Atrial Fibrillation Ablation Procedures Research Articles

Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 7 0 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Transseptal Puncture and Cryoballoon Ablation of Atrial Fibrillation in Patients with Atrial Septal Occluder or Atrial Septal Defect Surgical Repair: A Single Center Experience.

Atrial fibrillation (AF) is a common arrhythmia in patients with atrial septal defect (ASD). Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein (PV) isolation in the treatment of AF. Achieving left atrial access may be difficult in patients with atrial septal occluders (ASO) or surgical repair of ASD. The aim of this study was to present our experience with the efficacy and safety of transseptal puncture and AF ablation in CA in this subset of patients. We retrieved our data about patients with ASO or surgical repair of ASD undergoing cryoballoon AF ablation procedures at our center between August 2019 and January 2022. Nine patients (age 43.88 ± 9.73 years) with AF (5 paroxysmal and 4 persistent) and ASO or surgical repair of ASD were enrolled. All three patients had a 28 mm Amplatzer ASO device which occupied the whole septum, and direct puncture through the ASO was performed. Sequential balloon dilatation was performed in 2 patients with surgical ASD repair and all 3 patients with ASO. Four of 6 patients (66.7%) in the surgical repair group required transesophageal echocardiography during transseptal puncture. The endpoint of the procedure, isolation of all PVs, was achieved in all 9 patients. None of the patients had evidence of an interatrial shunt or pericardial effusion at the end of the procedure. Total procedural time (123 ± 28 minutes vs. 63 ± 21 minutes, P = .024) and total fluoroscopy time (41 ± 5 minutes vs. 23 ± 8 minutes, P = .024) were significantly higher in the percutaneous closure group. In patients with ASO or surgical repair of ASD, CA of AF might be feasible, safe, and effective. The balloon dilatation of the interatrial septum (IAS) might assist transseptal access through the ASO or a surgically repaired thickened IAS.

Efficacy of Commonly Used 3D Mapping Systems in Acute Success Rates of Catheter Ablation Procedures.

Introduction: This systematic review aims to summarize the procedural arrhythmia termination rates in catheter ablation (CA) procedures of atrial or ventricular arrhythmias using the commonly used mapping systems (CARTO, Rhythmia and EnSite/NavX). Materials and Methods: A systematic search in MEDLINE and Cochrane databases through February 2021 was performed. Results: With regard to atrial fibrillation ablation procedures, acute success rates ranged from 15.4 to 96.0% and 9.1 to 100.0% using the CARTO and EnSite/NavX mapping systems, respectively; acute atrial tachycardia (AT) termination to sinus rhythm ranged from 75 to 100% using the CARTO system. The acute success rate for different types of AT ranged from 75 to 97% using Rhythmia, while the NavX mapping system was also found to have excellent efficacy in the setting of AT, with acute arrhythmia termination rates ranging from 73 to 99%. With regard to ventricular tachycardia, in the setting of ischaemic cardiomyopathy, acute success rates ranged from 70 to 100% using CARTO and 64% using EnSite/NavX systems. The acute success rate using the Rhythmia system ranged from 61.5 to 100.0% for different clinical settings. Conclusions: Mapping systems have played a crucial role in high-density mapping and the observed high procedural success rates of atrial and ventricular CA procedures. More data are needed for the comparative efficacy of mapping systems in acute arrhythmia termination, across different clinical settings.

Coronary artery disease in atrial fibrillation ablation: impact on arrhythmic outcomes.

Catheter ablation (CA) is an established treatment for atrial fibrillation (AF). A computed tomography (CT) may be performed before ablation to evaluate the anatomy of pulmonary veins. The aim of this study is to investigate the prevalence of patients with coronary artery disease (CAD) detected by cardiac CT scan pre-ablation and to evaluate the impact of CAD and revascularization on outcomes after AF ablation. All consecutive patients with AF diagnosis, hospitalized at Universitair Ziekenhuis Brussel, Belgium, between 2015 and 2019, were prospectively screened for enrolment in the study. Inclusion criteria were (i) AF diagnosis, (ii) first procedure of AF ablation with cryoballoon CA, and (iii) contrast CT scan performed pre-ablation. A total of 576 consecutive patients were prospectively included and analysed in this study. At CT scan, 122 patients (21.2%) were diagnosed with CAD, of whom 41 patients (7.1%) with critical CAD. At survival analysis, critical CAD at CT scan was a predictor of atrial tachyarrhythmia (AT) recurrence during the follow-up, only in Cox univariate analysis [hazard ratio (HR) = 1.79] but was not an independent predictor in Cox multivariate analysis. At Cox multivariate analysis, independent predictors of AT recurrence were as follows: persistent AF (HR = 2.93) and left atrium volume index (HR = 1.04). In patients undergoing CT scan before AF ablation, critical CAD was diagnosed in 7.1% of patients. Coronary artery disease and revascularization were not independent predictors of recurrence; thus, in this patient population, AF ablation should not be denied and can be performed together with CAD treatment.

