Comparison of prognosis and outcomes of catheter ablation versus drug therapy in patients with atrial fibrillation and stable coronary artery disease: A prospective propensity‐score matched cohort study

BackgroundAtrial fibrillation (AF) and stable coronary artery disease (SCAD) frequently coexist.HypothesisTo investigate the prognosis of catheter ablation versus drug therapy in patients with AF and SCAD.MethodsIn total, 25 512 patients with AF in the Chinese AF Registry between 2011 and 2019 were screened for SCAD. 815 patients with AF and SCAD underwent catheter ablation therapy were matched with patients by drug therapy in a 1:1 ratio. Primary end point was composite of thromboembolism, coronary events, major bleeding, and all‐cause death. The secondary endpoints were each component of the primary endpoint and AF recurrence.ResultsOver a median follow‐up of 45 ± 23 months, the patients in the catheter ablation group had a higher AF recurrence‐free rate (53.50% vs. 18.41%, p < .01). In multivariate analysis, there was no significant difference between the strategy of catheter ablation and drug therapy in primary composite end point (adjusted HR 074, 95%CI 0.54–1.002, p = .0519). However, catheter ablation was associated with fewer all‐cause death independently (adjusted HR 0.36, 95%CI 0.22–0.59, p < .01). In subgroup analysis, catheter ablation was an independent risk factor for all‐cause death in the high‐stroke risk group (adjusted HR 0.39, 95%CI 0.23–0.64, p < .01), not in the low‐medium risk group (adjusted HR 0.17, 95%CI 0.01–2.04, p = .17).ConclusionsIn the patients with AF and SCAD, catheter ablation was not independently associated with the primary composite endpoint compared with drug therapy. However, catheter ablation was an independent protective factor of all‐cause death     

Diabetes and atrial fibrillation in hospitalized patients in the United States

BackgroundData on the burden of atrial fibrillation (AF) associated with diabetes among hospitalized patients are scarce. We assessed the AF‐related hospitalizations trends in patients with diabetes, and compared AF outcomes in patients with diabetes to those without diabetes.HypothesisAF‐related health outcomes differ between patient with diabetes and without diabetes.MethodsUsing the National Inpatient Sample (NIS) 2004–2014, we studied trends in AF hospitalization rate among diabetic patients, and compared in‐hospital case fatality rate, length of stay (LOS), cost and utilization of rhythm control therapies, and 30‐day readmission rate between patients with and without diabetes. Logistic or Cox regression models were used to assess the differences in AF outcomes by diabetes status.ResultsOver the study period, there were 4 325 522 AF‐related hospitalizations, of which 1 075 770 (24.9%) had a diagnosis of diabetes. There was a temporal increase in AF hospitalization rate among diabetic patients (10.4 to 14.4 per 1000 hospitalizations among patients with diabetes; +4.4% yearly change, p‐trend < .0001). Among AF patients, those with diabetes had a lower in‐hospital mortality (adjusted odds ratio [aOR]: 0.68; 95% CI: 0.65–0.72) and LOS (aOR: 0.95; 95% CI: 0.94–0.96), but no difference in costs (aOR: 0.95; 95% CI: 0.94–0.96) and a higher 30‐day rate of readmissions compared with no diabetes (aHR 1.05; 95% CI: 1.01–1.08), compared to individuals without diabetes.ConclusionAF and diabetes coexist among hospitalized patients, with rising trends over the last decade. Diabetes is associated with lower rates in‐hospital adverse AF outcomes, but a higher 30‐day readmission risk.     

Effect of electrical cardioversion on 1‐year outcomes in patients with early recurrence after catheter ablation for atrial fibrillation

BackgroundAtrial fibrillation (AF) recurrence is common in the 3‐month blanking‐period after catheter ablation, during which electrical cardioversion (ECV) is usually performed to restore sinus rhythm. Whether ECV can affect the clinical outcome of post‐ablation AF patients is inconsistent, however. We aimed to explore the 1‐year effect of ECV on AF recurrence and rehospitalization in patients experienced recurrence within 3‐month after AF catheter ablation.MethodsPatients who experienced recurrence within 3‐month after AF catheter ablation procedure were enrolled from the China Atrial Fibrillation Registry (China‐AF). A 1:3 Propensity score matching (PSM) method was applying to adjust the confounders between patients who had been treated by ECV or not. Logistic regression models were conducted to evaluate the association of ECV with 1‐year AF recurrence and rehospitalization.ResultsIn this study, 2961 patients experienced AF recurrence within 3‐month after the procedure, and 282 of them underwent successful ECV, 2155 patients did not undergo ECV. One‐year AF recurrence rates were 56.4% in ECV group versus 65.4% in non‐ECV group (p = .003), and were 55.9% versus 65.9%, respectively, after PSM (adjusted odds ratio [OR] 0.66; 95% confidence interval (CI): 0.49–0.88, p = .005). However, the difference of 1‐year rehospitalization rates between two groups were not statistically significant before (ECV group: 23.7% vs. non‐ECV group: 22.3%, p = .595) and after PSM (ECV group: 24.4% vs. non‐ECV group: 21.6%, adjusted OR1.14; 95% CI 0.81–1.62, p = .451).ConclusionsSuccessful ECV was associated with lower rate of one‐year recurrence in patients with early recurrent AF after catheter ablation.     

Defibrillation threshold of internal cardioversion prior to ablation predicts atrial fibrillation recurrence

BackgroundMany studies have reported the predictors of atrial fibrillation (AF) recurrence after persistent AF (peAF) ablation. However, the correlation between the atrial defibrillation threshold (DFT) for internal cardioversion (IC) and AF recurrence rate is unknown. Here we investigated the relationship between the DFT prior to catheter ablation for peAF and AF recurrence.HypothesisDFT prior to ablation was the predictive factor for AF recurrence after peAF ablation.MethodsFrom June 2016 to May 2019, we enrolled 82 consecutive patients (mean age, 65.0 ± 12.4 years), including 45 with peAF and 37 with long‐standing peAF, at Hamamatsu Medical Center. To assess the DFT, we performed IC with gradually increasing energy prior to radiofrequency application.ResultsForty‐nine and 33 patients showed DFT values less than or equal to 10 J (group A) and greater than 10 J or unsuccessful defibrillation (group B). During the mean follow‐up duration of 20.5 ± 13.1 months, patients in group B showed significantly higher AF recurrence rates than those in group A after the ablation procedure (p = .017). Multivariate analysis revealed that DFT was the only predictive factor for AF recurrence (odds ratio, 1.07; 95% CI, 1.00–1.13, p = .047).ConclusionsThe DFT for IC was among the strongest prognostic factors in the peAF ablation procedure.     

A predictive model using left atrial function and B‐type natriuretic peptide level in predicting the recurrence of early persistent atrial fibrillation after radiofrequency ablation

AimA predictive model using left atrial function indexes obtained by real‐time three‐dimensional echocardiography (RT‐3DE) and the blood B‐type natriuretic peptide (BNP) level was constructed, and its value in predicting recurrence in patients with early persistent atrial fibrillation (AF) after radiofrequency ablation was explored.MethodsA total of 228 patients with early persistent AF who were scheduled to receive the first circular pulmonary vein ablation (CPVA) were enrolled. Clinical data of patients were collected: (1) The blood BNP level was measured before radiofrequency ablation; (2) RT‐3DE was used to obtain the left atrial (LA) time‐volume curve; (3) The clinical characteristics, BNP level and LA function parameters were compared, and logistic regression was used to construct a prediction model with combined parameters; (4) The receiver operating characteristic (ROC) curve was used to examine the diagnostic efficacy of the model.Results(1) 215 patients with early persistent AF completed CPVA and the follow‐up. After 3–6 months of follow‐up, the patients were divided into sinus rhythm group (160 cases) and recurrence group (55 cases); (2) The recurrence group showed higher minimum LA volume index, diastolic ejection index, and preoperative BNP (all p ≤ .001), while the sinus rhythm group exhibited higher expansion index (PI) and left atrial appendage peak emptying velocity (p ≤ .001); (3) In univariate analysis, BNP level had the best diagnostic performance in predicting the recurrence of AF(AUC = 0.703). We constructed a model based on LA function and BNP level to predict the recurrence of persistent AF after CPVA. This combined model was better than BNP alone in predicting the recurrence of persistent AF after CPVA (AUC: 0.814 vs. 0.703, z = 2.224, p = .026).ConclusionThe combined model of LA function and blood BNP level has good predictive value for the recurrence of early persistent AF after CPVA.     

