Impact of Type-2 Diabetes Mellitus on the Outcomes of Catheter Ablation of Atrial Fibrillation (European Observational Multicentre Study)

Creta, António; Providência, Rui; Adragão, Pedro; Asmundis, Carlo de; Chun, Julian; Chierchia, Gian‐Battista; Defaye, Pascal; Schmidt, Boris; Anselme, Frédéric; Finlay, Malcolm; Hunter, Ross J.; Papageorgiou, Nikolaos S.; Lambiase, Pier D.; Schilling, Richard J.; Combes, Stéphane; Combes, Nicolas; Albenque, Jean‐Paul; Pozzilli, Paolo; Boveda, Serge

doi:10.1016/j.amjcard.2019.12.037

Cited by 44 publications

(43 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For example in 2014 over 50% of pacemaker or implantable cardioverter defibrillator surgery in the US were being performed in an ambulatory setting according to the Healthcare Cost and Utilization Project. 8 Catheter ablation has emerged as the most effective treatment for AF, 9,10 and the volume of AF ablation performed worldwide has increased exponentially over the last decade. 4,5 Same day discharge is a reasonable approach to mitigate limitations posed by healthcare economic and logistic resources, whilst improving patients' experience.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach

Creta

Ventrella

Providência

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

Introduction: The frequency of catheter ablation for atrial fibrillation (AF) has increased dramatically, stretching resources. Discharge on the same day as treatment may increase the efficiency and throughput. There are limited data regarding the safety of this strategy. Methods: We performed a retrospective analysis of consecutive patients undergoing AF ablation in a tertiary center and in a district general hospital, and identified those discharged on the same day of treatment. The safety endpoint was any complication and/or presentation to hospital in the 48-h and at 30 days postdischarge. We performed an economic analysis to calculate potential cost saving. Results: Among a total population of 2628 patients, we identified 727 subjects (61.1 ± 12.5 years, 69.6% male) undergoing day-case AF ablation. Cryoballoon technique was used in 79.2% of the day-cases, and 91.6% of the procedures were performed under conscious sedation. 1.8% (13) of the participants met the safety composite endpoint at 48-h, however only 0.7% (5) required at least 1 day of hospitalization. Bleeding or hematoma at the femoral access site (0.5%) and pericarditic chest pain (0.5%) were the main reasons for readmission. None experienced cardiac tamponade or other life-threatening complications in the 48-h postdischarge. Overall rate of complication and/or presentation to hospital at 30 days was 3.7%. Our day-case policy resulted in an annual cost-saving of approximately of £83 927 for our hospital. Conclusion: In this large multicentre cohort, same-day discharge in selected patients following AF ablation appears to be safe and cost-effective, with a very low rate of early readmission or post-discharge complication.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Catheter ablation has emerged as the most effective treatment for AF, 9,10 and the volume of AF ablation performed worldwide has increased exponentially over the last decade 4,5 . Same day discharge is a reasonable approach to mitigate limitations posed by healthcare economic and logistic resources, whilst improving patients' experience.…”

Section: Discussionmentioning

confidence: 99%

Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach

Creta

Ventrella

Providência

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…3,22 Catheter ablation represents an effective treatment for symptomatic drug-refractory AF. 23,24 However, the intra-and postprocedural thromboembolic risk is not negligible and requires effective anticoagulation. In fact, both manipulations of the catheters and creation of lesions inside the left atrium can lead to local thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

“…Catheter ablation represents an effective treatment for symptomatic drug‐refractory AF 23,24 . However, the intra‐ and postprocedural thromboembolic risk is not negligible and requires effective anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Creta

