Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation

Watanabe, Ryuta; Nagashima, Koichi; Wakamatsu, Yuji; Otsuka, Naoto; Yokoyama, Kenichi; Matsumoto, Naoya; Otsuka, Takayuki; Suzuki, Shinya; Hirata, Akio; Murakami, Masato; Takami, Mitsuru; Kimura, Masaomi; Fukaya, Hidehira; Kato, Takeshi; Hayashi, Hiroshi; Iwasaki, Yu‐ki; Shimizu, Wataru; Nakajima, Ikutaro; Harada, Tomoo; Koyama, Junjiroh; Okumura, Ken; Tokuda, Michifumi; Yamane, Teiichi; Tanimoto, Kojiro; Momiyama, Yukihiko; Nonoguchi, Noriko; Soejima, Kyoko; Ejima, Koichiro; Hagiwara, Nobuhisa; Harada, Masahide; Sonoda, Kazumasa; Inoue, Masato; Kumagai, Koji; Hayashi, Hidemori; Yazaki, Yoshinao; Sato, Kazuhiro; Watari, Yuji; Okumura, Yasuo; Investigators, AF Ablation Frontier Registry

doi:10.1253/circj.cj-21-0326

Cited by 24 publications

(15 citation statements)

References 38 publications

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“…This may due to its association with structural remodeling in AF. A similar conclusion was also found by Mesquita et al 21 and Wang et al 37 Type of AF was a commonly used predictor for AF recurrence prediction in some studies, 7,21,30-33, 38 and these studies indicated that non-PAF patients had a higher risk of recurrence. This conclusion is also compatible with our results, as shown in Supplementary Table 3, where the proportions of patients with non-PAF in the low-, mediumand high-risk groups are 0%, 21.4% and 88.5%, respectively.…”

Section: Discussionsupporting

confidence: 79%

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation

Zhou

Nakamura

Sahara

et al. 2022

Circ J

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Background: Radiofrequency catheter ablation (RFCA) is an effective therapy for atrial fibrillation (AF). However, it the problem of AF recurrence remains. This study investigates whether a deep convolutional neural network (CNN) can accurately predict AF recurrence in patients with AF who underwent RFCA, and compares CNN with conventional statistical analysis.Methods and Results: Three-hundred and ten patients with AF after RFCA treatment, including 94 patients with AF recurrence, were enrolled. Nine variables are identified as candidate predictors by univariate Cox proportional hazards regression (CPH). A CNNSurv model for AF recurrence prediction was proposed. The model's discrimination ability is validated by a 10-fold cross validation method and measured by C-index. After back elimination, 4 predictors are used for model development, they are N-terminal pro-BNP (NT-proBNP), paroxysmal AF (PAF), left atrial appendage volume (LAAV) and left atrial volume (LAV). The average testing C-index is 0.76 (0.72-0.79). The corresponding calibration plot appears to fit well to a diagonal, and the P value of the Hosmer-Lemeshow test also indicates the proposed model has good calibration ability. The proposed model has superior performance compared with the DeepSurv and multivariate CPH. The result of risk stratification indicates that patients with non-PAF, higher NT-proBNP, larger LAAV and LAV would have higher risks of AF recurrence. Conclusions:The proposed CNNSurv model has better performance than conventional statistical analysis, which may provide valuable guidance for clinical practice.

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Section: Discussionsupporting

confidence: 79%

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation

Zhou

Nakamura

Sahara

et al. 2022

Circ J

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“…It also enables more precise management of patients after ablation, including the duration of antiarrhythmic drug therapy, monitoring for asymptomatic recurrence. Previous studies have shown that dilated LA increases the risk of AF recurrence after single ablation [ 31 , 32 ]. In our study, we also found the LAd ≥ 4.5 cm and AF duration ≥ 24.5 months were the recurrence predictors after PVI-plus linear ablation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety Ablation Index-Guided High-Energy Linear Ablation for Persistent Atrial Fibrillation: PVI Plus Linear Ablation of Mitral Isthmus and Posterior Box Isolation

Liu

Cui

et al. 2023

JCM

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Background: For patients with persistent atrial fibrillation (AF), whether linear ablation should be performed remains controversial, and the efficacy and safety for ablation index (AI)-guided high-energy linear ablation of mitral isthmus (MI) and left atrial (LA) posterior box isolation is still unclear. The aims of this study were to assess the feasibility and clinical success rate of pulmonary veins isolation (PVI) combined with linear ablation of LA roof and posterior inferior (posterior wall isolation) and MI compare with the PVI-alone method in patients of persistent AF. Methods and results: 362 consecutive persistent AF patients were enrolled from two electrophysiology centers. A total of 200 cases were in PVI-plus group and 162 cases were in PVI-alone group. The PVI-alone group received wide circumferential isolation of both ipsilateral pulmonary veins. PVI combined with linear ablation of left atrial posterior wall isolation (LAPWI)and MI were performed in the PVI-plus group. The primary study end point was the first recurrence of an atrial arrhythmia. After 24 months, freedom from the primary endpoint was achieved in 73.5% of the patients in the PVI-plus group and 62.5% in the PVI-alone group (hazard ratio = 0.62, 95% confidence interval: 0.43–0.91, log rank p = 0.012). The procedure-related complication rates were 2.5% in PVI-plus group and 1.9% in PVI-alone group (p = 0.808). Conclusion: In this study, the ablation strategy of ablation (PVI plus linear ablation of mitral isthmus and posterior box isolation) was feasible and safe for persistent AF patients. Compared with the PVI-alone method, it improved outcomes in patients with persistent AF.

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“…Theoretically, PerAF in the 2014–2015 group might have had the worst AF/AT freedom rate, and therefore, the worst clinically relevant events, but no difference was noted among the three time period groups. The clinical impact of ablation may have been dependent on not only AF/AT recurrence, but also the baseline characteristics and post‐ablation AADs and OACs 40 . The lowest continuation rate of AADs but highest rate of OACs after ablation at the physicians' discretion in the 2016–2017 group may also have reflected the fear of a stroke risk when AF/AT recurrences occur.…”

Section: Discussionmentioning

confidence: 99%

Trends over the recent 6 years in ablation modalities and strategies, post‐ablation medication, and clinical outcomes of atrial fibrillation ablation

Hirata

Nagashima

Watanabe

et al. 2023

Journal of Arrhythmia

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Background: Ablation strategies and modalities for atrial fibrillation (AF) have transitioned over the past decade, but their impact on post-ablation medication and clinical outcomes remains to be fully investigated. Methods: We divided 682 patients who had undergone AF ablation in 2014-2019 (420 paroxysmal AFs [PAF], 262 persistent AFs [PerAF]) into three groups according to the period, that is, the 2014-2015 (n = 139), 2016-2017 (n = 244), and 2018-2019 groups (n = 299), respectively.Results: Persistent AF became more prevalent and the left atrial (LA) diameter larger over the 6 years. Extra-pulmonary vein (PV)-LA ablation was more frequently per-

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Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation

Cited by 24 publications

References 38 publications

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation

Efficacy and Safety Ablation Index-Guided High-Energy Linear Ablation for Persistent Atrial Fibrillation: PVI Plus Linear Ablation of Mitral Isthmus and Posterior Box Isolation

Trends over the recent 6 years in ablation modalities and strategies, post‐ablation medication, and clinical outcomes of atrial fibrillation ablation

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