been attempted to target non-pulmonary vein (PV) foci or to achieve substrate modification beyond pulmonary vein isolation (PVI). The efficacy of empirical ablation of the SVC, one of the most common non-PV foci, is unclear. The aim of this study was to investigate the efficacy and safety of additional superior vena cava (SVC) isolation in patients with non-paroxysmal atrial fibrillation (AF) undergoing thoracoscopic surgical ablation. Methods and Results: A total of 191 patients with persistent or longstanding persistent AF was enrolled. All patients underwent total thoracoscopic surgical ablation for AF, and half of them also received empirical SVC isolation. We compared the atrial-tachyarrhythmia (ATa)-free survival rate and procedure-related complications in the two groups of patients. The 3-year ATa-free survival rate was 53% in the SVC-isolation group and 52% in the no-SVC-isolation group, (p = 0.644). There were no differences between the two groups with respect to AF type or LA size. Procedure-related complications occurred in 12 patients (6%). Pacemakers were implanted only in 3 patients from the SVC-isolation group. The only factor influencing recurrence of ATa was LA diameter. Conclusions: Empirical SVC isolation during thoracoscopic ablation for persistent AF did not improve patient outcomes.


2021 ◽  
Author(s):  
Mahmoud E. Youssef ◽  
Mona F. El-Azab ◽  
Marwa A. Abdel-Dayem ◽  
Galal Yahya Metwally ◽  
Ibtesam S. Alanazi ◽  
...  

Abstract Diabetes is a clinical condition that is associated with insulin deficiency and hyperglycemia. Cardiomyopathy, retinopathy, neuropathy, and nephropathy are well known complications of the elevated blood glucose. Diabetic cardiomyopathy is a clinical disorder that is associated with systolic and diastolic dysfunction along with cardiac fibrosis, inflammation, and elevated oxidative stress. In this study, diabetes was induced by intraperitoneal injection of streptozotocin (STZ) 50 mg/kg. We determined the plasma levels of cardiac troponin-T (cTnT), and creatinine kinase MB (CK-MB) by ELISA. Diabetic rats showed abnormal cardiac architecture and increased collagen production. significant elevation in ST-segment, prolonged QRS and QT-intervals, and increased ventricular rate were detected. Additionally, diabetic rats showed a prolongation in P wave duration and atrial tachyarrhythmia was observed. Plasma levels of cTnT and CK-MB were elevated. In conclusion, these electrocardiographic changes (elevated ST-segment, prolonged QT interval, and QRS complex, and increased heart rate) along with histopathological changes and increased collagen formation could be markers for the development of diabetic cardiomyopathy in rats.


Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1023
Author(s):  
Hee-Jin Kwon ◽  
Ji Hoon Choi ◽  
Hye Ree Kim ◽  
Seung-Jung Park ◽  
Dong Seop Jeong ◽  
...  

Background and Objectives: Cryoballoon ablation (CBA) and totally thoracoscopic surgical ablation (TTA) have emerged as alternatives to radiofrequency catheter ablation (RFCA) for atrial fibrillation. In this study, we describe our experience comparing patient characteristics and outcomes of RFCA, CBA, and TTA. Materials and Methods: We retrospectively analyzed data from patients who underwent RFCA, CBA, or TTA. Both atrial fibrillation (AF)- and atrial tachyarrhythmia (ATa)-free survival rates were compared using time to recurrence after a 3-month blanking period (defined by a duration of more than 30 s). All patients were regularly followed using 12-lead ECGs or Holter ECG monitoring. Results: Of 354 patients in this study, 125 underwent RFCA, 97 underwent CBA and 131 underwent TTA. The TTA group had more patients with persistent AF, a larger LA diameter, and a history of stroke. The CBA group showed the shortest procedure time (p < 0.001). The CBA group showed significantly lower AF-free survival at 12 months than the RFCA and TTA groups (RFCA 84%, CBA 74% and TTA 85%, p = 0.071; p = 0.859 for TTA vs. RFCA, p = 0.038 for RFCA vs. CBA and p = 0.046 for TTA vs. CBA). There were no significant differences in ATa-free survival among the three groups (p = 0.270). There were no procedure-related adverse events in the RFCA group, but some complications occurred in the CBA group and the TTA group (6% and 5%, respectively). Conclusions: RFCA and CBA are effective and safe as first-line treatments for paroxysmal and persistent AF. In some high-risk stroke patients, TTA may be a viable option. It is important to consider patient characteristics when selecting an ablation method for AF.


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