Predictors of Recurrence of AF in Patients After Radiofrequency Ablation

Garvanski, Iskren; Симова, Яна; Angelkov, Lazar; Matveev, Mikhail

doi:10.15420/ecr.2019.30.2

Cited by 29 publications

(31 citation statements)

References 53 publications

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“…The most challenging issue in managing patients with AF is identifying those predictors for unsuccessful ablation. A large number of studies determined the risk factors for poor outcome following PVI as nonparoxysmal AF (particularly longstanding persistent AF), LA dilatation and higher CHA 2 DS 2 -VASc score, which was con rmed in our trial [2,8,9,12]. In our study, MV ordinal logistic regression analysis found an independent association between PVIOD and LA diameter, CHA 2 DS 2 -VASc score and AF type.…”

Section: Discussionsupporting

confidence: 79%

“…In the modern era, after multiple catheter ablations and additional substrate modi cation (ASM), long-term success was 62-79.5% in paroxysmal AF, 46.2-68.2% in persistent AF and 39-41% in longstanding persistent AF [3][4][5][6][7]. Many studies have explored the predictors of arrhythmia recurrence, such as non-paroxysmal AF, female sex, longer AF duration prior to the catheter ablation, sleep apnea, obesity, elderly patients, hypertension, structural heart disease, enlarged left atrial (LA) diameter, higher CHADS 2 , CHA 2 DS 2 -VASc, MB-LATER and APPLE scores, low LA voltage, C-reactive protein and increased LA brosis detected by cardiac magnetic resonance imaging [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Left atrial diameter, CHA2DS2-VASc score and type of atrial fibrillation predict pulmonary vein isolation outcome

Jurcevic

Angelkov

Ristic

et al. 2021

Preprint

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Purpose Pulmonary vein isolation (PVI) is the most effective treatment strategy for atrial fibrillation (AF). This study evaluated Pulmonary Vein Isolation Outcome Degree (PVIOD) as a new semi-quantitative measure for PVI success after a 7-year follow-up and determined predictors associated with PVIOD.Methods We enrolled 117 patients with symptomatic AF who underwent PVI and after a 7-year follow-up applied PVIOD with 4 possible outcomes. PVIOD 1 group included patients with successful single PVI. PVIOD 2 group included patients with efficacy after ≥ 2 re-PV isolation and/or additional substrate modification (ASM). PVIOD 3 group contained subjects with clinical success after PVI±ASM. Patients with procedural and clinical failure were in PVIOD 4 group.Results In multivariate ordinal logistic regression analysis PVIOD was independently associated with longstanding persistent AF with paroxysmal AF as referent category: odds ratio (OR) 4.1, 95% confidence interval (95% CI) 1.3-12.8 (P=0.014), left atrial (LA) diameter: OR 1.2, 95% CI 1.1-1.3 (P<0.001) and CHA2DS2-VASc score: OR 1.5, 95% CI 1.0-2.2 (P=0.039). LA size, CHA2DS2-VASc score and AF type predicted 7-year probability for procedural and procedural with clinical failure. LA diameter >41mm (AUC 0.741, 95% CI 0.6-0.8, P<0.001) and CHA2DS2-VASc score ≥2 (AUC 0.718, 95% CI 0.6-0.8, P<0.001) predicted long-term procedural and clinical failure. Conclusion PVIOD is a new classification for PVI success. LA diameter, CHA2DS2-VASc score and AF type are independently associated with PVIOD and predict procedural and procedural with clinical failure after the 7-year follow-up. LA diameter >41mm and CHA2DS2-VASc score ≥2 predict long-term PVI failure.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Left atrial diameter, CHA2DS2-VASc score and type of atrial fibrillation predict pulmonary vein isolation outcome

Jurcevic

Angelkov

Ristic

et al. 2021

Preprint

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“…Many recent references showed that P-wave duration decreases once catheter ablation ends [ 11 , 14 , 15 , 17 , 18 , 37 ], and heart rate increases (RR interval decreases) [ 38 , 39 , 40 ]. Our results are in line with these previous references.…”

Section: Discussionmentioning

confidence: 99%

“…Shortened P-wave duration is associated with a successful PVI outcome and lower rates of AF recurrence. However, despite the growing knowledge in the field, the identification of changes induced in the atrial substrate that yield a successful PVI are of paramount importance for the clinical management of the arrhythmia [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Ortigosa

