Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation

Gang, Uffe Jakob Ortved; Nalliah, C.; Lim, Toon Wei; Thiagalingam, Aravinda; Kovoor, Pramesh; Ross, David L.; Thomas, Stuart P.

doi:10.1161/circep.114.002052

Cited by 32 publications

(39 citation statements)

References 34 publications

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“…We demonstrated that high PAC burden after PVI was associated with less LA and LV reverse remodeling in AF patients even without AF recurrence. These results are consistent with the recent studies showing that patients with high PAC burden after PVI had higher risk for late AF recurrence . Gang et al demonstrated that PAC burden at 6 months after PVI was independently associated with a significantly increased risk of late AF recurrence .…”

Section: Discussionsupporting

confidence: 92%

“…High prevalence of PAC causes palpitation, which can be associated with reduced quality of life. Furthermore, recent studies showed that frequent PAC after PVI increased the risk of late AF recurrence . We hypothesized that frequent PAC after PVI procedure may attenuate the LA and LV reverse remodeling benefited from maintenance of sinus rhythm.…”

Section: Introductionmentioning

confidence: 97%

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Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation

Hasegawa

Nakanishi

Yoshida

et al. 2019

Pacing Clinical Electrophis

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Background Maintenance of sinus rhythm after pulmonary vein isolation (PVI) for atrial fibrillation (AF) is associated with left atrial (LA) and ventricular (LV) reverse remodeling, although the degree varies among individuals. We hypothesized that frequent premature atrial complex (PAC) after PVI may attenuate the left heart reverse remodeling benefited from maintenance of sinus rhythm. Methods We included 82 AF patients who underwent first‐time PVI and 24‐h Holter recordings at 6 months after PVI. All patients had no AF recurrence before this time. The number of PAC was categorized into tertiles: <90, 90‐488 and >488 PACs/day. All patients underwent two‐dimensional echocardiography and serum plasma B‐type natriuretic peptide (BNP) measurement before and 6 months after PVI. LA reverse remodeling was defined as ≥15% decrease in LA volume index. Results There was no significant difference in the baseline characteristics among the PAC tertiles except for sex. Six months after PVI, LA volume index, LV mass index, and serum BNP levels were significantly decreased in lower and middle PAC tertiles (all P < .05), whereas no significant changes were observed in upper PAC tertile. Frequency of LA reverse remodeling was significantly lower in upper tertile of PAC compared with middle and lower tertiles (22.2%, 57.1%, and 59.3%, P < .001). Baseline LA volume index, changes in LV mass index, and the frequency of PAC were independently associated with LA reverse remodeling (all P < .05). Conclusions Frequent PAC after PVI was associated with less left heart reverse remodeling in AF patients even without AF recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 97%

Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation

Hasegawa

Nakanishi

Yoshida

et al. 2019

Pacing Clinical Electrophis

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“…Non-PV triggers which were not targeted during the initial ablation may manifest as PACs during the ERAA period post-ablation, and may predict late AF recurrence. Gang et al[31] examined 7-d Holter monitors in 124 patients six months post-PVI (3 mo after the blanking period had ended) and found that frequent premature atrial complexes (PACs) strongly predicted late AF recurrence. Patients who developed late recurrence had a median of 248 PACs per day compared vs those without late recurrence (77 PACs per day).…”

Section: Mechanisms and Pathophysiology Of Eraamentioning

confidence: 99%

Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

Liang

Santangeli

2016

WJC

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Early recurrence of atrial arrhythmias (ERAA) after ablation is common and strongly predicts late recurrences and ablation failure. However, since arrhythmia may eventually resolve in up to half of patients with ERAA, guidelines do not recommend immediate reintervention for ERAA episodes occurring during a 3-mo post-ablation blanking period. Certain clinical demographic, electrophysiologic, procedural, and ERAA-related characteristics may predict a higher likelihood of long-term ablation failure. In this review, we aim to discuss potential mechanisms of ERAA, and to summarize the clinical significance, prognostic implications, and treatment options for ERAA.

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“…The predictive value of AES for development of AF recurrences was mainly examined after PVI in patients with PAF, whereas the present study evaluates the value of AES prior to PVI in both PAF and PeAF patients. Gang et al showed in a prospective study in 220 patients with PAF that ≥142 AES/day on the 6 months Holter recording was associated with a higher risk of AF recurrences after PVI (HR 2.84). However, the relation between AES prior to PVI and the long‐term AF‐free survival after PVI was not yet described.…”

Section: Discussionmentioning

confidence: 99%

Early markers of atrial fibrillation recurrence after pulmonary vein isolation

Lanters

Teuwen

Hokken

et al. 2020

Journal of Arrhythmia

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Background Postprocedural atrial extrasystole (AES) frequency predicts atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) in patients with paroxysmal AF. However, the predictive value of preprocedural AES frequency is unknown. We investigate whether preprocedural AES frequency is a feasible marker to predict (timing of) AF recurrence after PVI. Methods Patients (N = 684) with paroxysmal or persistent AF undergoing first‐time PVI were evaluated for (a) the frequency of AES/day on Holter recordings without AF prior to PVI, (b) AF episodes during the 90 days blanking period, and (c) AF recurrences afterward. The correlation between AES/day and both development and timing of AF recurrences was tested. Results Preprocedural AES/day was similar in patients with paroxysmal (66 [20‐295] AES/day) and persistent AF (115 [12‐248] AES/day, P = .915). During the blanking period, 302 (44.2%) patients showed AF episodes. AF recurred in 379 (55.4%) patients at 203 (105‐400) days after PVI. AF recurred more frequently in patients with persistent (N = 104 [69.3%]) than in patients with paroxysmal AF (N = 275 [51.5%], P < .001). Frequency of AES prior to PVI was not correlated with development (P = .203) or timing (P = .478) of AF recurrences. AF recurrences occurred both more frequently (P < .001) and earlier (P < .000) in patients with AF during the blanking period. Conclusion AES/day prior to PVI is not correlated with (timing of) AF during the blanking period or AF recurrences, and is therefore not a feasible marker for AF recurrences in patients with PAF. AF during the blanking period is correlated with AF recurrence.

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Atrial Ectopy Predicts Late Recurrence of Atrial Fibrillation After Pulmonary Vein Isolation

Cited by 32 publications

References 34 publications

Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation

Atrial ectopy after pulmonary vein isolation and left heart reverse remodeling in patients with atrial fibrillation

Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation

Early markers of atrial fibrillation recurrence after pulmonary vein isolation

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