The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up

Inada, Keiichi; Yamane, Teiichi; Tokutake, Kenichi; Yokoyama, Kenichi; Mishima, Tsuyoshi; Hioki, Mika; Narui, Ryohsuke; Ito, Keiichi; Tanigawa, Shin‐ichi; Yamashita, Seigo; Tokuda, Michifumi; Matsuo, Seiichiro; Shibayama, Kentaro; Miyanaga, Satoru; Date, Taro; Sugimoto, Kunihisa; Yoshimura, Michihiro

doi:10.1093/europace/eut159

Cited by 67 publications

(60 citation statements)

References 16 publications

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“…31,32 Our ablation approach targeting non-PV triggers along with PVAI appeared to yield higher long-term success rate, which is in agreement with findings from earlier studies. [8][9][10]15,16 Study result of Sorgente et al 7 was more disappointing with a 6-year multiprocedure success rate of 50% in PAF patients which could be because of stricter definition of recurrence as well as their ostial ablation approach.…”

Section: Discussionmentioning

confidence: 99%

“…3 Several published reports have provided information on the outcomes of AF ablation. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] A meta-analysis evaluating studies reporting >3 years of outcome after catheter ablation (CA) found that nearly 80% multiprocedure success rates can be achieved in patients with PAF. 21 Few series have reported long-term outcomes of AF ablation over 5 years.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

“…21 Few series have reported long-term outcomes of AF ablation over 5 years. 4,[6][7][8][9][10][12][13][14][15][16] However, data on long-term follow-up of PVAI are limited, which would provide valuable information regarding the efficacy and safety of CA and necessity of repeat procedures. Therefore, we sought to assess the outcome of PVAI in patients with PAF over a follow-up period of more than a decade.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

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Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

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Section: Discussionmentioning

confidence: 99%

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

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Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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“…76,84,85 In nonrandomized studies, a strategy of primary ablation for paroxysmal AF was superior to pacing and antiarrhythmic drug use. 84,86 Moreover, the majority of patients who underwent AF ablation no longer had an indication for pacing. However, continued surveillance is necessary in the postablation phase; early recurrences of atrial arrhythmias following an ablation may reproduce symptomatic sinus pauses.…”

Section: Pacing For the Treatment Of Sndmentioning

confidence: 99%

Sinus Node and Atrial Arrhythmias

2016

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Sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact to initiate and perpetuate each other. Atrial arrhythmias are present in 40% to 70% of patients at the time of diagnosis of SND.1,2 However, the complex relationship between the 2 remains ill defined. The documented degenerative changes in atrial myocardial structure relating to SND are primarily right atrial. Yet, the majority of triggers and substrates for atrial fibrillation (AF) originate from the left atrium. Although progressive biatrial fibrosis is a feature in patients with structural heart disease and in senescence, paroxysmal AF that occurs in patients with no structural heart disease may have a different pathophysiology. SND associated with this latter condition is likely to be primarily a result of electric remodeling and potentially reversible. The time course of the progression of SND and AF 3 and their individual clinical manifestations also vary depending on the underlying pathology. The purpose of this review is to summarize the state of our knowledge of sinus node (SN) function in both health and disease, and to understand the complex relationship between SN disease and atrial arrhythmias. Structure and Functional Components of the Sinus NodeIn the adult human heart, the SN is a crescent-shaped structure 1 to 2 cm long and 0.5 cm wide that lies at the junction of the superior vena cava with the right atrium and lies along the sulcus terminalis. The node itself is composed of clusters of pacemaker myocytes arranged in parallel rows with short digitations that frequently anastomose with the surrounding atrial tissue. The specialized pacemaker cells are interspersed with nerves and capillaries and scaffolded by dense connective tissue to form the SN pacemaker complex. The caudal portion fragments to merge with the atrial myocardium. The lack of a distinct encapsulation and the radiating sinoatrial connections explains the lack of a single breakthrough of the sinus impulse. The position of the leading pacemaker site shifts within the node and varies with sympathetic and vagal stimulation. 3The SN pacemaker cells are interspersed with interstitial collagen that varies in extent as a function of older age. 4 Collagen content increases from 24% in the infant to 70% in the adult heart.5 The fibrous matrix with surrounding fatty insulation of the SN together with distinct electrophysiological properties (see below) provides insulation and prevents the depression of pacemaker automaticity from the hyperpolarizing electric load of the surrounding atrial myocardium. 6 Multiple currents are involved in the activation of the SN. The predominant inward current in the center of the node is I CaL . Action potentials with slow upstrokes initiated in the center spreads peripherally and into the musculature of the terminal crest. However, in the periphery of the node, I Na is operative and is necessary for providing sufficient inward current to depolarize the larger mass of atrial tissue. Delayed rectifier potassium currents facili...

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“…6, 7 Previous studies of AF ablation in patients with SSS have demonstrated the feasibility of CA and that both paroxysmal AF (PAF) and prolonged sinus pauses could be successfully eliminated in the majority of patients with bradycardia-tachycardia syndrome (BTS) over mid-to long-term follow up. [8][9][10][11] Previous studies, however, included a relatively small number of patients, with several confounders such as high age and previous PMI, and also did not consider structural remodeling in patients with SSS. Therefore, the clinical efficacy of CA for PAF in SSS patients and the mechanism and predictors of AF recurrence in this population remain unknown.…”

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confidence: 99%

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

Hayashi

Fukunaga

Yamaji

et al. 2016

Circ J

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The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up

Abstract: Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time.

Cited by 67 publications

References 16 publications

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Sinus Node and Atrial Arrhythmias

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –

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The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up

Abstract: Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time.

Cited by 67 publications

References 16 publications

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Sinus Node and Atrial Arrhythmias

Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome – Important Role of Non-Pulmonary Vein Foci –

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Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –