Predictors of very late recurrence of atrial fibrillation after circumferential pulmonary vein ablation

BACKGROUND: Early recurrence of atrial fibrillation (ERAF) after catheter ablation is common and has been thoroughly studied. However, very late recurrence of atrial fibrillation (VLRAF) is rarely researched, and its characteristics have not been determined. HYPOTHESIS: The aim of this study was to investigate the clinical characteristics of VLRAF after circumferential pulmonary vein ablation (CPVA), and to identify the risk factors for VLRAF. METHODS: We retrospectively studied 259 consecutive patients with atrial fibrillation (AF) who were referred for CPVA. Clinical variables were investigated and predictors of VLRAF were identified. RESULTS: A total of 249 patients were enrolled in this study. After a mean follow-up of 18.2 +/- 4.4 mo, 14 patients (5.6%) had VLRAF. Patients with VLRAF were more likely than those without recurrence to have ERAF (78.6% versus 17.8%, p = 0.000) and persistent AF (50.0% versus 13.0%, p = 0.000), but were less likely to achieve pulmonary vein (PV) isolation (78.6% versus 97.6%, p = 0.000). Bivariate analysis demonstrated that ERAF (odds ratio [OR] 8.148, 95% confidence interval [CI] 2.197-30.222; p = 0.002), persistent AF (OR 8.853, 95% CI 1.773-16.155; p = 0.003), and lack of PV isolation (OR 7.530, 95% CI 1.792-33.122; p = 0.006) were related to VLRAF. Multivariate logistic regression analysis only identified ERAF as a predictor of VLRAF after CPVA (OR 7.461, 95% CI 1.696-24.836; p = 0.006). CONCLUSIONS: Very late recurrence of AF is uncommon after CPVA. That occurs more commonly in patients with ERAF.     

Characteristics and significance of very early recurrence of atrial fibrillation after catheter ablation

Very Early Recurrence of AF. Introduction: Early restoration of sinus rhythm following ablation of atrial fibrillation (AF) facilitates reverse atrial remodeling and improves the long‐term outcome. The purpose of this study was to determine the predictors and outcome in patients with very early AF recurrences (< 2 days). Methods and Results: Ablation was performed in 339 consecutive AF patients (paroxysmal AF = 262). Biatrial voltage was mapped during sinus rhythm. If recurrent AF occurred within 2 days following the ablation, electrical cardioversion was performed to restore sinus rhythm. Very early recurrences of AF occurred in 39 (15%) patients with paroxysmal AF and 26 (34%) with nonparoxysmal AF. Patients with very early recurrence had a higher incidence of nonparoxysmal AF (40% vs 18.6%, P< 0.001), requirement of electrical cardioversion during procedure, larger left atrial (LA) diameter (43 ± 7 vs 39 ± 6 mm, P< 0.001), lower left ventricular ejection fraction (54 ± 10% vs 59 ± 7, P< 0.001), longer procedural time, and lower LA voltage (1.5 ± 0.7 vs 1.9 ± 0.8 mV, P< 0.001). A multivariate analysis revealed that the independent predictors of a very early recurrence were a longer procedural time and lower LA voltage. During a follow‐up of 13 ± 5 months, a very early recurrence did not predict the long‐term outcome of a single procedure recurrence in the patients with paroxysmal AF, but was associated with a late recurrence in the nonparoxysmal AF patients. Conclusion: Very early recurrence occurred in patients with paroxysmal AF is not associated with long‐term recurrence. Nonparoxysmal AF is an independent predictor of late recurrence of AF in patients with very early recurrence. (J Cardiovasc Electrophysiol, Vol. pp. 1‐6)     

Clinical outcome of very late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation

