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

Fiala, Martin; Bůlková, Veronika; Škňouřil, Libor; Nevřalová, Renáta; Toman, Ondřej; Januška, Jaroslav; Špinar, Jindřich; Wichterle, Dan

doi:10.1016/j.hrthm.2015.01.004

Cited by 20 publications

(30 citation statements)

References 27 publications

(50 reference statements)

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“…CA of persistent AF is considered to be difficult, and many techniques have been introduced during the past 10 years, yielding various but mostly disappointing results, especially when used by operators other than the proponents of the technique. [2][3][4][5][6][7] Fiala et al, 20 using an extensive ablation approach (procedural time, 321±54 minutes with some ablations reaching 430 minutes) demonstrated longterm efficacy only between 20% to 30% after a single CA procedure. Additionally, reports from other renowned European centers have found similarly low (≈20%) success rates after a single CA procedure.…”

Section: Long-term Efficacy and Predictors Of Recurrencementioning

confidence: 99%

“…Our conclusion is in agreement with other published data derived from catheter-based procedures dealing with structurally remodeled atria. 20,23,29,30 However, in contrast to CA techniques, the staged hybrid approach allows testing of arrhythmia inducibility during the first CA procedure and allows to meaningfully target all clinically relevant atrial arrhythmias, something which is considered largely unrealistic because of time constraints and technical demands associated with a catheter-only approach. As a result, >90% of patients had been rendered noninducible by the end of our hybrid procedure.…”

Section: Long-term Efficacy and Predictors Of Recurrencementioning

confidence: 99%

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Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

Bulava

Mokráček

Haniš

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background-Long-term efficacy of catheter-based treatment of persistent atrial fibrillation is unsatisfactory. Minimally invasive surgical ablation techniques have been developed recently, but their efficacy has never been systematically tested. Methods and Results-Seventy patients (median age, 63.5 years) with persistent atrial fibrillation underwent epicardial thoracoscopic radiofrequency pulmonary vein isolation, linear ablation, Marshal ligament disruption, and exclusion of the left atrial appendage. The procedure was followed by electroanatomic mapping and ablation (EAM) 2 to 3 months later. Only 76% of patients were in normal sinus rhythm at the beginning of EAM. All 4 pulmonary veins and the left atrium posterior wall were found isolated in 69% and 23% of patients, respectively. Arrhythmia-free survival off antiarrhythmic drugs 12 months after EAM was 77%. Using previously ineffective antiarrhythmic drugs and reablation procedures, arrhythmia free-survival increased to 97% during follow-up (mean, 936±432 days; range, 346-1509 days). The majority of arrhythmia recurrences occurred during the first 12 months after EAM. In a multivariable-adjusted estimates, left atrium volume >165 mL, absent normal sinus rhythm at admission for EAM, and inducibility of any sustained tachyarrhythmia at the end of EAM procedure were identified as independent correlates of atrial fibrillation recurrence. Conclusions-Our report demonstrated that the majority of patients after epicardial ablation, using bipolar radiofrequency instruments, required endocardial catheter ablation to complete the linear ablation lesions and a significant proportion of patients required spot-ablations to complete electric pulmonary vein isolation. Noninducibility of any arrhythmia after a staged hybrid procedure seemed to be the strongest correlate of long-term arrhythmia-free survival.

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Section: Long-term Efficacy and Predictors Of Recurrencementioning

confidence: 99%

Section: Long-term Efficacy and Predictors Of Recurrencementioning

confidence: 99%

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

Bulava

Mokráček

Haniš

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…Termination of AF by ablation is associated with good clinical outcome . In 28–45% of patients, however, ATs occur after the stepwise ablation strategy and repeat ablations are required . Furthermore, in other ablation strategies, occurrence of ATs is one of the major mechanisms of tachyarrhythmia recurrence after AF ablation .…”

