Differential Clinical Characteristics and Prognosis of Patients with Longstanding Persistent Atrial Fibrillation Presenting with Recurrent Atrial Tachycardia versus Recurrent Atrial Fibrillation After First Ablation

Zhao, Liang; Wu, Shaohui; Jiang, Weifeng; Zhou, Li; Gu, Jun; Wang, Yuanlong; Liu, Yugang; Zhang, Xiaodong; Liu, Xu

doi:10.1111/jce.12311

Cited by 5 publications

(5 citation statements)

References 22 publications

(40 reference statements)

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“…[1] While lesions for AFL/AT with identifiable mechanisms are mostly limited to the critical isthmus. Previous studies also reported less favorable outcome of RFCA for patients with recurrent AF than AT, [12,13] which is consistent with our study.…”

Section: Discussionsupporting

confidence: 93%

Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

Wang¹,

Chen²,

Zhou³

et al. 2019

Preprint

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Background: Many atrial fibrillation (AF) patients require more than one radiofrequency catheter ablation (RFCA) procedure to maintain sinus rhythm. This study aimed to evaluate risk and risk factors of atrial tachyarrhythmia (ATa) recurrence in patients undergoing multiple (≥3) RFCA procedures for AF. Methods: This single-center, retrospective, observational study enrolled 118 consecutive patients who underwent multiple ablation procedures for paroxysmal and non-paroxysmal AF with circumferential pulmonary vein ablation (CPVA), and bidirectional block of lines with disappearance of complex fractionated atrial electrograms (CFAEs) as index procedural endpoints, respectively. Results: At a median follow-up of 18 (range, 6-91) months after the last procedure (mean, 3.2 procedures), freedom from ATa recurrence was 40.7% (48/118). Initially diagnosed non-paroxysmal AF (P=0.039), baseline LA size (P=0.044), and recurrent AF after the second procedure (P=0.044) were univariate predictors of ATa recurrence, while only the latter (P=0.010) was an independent multivariate predictor (hazard ratio for ATa recurrence of 1.88 [95% CI, 1.16-3.05]. Conversion of recurrent types between AF and AFL/AT occurred in 52.9% (37/70) of patients with ATa recurrence, and 29.2% (14/48) of patients with sinus rhythm after last procedure. Few patients (7.8% [20/257]) recovered PV potential induced recurrent ATa during multiple procedures, and most (87.6% [141/161]) were bystanders of recurrent ATa. Conclusions: Multiple (>3) RFCA for paroxysmal or non-paroxysmal AF yielded unsatisfactory ATa recurrence rates with recurrent AF after the second procedure as multivariate predictor and recovered PV potential as a bystander commonly as underlying mechanism. Conversion of recurrent types between AF and AFL/AT was common.

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Section: Discussionsupporting

confidence: 93%

Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

Wang¹,

Chen²,

Zhou³

et al. 2019

Preprint

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“…4,5 In contrast, patients with persistent and long-standing persistent AF treated with a more targeted ablation strategy (PVI with or without documented non-PV trigger ablation) are more likely to experience arrhythmia recurrences in the form of AF instead of OATs. However, when the arrhythmia recurrence in these patients is paroxysmal in nature, this likely suggests a favorable modification of the underlying AF substrate, which becomes less capable of sustaining AF.…”

