Atrial Fibrillation Ablation In Patients Research Articles

Atrial fibrillation ablation in patients with pulmonary hypertension: Multicenter experience

Atrial fibrillation ablation in patients with pulmonary hypertension: Multicenter experience

Pre-procedural Stratification by the Endothelial Function in Patients with Heart Failure Undergoing Atrial Fibrillation Ablation

BackgroundEndothelial dysfunction (ED), a well-established risk marker of cardiovascular events, is associated with heart failure (HF) and atrial fibrillation (AF). Its relationship with cardiovascular events in patients with HF undergoing AF ablation remains unclear. We aimed to elucidate the association between ED and the outcomes after AF ablation in patients with HF. MethodsThis prospective cohort study included patients with HF who underwent an endothelial function assessment using the peripheral vascular reactive hyperemia index (RHI) before first-time AF ablation. We defined AF recurrence according to the following types: the conventional form (AF≥30 seconds) and persistent form (requiring cardioversion). An RHI<2.1 indicated ED. Those with and without ED were compared in terms of the 3-year incidence of AF recurrence and cardiovascular events after AF ablation. ResultsAmong 421 patients with HF (69 ± 9 years and 38% females), 343 (81.5%) had ED. Although the incidence of the conventional form of AF recurrence was similar between the groups, that of the persistent form was significantly higher in the ED group (25.7% vs. 15.3%, log-rank P = 0.028). The ED group also had a significantly higher rate of cardiovascular events (14.8% vs. 3.6%, log-rank P = 0.028). Pre-procedural ED was identified as an independent predictor of a persistent form of AF recurrence (adjusted hazard ratio [HR] 2.31, 95% confidence interval [CI] 1.06–5.06, P = 0.035) and that of cardiovascular events (adjusted HR 4.26, 95% CI 1.03–17.7, P = 0.028), respectively. ConclusionsThe endothelial function assessment enabled the risk stratification of clinically problematic outcomes after AF ablation in patients with HF.

Disturbed atrial metabolism, shear stress, and cardiac load contribute to atrial fibrillation after ablation: AXAFA biomolecule study.

Different disease processes can combine to cause atrial fibrillation (AF). Their contribution to recurrent AF after ablation in patients is not known. Cardiovascular processes associated with recurrent AF after AF ablation were determined by quantifying biomolecules related to inflammation, metabolism, proliferation, fibrosis, shear stress, atrial pressure, and others in the AXAFA biomolecule study. Twelve circulating cardiovascular biomolecules (ANGPT2, BMP10, CA125, hsCRP, ESM1, FABP3, FGF23, GDF15, IGFBP7, IL6, NT-proBNP, and hsTnT) were quantified in plasma samples obtained prior to a first AF ablation using high-throughput, high-precision assays. Cox regression was used to identify biomolecules associated with recurrent AF during the first 3 months after AF ablation. In 433 patients (64 years [58, 70]; 33% women), baseline concentrations of ANGPT2, BMP10, hsCRP, FGF23, FABP3, GDF15, and NT-proBNP were elevated in patients with recurrent AF (120/433; 28%). After adjustment for 11 clinical features and randomized treatment, elevated NT-proBNP [hazard ratio (HR) 1.58, 95% confidence interval (1.29, 1.94)], ANGPT2 [HR 1.37, (1.12, 1.67)], and BMP10 [HR 1.24 (1.02, 1.51)] remained associated with recurrent AF. Concentrations of ANGPT2, BMP10, and NT-proBNP decreased in patients who remained arrhythmia free, but not in patients with recurrent AF, highlighting their connection to AF. The other eight biomarkers showed unchanged concentrations. Elevated concentrations of ANGPT2, BMP10, and NT-proBNP are associated with recurrent AF after a first AF ablation, suggesting that processes linked to disturbed cardiomyocyte metabolism, altered atrial shear stress, and increased load contribute to AF after AF ablation in patients.