Atrial fibrillation catheter ablation complications in obese and diabetic patients: Insights from the US Nationwide Inpatient Sample 2005–2013

BackgroundObesity and diabetes are risk factors for atrial fibrillation (AF) incidence and recurrence after catheter ablation. However, their impact on post‐ablation complications in real‐world practice is unknown.ObjectivesWe examine annual trends in AF ablations and procedural outcomes in obese and diabetic patients in the US and whether obesity and diabetes are independently associated with adverse outcomes.MethodsUsing the Nationwide Inpatient Sample (2005–2013), we identified obese and diabetic patients admitted for AF ablation. Common complications were identified using ICD‐9‐CM codes. The primary outcome included the composite of any in‐hospital complication or death. Annual trends of the primary outcome, length‐of‐stay (LOS) and total‐inflation adjusted hospital charges were examined. Multivariate analyses studied the association of obesity and diabetes with outcomes.ResultsAn estimated 106 462 AF ablations were performed in the US from 2005 to 2013. Annual trends revealed a gradual increase in ablations performed in obese and diabetic patients and in complication rates. The overall rate of the primary outcome in obese was 11.7% versus 8.2% in non‐obese and 10.7% in diabetic versus 8.2% in non‐diabetic patients (p < .001).ConclusionsObesity was independently associated with increased complications (adjusted OR, 95% CI:1.39, 1.20–1.62), longer LOS (1.36, 1.23–1.49), and higher charges (1.16, 1.12–1.19). Diabetes was only associated with longer LOS (1.27, 1.16–1.38). Obesity, but not diabetes, in patients undergoing AF ablation is an independent risk factor for immediate post‐ablation complications and higher costs. Future studies should investigate whether weight loss prior to ablation reduces complications and costs.     

Remote magnetic‐guided ablation for three origins of idiopathic ventricular arrhythmias with right bundle branch block and superior axis

BackgroundIdiopathic ventricular arrhythmias (IVAs) with right bundle branch block (RBBB) and superior axis commonly originate from posterior mitral annulus (PMA), the left ventricular (LV) posterior fascicle (LPF), and the LV posterior papillary muscles (PPM).HypothesisRemote magnetic navigation (RMN)‐guided ablation might be safe and effective for these three origins of IVAs.MethodsThirty consecutive IVA patients with RBBB and superior axis (11 MPA‐IVAs, 11 LPF‐IVAs, and 8 PPM‐IVAs) were included in this study. Electrical mapping and ablation with RMN were performed in the LV through a trans‐septal approach. Navigation index, defined as the ratio of total radiofrequency (RF) time and the time from first burn to last burn, was used to determine the efficiency of RMN‐guided ablation.ResultsThe overall acute success rate was achieved in 93% (PMA, 100%; LPF, 91%; PPM, 88%; p > 0.05). No complication occurred in this study. The procedure time of PPM‐IVAs group was 34 and 14 min longer when compared with MPA‐IVAs and LPF‐IVAs group, respectively, without an increase of X‐ray time. The mean navigation index was 0.45 ± 0.20. The PPM‐IVAs group had an underperforming navigation index value (0.29 ± 0.11) (p < 0.01), as longer RF time was required in the PPM‐IVAs group.ConclusionsRMN‐guided ablation can achieve a high acute success rate for IVAs with RBBB and superior axis. The lower navigation index for PPM‐IVAs indicated that increasing the RF time and improving the catheter contact should be considered when using RMN.     