Esophageal injury, perforation, and fistula formation following atrial fibrillation ablation.

Esophageal perforation and fistula formation are rare but serious complications following atrial fibrillation ablation. In this review article, we outline the incidence, pathophysiology, predictors, and preventative strategies of this dreaded complication. We conducted an electronic search in 10 databases/electronic search engines to access relevant publications. All articles reporting complications following atrial fibrillation ablation, including esophageal injury and fistula formation, were included for systematic review. A total of 130 manuscripts were identified for the final review process. The overall incidence of esophageal injury following atrial fibrillation ablation was significantly higher with thermal ablation modalities (radiofrequency 5-40%, cryoballoon 3-25%, high-intensity focused ultrasound < 10%) as opposed to non-thermal ablation modalities (no cases reported to date). The incidence of esophageal perforation and fistula formation with the use of thermal ablation modalities is estimated to occur in less than 0.25% of all atrial fibrillation ablation procedures. The use of luminal esophageal temperature monitoring probe and mechanical esophageal deviation showed protective effect toward reducing the incidence of this complication. The prognosis is very poor for patients who develop atrioesophageal fistula, and the condition is rapidly fatal without surgical intervention. Esophageal perforation and fistula formation following atrial fibrillation ablation are rare complications with poor prognosis. Various strategies have been proposed to protect the esophagus and reduce the incidence of this fearful complication. Pulsed field ablation is a promising new ablation technology that may be the future answer toward reducing the incidence of esophageal complications.

Pulsed Field Ablation of Atrial Fibrillation: A Comprehensive Review.

Pulsed-field ablation (PFA) has emerged as a promising nonthermal ablation alternative for treating atrial fibrillation (AF). By delivering ultra-rapid high-energy electrical pulses, PFA induces irreversible electroporation, selectively targeting myocardial tissue while sparing adjacent structures from thermal or other damage. This article provides a comprehensive review of multiple pre-clinical studies, clinical studies, and clinical trials evaluating the safety, efficacy, and long-term outcomes of PFA in various settings and patient populations. Overall, the reviewed evidence highlights PFA's potential as a revolutionary ablation strategy for AF treatment. Offering comparable procedural efficacy to conventional ablation methods, PFA distinguishes itself with shorter procedure times and reduced risks of complications such as phrenic nerve palsy and potential esophageal injury. While further research is warranted to establish long-term efficacy, PFA's distinct advantages and evolving clinical evidence suggest a promising future for this novel nonthermal ablation approach. As PFA continues to advance, it has the potential to transform AF ablation procedures, providing a safer alternative for patients with atrial fibrillation.

Pulmonary Vein Stenosis After Catheter Ablation of Atrial Fibrillation Using a Cryoballoon, Hot Balloon, or Laser Balloon.

Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI. A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient. Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.

Comparison of Long-Term Clinical Outcomes Between Segmental and Circumferential Pulmonary Vein Isolation in Patients Undergoing Repeat Atrial Fibrillation Ablation.

Circumferential pulmonary vein isolation (CPVI) has supplanted segmental PVI (SPVI) as standard procedure for atrial fibrillation (AF). However, there is limited evidence examining the efficacy of these strategies in redo ablations. In this study, we investigated the difference in recurrence rates between SPVI and CPVI in redo ablations for PV reconnection.Methods and Results: This study retrospectively enrolled 543 patients who had undergone AF ablation between 2015 and 2017. Among them, 167 patients (30.8%, including 128 male patients and 100 patients with paroxysmal AF) underwent redo ablation for recurrent AF. Excluding 26 patients without PV reconnection, 141 patients [90 patients of SPVI (Group 1) and 51 patients of CPVI (Group 2)] were included. The AF-free survival rates were 53.3% and 56.9% in Group 1 and Group 2, respectively (P=0.700). The atrial flutter (AFL)-free survival rates were 90% and 100% in Group 1 and Group 2, respectively (P=0.036). The ablation time was similar between groups, and there no major complications were observed. For redo AF ablation procedures, SPVI and CPVI showed similar outcomes, except for a higher AFL recurrence rate for SPVI after long-term follow-up (>2 years). This may be due to a higher probability of residual PV gaps causing reentrant AFL.