Cano

Sandberg

2021

Sensors

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Atrial fibrillation is the most common type of cardiac arrhythmia in clinical practice. Currently, catheter ablation for pulmonary-vein isolation is a well-established treatment for maintaining sinus rhythm when antiarrhythmic drugs do not succeed. Unfortunately, arrhythmia recurrence after catheter ablation remains common, with estimated rates of up to 45%. A better understanding of factors leading to atrial-fibrillation recurrence is needed. Hence, the aim of this study is to characterize changes in the atrial propagation pattern following pulmonary-vein isolation, and investigate the relation between such characteristics and atrial-fibrillation recurrence. Fifty patients with paroxysmal atrial fibrillation who had undergone catheter ablation were included in this study. Time-segment and vectorcardiogram-loop-morphology analyses were applied to characterize P waves extracted from 1 min long 12-lead electrocardiogram segments before and after the procedure, respectively. Results showed that P-wave vectorcardiogram loops were significantly less round and more planar, P waves and PR intervals were significantly shorter, and heart rate was significantly higher after the procedure. Differences were larger for patients who did not have arrhythmia recurrences at 2 years of follow-up; for these patients, the pre- and postprocedure P waves could be identified with 84% accuracy.

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“…AF ablation is associated with various recurrence rates, mostly due to patient-specific preprocedural factors and specific procedural factors [ 14 ]. Predictors of recurrence after AF ablation divided depending on underling structural, electrical, and autonomic substrate [ 14 , 15 ]. In this study, age, non-paroxysmal AF, overweight/obesity, hypertension, diabetes mellitus, LA diameter, MR LGE, and AF duration were found to be associated with AF recurrence by univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation

Baek

Choi

Lee

et al. 2020

JCM

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Prediction of recurrences after catheter ablation of atrial fibrillation (AF) remains challenging. We sought to investigate the long-term outcomes after AF catheter ablation. A total of 2221 consecutive patients who underwent catheter ablation for symptomatic AF were included in this study (mean age 55 ± 11 years, 20.3% women, and 59.0% paroxysmal AF). Extensive ablation, in addition to circumferential pulmonary vein isolation, was more often accomplished in patients with non-paroxysmal AF than in those with paroxysmal AF (87.4% vs. 25.3%, p < 0.001). During a median follow-up of 54 months, sinus rhythm (SR) was maintained in 67.1% after index procedure. After redo procedures in 418 patients, 83.3% exhibited SR maintenance. Recurrence rates were similar for single and multiple procedures (17.4% vs. 16.7%, p = 0.765). Subanalysis showed that the extent of late gadolinium enhancement (LGE), as assessed by cardiac magnetic resonance, is greater in patients with recurrence than in those without recurrence (36.2 ± 23.9% vs. 21.8 ± 13.7%, p < 0.001). Cox-regression analysis revealed that non-paroxysmal AF (hazard ratio (HR) 2.238, 95% confidence interval (CI) 1.905–2.629, p < 0.001), overweight (HR 1.314, 95% CI 1.107–1.559, p = 0.020), left atrium dimension ≥ 45 mm (HR 1.284, 95% CI 1.085–1.518, p = 0.004), AF duration (HR 1.020 per year, 95% CI 1.006–1.034, p = 0.004), and LGE ≥ 25% (HR 1.726, 95% CI 1.330–2.239, p < 0.001) are significantly associated with AF recurrence after catheter ablation. This study showed that repeated catheter ablation improves the clinical outcomes of patients with non-paroxysmal AF, suggesting that AF substrate based on LGE may underpin the mechanism of recurrence after catheter ablation.

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Predictors of Recurrence of AF in Patients After Radiofrequency Ablation

Cited by 29 publications

References 53 publications

Left atrial diameter, CHA2DS2-VASc score and type of atrial fibrillation predict pulmonary vein isolation outcome

Left atrial diameter, CHA2DS2-VASc score and type of atrial fibrillation predict pulmonary vein isolation outcome

Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Atrial Substrate Underlies the Recurrence after Catheter Ablation in Patients with Atrial Fibrillation

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