Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Takigawa, Masateru; Takahashi, Atsushi; Kuwahara, Taishi; Okubo, Kenji; Takahashi, Yoshihide; Watari, Yuji; Takagi, Katsumasa; Fujino, Tadashi; Kimura, Shigeki; Hikita, Hiroyuki; Tomita, Makoto; Hirao, Kazuyuki; Isobe, Mitsuaki

doi:10.1161/circep.113.000471

Cited by 95 publications

(40 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 Several published reports have provided information on the outcomes of AF ablation. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] A meta-analysis evaluating studies reporting >3 years of outcome after catheter ablation (CA) found that nearly 80% multiprocedure success rates can be achieved in patients with PAF. 21 Few series have reported long-term outcomes of AF ablation over 5 years.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

“…21 Few series have reported long-term outcomes of AF ablation over 5 years. 4,[6][7][8][9][10][12][13][14][15][16] However, data on long-term follow-up of PVAI are limited, which would provide valuable information regarding the efficacy and safety of CA and necessity of repeat procedures. Therefore, we sought to assess the outcome of PVAI in patients with PAF over a follow-up period of more than a decade.…”

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background-We report the outcome of pulmonary vein (PV) antrum isolation in paroxysmal atrial fibrillation (AF) patients over more than a decade of follow-up. Methods and Results-A total of 513 paroxysmal AF patients (age 54±11 years, 73% males) undergoing catheter ablation at our institutions were included in this analysis. PV antrum isolation extended to the posterior wall between PVs plus empirical isolation of the superior vena cava was performed in all. Non-PV triggers were targeted during repeat procedure(s). Follow-up was performed quarterly for the first year and every 6 to 9 months thereafter. The outcome of this study was freedom from recurrent AF/atrial tachycardia. At 12 years, single-procedure arrhythmia-free survival was achieved in 58.7% of patients. Overall, the rate of recurrent arrhythmia (AF/atrial tachycardia) was 21% at 1 year, 11% between 1 and 3 years, 4% between 3 and 6 years, and 5.3% between 6 and 12 years. Repeat procedure was performed in 74% of patients. Reconnection in the PV antrum was found in 31% of patients after a single procedure and in no patients after 2 procedures. Non-PV triggers were found and targeted in all patients presenting with recurrent arrhythmia after ≥2 procedures. At 12 years, after multiple procedures, freedom from recurrent AF/atrial tachycardia was achieved in 87%. Conclusions-In patients with paroxysmal AF undergoing extended PV antrum isolation, the rate of late recurrence is lower than what previously reported with segmental or less extensive antral isolation. However, over more than a decade of follow-up, nearly 14% of patients developed recurrence because of new non-PV triggers. (Circ Arrhythm Electrophysiol. 2016;9:e003660.

show abstract

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

Section: See Editorial By Kumar and Michaudmentioning

confidence: 99%

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Gökoğlan¹,

Mohanty²,

Güneş³

et al. 2016

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…ATRIAL FIBRILLATION (AF), a rapid irregular rhythm of the atria, is associated with electrical, functional, and structural changes in the atria that promote the substrate for its recurrence and progression (36,53,60). The incidence and prevalence of AF increase with advancing age and aging-associated diseases such as hypertension, ischemic heart disease, and heart failure (2,40) and contribute to increased morbidity, particularly an increased risk for stroke, heart failure, and death (25,52).…”

mentioning

confidence: 99%

Selective downregulation of mitochondrial electron transport chain activity and increased oxidative stress in human atrial fibrillation

Emelyanova

Ashary

Cosic

et al. 2016

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

Selective downregulation of mitochondrial electron transport chain activity and increased oxidative stress in human atrial fibrillation. Am J Physiol Heart Circ Physiol 311: H54 -H63, 2016. First published May 6, 2016 doi:10.1152/ajpheart.00699.2015Mitochondria are critical for maintaining normal cardiac function, and a deficit in mitochondrial energetics can lead to the development of the substrate that promotes atrial fibrillation (AF) and its progression. However, the link between mitochondrial dysfunction and AF in humans is still not fully defined. The aim of this study was to elucidate differences in the functional activity of mitochondrial oxidative phosphorylation (OXPHOS) complexes and oxidative stress in right atrial tissue from patients without (non-AF) and with AF (AF) who were undergoing open-heart surgery and were not significantly different for age, sex, major comorbidities, and medications. The overall functional activity of the electron transport chain (ETC), NADH:O2 oxidoreductase activity, was reduced by 30% in atrial tissue from AF compared with non-AF patients. This was predominantly due to a selective reduction in complex I (0.06 Ϯ 0.007 vs. 0.09 Ϯ 0.006 nmol·min Ϫ1 ·citrate synthase activity Ϫ1 , P ϭ 0.02) and II (0.11 Ϯ 0.012 vs. 0.16 Ϯ 0.012 nmol·min Ϫ1 ·citrate synthase activity Ϫ1 , P ϭ 0.003) functional activity in AF patients. Conversely, complex V activity was significantly increased in AF patients (0.21 Ϯ 0.027 vs. 0.12 Ϯ 0.01 nmol·min Ϫ1 ·citrate synthase activity Ϫ1 , P ϭ 0.005). In addition, AF patients exhibited a higher oxidative stress with increased production of mitochondrial superoxide (73 Ϯ 17 vs. 11 Ϯ 2 arbitrary units, P ϭ 0.03) and 4-hydroxynonenal level (77.64 Ϯ 30.2 vs. 9.83 Ϯ 2.83 ng·mg Ϫ1 protein, P ϭ 0.048). Our findings suggest that AF is associated with selective downregulation of ETC activity and increased oxidative stress that can contribute to the progression of the substrate for AF. atrial fibrillation; humans; mitochondria; electron transport chain complexes; oxidative phosphorylation; oxidative stress; superoxide; 4-hydroxynonenal protein adducts NEW & NOTEWORTHYThe study provides evidence of a selective downregulation of mitochondrial electron transport chain functional activity predominantly affecting complexes I and II and associated increase ATRIAL FIBRILLATION (AF), a rapid irregular rhythm of the atria, is associated with electrical, functional, and structural changes in the atria that promote the substrate for its recurrence and progression (36, 53, 60). The incidence and prevalence of AF increase with advancing age and aging-associated diseases such as hypertension, ischemic heart disease, and heart failure (2, 40) and contribute to increased morbidity, particularly an increased risk for stroke, heart failure, and death (25,52). Although the pathophysiology of AF has been well characterized, the underlying mechanisms that contribute to the progression of AF in human atria have not been fully defined (33,35,57,58,60). Mitochondria, occupying 30% ...

