No abstract

Radiofrequency catheter ablation (RFCA) has become widely used for drug-refractory atrial fibrillation (AF). However, there is a paucity of data on the long-term clinical outcomes after RFCA for AF. The aim of the present study was to investigate the very long-term outcomes after RFCA for AF in a large number of consecutive patients. Methods and results: In this retrospective single-center study, we evaluated very long-term follow-up results in 1206 consecutive patients undergoing first RFCA for AF. The primary outcomes were adverse outcomes at 30-day as a safety outcome measure and event-free rates from recurrent atrial tachyarrhythmias as efficacy outcome measures. Final follow-up rate reached 99.3% with a mean follow-up duration of 5.0 ± 2.5 years. The incidence of overall 30-day adverse outcomes was 3.6% without death. The 10-year event-free rates from recurrent atrial tachyarrhythmias after the initial and last procedures were 46.9% and 76.4%, respectively. Arrhythmia recurrence occurred most commonly during the first year and decreased beyond 3-year, although it continued to occur at an annual rate of 2.0% and 1.3%, respectively, throughout the 10-year follow-up period. The cumulative 10-year incidences of stroke and major bleeding were 4.2% and 3.5%, respectively, with annual rates of 0.3%. Discontinuation rate of oral anticoagulation at 1-, 3-, and 10-year was 34.6%, 53.4%, 58.0% and 61.9%. Conclusions: RFCA for AF provided favorable very long-term arrhythmia-free survival without much safety concerns. The 10-year rates of stroke and major bleeding were low even with discontinuation of oral anticoagulation in a large proportion of patients.

Background: Radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF) is still challenging even in RFCA-era for AF. The aim of this study was to assess the clinical utility of nifekalant, a pure potassium channel blocker,during RFCA for persistent AF. Methods and Results: We retrospectively enrolled 157 consecutive persistent AF patients undergoing first RFCA procedure with complex fractionated atrial electrogram (CFAE) ablation after pulmonary veins isolation and compared outcomes between patients with (NFK group: N=79) and without (No-NFK group: N=78) additional CFAE ablation using intravenous nifekalant (0.3mg/kg). Primary endpoint was 24-month atrial arrhythmia-free survival post ablation.The prevalence of AF termination was significantly higher in NFK group than No-NFK group (64.6% versus 7.7%, P<0.001). Arrhythmia-free survival, however, was not significantly different between 2 groups (61.5% versus 54.1%, P=0.63).There was no significant difference between 2 groups in the prevalence of recurrent atrial tachycardia (25.0% versus 23.5%, P=0.89). Arrhythmia-free survivalin patients with AF termination during procedure was significantly higher than those without (73.0% versus 41.0%, P=0.002; adjusted hazard ratio 0.48, 95% confidence interval 0.17-0.84, P=0.02) among NFK group,but not among No-NFK group (66.7% versus 53.2%, P=0.53). Conclusions: Intravenous nifekalant injection during additional CFAE ablation did not improve sinus maintenance rate after RFCA procedure for AF, but AF termination by nifekalant injection could be a clinical predictor of better success rates after procedure.

Plasma prostaglandins (PGs; PGE₂, PGF_2α, 6-keto-PGF_1α and TXB₂) and plasma renin activity (PRA) were measured in 94 end-stage renal disease (ESRD) patients including 15 undialyzed, 74 maintenance-hemodialyzed and 5 anephric patients, and in 27 healthy controls. In the healthy controls, 6-keto-PGF_1α inversely correlated with age, while TXB₂ and the TXB₂/6-keto-PGF_1α ratio correlated with age. In the ESRD patients, 6-keto-PGF_1α showed a tendency to decrease with age, and the TXB₂/6-keto-PGF_lα ratio significantly correlated with age. The undialyzed group showed significantly higher blood pressure and TXB₂ but significantly lower 6-keto-PGF_1α compared to the other groups. In the dialyzed group, PGE₂ and 6-keto-PGF_1α tended to be lower and TXB₂ higher compared to the healthy control group. In the dialyzed group, 6-keto-PGF_1α correlated inversely with blood pressure independently from PRA. As for PGF_2α, it was higher in the undialyzed, dialyzed and anephric groups than in the healthy control group. These results suggested that PGs were involved in blood pressure abnormalities, and that PGI₂ played an important role in controlling blood pressure in ESRD patients as one of the depressor factors.

PMI was avoided in >85% of patients undergoing RFCA for PAF with pre-existing SND, although care should be taken for female patients. Decision-making regarding RFCA for non-PAF patients with slow VR, especially in the elderly, should be cautious.