Outcome of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy: A comparison with medical therapy

ObjectiveThe aim of this study was primarily to determine efficacy after alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class II) with hypertrophic obstructive cardiomyopathy (HOCM), as compared to medical therapy.MethodsThis retrospective study included 163 mildly symptomatic patients with HOCM evaluated in Beijing Anzhen Hospital between March 2001 and August 2019, consisting of the medical group (n = 105) and the ASA group (n = 58). All‐cause mortality and HCM‐related death were mainly observed.ResultsFollow‐up was completed in 161 patients and the median follow‐up was 6.0 years. Compared to medically treated patients, patients post‐ASA had comparable survival free of all‐cause mortality (98.3% and 95.1% vs. 93.0% and 83.1% at 5 and 10 years, respectively; p = 0.374). Survival free of HCM‐related death was also similar between ASA and medical groups (98.3% and 95.1% vs. 94.3% and 86.2% at 5 and 10 years, respectively; p = 0.608). However, compared to medical therapy, ASA had advantages on the improvement of NYHA class (1.4 ± 0.6 vs. 2.1 ± 0.5, p = .000) and lower occurrence of new‐onset atrial fibrillation (AF) (7.8% vs. 20.4%, p = .048). Multivariate analysis demonstrated that resting LVOT gradient at the last clinical check‐up was an independent predictor of all‐cause mortality (HR = 1.021, 95%CI 1.002–1.040, p = .027).ConclusionThis registry suggests that mildly symptomatic patients with HOCM treated with ASA have comparable survival to that of medically treated patients, with the improvement of NYHA class and lower occurrence of new‐onset AF. All‐cause mortality is independently associated with resting LVOT gradient at the last clinical check‐up.     

Predictors of rhythm outcomes after cardiac resynchronization therapy in atrial fibrillation patients: When should we use an atrial lead?

BackgroundCardiac resynchronization therapy (CRT) is widely used in atrial fibrillation (AF) patients and could impact rhythm stability.HypothesisWe aimed to identify predictors of sinus rhythm (SR) stability or AF progression in a real‐word cohort of CRT‐AF patients.MethodsFrom 330 consecutive implantable cardioverter‐defibrillator implantations due to ischemic or dilated cardiomyopathy, 65 (20%) patients with AF history (paroxysmal, n = 32) underwent a CRT implantation with an atrial electrode and were regularly followed every 4–6 months. Rhythm restoration was attempted for most AF patients based on symptoms, biventricular pacing (BP), and lack of thrombi.ResultsAfter 33 months, 18 (28%) patients progressed to permanent mode switch (MS≥99%) and 20 (31%) patients had stable SR (MS < 1%). Logistic regression showed that history of persistent AF (OR: 8.01, 95%CI: 2.0–31.7, p = .003) is associated with higher risk of permanent MS. In persistent AF patients, a bigger left atrium (OR: 1.2 per mm, 95%CI: 1.03–1.4, p = .025) and older age (OR: 1.15 per life‐year, 95%CI: 1.01–1.3, p = .032) were predictors of future permanent MS. Paroxysmal AF at implantation (OR: 5.96, 95%CI: 1.6–21.9, p = .007) and increased BP (OR: 1.4 per 1%, 95%CI: 1.05–1.89, p = .02) were associated with stable SR. In persistent AF patients, stable SR correlated with higher BP (98 ± 2 vs. 92 ± 8%, p < .001).ConclusionIn patients with AF undergoing CRT implantation, persistent AF, LA dilatation and advanced age relate to future permanent MS (AF), whereas high BP promotes SR stability. These findings could facilitate the management of CRT‐AF patients and guide therapy in order to maximize its effect on rhythm.     

Comparison among random forest,logistic regression,and existing clinical risk scores for predicting outcomes in patients with atrial fibrillation: A report from the J‐RHYTHM registry