Hunter

Earley

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

Introduction: Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) require chronic anticoagulation due to high thromboembolic risk. Evidence supporting the use of non-vitamin K oral anticoagulants (NOACs) in patients with HCM remains sparse, and there are no data regarding the use of NOACs in patients with HCM undergoing catheter ablation of AF. Methods: Observational nonrandomized study in four European centers. We aimed to investigate the safety and efficacy of NOACs compared with vitamin K antagonists (VKAs) in patients with HCM undergoing catheter ablation for AF. Results: A total of 137 patients with HCM (mean age: 55.0 ± 13.4, 29.1% female) underwent 230 catheter ablations for AF (1.7 ± 1.0 per patient). A total of 55 patients (39.4%) underwent 70 procedures (30.4%) on NOAC, while the remaining were on VKA. Warfarin (97.6%) and rivaroxaban (56.4%) were the most frequently used agents in the respective groups. No procedure-related deaths were reported. We observed no significant difference in the rate of thromboembolism (VKA: 0.6%; NOAC: 0%; p = 1.0) or minor bleeding (VKA: 0.6%; NOAC: 1.4%; p = .54). There was a nonsignificant trend towards a lower incidence of major bleeding (VKA: 6.9%; NOAC: 1.4%; p = .09). Conclusion: These preliminary data suggest that NOACs are at least as safe and effective as VKAs in patients with HCM undergoing catheter ablation for AF.

show abstract

“…If PV reconnection occurs and ectopic triggers appear during this early recovery phase, the atria may be more susceptible to AF than at a later phase. Furthermore, a strong relationship between diabetes mellitus, sympathetic over-activity, and AF is clear because metabolic changes lead to inflammatory reaction, endothelial dysfunction, and abnormal activation of the renin–angiotensin–aldosterone system [ 21 , 22 ]. Of note, the triggers of all AF episodes in the short-term recurrence group were considered to be sympathetic over-activity during the daytime.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

et al. 2020

View full text Add to dashboard Cite

Background and objectives: Pulmonary vein (PV) reconnection is a major reason for recurrence after catheter ablation of paroxysmal atrial fibrillation (PAF). However, the timing of the recurrence varies between patients, and recurrence >1 year after ablation is not uncommon. We sought to elucidate the characteristics of atrial fibrillation (AF) that recurred in different follow-up periods. Materials and Methods: Study subjects comprised 151 consecutive patients undergoing initial catheter ablation of PAF. Left atrial volume index (LAVi) and atrial/brain natriuretic peptide (ANP/BNP) levels were systematically measured annually over 3 years until AF recurred. Results: Study subjects were classified into four groups: non-recurrence group (n = 84), and short-term- (within 1 year) (n = 30), mid-term- (1–3 years) (n = 26), and long-term-recurrence group (>3 years) (n = 11). The short-term-recurrence group was characterized by a higher prevalence of diabetes mellitus (hazard ratio 2.639 (95% confidence interval, 1.174–5.932), p = 0.019 by the Cox method), frequent AF episodes (≥1/week) before ablation (4.038 (1.545–10.557), p = 0.004), and higher BNP level at baseline (per 10 pg/mL) (1.054 (1.029–1.081), p < 0.0001). The mid-term-recurrence group was associated with higher BNP level (1.163 (1.070–1.265), p = 0.0004), larger LAVi (mL/m2) (1.033 (1.007–1.060), p = 0.013), and longer AF cycle length at baseline (per 10 ms) (1.194 (1.058–1.348), p = 0.004). In the long-term-recurrence group, the ANP and BNP levels were low throughout follow-up, as with those in the non-recurrence group, and AF cycle length was shorter (0.694 (0.522–0.924), p = 0.012) than those in the other recurrence groups. Conclusions: Distinct characteristics of AF were found according to the time to first recurrence after PAF ablation. The presence of secondary factors beyond PV reconnections could be considered as mechanisms for the recurrence of PAF in each follow-up period.

show abstract

Impact of Type-2 Diabetes Mellitus on the Outcomes of Catheter Ablation of Atrial Fibrillation (European Observational Multicentre Study)

Cited by 44 publications

References 15 publications

Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach

Same‐day discharge following catheter ablation of atrial fibrillation: A safe and cost‐effective approach

Non–vitamin K oral anticoagulants in hypertrophic cardiomyopathy patients undergoing catheter ablation of atrial fibrillation

Predictors of Recurrence after Catheter Ablation of Paroxysmal Atrial Fibrillation in Different Follow-Up Periods

Contact Info

Product

Resources

About