Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial

Nielsen, Jens Cosedis; Johannessen, Arne; Raatikainen, Pekka; Hindricks, Gerhard; Walfridsson, Håkan; Pehrson, Steen; Englund, Anders; Hartikainen, Juha; Mortensen, Leif Spange; Hansen, Peter S.

doi:10.1136/heartjnl-2016-309781

Cited by 83 publications

(62 citation statements)

References 31 publications

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“…Intermittent monitoring may have contributed to the conflicting results reported by these studies, with some reporting improvement in generic PROs regardless of AF recurrences and others improvement only in patients who are classified as free of AF recurrences . The recently published 5‐year follow‐up of MANTRA‐PAF (The Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) trial showed that the improvement in generic HRQoL measured by SF‐36 seen at 2 years after ablation remained and was similar in patients who underwent AF ablation and pharmacological rhythm control in spite of more AF recurrences in the latter group . However, previous studies that did include AF‐specific instruments (Mayo AF‐Specific Symptom Inventory, Atrial Fibrillation Effect on Quality‐of‐Life, and University of Toronto atrial fibrillation severity scale) showed that ablation outcome is most often correlated with AF‐specific PROs …”

Section: Discussionmentioning

confidence: 99%

Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Björkenheim

Brandes

Magnuson

et al. 2018

JAHA

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BackgroundAtrial fibrillation (AF) ablation improves patient‐reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF‐specific and a generic patient‐reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.Methods and ResultsFifty‐four patients completed the generic 36‐Item Short‐Form Health Survey and the AF‐specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient‐reported outcomes scores were compared with those of a Swedish age‐ and sex‐matched population. After ablation, both summary scores reached normative levels at 24 months, while role‐physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36‐Item Short‐Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.ConclusionsThe AF‐specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36‐Item Short‐Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF‐specific patient‐reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF‐specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.

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Section: Discussionmentioning

confidence: 99%

Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Björkenheim

Brandes

Magnuson

et al. 2018

JAHA

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“…Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is based on the knowledge that the most focal triggers for AF originate from the pulmonary vein (PV) muscular sleeves. When compared with antiarrhythmic drugs (AADs), catheter ablation has shown superior rhythm control strategy for paroxysmal AF even as first‐line treatment . However, stable sinus rhythm cannot be maintained by PVI alone in some paroxysmal AF and in the majority of persistent or longstanding persistent AF …”

Section: Introductionmentioning

confidence: 99%

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Chen

Schmidt

Bordignon

et al. 2019

Cardiovasc electrophysiol

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Introduction: Pulmonary vein isolation (PVI) is the cornerstone ablation strategy for treatment of atrial fibrillation (AF). Ablation outside the PVs is sometimes needed particularly in persistent or longstanding AF. This study reported left atrial appendage isolation (LAAI) using cryoballoon (CB) focusing on technical data and short-term clinical follow-up.Methods and results: Patients with recurrent persistent AF after multiple AF procedures were enrolled. LAAI was performed using the second generation CB guided by compound motor action potential (CMAP) and 240 seconds plus bonus freeze (ICE-B) protocol. Ten patients were included, median age was 69.5 (56-73) years, CHA 2 DS 2 -VASc score was 3 (1.8-4), LA diameter was 44 (38.8-46.5) mm. All patients had a mean of three AF procedures before the LAAI procedure. All patients were under successful CMAP guidance. During the CB LAAI procedure, the median time to LAA isolation was 100 (76-270) seconds, minimal freeze temperature was −50 (−57 to −47)°C. A "pull-down (or pull-away)" CB maneuver was performed in all patients. Median fluoroscopic time was 4.8 (3.4-6.8) minutes and acute LAAI success rate was 100%. No phrenic nerve injury or other major complications were observed.At 6-week follow-up, remapping of the LAA showed durable isolation of all PVs (100%), all patients were scheduled for LAA occlusion. Six-month follow-up showed that 80% of patients were free from AF/AT recurrence. Conclusion: CMAP plus ICE-B guided LAAI using cryo-technology appears feasible and safe, results in durable LAAI, and shows promising clinical results in patients with recurrent persistent AF. K E Y W O R D S ablation, atrial fibrillation, cryoballoon, left atrial appendage, pulmonary vein isolation J Cardiovasc Electrophysiol. 2019;30:272-283. wileyonlinelibrary.com/journal/jce 272 |

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“…Therefore, treatment recommendations are mainly based on pathophysiological considerations, small observational studies in athletes, and individual experience. Studies comparing different treatment options in non‐athletes can also be taken into consideration …”

Section: Discussionmentioning

confidence: 99%

Excess of exercise increases the risk of atrial fibrillation

Müssigbrodt

Weber

Mandrola

et al. 2017

Scandinavian Med Sci Sports

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An interesting and still not well-understood example for old medical wisdom "Sola dosis facit venenum" is the increased prevalence of atrial fibrillation (AF) in athletes. Numerous studies have shown a fourfold to eightfold increased risk of AF in athletes compared to the normal population. Analysis of the existing data suggests a dose-dependent effect of exercise. Moderate exercise seems to have a protective effect and decreases the risk of AF, whereas excessive exercise seems to increase the risk of AF. The described cases illustrate clinical manifestations within the spectrum of AF in elderly athletes, that is, exercise-induced AF, vagal AF, chronic AF, and atrial flutter. As the arrhythmia worsened quality of life and exercise capacity in all patients, recovery of sinus rhythm was desired in all described cases. As the atrial disease was advanced on different levels, different treatment regimes were applied. Lifestyle modification and temporary anti-arrhythmic drug therapy could stabilize sinus rhythm in one patient, whereas others needed radiofrequency ablation to achieve a stable sinus rhythm. The patient with the most advanced atrial disease necessitated anti-arrhythmic drug therapy and another left atrial ablation. All described patients remained in sinus rhythm during the long-term follow-up.

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Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial

Abstract: NCT00133211; Results.

Cited by 83 publications

References 31 publications

Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Excess of exercise increases the risk of atrial fibrillation

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