Potential risk factors of atrial fibrillation recurrence after cryoballoon ablation

Abstract

Aim To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12 months. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month “blind” period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6 %) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7 % vs. 11.6 %; р<0.001). Such patients had a history of multiple ineffective treatments with antiarrhythmic drugs (AAD), common pulmonary venous (PV) collector (41.3 % vs. 20.0 %; р=0.008), and stroke/recurrent ischemic attacks (15.2 % vs. 5.2 %; р=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95 % confidence interval (CI) 1.29–4.25; р=0.005), multiple ineffective AADs (RR 1.42; 95 % CI 1.08–1.86; р=0.011), and early AF recurrence (RR 7.57; 95 % CI 3.84–14.90; р<0.001).Conclusion Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.

T-Cell Receptor Sequences Identify Combined Coxsackievirus–Streptococci Infections as Triggers for Autoimmune Myocarditis and Coxsackievirus–Clostridia Infections for Type 1 Diabetes

“…As with T1DM, the association of coxsackieviruses and AM is very strong and is not reviewed here (e.g., [48,49]). More relevant to the identification of both coxsackieviruses and Streptococci by AM TCRs is the evidence of unusually frequent and high antibody titers against both microbes in 65 and 90 percent of AM patients [75][76][77][78][79][80]. Thus, antibodies against both coxsackieviruses and Streptococci and the expansion of T cells mimicking both microbes are present in the majority of AM patients who have been tested for both.…”

“…One likely combination is CV with GAS [73]. Epidemiological studies demonstrate that 65-95 percent of RHD and AM cases presented with concurrent GAS and CV infections, while uncomplicated CV or GAS infections were almost never associated with the development of RHD or AM [74][75][76][77][78][79][80][81]. In addition, some cases of AM are associated with multiple viral infections.…”