Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation

Kim, Yun Gi; Boo, Ki Yung; Choi, Jong Il; Choi, Yun Young; Choi, Ha Young; Roh, Seung Young; Shim, Jaemin; Kim, Jin-Seok; Kim, Young Hoon

doi:10.1016/j.jacep.2020.09.029

Cited by 52 publications

(59 citation statements)

References 22 publications

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“…The association between ERAF and LRAF has been reported: in the study of 3120 patients, Kim YG et al 26 concluded that early recurrence was a reliable predictor for late recurrence. They did not analyze LRAF and VLRAF separately but we consider them nevertheless consistent with our results.…”

Section: Discussionmentioning

confidence: 99%

“…The association between ERAF and LRAF has been reported: in the study of 3120 patients, Kim YG et al 26 Several predictors of VLRAF had been described in previous reports and some of them are thought to be associated with left ventricular diastolic dysfunction. [5][6][7]13 Given that LVAs are also reportedly associated with left ventricular diastolic dysfunction, ventricular diastolic dysfunction appears a major factor in the progression of postprocedural arrhythmogenicity leading to VLRAF occurrence.…”

Section: Clinical Factors Associated With Vlrafmentioning

confidence: 98%

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Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

Kanda

Masuda

Asai

et al. 2022

Cardiovasc electrophysiol

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Background: Very late recurrence of atrial fibrillation (VLRAF) occurring >1 year after catheter ablation may influence long-term follow-up strategies, including oral anticoagulant therapy. However, little is known about the predictors of this condition. Given that the prevalence of left atrial low-voltage areas (LVAs) is strongly associated with the recurrence of atrial tachyarrhythmias following catheter ablation, we hypothesized that VLRAF might occur more frequently in patients with LVAs at the time of initial ablation.The purpose of this study was to investigate the impact of LVAs on VLRAF.Methods: This study included 1001 consecutive patients undergoing initial ablation procedures for AF. LVAs were defined as regions with bipolar peak-to-peak voltages of <0.50 mV on the voltage map obtained during sinus rhythm after pulmonary vein isolation. During a 1-year follow-up period, 248 patients had a late recurrence of AF (LRAF), defined as recurrence within 3-12 months after ablation. The occurrence of VLRAF was examined in 711 patients without LRAF who were followed for more than 1 year.Results: A total of 711 patients who did not develop AF recurrence within 1 year and for whom clinical data were available after 1 year were analyzed. During a median follow-up of 25 (19, 37) months, VLRAF more than 1 year after the initial ablation was detected in 123 patients. On multivariate analysis, independent predictors of VLRAF were the existence of LVAs, female, left atrial diameter and early recurrence of AF. A Kaplan-Meier analysis showed that the AF-free survival rate was significantly lower in patients with LVAs than in those without LVAs within 1 year and on more than 1-year follow-up (p < .001). An additional Kaplan-Meier analysis of the incidence of VLRAF in propensity score-matched patients with and without LVAs showed that VLRAF occurred significantly more frequently in patients with LVAs (p = .003).Conclusions: LVAs during the initial AF ablation procedures have an impact on VLRAF occurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Factors Associated With Vlrafmentioning

confidence: 98%

Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

Kanda

Masuda

Asai

et al. 2022

Cardiovasc electrophysiol

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“…The major limitation of the retrospective study was that it was conducted in a single-center and had a small sample size. In particular, most of the study population were men (81.5%), although men account for a large percentage (64–83%) in other studies of patients with atrial fibrillation recurrence after catheter ablation [ 17 – 19 ]. Moreover, the operator’s habit to apply the catheter might have effect on the gap area because the contact angle tended to be the same in the same area.…”

Section: Discussionmentioning

confidence: 99%

Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

Ohta

Hayashi

Sato

et al. 2022

J Interv Card Electrophysiol

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Purpose This study is aimed to evaluate the impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation (PVI). Methods Both in vitro experiment and retrospective observational study were conducted. For in vitro experiment, radiofrequency lesions were created on explanted swine hearts in three different catheter contact angles (0°, 45°, and 90°). In the retrospective observational study, we assessed patients who had undergone repeat catheter ablation due to atrial fibrillation recurrence after initial PVI. When pulmonary vein (PV) reconnection was observed, we analyzed the previous ablation points within and without the gap area. The gap areas were where ablation had changed the PV activation sequence or eliminated the PV potential in the repeat session. Results In the in vitro experiment, lesion width was the smallest (5.3 ± 0.4 mm) in perpendicular contact compared to 0° (vs 5.8 ± 0.5 mm, p = 0.040) and 45° (vs 6.4 ± 0.4 mm, p < 0.001). In the retrospective observational study, we assessed 666 tags of 16 patients with PV reconnections, and 60 tags were in the gap area. Tags in the gap area had longer interlesion distance (odds ratio [OR] 1.49, p < 0.001), greater contact force variability (OR 1.03, p = 0.008), and higher rate of perpendicular contact (OR 3.26, p < 0.001) on multivariate analysis. Conclusions Perpendicular contact was associated with a smaller lesion and higher rate of PV reconnection.

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“…Clinical course of persistent AFib/AFl and appearance of arrhythmia recurrences after successful cardioversion may depend on atrial cardiomyopathy and development of electrical remodeling [6]. Rare appearance of arrhythmia may refl ect priority of fi nding and avoiding special triggers, often without necessity of preventive antiarrhythmic therapy.…”

Section: Discussionmentioning

confidence: 99%

An Exploratory Study of Predictors of Late Arrhythmia Recurrences in Patients With Persistent Atrial Fi Brillation After Cardioversion

Pavlyk

Chernyaha-Royko

Zharinov

et al. 2021

PSSS MS

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Introduction. The existing guidelines do not contain a clear algorithm for predicting the late recurrences of atrial fibrillation (AFib). Objectives. We have studied the predictors of late recurrence of arrhythmia in patients with persistent AFib after the restoration of sinus rhythm (SR). Research methods. A prospective single-center study included 120 hospitalized patients with persistent AFib who underwent successful cardioversion. The recurrence of AFib was assessed in the early period after cardioversion by recording 12-channel ECG, Holter ECG monitoring and event ECG monitoring. After a nine-month period follow-up visit was performed. Baseline demographic, clinical-functional features and comorbidities were compared in group with (n = 87) and without (n = 33) late recurrences of Afib. Results. There were no differences in demographic, anthropometric data and comorbidities. Patients with late recurrence of AFib had a lower heart rate (HR) after SR recovery (p <0.001). Early recurrences of AFib were found in 43 (49.4%) patients with late recurrences of arrhythmia and only in two (6.0%) without late recurrences (p <0.001). Patients with late recurrences of arrhythmia had a lower average daily HR (p <0.001), a higher number of single atrial extrasystoles (p = 0.001), atrial pairs and runs (p = 0.01) recorded by Holter ECG monitoring. Conclusions. Late recurrences of arrhythmia during the nine-month follow-up period were reported in 72.5% of patients. Groups of patients with and without late recurrence of arrhythmia had significant differences in the incidence of early recurrences, mean HR on SR, and the presence of atrial extrasystoles after rhythm recovery.

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Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation

Cited by 52 publications

References 22 publications

Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

Impact of left atrial low‐voltage areas during initial ablation procedures on very late recurrence of atrial fibrillation

Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

An Exploratory Study of Predictors of Late Arrhythmia Recurrences in Patients With Persistent Atrial Fi Brillation After Cardioversion

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