Linking Electrical Drivers With Atrial Cardiomyopathy for the Targeted Treatment of Atrial Fibrillation

Ho, Gordon; Lin, Andrew; Krummen, David E.

doi:10.3389/fphys.2020.570740

Cited by 2 publications

(3 citation statements)

References 127 publications

(187 reference statements)

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“…In this study, performance of empiric linear ablation was not associated with reduced AF recurrence or composite endpoint. This is consistent with the results of the STAR-AF2 trial 7 which showed that empiric linear ablation or CFAE ablation was not associated with decreased AF recurrence.…”

Section: Empiric Linear Line Ablationsupporting

confidence: 91%

“…2,4 It is unclear whether additional ablations beyond PVI have any benefit in outcomes, although guidelines state that operators should consider more extensive ablation in recurrent AF. 7,8 The aim of the present study is to determine the prevalence of PV reconnections and non-PV organized atrial arrhythmias (atrial tachycardia [AT]/premature atrial contractions [PAC] and macro-reentrant atrial flutter [AFL]) in patients with recurrent AF undergoing repeat AF ablation and evaluate the impact of their ablation on clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation

Vanam

Darden

Munir

et al. 2022

J Interv Card Electrophysiol

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Background The mechanisms for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) catheter ablation are unclear. Non-PV organized atrial arrhythmias (PAC, AT, macro-reentrant AFL) are possible contributors; however the prevalence and effect of their ablation on recurrent AF are unknown. We hypothesize that the identification and ablation of non-PV organized atrial arrhythmias were associated with less AF recurrence. Methods Patients who underwent repeat ablation for recurrent AF after prior PVI were retrospectively enrolled. The prevalence and characteristics of PV reconnections and non-PV organized atrial arrhythmias were identified. The outcomes of time to clinical AF recurrence, heart failure (HF) hospitalization, and mortality were analyzed in patients using multivariable adjusted Cox regression. Results In 74 patients with recurrent AF (age 66 ± 9 years, left atrial volume index 38 ± 10 ml/m2, 59% persistent AF), PV reconnections were found in 46 patients (61%), macro-reentrant atrial flutter in 27 patients (36%), and focal tachycardia in 12 patients (16%). Mapping and ablation of non-PV organized atrial arrhythmias were associated with a reduced recurrence of late clinical AF (adjusted HR 0.26, CI 0.08–0.85, p = 0.03) and the composite outcome of recurrence of late AF, HF hospitalization, and mortality (adjusted HR 0.38, CI 0.17–0.85, p = 0.02), with median follow-up of 1.6 (IQR 0.7–6.3) years. The presence of PV reconnections or empiric linear ablation was not associated with reduction in clinical AF or composite endpoints. Conclusion The ablation of non-PV organized atrial arrhythmias resulted in a reduction of late clinical AF recurrence and composite outcome. In this challenging population, alternate mechanisms beyond PV reconnections need to be considered. Prospective studies are needed.

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Section: Empiric Linear Line Ablationsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation

Vanam

Darden

Munir

et al. 2022

J Interv Card Electrophysiol

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“…While the ultimate marker of ablation success remains long‐term freedom from AF, there are several advantages to studying first pass isolation. Comorbidities related to arrhythmia recurrence following AFA may exert effects either through a relationship to extra‐PV substrate, 3 or an impact on lesion formation. Focusing on an acute intraprocedural outcome like FPI may allow us to isolate the effects of such comorbidities on vein isolation only to provide mechanistic insights.…”

Section: Introductionmentioning

confidence: 99%

Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL‐AF registry

Kreidieh,

Hunter,

Goyal

et al. 2024

Cardiovasc electrophysiol

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IntroductionDuring atrial fibrillation ablation (AFA), achievement of first pass isolation (FPI) reflects effective lesion formation and predicts long‐term freedom from arrhythmia recurrence. We aim to determine the clinical and procedural predictors of pulmonary vein FPI.MethodsWe reviewed AFA procedures in a multicenter prospective registry of AFA (REAL‐AF). A multivariate ordinal logistic regression, weighted by inverse proceduralist volume, was used to determine predictors of FPI.ResultsA total of 2671 patients were included with 1806 achieving FPI in both vein sides, 702 achieving FPI in one, and 163 having no FPI. Individually, age, left atrial (LA) scar, higher power usage (50 W), greater posterior contact force, ablation index >350 posteriorly, Vizigo™ sheath utilization, nonstandard ventilation, and high operator volume (>6 monthly cases) were all related to improved odds of FPI. Conversely sleep apnea, elevated body mass index (BMI), diabetes mellitus, LA enlargement, antiarrhythmic drug use, and center's higher fluoroscopy use were related to reduced odds of FPI. Multivariate analysis showed that BMI > 30 (OR 0.78 [0.64–0.96]) and LA volume (OR per mL increase = 1.00 [0.99–1.00]) predicted lower odds of achieving FPI, whereas significant left atrial scarring (>20%) was related to higher rates of FPI. Procedurally, the use of high power (50 W) (OR 1.32 [1.05–1.65]), increasing force posteriorly (OR 2.03 [1.19–3.46]), and nonstandard ventilation (OR 1.26 [1.00–1.59]) predicted higher FPI rates. At a site level, high procedural volume (OR 1.89 [1.48–2.41]) and low fluoroscopy centers (OR 0.72 [0.61–0.84]) had higher rates of FPI.ConclusionFPI rates are affected by operator experience, patient comorbidities, and procedural strategies. These factors may be postulated to impact acute lesion formation.

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Linking Electrical Drivers With Atrial Cardiomyopathy for the Targeted Treatment of Atrial Fibrillation

Cited by 2 publications

References 127 publications

Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation

Characteristics and outcomes of recurrent atrial fibrillation after prior failed pulmonary vein isolation

Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL‐AF registry

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