The efficacy and safety of cryoballoon atrial fibrillation ablation in patients with heart failure: A systematic review and meta-analysis

IntroductionWhile atrial fibrillation (AF) ablation has proven beneficial for heart failure (HF) patients, most reports were performed with radiofrequency ablation. We aimed to evaluate the efficacy and safety of cryoballoon AF ablation in patients with HFrEF. MethodWe comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane database from inception to December 2022. Studies that reported the outcomes of freedom from atrial arrhythmia, complications, NYHA functional class (NYHA FC), and left ventricular ejection fraction (LVEF) after Cryoballoon AF ablation in HF patients were included. Data from each study were combined with a random-effects model. ResultA total of 9 studies observational studies with 1414 HF patients were included. Five studies had only HF with reduced ejection fraction (HFrEF), 1 study with HF with preserved ejection fraction (HFpEF), and others with mixed HF types. Freedom from AA in HFrEF at 12 months was 64% (95% CI 56–71%, I2 58%). There was a significant improvement of LVEF in these patients with a standard mean difference of 13% (95% CI 8.6–17.5%, I2 99% P < 0.001. The complication rate in HFrEF group was 6% (95% CI 4–10%, I2 0%). The risk of recurrence of atrial arrhythmia was not significantly different between HF and no HF patients (RR 1.34, 95% CI 0.8–2.23, I2 76%). ConclusionCryoballoon AF ablation is effective in HFrEF patients comparable to radiofrequency ablation. The complication rate was low.

Enlarged right atrium predicts pacemaker implantation after atrial fibrillation ablation in patients with tachycardia-bradycardia syndrome

IntroductionAlthough catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. MethodsFrom 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). ResultsWhen comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). ConclusionRight atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.

Temporal trends in the utilization, referral patterns, and complications of catheter ablation for atrial fibrillation in the Netherlands, 2013-2021

Abstract Background Over the past decade, atrial fibrillation (AF) ablation technologies have evolved, operator experience has improved, and indications for referral to AF ablation has expanded. A recent population-level assessment is warranted to assess the impact of these changes on trends in the utilization, referrals, and adverse events (AEs) of AF ablation. Purpose Our aim was to describe temporal trends in the population-level incidence, patients referred, and AEs of AF ablation in the Netherlands from 2013 to 2021. Methods Temporal trend analyses were conducted using the AF ablation population in the Netherlands Heart Registration and included all consecutive patients treated with catheter ablation for AF between 2013 and 2021 at 16 hospitals in the Netherlands. Annual crude, sex- and age-standardized incidence rates of AF ablation were calculated. Poisson regression models with robust variances were used to evaluate trends in the incidence of AF ablation. Trends in patient characteristics, AEs, and repeat ablations over the study period were evaluated with ANOVA tests. Results Between 2013 and 2021, 37,538 AF ablations were performed in the Netherlands, of which 27,027 (72.0%) were index ablations. Repeat ablations (10,511 procedures) were performed within a median time to repeat ablation of 1 (IQR 1-2) year. AF ablation patients were a median age 63 (IQR 56-69) years, 32.8% women, 70.7% had paroxysmal AF, and median CHA2DS2-VASC score was 1 (IQR 1-2). Most patients underwent radiofrequency ablation (55.4%), followed by cryoballoon (33.4%), PVAC (0.6%), pulse-field (0.3%), laser balloon ablation (0.1%), and other (0.1%) (10.1% missing). Over the 9-year period, there was a statistically significant increase in index [incidence rate ratio (IRR) 1.07 (95% CI 1.05-1.08)] and repeat [IRR 1.09 (95% CI 1.05-1.12)] ablations from 2013 to 2021 (Figure 1). The annual sex-standardized incidence rates of AF ablations were approximately double for men compared to women throughout follow-up (Figure 2). In recent years, AF ablation patients had more persistent AF, higher CHA2DS2-VASC scores, and lower LVEF (p&amp;lt;0.05 for all). Minor vascular AEs within 30 days were the most frequent AE of AF ablation (1.1%), followed by phrenic nerve paralysis (0.6%), in-hospital bleeding (0.6%), cardiac tamponade (0.5%), thrombosis (0.3%), major vascular AEs (0.2%) and all-cause mortality (0.1%). Incidence of most AEs remained stable over time (p&amp;gt;0.05 for all). CONCLUSION In the Netherlands, the utilization of AF ablation increased by 7% from 2013 to 2021. In recent years, populations referred for AF ablation were increasingly older, had more persistent AF, higher CHA2DS2-VASC scores, and lower LVEF; however, men remained twice as likely to undergo AF ablation compared to women. Reasons for the lower rate of AF ablation among women requires further investigation.

