Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

Kumagai, Koji; Sakamoto, Tamotsu; Nakamura, Keijiro; Hayano, Mamoru; Yamashita, Eiji

doi:10.1253/circj.cj-12-0934

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…8 In the second study using PV isolation and complex fractionated electrogram ablation, the low SR restoration rate (14%) offered limited statistical power to detect the association with outcome. 9 Our observation is in accordance with the results of studies in patients having all forms of persistent AF 2,4,6,18,[12][13][14][15][16][17][18][19][20][21][22] and confirms that the predictive value of restored SR at initial ablation extends beyond repeat procedures. 4,5,22 In patients with persistent AF, prior investigations of preprocedural factors identified smaller LA size, 2,22 shorter continuous AF duration, 1,2,4,8,21 younger age, 5,23 male gender, 4 absence of congestive heart failure, 4 absence of hypertension, 5 higher LAA outflow velocity, 15 LA systolic strain, and LAA wall velocity 22 as the predictors of arrhythmia-free outcome after the initial or repeat procedure(s).…”

Section: Prediction Of Af/at Recurrencessupporting

confidence: 88%

“…In prior studies of mixed persistent AF populations or small series of selected patients with LSPAF, this end-point was predicted by shorter duration of continuous AF, 1 smaller LA size, 5 better LAA mechanical function, 16,17 or preserved LV ejection fraction. 18 We confirmed lower SR restoration rate in patients with shorter LAA AFCL, which had been earlier explained by an inverse relationship between AFCL and the number of distinct AF sources.…”

Section: Prediction Of Sr Restoration At Initial Proceduresmentioning

confidence: 95%

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Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

et al. 2015

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Section: Prediction Of Af/at Recurrencessupporting

confidence: 88%

Section: Prediction Of Sr Restoration At Initial Proceduresmentioning

confidence: 95%

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

et al. 2015

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“…When ablating the posterior wall in front of the esophagus, a maximum power of 20–25 W was used to avoid esophageal damage from the high energy supplied, and when the temperature exceeded 39 °C, the energy supply was discontinued. Each application of radiofrequency energy was delivered for about 30–90 s while dragging, with the goal of a ≥70% decrease in the electrogram amplitude at the local site [14]. The completion of the PVAI procedure was defined as the achievement of bidirectional conduction block between the LA and PVs under the administration of isoproterenol and adenosine.…”

Section: Methodsmentioning

confidence: 99%

Clinical benefits of deep sedation with a supraglottic airway while monitoring the bispectral index during catheter ablation of atrial fibrillation

Hida

Takemoto

Masumoto

et al. 2017

Journal of Arrhythmia

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BackgroundPulmonary vein antrum isolation (PVAI) under sedation has proven to be a useful strategy for catheter ablation of atrial fibrillation (AF).MethodsTo evaluate the clinical benefits of respiratory management using supraglottic airways (SGAs) under deep sedation while monitoring the bispectral (BIS) index during the PVAI and the durations from admission to the catheterization room to starting the radiofrequency energy delivery (Time α), and from starting the radiofrequency energy delivery to completion of the PVAI (Time β), X-ray time, frequency of dislocations of the three-dimensional maps (D3DM), procedure-related complications, and proportion of an AF-free rate 15 months after the PVAI (PAFFR) in patients who received deep sedation without SGAs (Group A: n=48) and those with SGAs (Group B: n=51) were evaluated.ResultsThere were no significant differences in patient characteristics, Time α (77±3 versus 78±2 min; p=0.816), complications of cardiac tamponade (2% versus 2%; p=0.966), or PAFFR (81% versus 88%; p=0.313) between the two groups. However, the Time β (84±4 versus 67±3; p=0.001), X-ray time (53±2 versus 34±2; p<0.001), and minor complications of nasal bleeding (25% versus 0%; p=0.001) were significantly shorter and lower in Group B than in Group A, in accordance with a reduction in the hypoxia (15% versus 0%; p=0.007) and D3DM (31% versus 8%; p=0.003).ConclusionsThese results may demonstrate the clinical benefits of deep sedation with SGAs while monitoring the BIS index without any hypoxia during PVAI in patients with AF.

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“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In these studies, both increased single procedural success 3,5,8,10,[13][14][15][16]19,21 and overall clinical success with multiple procedures 2,6,7,[11][12][13][15][16][17]20,21 were reported when compared with patients who did not achieve AF termination. In a study by Rostock et al, 22 which evaluated the long-term predictors of single-and multiple-procedure outcomes for 395 patients who had undergone persistent AF ablation, AF termination during the index procedure significantly predicted single-procedure success and also a favorable outcome after the final procedure.…”

Section: Circ Arrhythm Electrophysiolmentioning

confidence: 99%

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

Lim

Derval

Komatsu³

et al. 2015

Circ: Arrhythmia and Electrophysiology

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A lthough effective results are attained with paroxysmal atrial fibrillation (AF) ablation based on pulmonary vein isolation (PVI), catheter ablation of persistent AF remains a challenging task. Current ablation approaches in persistent AF ablation are markedly diverse, and there is a considerable variation in the reported clinical outcomes.1 Moreover, the lack of a distinct procedural end point makes comparison between the studies difficult. Response by Latchamsetty and Oral on p 971Recently, significant advances have been made with the development of novel technologies, such as computational mapping and panoramic noninvasive mapping to map drivers (rotors and focal discharges) during AF. The advent of these newer technologies and strategies for persistent AF ablation further raise the question as to whether AF termination should be the procedural end point, and whether it confers additional long-term clinical benefit.In this article, we review the current evidence on AF termination and long-term clinical outcome, procedural AF termination as a predictor of freedom from recurrent atrial arrhythmias, AF termination rates with various ablation strategies, and potential underlying mechanisms conferring clinical benefit and future directions. AF Termination and Clinical Outcome Search StrategyThe English scientific literature in the PubMed database was searched using the terms catheter ablation, persistent AF, and termination in any region of the PubMed record until October 2014. Studies that described procedural AF termination rates during ablation together with clinical outcomes after ablation for patients with persistent AF or long-standing persistent AF were included. References from the relevant articles were reviewed to identify further related articles. Definition of AF termination included direct conversion to sinus rhythm (SR) and organization to atrial tachycardia (AT) during ablation.

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Pre-Procedural Prediction of Termination of Persistent Atrial Fibrillation by Catheter Ablation as an Indicator of Reverse Remodeling of the Left Atrium

Cited by 14 publications

References 21 publications

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

Sinus rhythm restoration and arrhythmia noninducibility are major predictors of arrhythmia-free outcome after ablation for long-standing persistent atrial fibrillation: A prospective study

Clinical benefits of deep sedation with a supraglottic airway while monitoring the bispectral index during catheter ablation of atrial fibrillation

Is Ablation to Termination the Best Strategy for Ablation of Persistent Atrial Fibrillation?

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