Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence

Sotomi, Yohei; Inoue, Koichi; Tanaka, Kõji; Toyoshima, Yuko; Oka, Takahiro; Tanaka, Nobuaki; Nozato, Yoichi; Orihara, Yoshiyuki; Koyama, Yasushi; Iwakura, Katsuomi; Sakata, Yasushi; Fujii, Kenshi

doi:10.1016/j.jjcc.2015.03.007

Cited by 18 publications

(20 citation statements)

References 24 publications

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“…Outcomes after ablation for L-PeAF are relatively poor and characterized by frequent failure, because of significantly advanced electrical and structural remodeling that occurs in these patients [16,17]. It has been reported that a longer duration of AF [18] and more advanced LA remodeling [19] are associated with a higher likelihood of recurrence after RFCA, and the results of our current study of patients with L-PeAF are consistent with these reports.…”

Section: Definition Of L-peaf and La Remodelingsupporting

confidence: 89%

Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Park

Lee

Yang

et al. 2017

Journal of Cardiology

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Section: Definition Of L-peaf and La Remodelingsupporting

confidence: 89%

Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Park

Lee

Yang

et al. 2017

Journal of Cardiology

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“…Reant et al analyzed the time course of post-ablation changes in LA chamber size using echocardiography and showed that LAV reduction was completed at 3 months post-ablation [8] . Some small-scale studies have reported that LAV reduction was positively associated with ablation outcomes during a short-term follow-up period [7] , [9] , [10] , [11] . Therefore, we validated the association between LARR and NPAF ablation outcomes over a longer follow-up period of 4 years.…”

Section: Discussionmentioning

confidence: 99%

“…We focused on the association between ERAT and LARR since they share two characteristics: i) both may occur during the same 90-day BP post ablation period, and ii) both showed an association with LR [7] , [9] , [10] , [11] . Therefore, we hypothesized that ERAT and LARR are closely associated.…”

Section: Discussionmentioning

confidence: 99%

“…Maintenance of sinus rhythm (SR) by AF ablation leads to a reduction in left atrial volume (LAV), which is referred to as left atrial reverse remodeling (LARR) [5] , [6] . LARR and ERAT have two common characteristics: they occur during the 90-day BP [7] , [8] and are associated with LR [7] , [9] , [10] , [11] . However, the association between ERAT and LARR has not been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Early recurrence during the blanking period and left atrial reverse remodeling after catheter ablation for non-paroxysmal atrial fibrillation

Oka

Koyama

Tanaka

et al. 2020

IJC Heart & Vasculature

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Background Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation. Methods We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0–7 days after ablation), Intermediate (N = 67, 8–30), and Late-ERAT (N = 70, 31–90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR. Results Late - ERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21–9.47, p = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups ( p < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; p = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06–0.27; p < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation. Conclusions Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.

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“…Interestingly, as we further explored the possible predictors, only LA diameter (HR adj = 1.067(1.028, 1.107)) and AF type (HR adj = 1.726(1.056, 2.822)) could significantly predict AF recurrence, which is in accordance with previous reports. Based on current knowledge, the contribution of comorbidities to the progression of AF is most likely the result of atrial remodeling and substrate modification, such as fibrosis . However, age and related comorbidities are sufficient but not necessary to modify the atrial substrate in every patient within a short follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

Zhang

Ren

Wang

et al. 2019

Cardiovasc electrophysiol

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Introduction Cryoballoon ablation (CBA) results in satisfactory outcomes for drug‐resistant atrial fibrillation (AF) patients. However, the efficacy and safety of CBA have not yet been tested in the Chinese elderly population. Therefore, this study compared the recurrence of AF and complications of CBA in patients ≥75 years and <75 years. Methods A total of 677 patients (<75 years, n = 550; ≥ 75 years, n = 127) with paroxysmal (n = 603) or persistent (n = 74) non‐valvular drug‐resistant AF were included. The efficacy was assessed by the recurrence of AF, and the safety was evaluated by peri‐ and post‐procedural complications. Results The CHA2DS2‐VASc (2.6 ± 1.7 vs 4.8 ± 1.6, P < .01) and HAS‐BLED (1.8 ± 0.8 vs 2.0 ± 0.8, P = .01) scores were significantly higher in the elderly group. The instant pulmonary vein isolation success rate was comparable (99.11% younger vs 98.98% older, P = .99). After a mean follow‐up time of 12.8 ± 9.6 months, the 1‐year freedom from AF rate was 80.6% vs 85.8% in the older and younger groups, respectively, while the survival analysis showed a nonsignificant difference in the rate of freedom from AF (log‐rank P = .46). Cox regression showed that age was not a predictive factor for AF recurrence and was not dichotomized (hazard ratio [HR] = 0.868, 95% confidence interval [CI] 0.509‐1.481; P = .6046) or continuous (HR = 0.990, 95% CI, 0.968‐1.012, P = .3642). Similar complications rates were observed, including stroke (1.0% younger vs 0.93% older, P = .95) and major hemorrhagic events (1.2% younger vs 0% elder, P = .25). Conclusions The efficacy and safety profiles of CBA in patients older than 75 years are comparable with those in younger patients.

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Persistent left atrial remodeling after catheter ablation for non-paroxysmal atrial fibrillation is associated with very late recurrence

Abstract: Persistent LA structural remodeling after initially successful CA for non-paroxysmal AF may be an important risk factor for VLR.

Cited by 18 publications

References 24 publications

Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Good responders to catheter ablation for long-standing persistent atrial fibrillation: Clinical and genetic characteristics

Early recurrence during the blanking period and left atrial reverse remodeling after catheter ablation for non-paroxysmal atrial fibrillation

Efficacy and safety of cryoballoon ablation for Chinese patients over 75 years old: A comparison with a younger cohort

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