This study demonstrates no advantage in long-term arrhythmia-free clinical outcome after circumferential PV isolation in patients with frequent PAF.

The majority of right and left AMRTs were related to the presence of ESA. Ablation can be successful with a favorable risk of atrial tachyarrhythmia recurrence.

No abstract

BackgroundChanges in quality of life (QoL) after catheter ablation for long‐standing persistent atrial fibrillation (LSPAF) are not well described. We sought to compare QoL improvement after catheter ablation of paroxysmal atrial fibrillation (PAF) versus that after LSPAF.Methods and ResultsA total of 261 PAF and 126 LSPAF ablation recipients were prospectively followed for arrhythmia recurrence, QoL, hospital stay, and sick leave. In PAF versus LSPAF groups, 1.3±0.6 versus 1.6±0.7 procedures were performed per patient (P<0.00001) during a 3‐year follow‐up. Good arrhythmia control was achieved in 86% versus 87% of patients (P=0.69) and in 69% versus 69% of patients not receiving antiarrhythmic drugs (P=0.99). The baseline QoL was better in the PAF than in the LSPAF group (European Quality of Life Group instrument self‐report questionnaire visual analog scale: 66.4±14.2 versus 61.0±14.2, P=0.0005; European Quality of Life Group 3‐level, 5‐dimensional descriptive system: 71.4±9.2 versus 67.7±13.8, P=0.002). Postablation 3‐year increase in QoL was significant in both groups (all P<0.00001) and significantly lower in PAF versus LSPAF patients (visual analog scale: +5.0±14.5 versus +10.2±12.8, P=0.001; descriptive system: +5.9±14.3 versus +9.3±13.9, P=0.03). In multivariate analysis, LSPAF, less advanced age, shorter history of AF and good arrhythmia control were consistently associated with postablation 3‐year improvement in QoL. Days of hospital stay for cardiovascular reasons and days on sick leave per patient/year were significantly reduced in both groups.ConclusionsPatients with LSPAF had worse baseline QoL. The magnitude of QoL improvement after ablation of LSPAF was significantly greater compared with after ablation of PAF, particularly when good arrhythmia control was achieved without the use of antiarrhythmic drugs.

Ablation of long-standing persistent atrial fibrillation was associated with significant recovery of haemodynamics and exercise capacity that projected onto the long-term improvement in quality of life.

Paravalvular leaks (PVL) occur in 5-17% of patients who underwent aortic or mitral valve implantation. The patients who have a paravalvular leak mostly present with heart failure, hemolytic anaemia, or both. The gold standard for treatment of severe symptomatic paravalvular leaks is reoperation, which is, nevertheless, associated with increased morbidity and is not always successful. Because of frequent patient morbidity and increased risk of reoperation, there is a trend to favor the less invasive approach of initial percutaneous closure without another sternotomy. The percutaneous approach requires implantation of specially dedicated occlusive devices and a choice of three different access sites: antegrade approach through femoral vein with transseptal puncture, retrograde approach through femoral artery and transapical approach. PVL closure is a complex and technically demanding intervention with a success rate between 40-90% and an acceptable rate of adverse events. In a group of patients with a high risk of redo surgery the percutaneous closure of PVL can lead to improving symptoms and outcomes. SOUHRNParavalvulární leaky (PVL) se vyskytují u 5-17 % pacientů, kteří podstupují náhradu aortální anebo mitrální chlopně. Nemocní s paravalvulárním leakem nejčastěji mají projevy srdečního selhání, hemolytické anemie anebo kombinace obou. Zlatým standardem léčby hemodynamicky závažných, symptomatických paravalvulárních leaků je reoperace, která je však spojena s vyšším rizikem komplikací a není vždy úspěšná. Časté komplikace a vyšší riziko reoperací vedly k novému trendu preference méně invazivních postupů, perkutánních uzávěrů leaků jako metody první volby. Perkutánní přístup zahrnuje implantaci speciálně určených okluzivních systémů do místa leaku, a to třemi různými přístupy: antegrádním, cestou femorální žíly spolu s transseptální punkcí, retrográdním cestou femorální tepny a transapikálním. Uzávěr PVL je komplexním a technicky náročným výkonem s očekávanou mírou úspěšnosti 40-90 % a akceptabilní mírou nežádoucích příhod. Ve skupině pacientů s vysokým rizikem opakovaného chirurgického výkonu perkutánní uzávěr PVL může vést ke zlepšení symptomů a dlouhodobých výsledků.

BackgroundLeft atrial (LA) enlargement is a predictor of worse outcome after catheter ablation for atrial fibrillation (AF). Widely used two-dimensional (2D)-echocardiography is inaccurate and underestimates real LA volume (LAV). We hypothesized that baseline clinical characteristics of patients can be used to adjust 2D-ECHO indices of LAV in order to minimize this disagreement.MethodsThe study enrolled 535 patients (59 ± 9 years; 67% males; 43% paroxysmal AF) who underwent catheter ablation for AF in three specialized centers. We investigated multivariately the relationship between 2D-echocardiographic indices of LA size, specifically LA diameter in M-mode in the parasternal long-axis view (LAD), LAV assessed by the prolate-ellipsoid method (LAVEllipsoid), LAV by the planimetric method (LAVPlanimetry), and LAV derived from 3D-electroanatomic mapping (LAVCARTO).ResultsCubed LAD of 106 ± 45 ml, LAVEllipsoid of 72 ± 24 ml and LAVPlanimetry of 88 ± 30 ml correlated only modestly (r = 0.60, 0.69, and 0.53, respectively) with LAVCARTO of 137 ± 46 ml, which was significantly underestimated with a bias (±1.96 standard deviation) of -31 (-111; +49) ml, -64 (-132; +2) ml, and -49 (-125; +27) ml, respectively; p < 0.0001 for their mutual difference. LA enlargement itself, age, gender, type of AF, and the presence of structural heart disease were independent confounders of measurement error of 2D-echocardiographic LAV.ConclusionAccuracy and precision of all 2D-echocardiographic LAV indices are poor. Their agreement with true LAV can be significantly improved by multivariate adjustment to clinical characteristics of patients.

Among clinical variables, shorter duration of persistent AF and higher voltage recorded around the LA predicted long-term maintenance of SR after single ablation.