Section: Discussionmentioning

confidence: 99%

“…Stepwise ablation strategy is recognized as an aggressive strategy, and recurrence of AF is unusual following this strategy if AF was terminated by ablation. However, 28–45% of patients do have recurrence of AT during follow‐up . As a result, nearly half of them require repeat ablation for maintenance of sinus rhythm.…”

Section: Introductionmentioning

confidence: 99%

Occurrence of Focal Atrial Tachycardia During the Ablation Procedure Is Associated With Arrhythmia Recurrence After Termination of Persistent Atrial Fibrillation

Iwai

Takahashi

Masumura

et al. 2017

Cardiovasc electrophysiol

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“…This is a key question that needs to be addressed in order to assess how hypertension may affect the genesis of AF. Differences in left atrial size and the presence of a left atrial scar are also important confounders that are known to have an effect on ablation outcome (22,23). Important measurable and unmeasurable confounders not accounted for in this study include the duration of AF, presence of sleep apnea (23,24),…”

mentioning

confidence: 99%

Triggers, Substrate, and Hypertension in Atrial Fibrillation

Parkash

2015

JACC: Clinical Electrophysiology

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A trial fibrillation (AF) is the most common sustained arrhythmia and is associated with significant morbidity, mortality, and cost (1,2).AF results from the occurrence of 3 mechanisms (3,4): 1) single-circuit re-entry; 2) multiple circuit reentry; or 3) rapid focal ectopic activity. Maintenance of AF requires that an appropriate substrate exist on which a trigger can initiate re-entry. The substrate for AF consists of 2 components: 1) altered electrophysiological properties; and 2) altered structural properties of the atrium. Uncontrolled hypertension can result in several changes to the left atrial substrate including effects on ion channel function and increased atrial fibrosis (Figure 1) (5-7).Despite advancements in ablation technologies over the past decade, including contact force technology and the second-generation cryoballoon, the recurrence rate of AF after catheter ablation remains high (8-10). These observations have led those of us who treat AF to examine other contributors to AF, with the realization that ablation alone may be insufficient to result in optimal arrhythmia control in patients. Hypertension is an obvious target given that is the most prevalent and potentially modifiable risk factor for AF (11,12). Multiple animal and clinical human studies have found a direct relationship between the risk of AF and systolic and diastolic blood pressure (13)(14)(15)(16)(17)(18)(19)(20). In this issue of JACC: Clinical Electrophysiology, Santoro et al. (21) report results of a carefully conducted prospective cohort study of 531 consecutive patients who underwent ablation for AF grouped by uncontrolled hypertension (n ¼ 160), controlled hypertension (n ¼ 192), or no hypertension (n ¼ 179). All patients underwent pulmonary vein (PV) antral isolation with additional ablation performed for non-PV triggers, as determined by operator discretion. The main findings of this study were that uncontrolled hypertension, as measured before the procedure, was associated with a significantly increased risk of recurrence (40.6%) at a follow-up of 19 AE 7.7 months after a single ablation procedure compared with those patients who had controlled hypertension (28.1%) or no hypertension (25.7%). The presence of non-PV triggers was greater (58.8% vs. 33.3%) in the group with uncontrolled hypertension.Ablation of non-PV triggers was associated with a significant reduction in AF recurrence compared with those whose non-PV triggers were left alone (69.8% vs. 37.3%).This study is certainly compelling in advancing the notion that blood pressure control is indeed exquisitely linked to recurrence of AF after catheter ablation. There are, however, important caveats to this study that prevent this trial from being definitive.The lack of randomization is an obvious limitation of the study, recognized by the authors. Most importantly, this study did not address the effect of aggressive blood pressure control and its interaction with outcomes of catheter ablation. This is a key question that needs to be addressed in order to assess how ...

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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

Cited by 20 publications

References 27 publications

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation

Occurrence of Focal Atrial Tachycardia During the Ablation Procedure Is Associated With Arrhythmia Recurrence After Termination of Persistent Atrial Fibrillation

Triggers, Substrate, and Hypertension in Atrial Fibrillation

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