Impact of high-power short-duration atrial fibrillation ablation technique on the incidence of silent cerebral embolism: a prospective randomized controlled study

BackgroundHigh-power short-duration (HPSD) ablation strategy has emerged as a popular approach for treating atrial fibrillation (AF), with shorter ablation time. The utilized Smart Touch Surround Flow (STSF) catheter, with 56 holes around the electrode, lowers electrode-tissue temperature and thrombus risk. Thus, we conducted this prospective, randomized study to investigate if the HPSD strategy with STSF catheter in AF ablation procedures reduces the silent cerebral embolism (SCE) risk compared to the conventional approach with the Smart Touch (ST) catheter.MethodsFrom June 2020 to September 2021, 100 AF patients were randomized 1:1 to the HPSD group using the STSF catheter (power set at 50 W) or the conventional group using the ST catheter (power set at 30 to 35 W). Pulmonary vein isolation was performed in all patients, with additional lesions at operator’s discretion. High-resolution cerebral diffusion-weighted magnetic resonance imaging (hDWI) with slice thickness of 1 mm was performed before and 24–72 h after ablation. The incidence of new periprocedural SCE was defined as the primary outcome. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) test.ResultsAll enrolled AF patients (median age 63, 60% male, 59% paroxysmal AF) underwent successful ablation. Post-procedural hDWI identified 106 lesions in 42 enrolled patients (42%), with 55 lesions in 22 patients (44%) in the HPSD group and 51 lesions in 20 patients (40%) in the conventional group (p = 0.685). No significant differences were observed between two groups regarding the average number of lesions (p = 0.751), maximum lesion diameter (p = 0.405), and total lesion volume per patient (p = 0.669). Persistent AF and CHA2DS2-VASc score were identified as SCE determinants during AF ablation procedure by multivariable regression analysis. No significant differences in MoCA scores were observed between patients with SCE and those without, both immediately post-procedure (p = 0.572) and at the 3-month follow-up (p = 0.743).ConclusionsInvolving a small sample size of 100 AF patients, this study reveals a similar incidence of SCE in AF ablation procedures, comparing the HPSD strategy using the STSF catheter to the conventional approach with the ST catheter.Trial registrationClinicaltrials.gov: NCT04408716.Graphical AF = Atrial fibrillation, DWI = Diffusion-weighted magnetic resonance imaging, HPSD = High-power short-duration, ST = Smart Touch, STSF = Smart Touch Surround Flow.

Intracardiac echocardiography-guided pulsed-field ablation for successful ablation of atrial fibrillation: a propensity-matched analysis from a large nationwide multicenter experience.

Intracardiac echocardiography (ICE) is increasingly employed in atrial fibrillation (AF) ablation procedures, with the potential to enhance procedural efficacy. Nevertheless, there is currently a lack of evidence assessing the impact of ICE on the efficiency, effectiveness, and safety outcomes in the context of novel pulsed-field ablation (PFA) for AF. We aimed to assess whether the use of ICE could improve procedural parameters in a large population undergoing AF ablation with FARAPULSE™ catheter. Consecutive patients who had undergone PFA of AF from nine Italian centers were included. In procedures where the ICE catheter was employed for guidance (ICE-guided group), it was used to maneuver the PFA catheter within the left atrium to achieve optimal contact with atrial structures. We analyzed 556 patients: 357 (66%) with paroxysmal AF, 499 (89.7%) de novo PVI. ICE-guided procedures (n = 138) were propensity matched with patients with a standard approach (n = 138), and their outcomes were compared. During ICE-guided procedures, no improvement in procedural metrics was recorded (ICE vs Standard, 23 ± 6min vs 18.5 ± 9min for time to PVI, p < 0.0001; 38.8 ± 7 vs 32.5 ± 5 number of PFA deliveries to achieve PVI, p < 0.0001; 68.8 ± 19min vs 71.8 ± 29min for primary operator time, p = 0.5301; 16.1 ± 8min vs 18.2 ± 10min for fluoroscopy time, p = 0.5476) except for support time (76.8 ± 26min vs 91.4 ± 37min, p = 0.0046). No major procedure-related adverse events were reported. Our findings confirmed that PFA could be consistently performed in a rapid, safe, and efficacious manner. The use of ICE to guide PFA was not associated with an improvement in procedural metrics.

