Catheter ablation approach and outcome in HIV+ patients with recurrent atrial fibrillation

Atrial fibrillation (AF) is the most common heart rhythm disorder in clinical practice. It worsens the quality of life of patients, leads to an increase in the mortality rate because of its association with a high risk of thromboembolic complications. The current pandemic of a new coronavirus infection, which began in March 2020, was marked by an increase in cardiovascular diseases, including an increase in the number of patients with AF. That is why it is extremely relevant to find answers to questions about the association and mutual influence of AF and coronavirus infection to reduce the risk of vascular complications. However, most research in this area has focused on hospital patients. In this study, an electronic database of outpatients with AF, including patients with a history of COVID-19 infection was analyzed in order to assess the most significant risk factors for complications.

Section: Resultsmentioning

confidence: 99%

Atrial fibrillation and COVID-19: an analysis of the ambulatory database

Sizova,

Zakharova,

Shindryaeva

et al. 2024

“…This study provides insights into the long-term efficacy and safety of ablation index-guided AF ablation for atrial fibrillation. Although long-term data are available on select patient cohorts ( 22 ), for the first time, this study presents long-term follow-up (beyond 5 years) data in a cohort of real-world consecutive patients utilising the ablation index and a pragmatic pre-defined ablation escalation strategy. Five-year data are particularly useful when counselling patients on treatment options as a common concern for them is the prognosis beyond the typically studied 1-year window.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of ablation index guided atrial fibrillation ablation: insights after 5+ years of follow-up from the MPH AF Ablation Registry

Fitzpatrick,

Herczeg,

Hong

et al. 2024

BackgroundCatheter ablation (CA) for symptomatic atrial fibrillation (AF) offers the best outcomes for patients. Despite the benefits of CA, a significant proportion of patients suffer a recurrence; hence, there is scope to potentially improve outcomes through technical innovations such as ablation index (AI) guidance during AF ablation. We present real-world 5-year follow-up data of AI-guided pulmonary vein isolation.MethodsWe retrospectively followed 123 consecutive patients who underwent AI-guided CA shortly after its introduction to routine practice. Data were collected from the MPH AF Ablation Registry with the approval of the institutional research board.ResultsOur patient cohort was older, with higher BMI, greater CHA2DS2-VASc scores, and larger left atrial sizes compared to similar previously published cohorts, while gender balance and other characteristics were similar. The probability of freedom from atrial arrhythmia with repeat procedures is as follows: year 1: 0.95, year 2: 0.92, year 3: 0.85, year 4: 0.79, and year 5: 0.72. Age >75 years (p = 0.02, HR: 2.7, CI: 1.14–6.7), BMI >35 kg/m2 (p = 0.0009, HR: 4.6, CI: 1.8–11.4), and left atrial width as measured on CT in the upper quartile (p = 0.04, HR: 2.5, CI: 1–5.7) were statistically significant independent predictors of recurrent AF.ConclusionAI-guided CA is an effective treatment for AF, with 95.8% of patients remaining free from atrial arrhythmia at 1 year and 72.3% at 5 years, allowing for repeat procedures. It is safe with a low major complication rate of 1.25%. Age >75 years, BMI >35 kg/m2, and markedly enlarged atria were associated with higher recurrence rates.

“…Currently, catheter ablation is the first choice in ERC treatment. La Fazia et al ( 28 ) found that human immunodeficiency virus (HIV) patients with AF have more serious inflammation and oxidative stress caused by HIV infection, which can contribute to atrial remodeling and AF burden ( 28 ). For HIV + AD patients, undergoing catheter ablation earlier can significantly reduce the incidence of atrial arrhythmias.…”

Section: Discussionmentioning

confidence: 99%

Cardiocerebrovascular benefits of early rhythm control in patients with atrial fibrillation detected after stroke: a systematic review and meta-analysis

Ma,

Wang,

Fan

et al. 2024

ObjectiveThis study aimed to evaluate the impact of early rhythm control (ERC) on the occurrence of cardiocerebrovascular events in patients diagnosed with atrial fibrillation detected after stroke (AFDAS).MethodsA systematic search was conducted across nine databases from inception to October 15, 2023 to identify clinical trials comparing ERC with usual care interventions in AFDAS patients. The primary outcome assessed was recurrent stroke, with secondary outcomes including all-cause mortality, adverse events related to arrhythmias, and dementia.ResultsAnalysis of five studies, consisting of two randomized clinical trials (RCTs) involving 490 patients and three cohort studies involving 95,019 patients, revealed a reduced rate of recurrent stroke [odds ratio (OR) = 0.30, 95% confidence interval (CI) 0.11–0.80, P = 0.016 in RCTs; OR = 0.64, 95% CI 0.61–0.68, P < 0.00001 in cohort studies] and all-cause mortality (hazards ratio = 0.94, 95% CI 0.90–0.98, P = 0.005 in cohort studies) in the ERC group compared to the usual care group. In addition, ERC was associated with superior outcomes in terms of dementia.ConclusionsPatients with AFDAS who underwent ERC treatment exhibited a decreased risk of cardiocerebrovascular events compared to those receiving usual care. These results support the potential benefits of implementing an ERC strategy for this specific patient population.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, Identifier [CRD42023465994].