A novel designed atrial septum linear ablation method (Icho line) for non-pulmonary vein triggers originating from atrial postero-septum and crista terminalis

Abstract Background Therapeutic strategy for non-pulmonary vein (PV) trigger of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-PV trigger sites of AF. For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line". Icho means ginkgo in Japanese. Methods Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers from the postero-septum or CT that initiate AF were analyzed. Premature atrial contractions that did not initiate AF were excluded. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation and CT were continuously ablated like the shape of a ginkgo leaf (Figure 1). Results A hundred and fifteen non-PV triggers were detected in 104 patients (12.5%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers from the postero-septum or CT (Figure 1). Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure 2). Conclusions A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.Icho Line Figure 1Icho Line Figure 2

Abstract 18414: Risk of Stroke After Atrial Fibrillation Ablation in Patients Without Pre-Ablation Left Atrial Appendage Evaluation

Introduction: Currently, transesophageal echocardiography (TEE), intracardiac echocardiography (ICE), or CT angiography (CTA) are often though not always performed to assess the left atrial appendage (LAA) prior to ablation to reduce the risk of stroke. We seek to evaluate in a large, real-world registry if rates of stroke are similar in patients who do not have this evaluation and are on at least three weeks of anticoagulation prior to ablation. Methods: The REAL-AF registry is a multicenter prospective registry that is enrolling patients undergoing AF ablation at high-volume centers. Data from a total of 2704 patients (mean age 66 ± 11 years, 42% female) receiving index ablation for paroxysmal and persistent AF were obtained and included in the analysis. The patients who suffered strokes within 12 months of ablation were analyzed. Results: A total of 1522 (56%) patients received TEE, 1143 (42%) received ICE, 153 (6%) received both TEE and ICE, 95 (4%) received CTA, and 97 (4%) did not received any evaluation for LAA clots pre-ablation. CHA 2 DS 2 VASc was significantly higher in the not screened group compared to the screened group ((3.18 [2.84 - 3.51]) vs 2.65 [2.59 - 2.71], p &lt; 0.01). Three patients (0.1%) suffered strokes after ablation, two who had been screened by ICE, and one who had not been screened. No patients who were screened by TEE or CTA suffered strokes. All three patients with strokes were on therapeutic oral anticoagulation prior to ablation. The two patients screened with ICE had a CHA2DS2VASC of 2 and 7, while the patient without screening had a score of 6. Patients who were not screened had a statistically significant higher likelihood of having a stroke compared to those who received LAA screening with TEE, ICE, or CTA (OR = 13.2 [1.2 - 147], p = 0.04). Conclusion: While absolute rates of stroke after AF ablation are low, in our cohort occurring in only 0.1% of patients, there was a statistically significantly higher odds of developing stroke in patients who did not have their LAA screened prior to ablation.

Abstract 12216: A Novel Designed Atrial Postero-Septum Linear Ablation Method (Icho Line) for Non-Pulmonary Vein Triggers of Atrial Fibrillation (AF)

Introduction: Therapeutic strategy for non-pulmonary vein (PV) triggers of atrial fibrillation (AF) has not been well established although they are the major cause of AF recurrence after PV isolation. The atrial postero-septum or right atrial crista terminalis (CT) are the common non-pulmonary vein (PV) trigger sites of atrial fibrillation (AF). For them, a focal ablation is often insufficient due to a regional arrhythmogenicity. We devised an original linear ablation method, named "Icho Line” covering the non-PV triggers from this area. Methods: Eight hundred and thirty-two AF ablation patients were retrospectively studied. An AF induction test was conducted after each PV isolation procedure. Non-PV triggers were detected in 104 patients (12.7%), among which Icho line ablation was performed in 39 patients (37.5%) with documented triggers of AF from postero-septum or CT. A linear ablation was designed horizontally from the anterior right PV isolation line to fossa ovalis in the left atrium. In the right atrium, the opposite side of the left atrial ablation was continuously ablated toward the CT like the shape of a ginkgo leaf (Figure). Results: Atrial tachyarrhythmia recurrence free rate in the Icho line group and other non-PV ablation patients were 61.8% and 45.4%, respectively (P=0.54, Figure). Recurrence with atrial tachycardia was very rare in the Icho line group. Conclusions: A novel designed Icho line is a feasible and effective ablation strategy covering non-PV triggers from the atrial septum and CT.