INTRODUCTION: High recurrence rate is still a major problem associated with ablation of paroxysmal atrial fibrillation (AF). Most of the recurrences occur within 6 months after ablation. The characteristics of very late recurrent AF (>12 months after ablation) have not been reported. METHODS AND RESULTS: Two hundred seven patients with drug-refractory AF underwent successful focal ablation or isolation of AF foci. After the first ablation procedure, Holter monitoring and event recorders were used to evaluate symptomatic recurrent AF. A second ablation procedure was recommended if the antiarrhythmic drugs could not control recurrent AF. During long-term follow-up (mean 30 +/- 11 months, up to 51 months), 70 patients had recurrent AF, including 13 patients (6%) with very late (>12 months) recurrent AF (group 1) and 57 patients (28%) with late (within 12 months after ablation) recurrent AF (group 2). Group 1 patients had a significantly lower incidence of multiple (> or = 2) AF foci (23% vs 63%, P = 0.02) than group 2 patients. In addition, the incidence of antiarrhythmic drugs use (38% vs 84%, P = 0.001) to maintain sinus rhythm after the first episode of recurrent AF was significantly lower in group 1 than group 2 patients, and the incidence of a second intervention procedure (8% vs 35%, P = 0.051) tended to be lower in group 1 than group 2 patients. CONCLUSION: The incidence of very late recurrent AF after ablation of paroxysmal AF is very low, and the clinical outcome of patients with very late recurrent AF is benign.     

Left atrial flutter after radiofrequency catheter ablation of focal atrial fibrillation

We report an arrhythmic complication in two patients in whom a procedure directed at isolating one or two pulmonary veins had been performed. The complication was related to pulmonary vein disconnection scars after ablation. Both patients developed new clinical tachycardia (atypical atrial flutter) secondary to a reentrant phenomena in the vicinity of a previously ablated pulmonary vein.     

Incidence and time course of early recovery of pulmonary vein conduction after catheter ablation of atrial fibrillation

Background: Although it is well recognized that recovery of pulmonary vein (PV) conduction is common among patients who fail atrial fibrillation (AF) ablation, little is known about the precise time course of recurrence.
Objective: To determine the incidence and time course of early recurrence of conduction after PV isolation during AF ablation.
Methods: The patient population was composed of 14 consecutive patients (9 men [64%]; age 56 ± 7 years) with AF who underwent radiofrequency catheter ablation via circumferential ablation with PV isolation, determined by a circular mapping catheter. After successful isolation of the PVs, repeat circular electrode recordings from each PV were obtained at 30 and 60 minutes.
Results: After complete isolation of all PVs, early PV recurrence was observed in 13 (93%) patients and 26 veins (50%). Seventeen veins (33%) showed a first recurrence at 30 minutes, while nine veins (17%) showed a first recurrence at 60 minutes.
Conclusion: The results reveal an extremely high rate of early recurrence of PV conduction following AF ablation. It is particularly notable that about one-fifth of the veins remained isolated at 30 minutes, but subsequently developed recurrence between 30 and 60 minutes. Of the veins that showed early recurrence, one-third developed a first recurrence at 60 minutes. These findings suggest that AF ablation procedures should incorporate a 60-minute waiting period after initial isolation in order to detect early recurrence of conduction.     

Incidence and predictors of pulmonary vein stenosis following catheter ablation of atrial fibrillation using the anatomic pulmonary vein ablation approach: results from paired magnetic resonance imaging

