Background: Data regarding long-term follow-up of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in patients with (Cardiol J 2017; 24, 1: 1-8)
Background: Left atrial enlargement (LAE) predicts atrial fibrillation (AF) recurrence after cryoballoon-based pulmonary vein isolation (CB). Increased left ventricular wall thickness (LVWT) is pathophysiologically associated with LAE and atrial arrhythmias. Aims:To assess effect of increased LVWT on long-term outcomes of CB depending on coexistence of LAE.Methods: LAE was defined using either echocardiography (>48 cm 3 /m 2 ) or multislice computer tomography (MSCT, ≥63 cm 3 /m 2 ). Increased LVWT was echocardiographic septal/posterior wall thickness >10 mm in males and >9 mm in females. All patients achieved 2-year follow-up.Results: Of 250 patients (median [interquartile range, IQR] age of 61 [49.0-67.3] years; 30% female) with AF (40% non-paroxysmal), 66.5% had hypertension, and 27.2% underwent redo procedure. MSCT was done in 76%. During follow-up of 24.5 (IQR, 6.0-31.00) months the clinical success rate was 72%, despite 46% of patients having arrhythmia recurrence. Arrhythmia recurrence risk was increased by LAE and increased LVWT (hazard ratio [HR], 1.801; P = 0.002 and HR, 1.495; P = 0.036; respectively). The highest arrhythmia recurrence (61.9% at 2 years) was among patients with LAE and increased LVWT (33.6% of patients); intermediate (41.8%) among patients with isolated LAE; and lowest among patients with isolated increased LVWT or patients without LAE or increased LVWT (36.8% and 35.2% respectively, P = 0.004). After adjustment for body mass index (BMI), paroxysmal AF, CHA 2 DS 2 -VASc score, clinically-significant valvular heart disease, and cardiomyopathy, patients with LAE and concomitant increased LVWT diagnosis had a 1.8-times increased risk of arrhythmia recurrence (HR, 1.784; 95% confidence interval [CI], 1.017-3.130; P = 0.043). Conclusion:Joint occurrence of LAE and increased LVWT is associated with the highest rate of arrhythmia recurrence after CB for AF.
In some patients with atrial fibrillation (AF), the causative agent of attack is stress (AF associated with adrenergic activity). In others, AF usually begins during relax or sleep (AF associated with vagal nerve dominance). This study aimed to investigate the individual factors associated with the adrenergic or vagal type of AF. This study included 138 patients with paroxysmal atrial fibrillation (AF). Sixty-eight patients reported that AF was frequently triggered by stress (sympathetic-type AF) and 70 patients reported that AF usually began during relaxation or sleep (vagal-type AF). Gender, age, ejection fraction, and temperament were compared across the two groups. Temperament was evaluated using the Formal Characteristics of Behaviour-Temperament Inventory. The groups differed only in temperament. Patients with sympathetic-type AF had a higher score for emotional reactivity (p = 0.002) and perseverance (p = 0.002) temperament traits and a lower score for endurance (p = 0.003) than patients with vagal-type AF and than the average in population.
The aim of the study was to provide quantitative data and to look for new landmarks useful during transseptal puncture (TSP) using a fluoroscopy‐guided approach. Methods and results A total of 104 patients at mean age 57 ± 12 years, of whom 92% underwent pulmonary vein isolation, were analysed. Before TSP catheters were placed in the coronary sinus (CS) and His bundle region. A guidewire running from femoral vein through great veins was left loose in superior vena cava. Before TSP X‐ray images were taken in right anterior oblique (RAO) 45° and RAO 53° projections. Locations posterior to TSP site in RAO were described with negative values and those anterior with positive values. The measured distances in millimeters were as follows: (a) between TSP site and posterior atrial wall (RAO 45 = –21 ± 7 mm; RAO 53 = –19 ± 6 mm (b) between TSP site and free guidewire (RAO 45 = –5 ± 4 mm, RAO 53 = –3 ± 4 mm (c) between TSP site and CS ostium (RAO 45 = 9 ± 6 mm; RAO 53 = 8 ± 5 mm (d) between TSP site and His region (RAO 45 = 29 ± 8 mm; RAO 53 = 30 ± 8 mm). We observed correlations between measured distances and age, body mass index and sizes of cardiac chambers. The distance between TSP site and the line projected by the guidewire running between great veins, measured in mid‐RAO projections, was very small. Conclusion The distances between TSP site and standard anatomical landmarks used during TSP vary with regard to age, physique and cardiac chamber dimensions. TSP site, as assessed in mid RAO, is in direct vicinity to the line projected by a guidewire running between the great veins.
Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter Ablation (CA) is considered as a first-line therapy for AF. The risk of 30-days all-cause mortality associated with CA for AF may be underestimated in clinical trials and selected-cohort studies due to selection bias. Hypothesis: We evaluated 30-days all-cause mortality associated with CA for AF in the entire country of Poland Methods: The data was collected from the Polish national healthcare service (the National Health Fund of Poland). In the Polish health system covers >99% of CA for AF for the entire country. All consecutive CA in patients >18 years of age, between Jan 2012 and Dec 2019 were included in the study. CA for AF was identified by unique codes assigned to pulmonary vein isolation and CA for AF. The mortality rate was calculated for each age group. Results: During 8-year follow-up period, 31,214 CA of AF were performed in 26,767 patients. 9315 (34.8%) patients were female. 13758 (51.4%) patients had Cryoballoon ablation. Thirty-two deaths (0.1%) within 30-days of the CA were identified. The mortality rate was low and similar in each age group except in the oldest age group (age>80). The oldest age group had significantly higher 30-days mortality than any other age group. (Figure). Conclusions: In the large, consecutive patient population in the entire country of Poland, 30- days mortality following AF ablation for past 8-years remains low. In real-world clinical practice patients over the age of 80 have higher risk of 30-day all-cause mortality than any other age group found over last seven years. Systematic review is needed to further risk-stratify these findings.
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