Sex-based differences and outcomes in patients undergoing pulmonary vein isolation for atrial fibrillation

Abstract Introduction Some studies have suggested that the risk of atrial fibrillation (AF) recurrence after catheter ablation (CA) is greater in women than in men, which suggests that sex may be an independent risk factor for AF recurrence. However, the impact of gender on time to AF recurrence after CA is unknown. Methods Retrospective, single-centre study including all patients who underwent a first AF ablation procedure between 2017 and 2021. Late recurrence (LR) was defined as any AF recurrence at least 90 days after ablation, while early recurrence (ER) occurred &amp;lt;90 days after ablation. The effect of sex on the cumulative freedom from LR was estimated using the Kaplan-Meier method and compared using the log-rank test and Cox proportional hazards model. In a subgroup of patients, cardiac adipose tissue was quantified using cardiac computerized tomography (CT) scans. Results 656 patients were included, of whom 32% were women. Average follow-up after ablation was 26 months. In comparison to male patients, women undergoing CA were more likely to be older, have a higher body mass index and were more likely to have comorbid hypertension, thyroid dysfunction and valvular disease. After model adjustment, women had a greater risk of LR (HR 1.78, 95% CI 1.20-2.62). A reanalysis was conducted using a time-split at one year of follow-up, which showed that risk of LR was greater in women more than 12 months after CA (HR 2.70, 95% CI 1.60-4.57), but not during the first year after CA (HR 1.22, 95% CI 0.74-2.02). Persistent AF was also an independent predictor of LR (HR 2.05, 95% CI 1.45-2.91). In a subgroup of patients who underwent cardiac adipose tissue analysis (n = 348; 37% women), increased epicardial and pericardial adipose tissue volume was associated with an increased risk of LR in univariate analysis, but not after co-variate adjustment. Conclusions Women are referred later and less frequently to CA than men. LR after CA is more frequent in women, particularly after one year. Epicardial adipose tissue volume was associated with LR in women, but this effect was not maintained after model adjustment. Further studies are needed to better understand the mechanisms responsible for the increase in LR in women undergoing pulmonary vein isolation.

Pulsed field ablation for atrial fibrillation - Lessons from magnetic resonance imaging.

Pulsed field ablation (PFA) is a promising technology for the treatment of atrial fibrillation (AF). Due to its unique tissue selectivity, PFA potentially bears superior characteristics as compared to established thermal energy sources in AF ablation procedures. Cardiovascular magnetic resonance imaging (CMR) using late gadolinium enhancement (LGE) is an established tool in the analysis of myocardial fibrosis representing atrial cardiomyopathy as well as ablation-induced atrial scar formation following catheter ablation with thermal energy. Mechanisms of atrial lesion formation differ between thermal ablation and electroporation and its impact on results of CMR imaging are not fully understood until now. In this review article, the potential of CMR imaging for PFA lesion assessment and available data are discussed. Further, additional needs to adopt imaging approaches to the cellular mechanisms of electroporation are considered.

Comparison of ultralow temperature cryoablation and classical cryoballoon ablation for pulmonary vein isolation in patients with atrial fibrillation