INTRODUCTION: There are currently no studies systematically evaluating pulmonary vein (PV) stenosis following catheter ablation of atrial fibrillation (AF) using the anatomic PV ablation approach. METHODS AND RESULTS: Forty-one patients with AF underwent anatomic PV ablation under the guidance of a three-dimensional electroanatomic mapping system. Gadolinium-enhanced magnetic resonance (MR) imaging was performed in all patients prior to and 8-10 weeks after ablation procedures for screening of PV stenosis. A PV stenosis was defined as a detectable (> or =3 mm) narrowing in PV diameter. The severity of stenosis was categorized as mild (<50% stenosis), moderate (50-70%), or severe (>70%). A total 157 PVs were analyzed. A detectable PV narrowing was observed in 60 of 157 PVs (38%). The severity of stenosis was mild in 54 PVs (34%), moderate in five PVs (3.2%), and severe in one PV (0.6%). All mild PV stenoses displayed a concentric pattern. Moderate or severe PV stenosis was only observed in patients with an individual encircling lesion set. Multivariable analysis identified individual encircling lesion set and larger PV size as the independent predictors of detectable PV narrowing. All patients with PV stenosis were asymptomatic and none required treatment. CONCLUSIONS: The results of this study demonstrate that detectable PV narrowing occurs in 38% of PVs following anatomic PV ablation. Moderate or severe PV stenosis occurs in 3.8% of PVs. The high incidence of mild stenosis likely reflects reverse remodeling rather than pathological PV stenosis. The probability of moderate or severe PV stenosis appears to be related to creation of individual encircling rather than encircling in pairs lesion.     

房颤射频消融术术后AF早期复发的预测因素

房颤(AF)是临床上最常见的一种心律失常。AF射频消融术作为一种非药物治疗AF的手段正被广泛利用,但术后AF的复发率较高。早期有研究显示,高龄、超重和肥胖、病程、左房内径、左房疤痕和纤维化等为预测AF消融术术后AF复发的相关因素。最新研究显示,阻塞性睡眠呼吸暂停综合征、伴有慢性肾脏疾病、4q25等位基因多态性等对AF早期复发的预测具有一定的意义。     

心房颤动经导管射频消融术后复发的预测因素

心房颤动（AF）是临床上最常见的心律失常,具有较高的致残率和死亡率,需尽早干预治疗。经导管射频消融（RFA）治疗AF已在世界范围内推广,逐渐成为AF的一线治疗方法。大量的研究表明,RFA治疗AF具有较大的优越性,避免了药物复律引起的副作用,总成功率达73.3％,但仍有近26．1％的复发率。因此,降低RFA治疗AF的复发率及寻找RFA术后复发的预测因素对临床医师识别患者、选择合适的治疗策略具有重要意义。本文从基础指标、临床特征、病理解剖因素、临床生化指标、消融术式及术后管理等方面综述了AF经RFA治疗后复发的预测因素。     

The different mechanisms between late and very late recurrences of atrial fibrillation in patients undergoing a repeated catheter ablation

Introduction: The mechanisms of late (<1 year after the ablation) and very late (>1 year after the ablation) recurrences of paroxysmal atrial fibrillation (AF) after catheter ablation have not been reported.
Methods and Results: Fifty consecutive patients undergoing a repeated electrophysiologic study to investigate the recurrence of paroxysmal AF after the first ablation were included. Group 1 consisted of 12 patients with very late (26 ± 13 months) and group 2 consisted of 38 patients with late (3 ± 3 months) recurrence of paroxysmal AF. In the baseline study, group 1 had a lower incidence of AF foci from the pulmonary veins (PVs) (67% vs 92%, P = 0.048) and a higher incidence of AF foci from the right atrium (50% vs 13%, P = 0.014) than group 2. In the repeated study, group 1 had a higher incidence of AF foci from the right atrium (67% vs 3%, P < 0.001) and a lower incidence of AF foci from the left atrium (50% vs 97%, P < 0.001), including a lower incidence of AF foci from the PVs (50% vs 79%, P = 0.07) and from the left atrial free wall (0% vs 29%, P = 0.046) than group 2. Furthermore, most of these AF foci (64% of group 1, 65% of group 2) were from the previously targeted foci.
Conclusion: The right atrial foci played an important role in the very late recurrence of AF, whereas the left atrial foci (the majority were PVs) were the major origin of the late recurrence of AF after the catheter ablation of paroxysmal AF.     

