Early rhythm‐control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry

Solimene, Francesco; Santoro, M Giannotti; Stabile, Giuseppe; Malacrida, Maurizio; Simone, Antonio De; Pandozi, Claudio; Pelargonio, Gemma; Rossi, Pietro; Battaglia, Alberto; Pecora, Domenico; Bongiorni, Maria Grazia; Zucchelli, Giulio; Stocco, Camilla; Arestia, Alberto; Iuliano, Sara; Russo, Maurizio; Narducci, Maria Lucia; Segreti, Luca

doi:10.1111/pace.14374

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…In the AF patients enrolled in the CABANA trial who also had clinically diagnosed heart failure, catheter ablation also showed superiority for improvements in survival and quality of life when compared with medical therapy [ 27 ]. Previous studies have verified that early rhythm control therapy leads to a lower risk of cardiovascular complications in AF patients [ 29 , 30 , 31 ]. Emerging clinical evidence has also indicated that percutaneous left atrial appendage occlusion is a safe and effective therapeutic strategy for cardioembolic stroke prevention in non-valvular AF patients [ 32 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

Zang

Zheng

et al. 2022

JCM

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: The COVID-19 pandemic has severely impacted healthcare systems worldwide. This study investigated cardiologists’ opinions on how the COVID-19 pandemic impacted clinical practice patterns in atrial fibrillation (AF). A multicenter clinician survey, including demographic and clinical questions, was administered to 300 cardiologists from 22 provinces in China, in April 2022. The survey solicited information about their treatment recommendations for AF and their perceptions of how the COVID-19 pandemic has impacted their clinical practice patterns for AF. The survey was completed by 213 cardiologists (71.0%) and included employees in tertiary hospitals (82.6%) and specialists with over 10 years of clinical cardiology practice (53.5%). Most respondents stated that there were reductions in the number of inpatients and outpatients with AF in their hospital during the pandemic. A majority of participants stated that the pandemic had impacted the treatment strategies for all types of AF, although to different extents. Compared with that during the assumed non-pandemic period in the hypothetical clinical questions, the selection of invasive interventional therapies (catheter ablation, percutaneous left atrial appendage occlusion) was significantly decreased (all p < 0.05) during the pandemic. There was no significant difference in the selection of non-invasive therapeutic strategies (the management of cardiovascular risk factors and concomitant diseases, pharmacotherapy for stroke prevention, heart rate control, and rhythm control) between the pandemic and non-pandemic periods (all p > 0.05). The COVID-19 pandemic has had a profound impact on the clinical practice patterns of AF. The selection of catheter ablation and percutaneous left atrial appendage occlusion was significantly reduced, whereas pharmacotherapy was often stated as the preferred option by participating cardiologists.

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Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

Zang

Zheng

et al. 2022

JCM

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“… 3 , 4 However, postablation arrhythmia could relapse in at least 20% to 40% of patients after initially successful ablation in the first year. 24 , 25 , 26 In a recent small‐sample RCT, Kishima et al showed that tofogliflozin, a type of SGLT2i drug, achieved greater suppression of AF recurrence in patients with diabetes after CA. 14 A similar conclusion was also drawn in 2 other retrospective studies, as the use of SGLT2i among patients with AF and comorbid diabetes undergoing ablation was associated with lower incidence of AF recurrence comparing to those without SGLT2i.…”

Section: Discussionmentioning

confidence: 99%

Impact of Sodium‐Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Diabetes: A Propensity‐Score Matching Study and Meta‐Analysis