Abstract Introduction Pulmonary vein isolation (PVI) has become the standard-of-care in the treatment of atrial fibrillation (AF). In cryoablation cell damage is caused by freezing using predominantly nitrous oxide gas allowing temperature drops down to -60°C usually using a cryoballoon-based catheter (CB). Ultralow temperature cryoablation (ULTC) represents a novel ablation technique promising higher efficacy rates by achieving better transmurality of generated lesions. By using Nitrogen near it’s liquid vapor critical point (Near-critical nitrogen) in a linear catheter, ULTC achieves cooling temperatures as low as -196 °C. First studies using ULTC for PVI reported promising success rates. However, to date there is only limited data on outcomes of patients undergoing cryoablation with ULTC compared to CB. Material and Methods Our study aimed to compare the efficacy and safety of CB and ULTC ablation for PVI in AF patients. 90 consecutive patients with AF undergoing PVI by cryoablation at our university hospital between July 2020 and November 2022 were included in the analysis. The primary outcome was freedom from atrial arrythmia after 12 months. Furthermore, procedural parameters and periprocedural complications were compared. Results In total 90 patients, n=72 treated by CB ablation and n=18 by ULTC, were included in our study. Median age was 64yrs in CB and 70yrs in ULTC patients. Majority of patients of the CB (64%) and of the ULTC group (72%) were male. Paroxysmal AF was present in 57% of CB and 55% in the ULTC group. Median follow up was 365d for the CB and 232d for the ULTC group, respectively. The primary endpoint (Atrial arrythmia recurrence) occurred in 24/72 patients in the CB and in 10/18 patients in the ULCT group (HR: 0.47; 95% CI: 0.19-1.16; p=0.037). There were no differences in periprocedural complications (CB: 12,5% vs. ULCA: 17%). Analysis of procedural parameters showed that the total procedure time was longer in the ULTC group (CB: 135 [124, 167] min, ULTC: 198 [168, 242] min; p=&amp;lt;0.0001). Fluoroscopy time was increased (CB: 23 min [16, 28] min, ULTC: 44 [38, 48] min; p=&amp;lt;0.0001) as was the median number of required freezes per vein in the ULTC group (ULTC: 4 [3, 6] vs CB: 1 [1, 2], p=&amp;lt; 0.0001). Conclusion The findings of this retrospective analysis comparing cryoablation by ULTC vs. CB for PVI in AF patients suggests that ULTC is not yet equivalent to CB ablation with respect to procedural parameters and freedom from AF. Nevertheless, learning curve and limited device handling experience has to be taken into account. Future controlled studies and randomized trials are required to further elucidate the value of ULTC in AF ablation procedures, especially in the context of the novel Pulsed field ablation technology.

A cardiac rehabilitation and those effects using cardiopulmonary exercise testing in patients undergoing catheter ablation for atrial fibrillation

Abstract Background Patients with atrial fibrillation (AF) are more likely to have impaired social and physical function, impaired general health and mental and reduced quality of life and exercise tolerance (ET). From the AHA guideline, the indications of cardiac rehabilitation (CR) are for the patients with heart failure, coronary artery disease including coronary artery bypass graft surgery and percutaneous coronary intervention, after valve replacement, a pacemaker or implantable cardioverter defibrillator, however, the patients undergoing catheter ablation (CA) for AF is not included. Purpose The relationships between burden of AF and ET, and CR and those effects in patients undergoing CA for AF are unclear. Methods To evaluate ET, exercise intensity (METs) and oxygen consumption (VO2/W) at peak and anaerobic threshold (AT) points were measured using cardiopulmonary exercise testing (CPX) at 3 and 12 months later after the ablation procedure. Results This study included 50 consecutive patients (mean age: 68±12 y.o.) undergoing 1st ablation procedure for paroxysmal (PAF: n=28) or persistent AF (PEF: n=22), and all patients kept sinus rhythm after the procedure. Before ablation and after ablation 3 months later, value of exercise intensity and oxygen consumption were significantly lower in PEF patients at AT point ([Before] PAF vs. PEF = 3.3±0.7vs. 2.8±0.6 METs, p=0.02, 12.0±2.6 vs. 9.8±2.1 ml/kg/min, p=0.01, [3 months later] PAF vs. PEF = 3.7±0.9vs. 3.1±0.7 METs, p=0.04, 13.0±3.4 vs. 10.4±3.1 ml/kg/min, p=0.03, Figure 1). However, there were no significant differences between 2 groups at 12 months later. On the other hand, twenty patients received CR at hospital for 3 months (group-R) and 30 patients were recommended exercise at home (group-E). Interestingly, at 12 months after the ablation procedure, the value of exercise intensity at AT point was improved in 100% of patient in group-R versus those of 68% in group-E (+0.5±0.4 vs. +0.3±0.6 METS, p=0.02), and value of oxygen consumption at AT point was also improved in 100% of patient in group-R versus those of 68% in group-E (+2.4±2.4 vs. +1.3±3.0 ml/kg/min, p=0.02) (Figure 2). Conclusion This study demonstrates that AF is associated with ET and CA is effective for the improvement of their capacity. In patients with PEF, ET recovers close to PAF patients at 12 months. In addition, a CR is effective for further improvement of their capacity of ET in patients undergoing CA for AF.Figure 1Figure 2

Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1- year outcome from an international multicenter clinical setting