BackgroundMachine learning (ML) has emerged as a promising tool for risk stratification. However, few studies have applied ML to risk assessment of patients with atrial fibrillation (AF).HypothesisWe aimed to compare the performance of random forest (RF), logistic regression (LR), and conventional risk schemes in predicting the outcomes of AF.MethodsWe analyzed data from 7406 nonvalvular AF patients (median age 71 years, female 29.2%) enrolled in a nationwide AF registry (J‐RHYTHM Registry) and who were followed for 2 years. The endpoints were thromboembolisms, major bleeding, and all‐cause mortality. Models were generated from potential predictors using an RF model, stepwise LR model, and the thromboembolism (CHADS₂ and CHA₂DS₂‐VASc) and major bleeding (HAS‐BLED, ORBIT, and ATRIA) scores.ResultsFor thromboembolisms, the C‐statistic of the RF model was significantly higher than that of the LR model (0.66 vs. 0.59, p = .03) or CHA₂DS₂‐VASc score (0.61, p < .01). For major bleeding, the C‐statistic of RF was comparable to the LR (0.69 vs. 0.66, p = .07) and outperformed the HAS‐BLED (0.61, p < .01) and ATRIA (0.62, p < .01) but not the ORBIT (0.67, p = .07). The C‐statistic of RF for all‐cause mortality was comparable to the LR (0.78 vs. 0.79, p = .21). The calibration plot for the RF model was more aligned with the observed events for major bleeding and all‐cause mortality.ConclusionsThe RF model performed as well as or better than the LR model or existing clinical risk scores for predicting clinical outcomes of AF.     

Type of atrial fibrillation and outcomes in patients without oral anticoagulants

BackgroundThe effect of type of atrial fibrillation (AF) on adverse outcomes in Chinese patients without oral anticoagulants (OAC) was controversial.HypothesisThe type of AF associated with adverse outcomes in Chinese patients without OAC.MethodsA total of 1358 AF patients without OAC from a multicenter, prospective, observational study was included for analysis. Univariable and multivariable Cox regression models were utilized. Net reclassification improvement analysis was performed for the assessment of risk prediction models.ResultsThere were 896(66%) patients enrolled with non‐paroxysmal AF (NPAF) and 462(34%) with paroxysmal AF (PAF). The median age was 70.9 ± 12.6 years, and 682 patients (50.2%) were female. During 1 year of follow‐up, 215(16.4%) patients died, and 107 (8.1%) patients experienced thromboembolic events. Compared with the PAF group, NPAF group had a notably higher incidence of all‐cause mortality (20.2% vs. 9.4%, p < .001), thromboembolism (10.5% vs. 3.8%, p < .001). After multivariable adjustment, NPAF was a strong predictor of thromboembolism (HR 2.594, 95%CI 1.534–4.386; p < .001), all‐cause death (HR 1.648, 95%CI 1.153–2.355; p = .006). Net reclassification improvement analysis indicated that the addition of NPAF to the CHA₂DS₂‐VASc score allowed an improvement of 0.37 in risk prediction for thromboembolic events (95% CI 0.21–0.53; p < .001).ConclusionsIn Chinese AF patients who were not on OAC, NPAF was an independent predictor of thromboembolism and mortality. The addition of NPAF to the CHA₂DS₂‐VASc score allowed an improvement in the accuracy of the prediction of thromboembolic events.     

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A systematic review and meta‐analysis

BackgroundAtrial fibrillation (AF) is the most common cardiac rhythm disturbance and leads to morbidity and mortality. Peripheral artery disease (PAD) is associated with atherosclerotic risk factors and always classified as a vascular disease and deemed to be a bad complication of AF. In patients with AF, the risk and prognostic value of PAD have not been estimated comprehensively.HypothesisPAD is associated with all‐cause mortality, cardiovascular (CV) mortality, and other outcomes in patients with AF.MethodsWe searched PubMed, Embase, and Cochrane Library databases for prospective studies published before April 2021 that provided outcomes data on PAD in confirmed patients with AF. Heterogeneity was estimated using the I ² statistic. The fixed‐effects model was used for low to moderate heterogeneity studies, and the random‐effects model was used for high heterogeneity studies.ResultsEight prospective studies (Newcastle‐Ottawa score range, 7–8) with 39 654 patients were enrolled. We found a significant association between PAD and all‐cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.25–1.62; p < .001), CV mortality (HR, 1.64; 95% CI, 1.32–2.05; p < .001) and MACE (HR, 1.75; 95% CI, 1.38–2.22; p < .001) in patients with AF. No significant relationship was found in major bleeding (HR, 1.22; 95% CI, 0.95–1.57; p = 0.118), myocardial infarction (MI) (HR, 2.07; 95% CI, 1.17–3.67; p = .038), and stroke (HR, 1.14; 95% CI, 0.87–1.50, p = 0.351).ConclusionsPAD is associated with an increased risk of all‐cause mortality, CV mortality, and MACE in patients with AF. However, no significant association was found with major bleeding, MI, and stroke.     