mentioning

confidence: 99%

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Liang¹,

Elafros²,

Muser³

et al. 2016

Circ: Arrhythmia and Electrophysiology

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A lthough pulmonary vein isolation (PVI) is well accepted to be the cornerstone of ablation for paroxysmal atrial fibrillation (AF), there remains lack of consensus on the optimal ablation strategy in patients with persistent and longstanding persistent AF. [1][2][3] Although an ablation strategy limited primarily to PVI, with or without targeting of documented nonpulmonary vein (PV) triggers, results in lower long-term AF-free survival rates in patients with persistent and longstanding persistent AF than paroxysmal AF, outcomes are not improved with more extensive substrate modification strategies.2,3 It has been shown that ≈50% of patients with persistent and long-standing persistent AF who undergo extensive substrate modification experience persistent organized atrial tachyarrhythmias (OAT) after ablation. 4,5 In contrast, patients with persistent and long-standing persistent AF treated with a more targeted ablation strategy (PVI with or without documented non-PV trigger ablation) are more likely to experience arrhythmia recurrences in the form of AF instead of OATs. However, when the arrhythmia recurrence in these patients is paroxysmal in nature, this likely suggests a favorable modification of the underlying AF substrate, which becomes less capable of sustaining AF.The objective of this study, therefore, was to determine the nature of initial arrhythmia recurrence in patients with © 2016 American Heart Association, Inc. Original ArticleBackground-Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. Methods and Results-Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included. AF recurrence was defined as early (≤6 weeks) or late (>6 weeks after ablation) and paroxysmal (either spontaneous conversion or treated with cardioversion ≤7 days) or persistent (lasting >7 days). During median follow-up of 29.8 (interquartile range: 14.8-49.9) months, 221 patients had ≥1 recurrence. Initial recurrence was paroxysmal in 169 patients (76%) and persistent in 52 patients (24%). Patients experiencing paroxysmal (versus persistent) initial recurrence were more likely to achieve long-term freedom off antiarrhythmic drugs (hazard ratio, 2.2; 95% confidence interval, 1.5-3.2; P<0.0001), freedom on/off antiarrhythmic drugs (hazard ratio, 2.5; 95% confidence interval, 1.6-3.8; P<0.0001), and arrhythmia control (hazard ratio, 5.2; 95% confidence interval, 2.9-9.2; P<0.0001) after last ablation. Conclusions-In patients with persistent and long-standing persistent AF, limited ablation targeting pulmonary veins and documented nonpulmonary vein triggers improves the maintenance of sinus rhythm and re...

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“…17 During the second ablation procedure, more recurrent atrial tachycardia had clear targets than recurrent atrial fibrillation and had more favourable prognosis. 18 Atrial fibrillation with pulmonary vein trigger had clear target, and pulmonary vein isolation was effective. It was difficult in identifying and mapping the non-pulmonary vein triggers during the procedures, and the exact mechanisms by which linear and complex fractionated atrial electrograms ablation eliminated atrial fibrillation and prevented recurrence were not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation for lone atrial fibrillation in individuals aged under 35 years

et al. 2019

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Background:To assess the effectiveness of radiofrequency catheter ablation for lone atrial fibrillation in young adults.Methods:This single-centre, retrospective, observational study enrolled 75 consecutive patients (86.7% men) under 35 (median, 30) years old with lone atrial fibrillation (68% paroxysmal, 26.7% persistent, and 5.3% long-standing persistent) without other cardiopulmonary diseases who underwent catheter ablation between April 2009 and May 2017. Procedural endpoints were circumferential pulmonary vein ablation for atrial fibrillation with pulmonary vein trigger, and target ablation or bidirectional block of lines and disappearance of complex fractionated atrial electrograms for atrial fibrillation with clear and unclear non-pulmonary vein triggers, respectively.Results:Main study outcome was rate of survival free from atrial tachyarrhythmia recurrence, which at median 61 (range, 5–102) months follow-up was 62.7% (64.7 and 58.3% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after single ablation, and 69.3% (68.6 and 70.8% for paroxysmal and non-paroxysmal atrial fibrillation, respectively) after mean 1.2 ablations (two and three ablations in 11 and 2 patients, respectively). In multivariate analysis, non-pulmonary vein trigger was a significant independent predictor of recurrent atrial tachyarrhythmia (OR, 10.60 [95%CI, 2.25–49.96]; p = 0.003). There were no major periprocedural adverse events.Conclusions:In patients under 35 years old with lone atrial fibrillation, radiofrequency catheter ablation appeared effective particularly for atrial fibrillation with pulmonary vein trigger and regardless of left atrial size or atrial fibrillation duration or type. Atrial tachyarrhythmia recurrence after multiple ablations warrants further study.

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Differential Clinical Characteristics and Prognosis of Patients with Longstanding Persistent Atrial Fibrillation Presenting with Recurrent Atrial Tachycardia versus Recurrent Atrial Fibrillation After First Ablation

Abstract: LS-AF patients who develop R-AT versus R-AF after first ablation have more favorable baseline characteristics and prognosis.

Cited by 5 publications

References 22 publications

Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

Characteristics and outcomes of patients after multiple (≥3) catheter ablation procedures for atrial fibrillation

Pulmonary Vein Antral Isolation and Nonpulmonary Vein Trigger Ablation Are Sufficient to Achieve Favorable Long-Term Outcomes Including Transformation to Paroxysmal Arrhythmias in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation

Catheter ablation for lone atrial fibrillation in individuals aged under 35 years

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