Abstract Background The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Objective We report the outcomes of our acute and long-term clinical evaluation of CF-LI guided PVI in consecutive AF ablation cases from an international multicenter clinical setting. Methods Consecutive patients (pts) from 16 European centers undergoing de novo AF RF catheter ablation with the Stablepoint catheter endowed of CF and LI measurement capabilities were enrolled in the CHARISMA registry. Ablation was guided by the magnitude and time-course of LI drop during RF delivery. The maximum distance between each ablation spot (center-to-center) was suggested to be ≤6 mm. Procedural endpoint was the achievement of the PVI as assessed by entrance and exit block. Post-ablation, all patients were monitored with ambulatory event monitoring. Additional ECG monitoring was performed as indicated by patient symptoms. Data are reported as mean±SD. Results From a total of 212 consecutive pts, 151 were followed-up for at least 12 months after the procedure and were included in this 1-year outcome analysis (61.6% paroxysmal AF, 38.4% persistent AF, 78.8% de novo procedures, 21.2% redo procedures). Baseline LI was 161.2±19 Ω with LI drop of 21.9±9 Ω (LI drop rate=3.1±2 Ω/s). The first pass isolation rate per vein was 93.3%. LI drop was predicted by baseline LI (r=0.56, 95%CI:0.55 to 0.57, p&amp;lt;0.0001). Effective ablation spots showed both higher baseline LI and LI drop compared with PV gap spots (161.4Ω vs 153.0Ω, p&amp;lt;0.0001 for baseline LI; 22.1Ω vs 14.4Ω, p&amp;lt;0.0001 for LI drop). No steam pops or complications, including atrio-esophageal fistula or tamponade were reported during or after the procedures. At the end of the procedures all PVs were successfully isolated in all study patients. During a median follow-up of 377 [365 – 402] days, 11 (7.3%) patients experienced an early recurrence of AF during the 90-day blanking period. Overall, 21 pts (13.9%) suffered an AF recurrence after the 90-days blanking period (10.8% with paroxysmal AF vs 19% with persistent AF, p=0.226; 10.9% for de novo procedures vs 25.0% for redo procedures, p=0.079). De novo paroxysmal AF pts showed the lowest rate of recurrence (5 out 69 pts, 7.2%). The time to recurrence was comparable among AF type (HR=1.73; 0.73 to 4.05; p=0.210 for persistent vs paroxysmal AF) whereas was shorter in repeated AF ablation procedures (HR=2.49; 1.04 to 5.98; p=0.042 for redo vs de novo procedure). Early recurrence was not associated with late recurrence (HR=2.29; 0.68 to 7.76; p=0.182). Conclusions In our experience, the magnitude of LI drop is predictive of PV segment isolation. An ablation strategy for PVI guided by CF-LI technology was safe and effective, and resulted in a low recurrence rate of AF at 1-year follow-up irrespective of underlying AF type.

Cryoballoon versus radiofrequency catheter ablation for atrial fibrillation: insights from the Netherlands Heart Registration (2013-2021)

Abstract Background Cryoballoon ablation has emerged as a viable alternative to radiofrequency (RF) ablation in the treatment of atrial fibrillation (AF) with catheter ablation. Randomized trials and observational studies have demonstrated no statistically significant difference in the overall safety, efficacy, and effectiveness of RF and cryoballoon technologies. Despite over a decade of cryoballoon ablation use, there is limited population-level data comparing uptake in the utilization, populations referred, complications, and rates of repeat ablation of cryoballoon versus RF ablation. Purpose Our objective was to compare the real-world temporal trends in the utilization and complication rates of cryoballoon versus RF ablation for AF in the Netherlands between 2013 and 2021. Methods The Netherlands Heart Registration was used for the present study and included all consecutive patients who underwent AF ablation at 16 hospitals in the Netherlands (2013-2021). Only patients who underwent RF or cryoballoon ablation were included. Crude, age-, and sex-standardized annual incidence rates for AF ablation were calculated. Incidence rate ratios (IRR) and temporal trends were assessed with Poisson regression models with robust variances. Multivariable logistic regressions were used to compare the incidence complications between ablation methods. Results Of 37,538 AF ablations performed in the Netherlands, 20,799 (55.4%) and 12,549 (33.4%) underwent RF and cryoballoon ablations, respectively. At index AF ablation, patients referred to cryoballoon ablation were more likely women (34.3% vs 31.9%) and more frequently treated for paroxysmal AF (76.8% vs 68.0%) compared to RF patients [cryoballoon vs RF, respectively; p&amp;lt;0.05 for both]. Age of patients did not differ between ablation methods [median age for both: 63 (IQR 56-69) years; p=0.9]. From 2013 to 2021, the utilization of cryoballoon ablation increased by 16% for index ablations (p&amp;lt;0.05; Figure 1). Further, the population-level incidence of cryoballoon ablation was similar to RF ablation for index ablations from 2016 onwards (Figure 1). Repeat ablations (n=10,511) were primarily performed with RF (91.5%). Patients with cryoballoon ablation had a reduced risk of referral for repeat ablation [aHR 0.7 (95% CI 0.6-0.7)]. After multivariable adjustment, cryoballoon ablation was a risk factor for phrenic nerve paralysis [aOR 18.6 (95% CI 9.5- 36.4)] and RF was a risk factor for cardiac tamponade [aOR 2.7 (95% CI 1.7-4.3)] and minor vascular complications [aOR 1.4 (95% CI 1.1-1.8)] for index ablation. No difference was detected for the incidence of other complications between ablation methods (Figure 2). Incidence of all complications remained stable over time (p&amp;gt;0.05 for both). Conclusion The utilization of cryoballoon and RF ablation has rapidly increased from 2013 to 2021 in the Netherlands. Further, cryoballoon was used as frequently as RF ablations for index AF ablation procedures from 2016 onwards.