Predictive value of HMGB1 for atrial fibrillation recurrence after cryoballoon ablation in paroxysmal atrial fibrillation patients

BackgroundCryoballoon ablation (CBA) is recommended for patients with symptomatic drug refractory paroxysmal atrial fibrillation (pAF). However, substantial atrial fibrillation (AF) recurrence is common during follow‐up. Searching for a potential biomarker representing both myocardial injury and inflammation to identify patients at high risk of AF recurrence after CBA is very meaningful for postoperative management of AF patients.HypothesisTo evaluate the clinical efficacy of high‐mobility group box 1 (HMGB1) protein released from the left atrium to predict AF recurrence in pAF patients after CBA at 1‐year follow‐up.MethodsWe included 72 pAF patients who underwent CBA. To determine the expression levels of HMGB1, left atrial blood samples were collected from the patients before CBA and after the procedure through the transseptal sheath. Patients were followed up for AF recurrence for 1 year.ResultsA total of 19 patients of the 72 experienced AF recurrence. The level of postoperative HMGB1 (HMGB1post) was higher in the AF recurrence group than in the AF non recurrence group (p = .03). However, no differences were noted in the levels of other biomarkers such as preoperative high‐sensitivity C‐reactive protein (hs‐CRP), postoperativehs‐CRP, and preoperative HMGB1 between the two groups. Multiple logistic regression analysis revealed that a higher level of serum HMGB1post was associated with AF recurrence (odds ratio: 5.29 [1.17–23.92], p = .04). Receiver operating characteristic analysis revealed that HMGB1post had a moderate predictive power for AF recurrence (area under the curve: 0.68; sensitivity: 72%; and specificity: 68%). The 1‐year AF‐free survival was significantly lower in patients with a high HMGB1post level than in those with a low HMGB1post level (hazard ratio: 3.81 [1.49–9.75], p = .005).ConclusionIn pAF patients who under went CBA, the level of HMGB1 after CBA was associated with AF recurrence and demonstrated a moderate predictive power. Thus, we offer a potential biomarker to identify pAF patients at high risk of AF recurrence.     

Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter

INTRODUCTION: The aims of this study were to identify predictors of recurrence after catheter ablation of atrial fibrillation (AF) and to report the safety and efficacy of catheter ablation of AF using an irrigated-tip ablation catheter. METHODS AND RESULTS: Seventy-five consecutive patients (51 men [68%]; age 54 +/- 13 years) with symptomatic drug-refractory paroxysmal (42 patients), persistent (21 patients), or permanent (12 patients) AF underwent catheter ablation of AF using an irrigated-tip ablation catheter and a standard ablation strategy, which involved electrical isolation of all pulmonary veins (PVs) and creation of a cavotricuspid linear lesion. At 10.5 +/- 7.5 months of follow-up following a single (n = 75) or redo ablation procedure (n = 11), 39 (52%) of the 75 patients were free of AF, 10 were improved (13%), and 26 had experienced no benefit from the ablation procedure (35%). Seventy-six percent of patients with paroxysmal AF were free from recurrent AF. The most significant complications were two episodes of pericardial tamponade, mitral valve injury in one patient, two strokes, and complete but asymptomatic PV stenosis in one patient. Cox proportional hazards multivariate regression analysis identified the presence of persistent AF, permanent AF, and age >50 years prior to the ablation are the only independent predictors of AF recurrence after the first PV isolation procedure. CONCLUSION: Catheter ablation of AF using a strategy involving isolation of all PVs and creation of a linear lesion in the cavotricuspid isthmus using cooled radiofrequency energy is associated with moderate efficacy and an important risk for complications. The best results of this procedure are achieved in the subset of patients who are younger than 50 years and have only paroxysmal AF.     

