The incremental benefit of non-pulmonary vein left atrial ablation in patients undergoing a repeat persistent atrial fibrillation ablation procedure

Goldenberg, Gustavo; Ono, M.; Aryana, Arash; Reddy, Vivek Y.; Saad, Eduardo; Singh, Steve K.; Singh, Sheldon M.

doi:10.1007/s10840-016-0204-8

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…Although the surgical effect is satisfactory, the long-term recurrence rate post-operative remains high, because non-PV areas other than PVI may be the source of initiation and maintenance of AF ( 28 – 30 ). The most common areas include the superior vena cava, the coronary sinus, the ligament of marshall, the crista terminalis, the LA posterior wall and the LAA ( 31 – 33 ). LAA is a finger-like projection extending from the main body of the LA and is primarily formed by the adsorption of the primordial PV and their branches ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: A systematic review and meta-analysis

Chen

Shi

et al. 2022

Front. Cardiovasc. Med.

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PurposeThere is increasing evidence that left atrial appendage flow velocity (LAAFV) is linked to the recurrence of atrial fibrillation (AF) after catheter ablation (CA), suggesting the potential predictable significance of LAAFV in this setting. We performed a systematic review and meta-analysis to assess whether LAAFV is association with AF recurrence after CA.MethodsUp to May 1, 2022, six databases (PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and CINAHL) were searched for literature reporting the association between LAAFV and AF recurrence after CA. All statistical analyses were carried out using STATA version 16 software. Heterogeneity was determined by the Cochrane’s Q test and I2 statistics. The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of each included study, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was adopted to evaluate the quality of evidence.ResultSixteen studies with 5,006 AF patients after CA (1,479 patients with AF recurrence, 3,527 without AF recurrence) were included in the meta-analysis. The meta-analysis of 15 studies (16 data sets) showed that patients with recurrence exhibited lower LAAFV values than those without recurrence [standardized mean difference (SMD): −0.65, 95% CI: −0.88 to −0.42, P < 0.01]. Moreover, we evaluated the association of LAAFV and the risk of AF recurrence after CA. Nine studies (11 data sets) defined LAAFV as continuous variables, and the pooled analysis suggested that for every 1 cm/s rise in LAAFV values, the risk of AF recurrence after CA decreased by 3% [Odds Ratio (OR): 0.97, 95% CI: 0.95 to 0.99, P < 0.01]. Seven studies defined LAAFV as categorical variables, and the pooled analysis showed that lower LAAFV were associated with an increased risk of AF recurrence after CA [OR: 2.28, 95% CI: 1.46 to 3.57, P < 0.01]. The subgroup analyses showed that the association between LAAFV and AF recurrence after CA was not significantly affected by the AF type and ablation procedure. The NOS indicated that included studies were moderate to high quality, while the GRADE assessment suggested a low certainty of the evidence.ConclusionLower LAAFV may be associated with an increased risk of AF recurrence after CA. Further studies with well designed and randomized studies for LAAFV should be conducted.Systematic review registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022333627].

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Section: Discussionmentioning

confidence: 99%

Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: A systematic review and meta-analysis

Chen

Shi

et al. 2022

Front. Cardiovasc. Med.

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“…While repeat ablation has been shown to be superior to medical therapy for patients with recurrent AF after ablation, there are no clear guidelines to recommend the best ablation technique for this population 4,9,24 . Studies on various techniques for substrate modification including left atrial roof lines, left atrial posterior wall lines, posterior wall isolation, superior vena cava isolation, and ablation of complex fractionated electrograms have yielded variable results 5,25 …”

Section: Discussionmentioning

confidence: 99%

“…If patients have recurrent AF after PVI, a second ablation is often pursued. FFAF after pulmonary vein reisolation (PVRI) remains suboptimal at 40% to 75%, with lower rates of FFAF if patients have nonparoxysmal atrial fibrillation (NPAF) before PVRI 4‐7 . There are limited data to guide ablation technique in patients who have recurrent AF after PVI 8,9 …”

Section: Introductionmentioning

confidence: 99%

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

Peigh

Wasserlauf

Kaplan

et al. 2020

Cardiovasc electrophysiol

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Introduction: Focal impulse and rotor modulation (FIRM) ablation can be used to target nonpulmonary vein (PV) sources of atrial fibrillation (AF). No published studies have compared freedom from atrial fibrillation (FFAF) after pulmonary vein reisolation (PVRI) plus FIRM to PVRI alone in patients with reconnected PVs undergoing repeat ablation. Methods: A 3:1 matched retrospective cohort study was performed on 21 patients with recurrent AF and PV reconnection who underwent PVRI plus FIRM-guided ablation and 63 patients with recurrent AF treated with PVRI alone at a single institution. All patients in the PVRI-alone cohort had cryoballoon PVRI at the time of repeat ablation without additional lesion sets for AF. Cases were matched based on the type of AF (paroxysmal vs nonparoxysmal), left atrial diameter (±4 mm), left ventricular ejection fraction (±10%), duration of AF (±18 months), and age (±5 years). The primary endpoint was FFAF after a 3-month blanking period. Results: Out of 53 total FIRM cases performed at Northwestern Memorial Hospital between 2015 and 2017, 21 patients had PVRI plus FIRM for recurrent AF with PV reconnection. These patients had an average of 3.3 ± 2.1 rotors (60% left atrial) ablated. Over a median follow-up time of 24.7 months (interquartile range, 13-36 months), patients in the PVRI-alone cohort demonstrated a higher rate of FFAF (n = 35; 55.6%) than patients in the PVRI plus FIRM-guided ablation cohort (n = 7; 33.3%) (logrank P = .049). Conclusion: In patients undergoing repeat ablation for AF with PV reconnection, PVRI plus FIRM did not increase FFAF compared to PVRI alone. K E Y W O R D S atrial fibrillation ablation, cryoballoon ablation, focal impulse and rotor modulation How to cite this article: Peigh G, Wasserlauf J, Kaplan RM, et al. Repeat pulmonary vein isolation with or without FIRM-guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection.

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High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

Călburean

Osório

Sieira

et al. 2020

J Interv Card Electrophysiol

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The incremental benefit of non-pulmonary vein left atrial ablation in patients undergoing a repeat persistent atrial fibrillation ablation procedure

Abstract: LA ablation in addition to pulmonary vein re-isolation during a repeat persistent AF ablation procedure was not associated with reduced arrhythmia recurrence after a repeat persistent AF ablation procedure.

Cited by 7 publications

References 10 publications

Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: A systematic review and meta-analysis

Left atrial appendage flow velocity predicts recurrence of atrial fibrillation after catheter ablation: A systematic review and meta-analysis

Repeat pulmonary vein isolation with or without FIRM‐guided ablation for recurrent atrial fibrillation with pulmonary vein reconnection

High parasympathetic activity as reflected by deceleration capacity predicts atrial fibrillation recurrence after repeated catheter ablation procedure

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