Abstract 12151: Impact of Psychosocial Risk Factors on the Outcomes of Patients Undergoing Cather Ablation for Atrial Fibrillation

Introduction: There is limited data on how psychosocial risk factors (PSRFs) affect the outcomes of patients undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of PSRFs affects the outcomes of AF ablation and tested this hypothesis using a nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients were divided into two cohorts based on the presence or absence of ≥1 PSRF. PSRFs were divided into 5 domains including limited cognitive understanding, substance use, psychiatric disease, low socioeconomic status, and uninsured status. A multivariable logistic regression model was utilized to adjust for confounders. Results: Our cohort included 50,623 AF ablation procedures, of which 21,363 (42.2%) had ≥ 1 PSRF. On multivariable analysis, the presence of ≥ 1 PSRF was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.11; 95% confidence interval [CI]: 1.02-1.22; p=0.02), peripheral vascular complications (aOR:1.18; 95% CI: 1.01-1.38; p=0.04), pulmonary complications (aOR:1.16; 95% CI: 1.05-1.29; p&lt;0.01) and neurological complications (aOR:1.42; 95% CI: 1.12-1.78; p&lt;0.01), along with higher odds of 30-day all-cause readmissions (aOR:1.30; 95% CI: 1.19-1.43; p&lt;0.01) and atrial fibrillation/flutter related readmissions (aOR:1.27; 95% CI: 1.08-1.50; p&lt;0.01), 90-day all-cause readmissions (aOR:1.30; 95% CI: 1.20-1.40; p&lt;0.01) and atrial fibrillation/flutter related readmissions (aOR:1.22; 95% CI: 1.06-1.41; p&lt;0.01), and 180-day all-cause readmissions (aOR:1.35; 95% CI: 1.24-1.45; p&lt;0.01) (Figure 1). Conclusion: In conclusion, our data suggest an association between PSRFs and worse in-hospital outcomes along with increased all-cause and arrhythmia-related readmissions in patients undergoing AF ablation.

Abstract 18759: Reliability and Accuracy of Non-Invasive versus Invasive Blood Pressure Monitoring During Atrial Fibrillation Ablation

