The Blinding Period Following Ablation Therapy for Atrial Fibrillation

Gottlieb, Lisa A.; Dekker, Lukas; Coronel, Ruben

doi:10.1016/j.jacep.2021.01.011

Cited by 38 publications

(45 citation statements)

References 184 publications

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“…Since persistent AF (HR 3.27; 95 % CI 1.32-8.08; p = 0.010) and duration of AF history (HR 1.047; 95 % CI 1.008-1.086, p = 0.015) were independent predictors for ERAA occurrence too, we may suggest the same underlying mechanism of early and late AF relapse. This is an important finding as many researchers consider that ERAA occurrence indicates a continuation of the preexisting initial AF mechanisms [16]. However, the short-therm prescription of AADs in the post-ablation 1-3 months might mask the ERAA occurrence and its' association with the late recurrence.…”

Section: Discussionmentioning

confidence: 87%

The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring

Davtyan

Topchyan

Brutyan

et al. 2021

BMC Cardiovasc Disord

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Background Early recurrences of atrial arrhythmias (ERAA) after atrial fibrillation (AF) catheter ablation do not predict procedural failure. A well-demarcated homogeneous lesion delivered by cryoballoon is less arrhythmogenic, and the recommended three-months blanking period may not refer to cryoballoon ablation (CBA). Objective We aimed to evaluate the predictive role of ERAA after second-generation CBA using an implantable loop recorder. Methods This prospective observational study enrolled 100 patients (58 males, median age 58) with paroxysmal/persistent AF undergoing pulmonary vein (PV) CBA using second-generation cryoballoon with simultaneous ECG loop recorder implantation. The duration of follow-up was 12 months, with scheduled visits at 3, 6 and 12 months. Results 99 patients from 100 completed the 12-month follow-up period. ERAA occurred in 31.3 % of patients. 83.9 % of patients with ERAA also developed late recurrences. The 12-month freedom from AF in patients with ERAA was significantly lower than in those without ERAA (p < 0.0001). Non-paroxysmal AF and longer arrhythmia history were associated with increased risk of both early (HR 3.27; 95 % CI 1.32–8.08; p = 0.010 and HR 1.0147; 95 % CI 1.008–1.086; p = 0.015, respectively) and late recurrences (HR 3.89; 95 % CI 1.67–9.04; p = 0.002 and HR 1.0142; 95 % CI 1.007–1.078; p = 0.019, respectively) of AF. ERAA were another predictor for procedural failure (HR 15.2; 95 % CI (6.42–35.99; p = 0.019). Conclusions ERAA occurred in the third of the patients after PV second-generation CBA and are strongly associated with procedural failure. Longer duration of AF history and persistent AF are independent predictors of AF’s early and late recurrence.

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Section: Discussionmentioning

confidence: 87%

The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring

Davtyan

Topchyan

Brutyan

et al. 2021

BMC Cardiovasc Disord

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“…Although several factors were established as AF recurrence predictors, oxidative stress has been known as one of the most seminal pathogenesis. 10 , 12 , 13 Excessive production of reactive oxygen species is involved in the structural and electrical remodeling of the atrium, leading to pro‐arrhythmogenicity. 14 Among the key factors of oxidative stress production including mitochondria, NAD(P)H oxidase, xanthine oxidase, uncoupled nitric oxide synthase, and cytochrome C oxidase, xanthine oxidase activity contributes to producing U‐IXP.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] Oxidative stress, which evokes cardiovascular inflammation, has recently been clarified to have a deep association with AF recurrence. 10 However, given its complexity to quantify the degree of oxidative stress, their detailed association remains uncertain. Recently, urinary isoxanthopterin (U-IXP), which is converted from pterin mainly by xanthine oxidase, was proposed as a novel biomarker to predict clinical outcomes in the heart failure cohort.…”

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confidence: 99%

Urinary isoxanthopterin as a novel predictor following catheter ablation for atrial fibrillation

Koi

Kataoka

Uchida

et al. 2023

Journal of Arrhythmia

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Pulmonary vein isolation for atrial fibrillation (AF) has become widely accepted as a therapeutic strategy irrespective of the AF duration. However, the success rates of the first procedure are limited to around 50%-70% in paroxysmal and 40%-50% in persistent AF. 1 Of note, asymptomatic recurrence rate is approximately 50% following catheter ablation. 2,3 Patients with asymptomatic recurrence are at risk of cardiovascular events due to its delayed recognition and physicians' intervention. 4 Implantable loop recorders are recommended to monitor the recurrence of AF following catheter ablation. 5 However, given its invasiveness and high cost, it cannot be recommended for all Japanese candidates for catheter ablation. 6 Thus, methodologies to identify high-risk cohorts have been desired.Several biomarkers, including myocardial injury biomarkers, natriuretic peptides, and serum uric acid, as well as left atrial size, are

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“…The pulmonary vein myocardium is often the origin of arrhythmia in AF patients [27]. Both structural and electrical remodeling are thought to play an important role in the development of AF [28,29]. In addition, several transcription factors determining pulmonary vein fate during development have been implicated in susceptibility to AF, and some reports suggest the presence of nodal-like cells in the myocardial sleeve of the pulmonary veins [30,31].…”

Section: Pulmonary Vein Myocardium and Arrhythmiasmentioning

confidence: 99%

How Cardiac Embryology Translates into Clinical Arrhythmias

Rivaud

Blok

Jongbloed

et al. 2021

JCDD

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The electrophysiological signatures of the myocardium in cardiac structures, such as the atrioventricular node, pulmonary veins or the right ventricular outflow tract, are established during development by the spatial and temporal expression of transcription factors that guide expression of specific ion channels. Genome-wide association studies have shown that small variations in genetic regions are key to the expression of these transcription factors and thereby modulate the electrical function of the heart. Moreover, mutations in these factors are found in arrhythmogenic pathologies such as congenital atrioventricular block, as well as in specific forms of atrial fibrillation and ventricular tachycardia. In this review, we discuss the developmental origin of distinct electrophysiological structures in the heart and their involvement in cardiac arrhythmias.

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The Blinding Period Following Ablation Therapy for Atrial Fibrillation

Cited by 38 publications

References 184 publications

The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring

The predictive role of early recurrences of atrial arrhythmias after pulmonary vein cryoballoon ablation. Is blanking period an outdated concept? Insights from 12-month continuous cardiac monitoring

Urinary isoxanthopterin as a novel predictor following catheter ablation for atrial fibrillation

How Cardiac Embryology Translates into Clinical Arrhythmias

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