Left Atrial Volume and Age Are the Strongest Predictors of Atrial Fibrillation Burden After Pulmonary Vein Isolation for Persistent Atrial Fibrillation- Findings From Decaaf Ii Randomized Controlled Trial

Mekhael, Mario; Wilber, David J.; Noujaim, Charbel; Chouman, Nour; Assaf, Ala; Younes, Hadi; Hajjar, Abdel Hadi El; Dagher, Lilas; Khoury, Carlo; Shan, Botao; Lanier, Brennan; Dhore, Aneesh; Hong, Feng; Li, Dan; Donnellan, Eoin; Marrouche, Nassir F.; Kreidieh, Omar

doi:10.1016/s0735-1097(23)00450-3

Cited by 4 publications

(5 citation statements)

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“…found similar results, although the majority of patients evaluated had paroxysmal AF (71% and 62%, respectively), whereas our study focused solely on patients with persistent AF 11,17 . Our study also found that left atrial volume and age were predictors of the primary outcome, which is consistent with our previous subanalysis from the DECAAF II trial 18 …”

Section: Discussionsupporting

confidence: 91%

“…11,17 Our study also found that left atrial volume and age were predictors of the primary outcome, which is consistent with our previous subanalysis from the DECAAF II trial. 18 The DECAAF II database is one the largest to date to evaluate patients with persistent AF undergoing atrial ablation, and this subanalysis demonstrated circulating biomarkers, such as BNP, should be considered in clinical practice when isolating pulmonary veins to better assess recurrence risk and personalize management.…”

Section: Discussionmentioning

confidence: 99%

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Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Younes

Mekhael

Feng

et al. 2023

Pacing Clinical Electrophis

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BackgroundBrain natriuretic peptide (BNP) is a marker of myocardial stretch and may have prognostic significance in patients with atrial fibrillation (AF) without heart failure (HF). We investigated the association between baseline BNP levels and arrhythmia recurrence following pulmonary vein isolation (PVI) among patients with persistent AF without HF.MethodsWe analyzed 125 patients with persistent AF without HF who had baseline BNP measured from the DECAAF II trial. The primary outcome was arrhythmia recurrence following ablation. The baseline characteristics across the two groups were compared using Chi‐square test and Wilcoxon rank test accordingly. Cox regression analysis was used to analyze the association between baseline BNP levels and the primary outcome.ResultsAcross the entire cohort, 64 (51%) patients experienced arrhythmia recurrence. When comparing patients who experienced arrythmia recurrence to patients who did not, patients with recurrent arrhythmia had higher levels of pre‐ablation BNP, as evidenced by differences in means (330.05 pg/mL) compared to patients without recurrent arrhythmia (182.39 pg/mL) (p < .05). A cut‐off BNP value of 300 pg/mL provided the largest area under curve (AUC) of receiver‐operating characteristic (ROC) curve on univariate logistic regression. On unadjusted Cox analysis, for every 100 unit increase in BNP, the hazard ratio for the primary outcome increased 1.09 (1.026–1.158) times (p = .004). After adjusting for sex, hypertension, and stroke, the results remained significant (HR = 1.8516, CI 95% [1.0139 – 3.381], p = .045).ConclusionIn the non‐heart failure population, BNP levels predict AF recurrence following PVI in persistent AF patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Younes

Mekhael

Feng

et al. 2023

Pacing Clinical Electrophis

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“…The Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs. Conventional Catheter Ablation of Atrial Fibrillation (DE-CAAF II) sub study demonstrated that LA volume (LAV) was the strongest predictor of atrial arrhythmia recurrence after PVI in persistent AF patients [117]. Patients with a LAV less than 114 cc had 73% one-year freedom from recurrence of atrial arrhythmias, whereas patients with LAV greater than 114 cc had 53% freedom from recurrence of atrial arrhythmias, which worsened as LAV increased [117].…”

Section: Potential Candidates For Hybrid Af Therapiesmentioning

confidence: 99%

“…Conventional Catheter Ablation of Atrial Fibrillation (DE-CAAF II) sub study demonstrated that LA volume (LAV) was the strongest predictor of atrial arrhythmia recurrence after PVI in persistent AF patients [117]. Patients with a LAV less than 114 cc had 73% one-year freedom from recurrence of atrial arrhythmias, whereas patients with LAV greater than 114 cc had 53% freedom from recurrence of atrial arrhythmias, which worsened as LAV increased [117]. These findings were corroborated by the prospective randomized Left Atrial Appendage Ligation With the LARIAT™ Suture Delivery System as Adjunctive Therapy to Pulmonary Vein Isolation for Persistent or Longstanding Persistent Atrial Fibrillation (aMAZE) trial, in which the prespecified variable of LA size was associated with recurrence of AF following PVI.…”