Introduction Patients with atrial fibrillation (AF) have multiple confounders that could affect the reliability of non-invasive blood pressure (NIBP). We sought to investigate if AF and paced rhythms (PR) modify the reliability of NIBP and accuracy against an invasive blood pressure (IBP) reference, as compared to sinus rhythm (SR), and impact NIBP validity for procedural monitoring. Hypothesis Changes in heart rhythm between AF, SR and PR, within a patient would not alter the reliability and accuracy of NIBP. Methods We conducted an observational study in patients undergoing an AF ablation procedure under general anesthesia with paired IBP, NIBP, and heart rhythm measurements available. Results We evaluated 91 patients ( Table 1 ) with 1,179 usable NIBP vs. IBP pairs; 547 (46.4%) during SR, 376 during AF (31.9%), and 256 (21.7%) during PR. In the entire sample, the average difference (standard error) between systolic NIBP and IBP was 2.9 (1.8) mmHg (P=0.10 against H0=0) with a within-subject standard deviation (SD) for the difference of 11.6 mmHg and intraclass correlation coefficient of 0.76 ( Fig. 1 ). Systolic NIBP was higher on average vs. IBP when in SR (6.2 [1.1] mmHg; P&lt;0.001), but not when in AF (1.5 [2.6] mmHg; P=0.55) or in PR (-2.0 [3.3] mmHg; P=0.54). However, the within-patient SD of the difference was high in SR, AF, and PR (SD 10.5, 12.9, and 11.9 mmHg, respectively). Results were similar for diastolic and mean NIBP vs. IBP. Conclusion AF or PR, as compared to SR, did not materially change the reliability and accuracy of NIBP vs. IBP. However, the high within-patient variation in systolic NIBP versus IBP raises concerns on the validity of NIBP for systolic blood pressure monitoring.

Abstract 12298: Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Rheumatic Mitral Valve Disease

Introduction: There is a lack of data on procedural safety and outcomes in patients with rheumatic mitral valve disease (RMVD) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of RMVD may affect the outcomes of patients undergoing AF ablation and tested this hypothesis using data from a large, nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients with RMVD were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders. Results: Our cohort included 50,728 weighted AF ablation procedures, of which 3,500 (6.9%) patients had RMVD. Patients with RMVD were older at the time of catheter ablation, with a significantly higher percentage of females, less likely to have paroxysmal AF, and had a higher burden of comorbidities including congestive heart failure, renal failure, and hypertension. On multivariable analysis, the presence of RMVD was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.28; 95% confidence interval [CI]: 1.12-1.47; p&lt;0.01) with no difference in the odds of in-hospital mortality or other periprocedural outcomes. Also, RMVD was associated with longer length of stay (adjusted mean difference: +1.06; 95% CI: +0.67 - +1.45; p&lt;0.01) days and lower odds of routine home discharge (aOR:0.77; 95% CI: 0.69-0.87; p&lt;0.01). There was no difference in the odds of 30-day or 180-day all-cause, AF-related, or atrial flutter-related readmissions in patients with RMVD vs. no RMVD (Figure 1). Conclusion: In conclusion, patients with RMVD undergoing AF ablation have higher odds of periprocedural cardiovascular complications with similar odds of 30-day and 180-day all-cause and AF-related readmissions

Abstract 13269: Clinical and Electrophysiological Features of New Onset Ventricular Arrythmias Following Catheter Ablation of Atrial Fibrillation

Introduction: Data on new onset ventricular arrhythmias (VAs) following catheter ablation of atrial fibrillation (AF) is sparse. Hypothesis: We aimed to assess the incidence of new onset VA post AF RFA. Methods: We conducted a retrospective study of all patients at our institution that underwent AF ablation who also developed symptomatic high burden premature ventricular complexes (PVCs) requiring catheter ablation within 1 year of the index AF ablation procedure. All patients underwent post AF ablation monitoring with either 48 hr Holter monitors or implantable cardiac monitors. New onset VA was defined as symptomatic new onset PVC with &gt;5% burden. Data on PVC morphology and successful ablation sites was analyzed. Results: Out of 175 patients that underwent AF ablation during the study period, 2.8 % (n=5) patients developed new onset high burden PVCs requiring catheter ablation therapy within 1 year of AF ablation. Mean age was 68.6 + 11 years and all patients were male. Mean baseline LVEF was 56 + 9.6% and mean PVC burden was 10.3 + 8.8 %. A total of 9 PVCs were mapped in 5 patients. The number of VA morphology was 1 in 2 (40%) patients, 2 in 2 (40%) and 3 in 1 (20%) patient. Site of origin for the PVCs was in the left ventricle in all patients, with majority (55%) localizing to the LV outflow tract and summit region (table). Average time from AF RFA to PVC ablation was 4 + 2.9 months. PVC ablation was successful in all patients except one where ablation was deferred due to proximity to the conduction system. Conclusions: New onset VAs following catheter ablation of AF tend to localize to the LV outflow tract and areas of bipolar voltage abnormality. Potential mechanisms of new onset PVCs could include altered sympathetic tone due to ablation of cardiac ganglia, unmasking of PVCs due to regularization of ventricular rate and withdrawal of anti-arrhythmic medications. Further prospective studies are needed to understand true incidence of new onset VAs following AF ablation.