Meta‐analysis of cryoballoon ablation versus antiarrhythmic drugs as initial therapy for symptomatic atrial fibrillation

BackgroundThe optimal first‐line approach for patients with symptomatic atrial fibrillation (AF) remains unclear. We compared the efficacy and safety of cryoballoon ablation (CBA) and antiarrhythmic drugs (AADs) in the initial management of symptomatic AF.HypothesisCBA is superior to AAD as initial therapy for symptomatic AF.MethodsWe searched the EMBASE, PubMed, and Cochrane Library databases for randomized controlled trials (RCTs) that compared CBA with AAD as first‐line treatment for AF from the date of database establishment until March 18, 2021. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure of treatment effect.ResultsThree RCTs that enrolled 724 patients in total were included in this meta‐analysis. Majority of the patients were relatively young and had paroxysmal AF. CBA was associated with a significant reduction in the recurrence of atrial arrhythmia compared with AAD therapy, with low heterogeneity (RR, 0.59; 95% CI, 0.49–0.71; p < .00001; I ²  = 0%). There was a significant difference in the rate of symptomatic atrial arrhythmia recurrence (RR, 0.44; 95% CI, 0.29–0.65; p < .0001; I ²  = 0%); however, the rate of serious adverse events was similar between the two treatment groups (RR: 1.18; 95% CI: 0.71–1.97, p = .53; I ² = 0%). Transient phrenic nerve palsy occurred in four patients after the CBA procedure.ConclusionThe current meta‐analysis suggests that CBA is more effective than AAD as initial therapy in patients with symptomatic paroxysmal AF. Serious iatrogenic adverse events are uncommon in CBAs.     

Effect of pulmonary vein isolation on atrial fibrillation recurrence after accessory pathway ablation in patients with Wolff-Parkinson-White syndrome

BackgroundAlthough successful ablation of the accessory pathway (AP) eliminates atrial fibrillation (AF) in some of patients with Wolff‐Parkinson‐White (WPW) syndrome and paroxysmal AF, in other patients it can recur.HypothesisWhether adding pulmonary vein isolation (PVI) after successful AP ablation effectively prevents AF recurrence in patients with WPW syndrome is unknown.MethodsWe retrospectively studied 160 patients (102 men, 58 women; mean age, 46 ± 14 years) with WPW syndrome and paroxysmal AF who underwent AP ablation, namely 103 (64.4%) undergoing only AP ablation (AP group) and 57 (35.6%) undergoing AP ablation plus PVI (AP + PVI group). Advanced interatrial block (IAB) was defined as a P‐wave duration of >120 ms and biphasic (±) morphology in the inferior leads, using 12‐lead electrocardiography (ECG).ResultsDuring the mean follow‐up period of 30.9 ± 9.2 months (range, 3‐36 months), 22 patients (13.8%) developed AF recurrence. The recurrence rate did not differ in patients in the AP + PVI group and AP group (15.5% vs 10.5%, respectively; P = .373). Univariable and multivariable Cox regression analyses showed that PVI was not associated with the risk of AF recurrence (hazard ratio, 0.66; 95% confidence interval, 0.26‐1.68; P = .380). In WPW patients with advanced IAB, the recurrence rate was lower in patients in the AP + PVI group vs the AP group (90% vs 33.3%, respectively; P = .032).ConclusionsPVI after successful AP ablation significantly reduced the AF recurrence rate in WPW patients with advanced IAB. Screening of a resting 12‐lead ECG immediately after AP ablation helps identify patients in whom PVI is beneficial.     

