Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Background Atrial fibrillation (AF) ablation is increasingly used in patients with reduced left ventricular ejection fraction (LVEF). The aim of the present study was to evaluate the long‐term results of a single radiofrequency catheter ablation procedure in heart failure (HF) patients with AF. Hypothesis We tested the hypothesis that left atrial ablation is an effective therapeutic modality in patients with heart failure. Methods Our study included HF patients with LVEF <50% who underwent catheter ablation for AF at our department between January 2010 and March 2017. All patients underwent our institution's protocol for follow‐up post‐ablation. Results The study enrolled a total of 38 patients (mean age, 54.1 ± 12.2 years; 28 [73.7%] males; mean LVEF, 38.2% ± 6.3%). After a mean follow‐up period of 38.2 months (range, 5–92 months), 28 patients (73.7%) were free from arrhythmia recurrence. In multivariate analysis, early arrhythmia recurrence (P = 0.03) and amiodarone antiarrhythmic drug administration (P = 0.003) remained independent predictors of arrhythmia recurrence. Conclusions The main findings of this study are that (1) a single radiofrequency catheter ablation procedure is an effective and safe modality for AF in patients with concomitant HF; (2) after a mean 3.3 years of follow‐up, 73.7% of HF patients remained in sinus rhythm; and (3) early arrhythmia recurrence was a significant predictor of arrhythmia recurrence after the blanking period.

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“…Moreover, EAR is a well‐known predictor of late AF recurrence in both PAF and NPAF patients . This finding was similarly observed in our study.…”

Section: Discussionsupporting

confidence: 90%

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Bazoukis

Letsas

Tse

et al. 2018

Clinical Cardiology

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“…Patient‐specific substrate modification strategies targeting rotors or low‐voltage areas have produced encouraging early results but need to be verified in further studies. Therefore, AF ablation should be considered at the earlier stage of AF progression as much as possible, and careful patient selection according to clinical or genetic factors may improve the outcomes of catheter ablation for L‐PeAF …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, AF ablation should be considered at the earlier stage of AF progression as much as possible, 44 and careful patient selection according to clinical or genetic factors may improve the outcomes of catheter ablation for L-PeAF. 45…”

Section: Future Directionsmentioning

confidence: 99%

Does Additional Electrogram‐Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study

Kim

Uhm

Kim

et al. 2017

JAHA

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BackgroundAlthough circumferential pulmonary vein isolation (CPVI) catheter ablation may not be sufficient for long‐standing persistent atrial fibrillation (L‐PeAF), it is not clear which ablation strategy is beneficial in addition to CPVI. We sought to investigate whether additional complex fractionated atrial electrogram (CFAE)‐guided ablation improves clinical outcomes in L‐PeAF patients who exhibit continuous atrial fibrillation (AF) after CPVI and linear ablation (Line).Methods and ResultsThis study enrolled 137 L‐PeAF patients (71.4% male, 61.6±10.9 years old) who underwent radiofrequency catheter ablation. We conducted CPVI+Line based on the Dallas lesion set (posterior box+anterior line) after baseline CFAE mapping in all patients. If AF was defragmented (terminated or changed to atrial tachycardia), the procedure was stopped (AF‐Defrag group, n=29). If AF was maintained after CPVI+Line, we mapped the CFAE again and randomly assigned the patient to the CPVI+Line group (n=54) or the additional CFAE ablation group (CPVI+Line+CFAE group, n=54). L‐PeAF was defragmented during CPVI+Line in 21.2% of patients (29/137, AF‐Defrag group). The mean CFAE cycle length was prolonged (P<0.001), and CFAE area (CFAE cycle length <120 milliseconds) was reduced (P<0.001) after CPVI+Line in the remaining patients. Procedure time was longer in the CPVI+Line+CFAE group than the CPVI+Line group (P=0.023), but procedure‐related complication rates did not vary. During 22.3±13.2 months of follow‐up, the clinical recurrence rates were 17.2% in the AF‐Defrag group, 18.5% in the CPVI+Line group, and 32.1% in the CPVI+Line+CFAE group (log rank, P=0.166).ConclusionsAlthough CPVI+Line reduces and localizes CFAE area, additional CFAE ablation after CPVI+Line does not improve the clinical outcomes of catheter ablation in patients with L‐PeAF.

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“…1 For this reason, many operators have performed empirical extra-PV foci ablation such as linear the ZFHX3 genetic trait. 18 Regarding the intra-procedural factors, CPVI alone proved sufficient in patients with paroxysmal AF, 19 and appropriate parasympathetic modulation after AF ablation measured using heart rate variability (HRV) 5 and absence of post-ablation extra-PV triggers 9 were related to a good rhythm outcome after AF ablation. In the persistent AF group, recurrence was lower in those with posterior wall isolation in de novo ablation.…”

Section: Star-af2 and Extra-pv La Ablationmentioning

confidence: 99%

Trends and Outcome of Catheter Ablation of Atrial Fibrillation Over 9 Years　― Focus on Empirical Extra-Pulmonary Vein Ablation ―

Park

Kim

et al. 2019

Circ J

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Background:The Substrate and Trigger Ablation for Reduction of Atrial Fibrillation Trial Part II (STAR-AF2) emphasized the importance of circumferential pulmonary vein isolation (CPVI) during AF ablation. Methods and Results:This study involved 2,297 consecutive patients (mean age, 58±11 years; 73.1% male, 70.1% paroxysmal AF) undergoing AF ablation from 2009 to 2017. We investigated the ablation lesion set, ablation time, catheter type, and clinical outcomes. Over the 9 years, the extra-pulmonary vein (PV) left atrial (LA) ablation rate (76.8% to 19.4%, P<0.001 for trend) and ablation time (P<0.001 for trend) decreased dramatically, whereas the 1-year recurrence rates decreased (21.8% to 14.1%, P=0.04 for trend). In persistent AF patients, the extra-PV LA ablation rate (91.4% to 55.3%, P<0.001) and ablation time (P<0.001) decreased after the STAR-AF2 report, but the 1-year recurrence rates remained similar (22.1% to 17.9%, P=0.281). A mesh-type flexible tip (MFT) catheter with a moderately increased radiofrequency power was used since 2012, and the MFT catheter was independently associated with a lower clinical recurrence compared to other irrigated-tip catheters (HR, 0.670; 95% CI: 0.559-0.803, P<0.001; log rank P=0.002) without increasing the procedure-related complications (OR, 1.434; 95% CI: 0.937-2.194, P=0.097). Conclusions:Over the 9 years the extra-PV LA ablation and 1-year recurrence rates in the AF ablation cohort decreased, in part due to improved catheter technology.

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Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Cited by 20 publications

References 29 publications

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Does Additional Electrogram‐Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study

Trends and Outcome of Catheter Ablation of Atrial Fibrillation Over 9 Years　― Focus on Empirical Extra-Pulmonary Vein Ablation ―

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Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Cited by 20 publications

References 29 publications

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Predictors of arrhythmia recurrence in patients with heart failure undergoing left atrial ablation for atrial fibrillation

Does Additional Electrogram‐Guided Ablation After Linear Ablation Reduce Recurrence After Catheter Ablation for Longstanding Persistent Atrial Fibrillation? A Prospective Randomized Study

Trends and Outcome of Catheter Ablation of Atrial Fibrillation Over 9 Years ― Focus on Empirical Extra-Pulmonary Vein Ablation ―

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Trends and Outcome of Catheter Ablation of Atrial Fibrillation Over 9 Years　― Focus on Empirical Extra-Pulmonary Vein Ablation ―