Pulmonary veins branching pattern, assessed by magnetic resonance, does not affect transcatheter atrial fibrillation ablation outcome

Anselmino, Matteo; Scaglione, Mariano; Blandino, Alessandro; Beninati, Serena; Caponi, Domenico; Boffano, Carlo; Montefusco, Antonio; Cesarani, Federico; Gaïta, Fiorenzo

doi:10.1080/ac.65.6.2059864

Cited by 20 publications

(22 citation statements)

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“…In fact, if abnormal PV anatomy is known to little influence the ablation outcome in case of the point-by-point approach [17,18], more conflicting data have been reported with other "one-shot" technologies.…”

Section: Discussionmentioning

confidence: 96%

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Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Stabile

Anselmino

Soldati

et al. 2016

J Interv Card Electrophysiol

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Results. Mean LA volume was 75±40 ml. A normal anatomy (4 PVs) was documented in 40 (53%) patients, an abnormal anatomy (common truncus or accessory PVs) in 35 patients. Mean procedural and fluoroscopy times were 94 ± 55 minutes and 8 ± 5 minutes, respectively, without significant differences among patients with normal or abnormal anatomy (92±45 min vs 95±64 min, p=0.85 and 6±3 min vs 8±4 min, p=0.65, respectively).Mean ablation time was 14 3 min, 99% of the targeted veins were isolated with a mean of 23±5 RF pulses per patient. After a mean follow-up of 17±8 months, 23(31%) patients had an atrial arrhythmia recurrence. Neither LA volume nor PV anatomy were predictors of outcome.Conclusions. LA volume and PV anatomy did not effect procedural data and outcome in patients who underwent PV isolation by an open-irrigated mapping and RF decapolar ablation catheter.3

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Section: Discussionmentioning

confidence: 96%

“…Larger series, enrolling thousands of patients, are required to assess if our strategy, to reduce the power to [15][16][17][18][19][20] W in case of electrodes in contact with the posterior wall, is effective in preventing atrioesophageal fistula.…”

Section: Limitationsmentioning

confidence: 99%

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Stabile

Anselmino

Soldati

et al. 2016

J Interv Card Electrophysiol

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“…1). One study was excluded because it included patients with hypertrophic cardiomyopathy [35], one because it appraised robotic navigation [34], 4 for duplicate reporting [36], [37], [38] and [39], and one because it included only female patients [40]. The research ended on the 4th of October, 2011.…”

Section: Resultsmentioning

confidence: 99%

Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis

D’Ascenzo

Corleto

Biondi‐Zoccai

et al. 2013

International Journal of Cardiology

179

123

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Context Transcatheter ablation of atrial fibrillation (AF) has undergone important development, with acceptable midterm results in terms of the safety and recurrence. A meta-analysis was performed to identify the periprocedural complications, midterm success rates and predictors of recurrence after AF ablation.Methods and results 4357 patients with paroxysmal AF, 1083 with persistent AF and 1777 with long standing AF were included. The pooled analysis showed that there was an in-hospital complication rate of tamponade requiring drainage of 0.99% (0.44-1.54; CI 99%), stroke with neurological persistent impairment of 0.22% (0.04-0.47; CI 99%), and stroke without of 0.36% (0.03-0.70; CI 99%) After a follow up of 22 (13-28) months and 1.23 (1.19-1.5; CI 99%) procedures per patient, the AF recurrence rate was 31. 20% (24.87-34.81; CI 99%). The persistent AF patients exhibited a greater risk of recurrence after the first ablation (OR 1.78 [1.14, 2.77] CI 99%), but a trend towards non significance was present in the patients with more than one procedure (OR 1.69 [0.95,3.00] CI 99%). The most powerful predictors of an AF ablation failure in the overall population were a recurrence within 30-days (OR 4.30; 2.00-10.80), valvular AF (OR 5.20; 2.22-9.50) and a left atrium diameter of more than 50 mm (OR 5.10 2.00-12.90; all CI 95%).Conclusions Persistent AF remains burdened from higher recurrence rates, however not so following redo-procedures. Three predictors, valvular AF, a left atrium diameter longer than 50 mm and recurrence within 30 days, could be appraised to drive selection of patients and therapeutic strategy. Many observational studies have reported predictors identified by multivariate analyses including the time spent in persistent AF, structural heart disease, left ventricular impairment, and, perhaps most consistently, the left atrial diameter [7]; in the case in which they were confirmed in larger datasets these clinical features could be very useful for cardiologists and general clinicians both for a correct selection of patients deferred to an invasive strategy and to accurately manage the following procedure. However, to the best of our knowledge, no meta-analyses have been performed to appraise the results of real life observational studies of AF ablation, and their complication rates and the most powerful predictors of recurrence. 2.MethodsThe present research was elaborated according to current guidelines, including the recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) amendment to the Search strategy and study selectionMedline, the Cochrane Library and Biomed Central were searched for related articles, according to the established methods [12], with terms related to catheter ablation of AF and predictors of recurrence obtained through multivariate analyses. All corresponding authors of the studies were directly emailed for further data and suggestions for additional research [13]. All citations at the abstract level were first appraised by independent revie...

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“…It is known that AF ablation achieves better results in patients with normal or mildly enlarged left atrium [16], however it is not contraindicated also in patients with severely enlarged atrial volumes and decreased atrial contractility. The present clinical perspective points out how the ECG-guided approach, on which AF ablation success/failure is traditionally based, may be unreliable, suggesting that the assessment of the atrial anatomy and mechanical function by transthoracic echocardiography may add significant data for the decision process of continuing/discontinuing OAC after "successful" AF ablation.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulant cessation following atrial fibrillation ablation: limits of the ECG-guided approach

Anselmino

Rovera

Marchetto

et al. 2017

Expert Review of Cardiovascular Therapy

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Introduction: Long-term cessation of oral anticoagulation (OAC) following successful catheter or surgical ablation of atrial fibrillation (AF) is debated. Usually, in the presence of sinus rhythm at serial ECG recordings, the CHADS2, CHA2DS2VASc, and HAS-BLED scores are adopted to guide decision regarding OAC management.Areas covered: The safety of OAC cessation in patients without recurrent AF but with historically elevated risk for thromboembolism remains largely unknown. Taking the cue from two clinical cases, we provide an updated summary of the latest evidence regarding how to manage OAC after a successful atrial fibrillation ablation.Expert commentary: The present clinical perspective suggests that, at least within patients with severely enlarged left atrium, previous cardiac surgery and catheter or surgical AF ablation, especially if repeated, assessment of atrial contractility by transthoracic echocardiography should be performed before discontinuing OAC in patients who maintain sinus rhythm, confirmed by serial ECG or Holter monitorings.

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Pulmonary veins branching pattern, assessed by magnetic resonance, does not affect transcatheter atrial fibrillation ablation outcome

Abstract: Less than half of the patients referred for transcatheter AF ablation present a typical PV branching pattern; the PV branching pattern, however, does not affect ablation outcome. LA volume strongly predicts AF ablation outcome.

Cited by 20 publications

References 0 publications

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Effect of left atrial volume and pulmonary vein anatomy on outcome of nMARQ™ catheter ablation of paroxysmal atrial fibrillation

Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis

Anticoagulant cessation following atrial fibrillation ablation: limits of the ECG-guided approach

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