Very long term outcomes of atrial fibrillation ablation

Winkle, Roger A.; Mead, R. Hardwin; Engel, Gregory; Salcedo, Jonathan; Brodt, Chad; Barberini, Patricia; Lebsack, Cynthia; Kong, Melissa H.; Kalantarian, Shadi; Patrawala, Rob A.

doi:10.1016/j.hrthm.2023.02.002

Cited by 22 publications

(21 citation statements)

References 11 publications

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“…The higher neurological event rate associated with deferring ablation in our study and deferring rhythm control in EAST‐AFNET 4, suggests that all AF patients should consider earlier ablation. After ablation we have reported a long‐term CVA/TIA rate of only 0.22%/year 9 …”

Section: Discussionmentioning

confidence: 88%

“…After ablation we have reported a long-term CVA/TIA rate of only 0.22%/year. 9 Increasing evidence supports the use of rhythm control strategies including ablation in the early stages of AF to minimize irreversible structural remodeling and physicians are more aggressively offering rhythm control to patients with new onset and recently diagnosed AF to address symptoms and reduce their risk of adverse cardiovascular outcomes. 10 Some older studies suggest a poorer ablation outcome with delay in ablation 11 and one study of only persistent AF showed an advantage for early ablation only in the earliest quartile of ablation delays with little further loss of ablation efficacy with longer ablation delays.…”

Section: Discussionmentioning

confidence: 99%

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Early ablation of newly diagnosed paroxysmal atrial fibrillation (NEWPaAF) versus newly diagnosed persistent atrial fibrillation (NEWPeAF): Comparison of patient populations and ablation outcomes

Winkle,

Hardwin Mead,

Engel

et al. 2024

Cardiovasc electrophysiol

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IntroductionLittle is known about very early atrial fibrillation (AF) ablation after first AF detection.MethodsWe evaluated patients with AF ablation <4 months from newly diagnosed paroxysmal AF (NEWPaAF) and newly diagnosed persistent AF (NEWPeAF). We compared the two patient populations and compared ablation outcomes to those undergoing later ablation.ResultsAblation was done <4 months from AF diagnosis in 353 patients (135 = paroxysmal, 218 = persistent). Early ablation outcome was best for NEWPaAF versus NEWPeAF for initial (p = 0.030) but not final (p = 0.102) ablation. Despite recent AF diagnosis in both groups, they were clinically quite different. NEWPaAF patients were younger (64.3 ± 13.0 vs. 67.3 ± 10.9, p = 0.0020), failed fewer drugs (0.39 vs. 0.60, p = 0.007), had smaller LA size (4.12 ± 0.58 vs. 4.48 ± 0.59 cm, p < 0.0001), lower BMI (28.8 ± 5.0 vs. 30.3 ± 6.0, p = 0.016), and less CAD (3.7% vs. 11.5%, p = 0.007), cardiomyopathies (2.2% vs. 22.9%, p = 0.0001), hypertension (46.7% vs. 67.4%, p < 0.0001), diabetes (8.1% vs. 17.4%, p = 0.011) and sleep apnea (20.0% vs. 30.3%, p = 0.031). For NEWPaAF, early ablation AF‐free outcome was no better than later ablation (p = 0.314). For NEWPeAF, AF‐free outcomes were better for early ablation than later ablation (p < 0.0001). Delaying ablation allowed more strokes/TIAs in both AF types (paroxysmal p = 0.014, persistent p < 0.0001).ConclusionsPatients presenting for early ablation after newly diagnosed persistent AF have more pre‐existing comorbidities and worse initial ablation outcomes than patients with NEWPaAF. For NEWPaAF, there was no advantage to early ablation, as long as the AF remained paroxysmal. For NEWPeAF, early ablation gave better outcomes than later ablation and they should undergo early ablation. For both AF types, waiting was associated with more neurologic events, suggesting all patients should consider earlier ablation.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Early ablation of newly diagnosed paroxysmal atrial fibrillation (NEWPaAF) versus newly diagnosed persistent atrial fibrillation (NEWPeAF): Comparison of patient populations and ablation outcomes

Winkle,

Hardwin Mead,

Engel

et al. 2024

Cardiovasc electrophysiol

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“…The use of contact-force catheters was associated with improved outcomes and a 5-years freedom from AF recurrence after first procedure of 52.0% and 37.0% in patients with persistent and long-standing persistent AF, respectively. 31 …”