show abstract

“…Several patient factors reduce the effectiveness of AF ablation, including duration of AF, age, concomitant cardiac disease, obesity, obstructive sleep apnoea, left atrium size and left ventricular function. 6 Success of ablation is defined as freedom from AF at a particular timepoint, but this outcome can differ between studies depending on the duration of the blanking period (ie the period after ablation when recurrence of AF is censored), the frequency of arrhythmia monitoring, whether atrial tachycardia is thought to be a recurrence and the use of antiarrhythmic drugs. Because ablation is predominantly performed for patients' symptoms, measures of quality of life, symptom scores and patient-reported outcomes should be considered.…”

Section: Current Evidence On Efficacy and Safety Of Catheter Ablationmentioning

confidence: 99%

The role of catheter ablation in the management of atrial fibrillation

Ang

Earley

2016

Clinical Medicine

View full text Add to dashboard Cite

Atrial fi brillation is driven by spontaneous electrical activation emerging from the pulmonary veins. Catheter ablation using either radiofrequency or cryothermal energy electrically isolates these veins from the left atrium, both reducing the burden of atrial fi brillation episodes and improving the patient's symptoms. Catheter ablation is superior to antiarryhthmic drugs when patients are carefully selected. Underlying medical problems -including obesity, hypertension and obstructive sleep apnoea -should be optimally treated before considering ablation. Although this treatment has the potential to cure patients of their symptoms, they should be aware of the important associated procedural complications. IntroductionAtrial fibrillation (AF) is a massive problem in the ageing UK population, and catheter ablation offers the current generation of physicians a curative treatment strategy. A discussion of ablation requires an understanding of the electrophysiology underlying AF, so in this article we review the types and mechanisms of AF, summarise the catheter ablation technologies currently available and discuss the evidence and guidelines supporting their use. We conclude by looking at future developments for this exciting field. Types and mechanisms of AFThe natural history of AF is to progress from short paroxysms that self-terminate, to longer episodes that will not terminate spontaneously (ie are persistent) and finally to the point when the atria can no longer support sinus rhythm -ie permanent AF. The precise definitions are provided in Box 1. Longstanding persistent AF is a useful term when assessing the outcomes of AF ablation because it is associated with worse outcomes than paroxysmal AF or AF of short duration. Fig 1 summarises the mechanisms that are important in the initiation and maintenance of AF.Paroxysmal AF is initiated primarily by ectopic beats originating from the pulmonary veins, 1 although other ABSTRACTThe role of catheter ablation in the management of atrial fibrillation anatomical sites of triggers are recognised, such as the superior vena cava. 2 The pulmonary veins have unique ion channel distribution and electrophysiological properties such that automatic activity and local re-entry circuits within the muscular sleeves of these veins generate ectopic beats.3 A series of atrial ectopic beats emerging from the pulmonary veins at a high frequency (3-10 Hz) cannot be conducted across the rest of the atria in a 1:1 fashion, so electrical wavefronts break up causing activation of the atria to degenerate into a heterogeneous or chaotic pattern, easily recognised on the surface electrocardiogram as fibrillation waves. However, the long refractory periods of atrial tissue will not perpetuate these multiple wavefronts so that, when the pulmonary veins stop firing, AF terminates.An episode of AF results in electrical (and later structural) remodelling of the atrial myocardium (shortening its refractory periods) and allows for the AF to be perpetuated even when the original triggers are removed ...

show abstract

Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation

Cited by 95 publications

References 36 publications

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Pulmonary Vein Antrum Isolation in Patients With Paroxysmal Atrial Fibrillation

Selective downregulation of mitochondrial electron transport chain activity and increased oxidative stress in human atrial fibrillation

The role of catheter ablation in the management of atrial fibrillation

Contact Info

Product

Resources

About