Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial

Zhang, Xiao Dong; Gu, Jun; Jiang, Wei; Zhao, Liang; Zhou, Li; Wang, Yuan Long; Liu, Yu-Gang; Liu, Xu

doi:10.1093/eurheartj/ehu017

Cited by 25 publications

(16 citation statements)

References 26 publications

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“…However, all these factors can not be effectively resolved by short-term use of AADs. A recent report by Zhang et al[ 48 ] has shown that a second ablation procedure was more effective in maintaining sinus rhythm than AADs in patients with late atrial arrhythmia recurrence after catheter ablation of AF. As we above discussed, the main causes for early recurrence of atrial arrhythmias included post-ablation inflammations, temporary autonomic imbalance, and also the delay of atrial radiofrequency lesion formation[ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation—A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials

et al. 2016

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BackgroundThe efficacy of short-term antiarrhythmic drugs (AADs) use compared with no-AADs prescription after catheter ablation of atrial fibrillation (AF) in preventing atrial arrhythmia recurrence is uncertain.MethodsWe searched PubMed, Embase, and the Cochrane Library through December 2015 to identify randomized controlled trials (RCTs) which evaluated the efficacy of short-term AADs use compared with no-AADs prescription after AF ablation in preventing atrial arrhythmia recurrence. The primary outcome was labeled as early atrial arrhythmia recurrence within 3 months after ablation. Secondary outcome was defined as late recurrence after 3 months of ablation. Random-effects model or fixed-effects model was used to estimate relative risks (RRs) with 95% confidence intervals (CIs).ResultsSix RCTs with 2,667 patients were included into this meta-analysis. Compared with no-AADs administration after AF ablation, short-term AADs use was associated with significant reduction of early atrial arrhythmia recurrence (RR, 0.68; 95% CI, 0.52–0.87; p = 0.003). Trial sequential analysis (TSA) showed that the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. However, compared with no-AADs prescription, short-term AADs use after AF ablation didn’t significantly reduce the risk of late atrial arrhythmia recurrence (RR, 0.92; 95% CI, 0.83–1.03; p = 0.15). TSA supported this result; meanwhile the estimated required information size (1,486 patients) was also met.ConclusionShort-term use of AADs after AF ablation can significantly decrease the risk of early atrial arrhythmia recurrence but not lead to corresponding reduction in risk of late atrial arrhythmia recurrence.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation—A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials

et al. 2016

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“…Whether to perform additional ablation including tricuspid valve isthmus ablation, continuous fractionated atrial electrogram ablation, and LA linear ablation was decided by the operator and/or the attending physician. The ablation procedure followed the method described by Liu X et al [16, 17]. …”

Section: Methodsmentioning

confidence: 99%

Very early recurrence predicts long-term outcome in patients after atrial fibrillation catheter ablation: a prospective study

Xue

Wang

Thapa

et al. 2017

BMC Cardiovasc Disord

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BackgroundLong-term recurrence (LR) is a tendency that re-occurs within 3 months after catheter ablation for atrial fibrillation (AF). Whether very early recurrence (VER) within 7 days of post ablation is a prognostic factor of LR or not is unclear. For this reason, present study sought to examine the relationship between VER and LR.MethodsIn this prospective analysis 378 consecutive patients underwent an initial catheter ablation for paroxysmal or persistent AF. The association between VER and LR was analyzed by univariate and multivariate Cox regression, as well as time-dependent receiver operator characteristic (ROC) analysis.ResultsAfter a mean follow-up of 14.71 ± 8.58 months, 81 (65.90%) patients with VER experienced LR and were associated with lower event of free survival from LR (Log rank test, P < 0.001). Multivariate Cox regression analysis revealed that VER (HR = 7.02, 95% CI = 4.78–10.31; P < 0.001), left atrial enlargement (HR = 2.92, 95% CI = 1.88–4.54; P < 0.001), tendency in advanced age (HR = 1.50, 95% CI = 0.99–2.28; P = 0.054), and tendency in male (HR = 0.71, 95% CI = 0.50–1.01; P = 0.060) were independent predictors of LR. According to time-dependent ROC analysis, it was found that VER was more sensitive than common risk factors in predicting LR (0.74 vs 0.66, P < 0.001) and combination model further improved the C statistic for predicting LR (0.82 vs 0.66, P < 0.001).ConclusionsAfter a single procedure of catheter ablation, patients with VER were strongly associated with LR and combination of VER and common risk factors could further improve prediction of patients who were at high risk for LR.

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“…Various approaches have been used to treat patients with AF [3]. However, clinical trials have shown unsatisfactory outcomes with existing therapeutic strategies [4].…”

Section: Introductionmentioning

confidence: 99%

Eplerenone Prevents Atrial Fibrosis via the TGF-β Signaling Pathway

Qin²,

Yi³

et al. 2017

Cardiology

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Objectives: Eplerenone (EPL), an antagonist of the mineralocorticoid receptor, is beneficial for atrial fibrillation and atrial fibrosis. However, the underlying mechanism remains less well known. We aimed to investigate the effect of EPL on atrial fibrosis using a mouse with selective atrial fibrosis and to explore the underlying mechanisms. Methods: EPL-treated MHC-TGFcys³³ser transgenic mice that have selective atrial fibrosis (Tx+EPL mice), as well as control mice, were used for in vivo studies including histological analyses, Western blotting, and qRT-PCR studies. TGF-β₁-stimulated atrial fibroblasts were treated with EPL or vehicle for the in vitro studies including Western blotting and qRT-PCR studies. In addition, Smad7 siRNA was used to knock down Smad7. Results: EPL inhibited atrial fibrosis in the Tx mice. In addition, EPL suppressed the expression of fibrosis-related molecules induced by TGF-β₁ in vivo and in vitro. This occurred in concert with a downregulation of Smad7 protein expression and an upregulation of p-Smad2/3 protein expression. In addition, knockdown of Smad7 by siRNA abolished the protective roles of EPL. Conclusions: EPL inhibited atrial fibrosis in Tx mice. The underlying mechanism may involve increased protein expression of Smad7, which enhances the inhibitory feedback regulation of TGF-β₁/Smad signaling.

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Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial

Abstract: This study demonstrates superiority of CA over AAD for recurrent AT after persistent AF ablation with regard to SR maintenance, long-term safety and QoL improvement. However, CA use might be limited by a higher risk for periprocedural complications.

Cited by 25 publications

References 26 publications

Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation—A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials

Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation—A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials

Very early recurrence predicts long-term outcome in patients after atrial fibrillation catheter ablation: a prospective study

Eplerenone Prevents Atrial Fibrosis via the TGF-β Signaling Pathway

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