Section: Discussionmentioning

confidence: 99%

Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience

et al. 2023

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Aims Hybrid atrial fibrillation (AF) ablation is a promising approach in non-paroxysmal AF. The aim of this study is to assess the long-term outcomes of hybrid ablation in a large cohort of patients after both an initial and as a redo procedure. Methods and results All consecutive patients undergoing hybrid AF ablation at UZ Brussel from 2010 to 2020 were retrospectively evaluated. Hybrid AF ablation was performed in a one-step procedure: (i) thoracoscopic ablation followed by (ii) endocardial mapping and eventual ablation. All patients received PVI and posterior wall isolation. Additional lesions were performed based on clinical indication and physician judgement. Primary endpoint was freedom from atrial tachyarrhythmias (ATas). A total of 120 consecutive patients were included, 85 patients (70.8%) underwent hybrid AF ablation as first procedure (non-paroxysmal AF 100%), 20 patients (16.7%) as second procedure (non-paroxysmal AF 30%), and 15 patients (12.5%) as third procedure (non-paroxysmal AF 33.3%). After a mean follow-up of 62.3 months ± 20.3, a total of 63 patients (52.5%) experienced ATas recurrence. Complications occurred in 12.5% of patients. There was no difference in ATas between patients undergoing hybrid as first vs. redo procedure (P = 0.53). Left atrial volume index and recurrence during blanking period were independent predictors of ATas recurrence. Conclusion In a large cohort of patients undergoing hybrid AF ablation, the survival from ATas recurrence was 47.5% at ≈5 years follow-up. There was no difference in clinical outcomes between patients undergoing hybrid AF ablation as first procedure or as a redo.

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“…The recurrence rate of paroxysmal AF is approximately 10% to 20% 1 year after surgery, whereas that of persistent AF is as high as 30% to 40%, with an annual increase of 2% to 5%. [2] Therefore, the effective reduction of the recurrence rate after AF has been the focus of clinical research. Administration of antiarrhythmic drugs during the blank period can improve the anatomical and electrical remodeling of the left atrium, thereby effectively reducing the recurrence risk of atrial arrhythmia.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Shensong Yangxin capsule combined with dronedarone in paroxysmal atrial fibrillation after ablation

Zhou,

Gong,

et al. 2024

Medicine

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Objective: To investigate whether postoperative administration of Shensong Yangxin capsules (SSYX) and dronedarone for atrial fibrillation (AF) can reduce the recurrence of paroxysmal AF after radiofrequency ablation, thus providing a more optimal choice of antiarrhythmic medication during the blank period. Methods: We included 120 patients with paroxysmal AF who underwent radiofrequency ablation at our hospital between July 2020 and July 2022. They underwent routine circumferential pulmonary vein ablation and, subsequently, left and right atrial pressure monitoring to assess sinoatrial node recovery time under burst 400/300 ms stimulation. Postoperatively, the patients were randomly divided into 2 groups (60 patients each). The control group was administered dronedarone orally for 3 months and the study group was treated with SSYX combined with dronedarone. This study aimed to compare differences in clinical efficacy of the treatment between the 2 groups. Results: The left and right atrial pressures in both groups were higher than those in the preoperative period (P < .05), with no statistically significant differences between the 2 groups (P > .05). Sinoatrial node recovery time under burst 400/300 ms stimulation showed no statistical difference between the 2 groups (P > .05). At 3 months and 1 year postoperatively, the AFEQT scale scores for both groups were lower than those before treatment (P < .05), with the study group scoring lower than the control group at 3 months (P < .05). However, no statistically significant difference was observed between the 2 groups at 1 year postoperatively (P > .05). At 3 months postoperatively, the sinus rhythm maintenance rate and heart rate were higher in the intervention group than in the control group (P < .05); however, these differences between the 2 groups were not statistically significant at 1 year postoperatively (P > .05). Conclusion subsections: The combination of SSYX and dronedarone could effectively reduce the early recurrence of paroxysmal AF after radiofrequency ablation, increase heart rate, and improve the quality of life.

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Very long term outcomes of atrial fibrillation ablation

Cited by 22 publications

References 11 publications

Early ablation of newly diagnosed paroxysmal atrial fibrillation (NEWPaAF) versus newly diagnosed persistent atrial fibrillation (NEWPeAF): Comparison of patient populations and ablation outcomes

Early ablation of newly diagnosed paroxysmal atrial fibrillation (NEWPaAF) versus newly diagnosed persistent atrial fibrillation (NEWPeAF): Comparison of patient populations and ablation outcomes

Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience

Efficacy of Shensong Yangxin capsule combined with dronedarone in paroxysmal atrial fibrillation after ablation

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