Radiofrequency catheter ablation combined with spironolactone in the treatment of atrial fibrillation: A single‐center randomized controlled study

At present, the question of whether radiofrequency ablation (RFA) combined with spironolactone can reduce the levels of plasma angiotensin II (AngII) and aldosterone (ALD) in patients with atrial fibrillation (AF) and reduce the recurrence of AF has not been reported.HypothesisThe present study evaluates the effect of spironolactone as an ALD antagonist on the short‐term and long‐term recurrence of AF after RFA. A total of 203 patients were enrolled in the present study, with 102 patients in the spironolactone therapy group (Group PVI/SP) and 101 patients in the control group (Group PVI alone). The AngII and ALD levels and the size of the left atrium in patients with AF were observed in order to evaluate the relationship between the combination therapy of spironolactone with RFA and the success rate in AF treatment. After therapy, the levels of AngII (52.8 vs. 64.3 pg/ml, p < .001), ALD (45.7 vs. 60.6 pg/ml, p = .016), and N‐terminal of B‐type natriuretic peptide (NT‐proBNP) (73.5 vs. 110 pg/ml, p = .016), along with the size of the left atrium (35.8 vs. 37.2 mm, p = .007), were all significantly lower in Group PVI/SP compared with Group PVI alone. The cumulative AF‐free survival rate was higher in Group PVI/SP than in Group PVI alone after treatment (85.3% vs.73.3%, p = .033). In RFA combined with spironolactone treatment, spironolactone can directly antagonize the effects of ALD and AngII and the recurrence of AF and improve left ventricular function.     

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

BackgroundIn idiopathic outflow tract ventricular arrhythmias (OT‐VAs), identifying the site with the earliest activation time (EAT) using activation mapping is critical to eliminating the arrhythmogenic focus. However, the optimal EAT for predicting successful radiofrequency catheter ablation (RFCA) has not been established.HypothesisTo evaluate the association between EAT and successful RFCA in idiopathic OT‐VAs and to determine the optimal cut‐off value of EAT for successful ablation.MethodsWe retrospectively analyzed patients undergoing RFCA for idiopathic OT‐VAs at a single center from January 2015 to December 2019.ResultsAcute procedural success was achieved in 168 patients (87.0%). Among these patients, 158 patients (81.9%) were classified in the clinical success group according to the recurrence of clinical VAs during median (Q1, Q3) follow‐up (330 days [182, 808]). EAT was significantly earlier in the clinical success group compared with the recurrence (p = .006) and initial failure (p < .0001) groups. The optimal EAT cut‐off value predicting clinical success was −30 ms in the right ventricular outflow tract (RVOT) with 77.4% sensitivity and 96.4% specificity. In all cases of successful ablation in the left ventricular outflow tract (LVOT), EAT in the RVOT was not earlier than −29 ms.ConclusionsEAT in patients with successful catheter ablation was significantly earlier than that in patients with recurrence and initial failure. EAT earlier than −30 ms could be used as a key predictor of successful catheter ablation as well as an indicator of the need to shift focus from the RVOT to the LVOT.     

Clinical outcomes of left bundle branch pacing compared to right ventricular apical pacing in patients with atrioventricular block

BackgroundLeft bundle branch pacing (LBBP) can produce near normalization of QRS duration. This has recently emerged as alternative technique to right ventricular pacing and His bundle pacing.HypothesisThe purpose of this study is to evaluate clinical outcomes of LBBP compared to right ventricular apical pacing (RVAP).MethodsA total of 70 AVB patients with indications for ventricular pacing were retrospectively studied. LBBP was attempted in 33 patients, classified as LBBP group. The other patients were classified as RVAP group. Pacing parameters, electrocardiogram and echocardiogram characteristics, heart failure hospitalization (HFH), and atrial fibrillation (AF) were evaluated perioperatively and at follow‐ups. Patients were followed in the device clinic for a minimum of 12 months and up to 24 months at a 3–6 monthly interval.ResultsLBBP was successful in 29 of 33(87.9%) patients while all 37 of the remaining patients successfully underwent RVAP. Paced QRS duration was significantly narrower in the LBBP group compare to RVAP(110.75 ± 6.77 ms vs. 154.29 ± 6.96 ms, p = .000) at implantation, and the difference persisted during follow‐ups. Pacing thresholds (at implantation: 0.68 ± 0.22 V in the LBBP group and 0.73 ± 0.23 V in the RVAP group, p = .620) remained low and stable during follow‐ups. The cardiac function in the LBBP group remained stable during follow‐ups (LVEF%:55.08 ± 4.32 pre‐operation and 54.17 ± 4.34 at the end of follow‐up, p = .609), and better than RVAP group (LVEF%: 54.17 ± 4.34 vs. 50.14 ± 2.14, p = .005). Less HFH was observed in the LBBP group (2/29,6.89%) compared to RVAP group (10/37,27.03%).ConclusionsThe present investigation demonstrates the safety and feasibility of LBBP that produces narrower paced QRS duration than RVAP. LBBP is associated with reduction in the occurrence of pacing‐induced left ventricular dysfunction and HFH compared to RVAP in patients requiring permanent pacemakers.     