Zhao,

Jiang,

et al. 2023

JAHA

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Background The association between sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and atrial fibrillation (AF) recurrence after catheter ablation among patients with diabetes and AF remains unclear. Methods and Results Patients with AF undergoing initial catheter ablation with a history of diabetes from the China AF registry were included. Patients using SGLT2i were identified and matched by propensity score with non‐SGLT2i patients in a 1:3 ratio. The main outcome was AF recurrence during the 18‐month follow‐up. A total of 138 patients with diabetes with SGLT2i therapy and 387 without SGLT2i were analyzed. AF recurrence occurred in 37 patients (26.8%) in the SGLT2i group and 152 patients (39.3%) in the non‐SGLT2i group during a total of 593.3 person‐years follow‐up. The SGLT2i group was associated with lower AF recurrence compared with the non‐SGLT2i group (hazard ratio, 0.63 [95% CI, 0.44–0.90], P =0.007). A total of 4 studies were analyzed in our meta‐analysis demonstrating that SGLT2i was associated with lower AF recurrence after catheter ablation (odds ratio, 0.61 [95% CI, 0.54–0.69]; P <0.001, I 2 =0.0%). Conclusions Our prospective study coupled with a meta‐analysis demonstrated a lower risk of AF recurrence with the use of SGLT2i among patients with diabetes after AF ablation.

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“… 18 However, a significant limitation of this approach is the absence of tissue feedback during lesion creation, which results in a blunt “one‐size‐fits‐all” approach. 25 Encouraging results with a novel technology that measures LI through mini‐electrodes on the tip of a dedicated ablation catheter both in an acute setting 9 , 11 , 26 and on arrhythmia recurrence during long‐term follow‐up 10 , 27 have been recently reported. However, without intraprocedural guidance regarding where existing lesions are most vulnerable to reconnection, it is difficult to improve on these results.…”

Section: Discussionmentioning

confidence: 99%

Improved procedural workflow for catheter ablation of paroxysmal AF with high‐density mapping system and advanced technology: Rationale and study design of a multicenter international study

Solimene¹,

Stabile²,

Ramos

et al. 2022

Clinical Cardiology

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Background The antral region of pulmonary veins (PV)s seems to play a key role in a strategy aimed at preventing atrial fibrillation (AF) recurrence. Particularly, low‐voltage activity in tissue such as the PV antra and residual potential within the antral scar likely represent vulnerabilities in antral lesion sets, and ablation of these targets seems to improve freedom from AF. The aim of this study is to validate a structured application of an approach that includes the complete abolition of any antral potential achieving electrical quiescence in antral regions. Methods The improveD procEdural workfLow for cathETEr ablation of paroxysmal AF with high density mapping system and advanced technology (DELETE AF) study is a prospective, single‐arm, international post‐market cohort study designed to demonstrate a low rate of clinical atrial arrhythmias recurrence with an improved procedural workflow for catheter ablation of paroxysmal AF, using the most advanced point‐by‐point RF ablation technology in a multicenter setting. About 300 consecutive patients with standard indications for AF ablation will be enrolled in this study. Post‐ablation, all patients will be monitored with ambulatory event monitoring, starting within 30 days post‐ablation to proactively detect and manage any recurrences within the 90‐day blanking period, as well as Holter monitoring at 3, 6, 9, and 12 months post‐ablation. Healthcare resource utilization, clinical data, complications, patients' medical complaints related to the ablation procedure and patient's reported outcome measures will be prospectively traced and evaluated. Discussion The DELETE AF trial will provide additional knowledge on long‐term outcome following a structured ablation workflow, with high density mapping, advanced algorithms and local impedance technology, in an international multicentric fashion. DELETE AF is registered at http://ClinicalTrials.gov (NCT05005143).

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Early rhythm‐control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry

Cited by 4 publications

References 26 publications

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

The Impact of COVID-19 Pandemic on the Clinical Practice Patterns in Atrial Fibrillation: A Multicenter Clinician Survey in China

Impact of Sodium‐Glucose Cotransporter 2 Inhibitor on Recurrence After Catheter Ablation for Atrial Fibrillation in Patients With Diabetes: A Propensity‐Score Matching Study and Meta‐Analysis

Improved procedural workflow for catheter ablation of paroxysmal AF with high‐density mapping system and advanced technology: Rationale and study design of a multicenter international study

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