Prevalence of asymptomatic recurrences of atrial fibrillation after successful radiofrequency catheter ablation

INTRODUCTION: The long-term efficacy of radiofrequency catheter ablation of atrial fibrillation (AF) has been based on patient-reported symptoms suggestive of AF. However, asymptomatic recurrences of AF may remain undetected. The aim of this study was to determine the prevalence of asymptomatic recurrences of AF after an apparently successful catheter ablation procedure for AF. METHODS AND RESULTS: Among 244 consecutive patients (mean age 53 +/- 11 years) who underwent a pulmonary vein isolation procedure for symptomatic paroxysmal AF and who reported no symptoms of recurrent AF at > or =6 months after the procedure, 60 patients with a history of > or =1 episode of AF per week were asked to participate in this study. Preablation, these patients had experienced 19 +/- 13 episodes of AF per month. The patients were provided with a patient-activated transtelephonic event recorder for 30 days, a mean of 642 +/- 195 days after the ablation procedure, and were asked to record and transmit recordings on a daily basis and whenever they felt palpitations. Seven patients (12%) felt palpitations during the study, although they had not experienced symptoms previously. Each of these 7 patients had an episode of AF documented with the event monitor during symptoms. In these 7 patients, the mean number of episodes per month decreased from 19 +/- 14 preablation to 3 +/- 1 postablation (P < 0.001). Among the 53 asymptomatic patients, an episode of AF was captured in 1 (2%) patient during the study period. CONCLUSION: Asymptomatic recurrences of AF after an apparently successful catheter ablation procedure for symptomatic paroxysmal AF are infrequent.     

甘油三酯葡萄糖指数对心房颤动射频消融术后晚期复发的应用价值

目的 探讨甘油三酯葡萄糖指数(TyG指数)在非糖尿病持续性房颤(PeAF)患者导管射频消融(RFCA)术后晚期复发方面的临床意义及应用价值。方法 回顾性分析2020年1月至2021年8月于郑州市第七人民医院与河南省胸科医院心血管内科就诊,首次行RFCA治疗的242例非糖尿病PeAF患者的临床资料,于术后1、3、6、12个月定期随访患者房颤复发情况。根据RFCA术后3个月至1年内是否复发将患者分为未复发组(190例)和复发组(52例)。采用SPSS 26.0与GraphPad 9.0软件进行统计与绘图。根据数据类型,分别采用t检验、Mann-Whitney U检验、χ²检验或校正χ²检验进行组间比较。采用多因素Cox回归分析非糖尿病PeAF患者晚期复发的独立危险因素及TyG指数对术后复发的预测价值。结果 复发组PeAF病史更久,更倾向合并冠状动脉粥样硬化性心脏病(CAD),左心房内径(LAD)、TyG指数明显更大,术后未应用血管紧张素受体脑啡肽酶抑制剂(ARNI)治疗的比例更高(P<0.05)。PeAF病史、CAD、LAD、术后应用ARN...     

重复消融对阵发性心房颤动复发患者远期获益的评估

目的:评估重复消融对阵发性心房颤动复发患者的远期获益.方法:入选2000-01-2004-12期间经导管消融(肺静脉电隔离)的阵发性心房颤动患者106例.所有患者心房颤动的症状明显,超过2种抗心律失常药物治疗无效.结果:106例中,失访9例(8.5％),非心源性死亡3例,2次消融时出现一过性脑梗死未完成完整术式1例,其余93例均纳入随访,平均随访5年.1次消融远期维持窦性心律39例,成功率为41.9％.复发者54例中39例(72.2％)进行2次消融,其中27例(69.2％)远期维持窦性心律,消融远期成功率提高了29.0％;复发者12例中5例(41.7％)进行3次消融,其中2例(40.0％)远期维持窦性心律,使远期成功率再提高2.2％;复发者3例中2例(66.7％)再行4次消融,术后均再次复发心房颤动.重复消融累计远期成功率较1次消融明显提高(73.1％:41.9％,P＜0.01).包括重复消融在内,12个月内的总成功率为81.7％,平均远期复发时间是术后(28.4±8.3)个月.1次消融因电隔离肺静脉电传导恢复导致心房颤动远期复发(6例),经重复消融均可实现远期维持窦性心律.结论:远期复发心房颤动的主要机制是电隔离肺静脉的电传导恢复,重复消融有望实现和维持远期窦性心律.