Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance

Objective ‒ to perform the analysis and biophysical substantiation of a new technique of catheter radiofrequency ablation (RFA) with high power and short duration based on mathematical modeling of own clinical data of the electro-thermodynamic effect of RFA on the myocardium; to investigate the morphological characteristics of the myocardium in different areas of the atrium and to determine the morphometric parameters of the display on the electroanatomical model of the heart of the ablation zone in the EnSite Precision navigation system, necessary for effective and safe high-power and short-duration RFA.Materials and methods. Clinical studies were performed in Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine. Specialized high-tech medical equipment was used for the objectivity of clinical data obtained and used in the work. Morphological characteristics of the myocardium (thickness of the wall of the left atrium, distance from the back wall of the heart to the esophagus, diameters of the pulmonary veins) were evaluated on the computed tomography images of the heart of the patients, which were obtained in the radiology department on a Toshiba device (Japan) using a spiral scanning. The morphometric parameters of the ablation zone, which were later used to evaluate the effectiveness of RFA and which formed the basis of standardized protocols for the operation, were determined for display on the electro-anatomical maps of the patients' hearts in the EnSite Precision system (Abbott, USA). Biophysical substantiation of the RFA technique with high power and short duration was performed using mathematical modeling of the electro-thermodynamic effect of RFA on the myocardium and own clinical data in the Comsol Multiphysics automated simulation of biophysical processes.Results. It is proposed for a group of patients with combined atrial fibrillation with an atrial septal defect to perform RFA using a new ablation technique with high power and short duration at one point of application of radio frequency energy. Achieving transmurality of ablation in a shorter time makes it possible to hold the electrode more precisely and stably in this area when isolating the pulmonary veins in a complex geometry and without support for the electrode in case of a defect. The morphological characteristics of the myocardium were studied and the morphometric parameters of the display on the electroanatomical heart model of the ablation zone, necessary for effective and safe RFA, were determined. These include: the diameter of the point-label of radiofrequency ablation on the anatomical model of the heart, which must correspond to the real data of the size of the destruction; the percentage of overlap of RFA points for the formation of an effective transmural line; estimated number of ablation points to standardize the evaluation of the effectiveness of the procedure.Conclusions. The conducted research made it possible to solve the current problems of catheter radiofrequency ablation in patients with atrial fibrillation and atrial septal defect, namely to increase the efficiency and safety of pulmonary vein isolation. Transmurality and integrity of the isolating line was achieved due to the determined morphological characteristics of the myocardium and the calculated morphometric parameters of the ablation zone. The obtained data are adapted to a real display visible to the surgeon on the electro-anatomical map of the heart in the EnSite Precision navigation system. This system is actively used in clinical practice, but it was necessary to optimize the clinical protocols of RFA with high power and short duration, which was achieved as a result of this work.

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Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Chen,

Zhang,

Fang

et al. 2024

Front. Cardiovasc. Med.

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BackgroundCatheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear.MethodsWe systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research.ResultsThe comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12–1.51, P = 0.19), (HR: 0.78; 95% CI: 0.48–1.27, P = 0.31), and (OR: 1.10; 95% CI: 0.83–1.44, P = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99–11.54, P < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, P =0.47), (OR: 0.97; 95% CI: 0.50–1.86, P = 0.93), (OR: 1.27; 95% CI: 0.47–3.41, P = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; P = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; P = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; P = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; P = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; P = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; P = 0.38)].ConclusionThis meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).

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Long-Term prognosis of radiofrequency catheter ablation for atrial fibrillation with different subtypes of heart failure in the era of ablation index guidance

Cited by 3 publications

References 40 publications

Application of Three-Dimensional Speckle Tracking Imaging in Evaluating Left Ventricular Function in Patients with Atrial Fibrillation before and after Radiofrequency Ablation

Application of Three-Dimensional Speckle Tracking Imaging in Evaluating Left Ventricular Function in Patients with Atrial Fibrillation before and after Radiofrequency Ablation

Optimization of high-power short duration catheter radiofrequency ablation for pulmonary veins isolation in patients with artiral septial defect

Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

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