Section: Potential Candidates For Hybrid Af Therapiesmentioning

confidence: 99%

“…The VATS hybrid arm had over an 85% efficacy rate of freedom from arrhythmias while catheter ablation 12-month efficacy was 41%. Combined with the data from the prospective randomized DECAAF and aMAZE trials where freedom from atrial arrhythmias were below 50% in patients with moderate to severely enlarged LA (magnetic resonance imaging or computerized tomography LA volumes greater than 130 cc) suggests that this patient population would benefit from hybrid therapy as a first line therapy [97,117].…”

Section: Potential Candidates For Hybrid Af Therapiesmentioning

confidence: 99%

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Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation

Wong,

Buch,

Beygui

et al. 2024

JCM

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Atrial fibrillation (AF) is a growing health problem that increases morbidity and mortality, and in most patients progresses to more advanced diseases over time. Recent research has examined the underlying mechanisms, risk factors, and progression of AF, leading to updated AF disease classification schemes. Although endocardial catheter ablation is effective for early-stage paroxysmal AF, it consistently achieves suboptimal outcomes in patients with advanced AF. Identification of the factors that lead to the increased risk of treatment failure in advanced AF has spurred the development and adoption of hybrid ablation therapies and collaborative heart care teams that result in higher long-term arrhythmia-free survival. Patients with non-paroxysmal AF, atrial remodeling, comorbidities, or AF otherwise deemed difficult to treat may find hybrid treatment to be the most effective option. Future research of hybrid therapies in advanced AF patient populations, including those with dual diagnoses, may provide further evidence establishing the safety and efficacy of hybrid endo-epicardial ablation as a first line treatment.

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Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial

Younes,

Sohns,

Akoum

et al. 2024

J Interv Card Electrophysiol

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Background Catheter ablation is recognized as an effective treatment for atrial fibrillation (AF). Despite its effectiveness, significant sex-specific differences have been observed, which influence the outcomes of the procedure. This study explores these differences in a cohort of patients with persistent AF. We aim to assess sex differences in baseline characteristics, symptoms, quality of life, imaging findings, and response to catheter ablation in patients with persistent AF. Methods This post hoc analysis of the DECAAF II trial evaluated 815 patients (161 females, 646 males). Between July 2016 and January 2020, participants were enrolled and randomly assigned to receive either personalized ablation targeting left atrial (LA) fibrosis using DE-MRI in conjunction with pulmonary vein isolation (PVI) or PVI alone. In this analysis, we aimed to compare female and male patients in the full cohort in terms of demographics, risk factors, medications, and outcomes such as AF recurrence, AF burden, LA volume reduction assessed by LGE-MRI before and 3 months after ablation, quality of life assessed by the SF-36 score, and safety outcomes. Statistical methods included t-tests, chi-square, and multivariable Cox regression. Results Females were generally older with more comorbidities and experienced higher rates of arrhythmia recurrence post-ablation (53.3% vs. 40.2%, p < 0.01). Females also showed a higher AF burden (21% vs. 16%, p < 0.01) and a smaller reduction in left atrial volume indexed to body surface area post-ablation compared to male patients (8.36 (9.94) vs 11.35 (13.12), p-value 0.019). Quality of life scores were significantly worse in females both pre- and post-ablation (54 vs. 66 pre-ablation; 69 vs. 81 post-ablation, both p < 0.01), despite similar improvements across sexes. Safety outcomes and procedural parameters were similar between male and female patients. Conclusion The study highlights significant differences in the outcomes of catheter ablation of persistent AF between sexes, with female patients showing worse quality of life, higher recurrence of AF and AF burden after ablation, and worse LA remodeling. Graphical Abstract

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Left Atrial Volume and Age Are the Strongest Predictors of Atrial Fibrillation Burden After Pulmonary Vein Isolation for Persistent Atrial Fibrillation- Findings From Decaaf Ii Randomized Controlled Trial

Cited by 4 publications

References 0 publications

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Baseline natriuretic peptides as a predictor of atrial fibrillation recurrence after radiofrequency‐based pulmonary vein isolation in a non‐heart failure population: A subanalysis from DECAAF II

Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation

Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial

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