General anesthesia is not superior to sedation in clinical outcome and cost‐effectiveness for ablation of persistent atrial fibrillation

BackgroundThe strategy of anesthesia used during ablation of atrial fibrillation (AF) remains controversial. This study aimed to compare sedation with general anesthesia (GA) for catheter ablation of AF.HypothesisThe presence of AF is associated with an increased risk of stroke and heart failure and decreased quality of life and survival.MethodsWe carried out a retrospective single‐centered study with 351 patients undergoing the first ablation procedure for AF under sedation or GA. The main outcome was freedom from recurrence of AF at 1 year. The total time of staying at the ablation laboratory and procedure cost were also calculated.ResultsFreedom from atrial arrhythmia and ablation time did not differ between AF patients under sedation and GA (77.9% vs 79.9% and 42.27 ± 9.84 minutes vs 41.51 ± 9.27 minutes, respectively), while the total procedure time and cost were lower in patients who underwent sedation than GA (171.39 ± 45.09 minutes vs 202.92 ± 43.85 and 8.00 ± 7.02 CNY vs 8.79 ± 11.63 CNY, respectively).ConclusionGA is not superior to sedation, in terms of ablation time and freedom from atrial arrhythmia at 1 year, whereas patients with GA had more anesthesia time and procedure cost than sedation.     

Rhythm outcomes after aortic valve surgery: Treatment and evolution of new‐onset atrial fibrillation

BackgroundThe impact of new‐onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid‐ and long‐term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid‐term prognosis and effectiveness of treatment for patients with new‐onset AF.MethodsThis single‐center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new‐onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new‐onset AF.ResultsNew‐onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new‐onset AF (1‐year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1‐year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3‐month and 1‐year rates of paroxysmal or persistent AF between patients with and without new‐onset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001). Multivariate models showed that advanced age, impaired ejection fraction, new‐onset AF and discontinuation of beta‐blockers were predictors of AF at 1 year.ConclusionsIn most cases, new‐onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new‐onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta‐blockers could be beneficial.     

Comparison of high-power short-duration and low-power long-duration radiofrequency ablation for treating atrial fibrillation: Systematic review and meta-analysis

BackgroundHigh power shorter duration (HPSD) ablation seen to increase efficacy and safety treating of atrial fibrillation (AF); however, comparative data between HPSD and low power longer duration (LPLD) ablation are limited.HypothesisWe thought that HPSD might bring more clinical benefits. The aim of this meta‐analysis was to evaluate the clinical benefits of HPSD in patients with AF.MethodsThe Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and LPLD ablation.ResultsTen trials with 2467 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first‐pass pulmonary vein isolation (PVI) (risk ratio [RR]: 1.20; 95% confidence interval [CI]: 1.10‐1.31, P < .001) and recurrence of atrial arrhythmias (RR: 0.73; 95% CI: 0.58‐0.91, P = .005). Additionally, HPSD could reduce procedural time (weighted mean difference [WMD]: −42.93; 95% CI, −58.10 to −27.75, P < .001), ablation time (WMD: −21.01; 95% CI: −24.55 to −17.47, P < .001), and fluoroscopy time (WMD: −4.11; 95% CI: −6.78 to −1.45, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44‐1.30, P = .31) and (RR: 0.57; 95% CI: 0.21‐1.51, P = .26).ConclusionsHPSD was safe and efficient for treating AF. Compared with LPLD, HPSD was associated with advantages of procedural features, higher first‐pass PVI and reducing recurrence of atrial arrhythmias. Moreover, major complications and ETI were similar between two groups.