Abstract 12614: Procedural Volume and Outcomes With Atrial Fibrillation Ablation: A Report From the NCDR AFib Registry

Introduction: Operator and hospital procedure volumes are associated with outcomes in many cardiac procedures. Objective: To determine the association between hospital/physician procedural volume and safety/success for atrial fibrillation (AF) ablation in the current era. Methods: Procedures reported to the NCDR AFib Registry between 7/2019 to 6/2022 were analyzed. Physician and hospital procedural volumes were annualized and stratified into quartiles (Q) to compare procedural success and major adverse events (MAE). Three level hierarchical (patient, hospital and physician) generalized linear models were used to assess the adjusted relationship between procedural volume and likelihood of acute outcomes. Results: A total of 70,296 first time AF ablation patients' at 186 US hospitals were studied. Mean age was 66.1 ± 10.3 years. 36% were women; mean CHA2DS2-VASc score was 2.7±1.6, and 57.4% were of paroxysmal AF. The median annual procedural volumes for hospitals and physicians were 230 and 66 respectively. Acute procedural success was 98.5% and the MAE rate was 1.0%. With Q4 (highest) hospital procedural volume as a reference, the adjusted likelihood of procedural success was significantly less among Q1 (OR: 0.44, CI: 0.3-0.7), Q2 (OR:0.50, CI:0.3-0.8) and Q3 (OR:0.60,CI:0.4-0.9). Similarly, for physician volume, the adjusted likelihood of success was less among Q1 (OR: 0.38,CI: 0.3-0.5), Q2 (OR: 0.51,CI: 0.4-0.7) and Q3 (OR:0.55,CI:0.4-0.7). With regards to MAE, compared to Q4, there was an inverse relationship to procedural volume for hospitals in Q1 (OR: 1.78, CI:1.3-2.5) but not in Q2 (OR: 1.06, CI 0.8-1.5) or Q3 (OR: 1.19, CI: 0.9-1.6) and for physicians in Q1 (OR: 1.93, CI 1.4-2.6) and Q2 (OR:1.49, CI: 1.1-2.0) but not in Q3 (OR: 1.22, CI: 0.9-1.6)(figure). Conclusions: In this national cohort of first time AF ablations, hospital and physician procedural volume were directly related to acute procedural success and inversely related to the rate of MAE.

Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature

Atrial Fibrillation Ablation in Patients With Chronic Kidney Disease: A Review of Literature

Atrial fibrillation ablation in patients with reduced left ventricular ejection fraction: does it only improve hemodynamics or does it affect the prognosis? (A systematic review)

Objective: To critically evaluate the results of studies concerning the impact of atrial fibrillation ablation on hemodynamics and prognosis in patients with heart failure with reduced left ventricular ejection fraction.Methods: We searched via keywords in the PubMed, Embase, Cochrane Library, and Web of Science databases and selected the most-cited studies containing data on the ablation treatment of patients with atrial fibrillation and heart failure with reduced left ventricular ejection fraction, including such treatment end points as left ventricular ejection fraction, mortality, etc. We analyzed the effect of ablation on changes in left ventricular ejection fraction and clinical outcomes in patients with atrial fibrillation compared with that of drug therapy.Results: We screened 4581 literature sources: of them, 48 were selected for the review. Compared with drug therapy in similar patients with atrial fibrillation and heart failure, there is a 4-fold absolute increase (P &lt; .001) in left ventricular ejection fraction after endocardial catheter ablation, thoracoscopic or hybrid ablation of atrial fibrillation. Some studies show a relative risk reduction in mortality (max 47%; P = .01) following the ablation in patients with atrial fibrillation and baseline reduced left ventricular ejection fraction.Conclusion: After atrial fibrillation ablation (regardless of the technique used and left ventricular dysfunction severity), patients with heart failure with reduced left ventricular ejection fraction show a statistically significant improvement in systolic function probably due to a decreased arrhythmia burden. Further research could determine the population of heart failure patients who would benefit most from atrial fibrillation ablation. Received 20 April 2023. Revised 6 June 2023. Accepted 7 June 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Atrial fibrillation ablation in patients with arrhythmia-induced cardiomyopathy: a prospective multicentre study.

This study aims to investigate the clinical and biochemical characteristics of patients with atrial fibrillation (AF) referred for ablation who develop arrhythmia-induced cardiomyopathy (AiCM) as well as their long-term outcomes after catheter ablation (CA). A prospective multicentre study was conducted on consecutive AF patients who underwent CA. AiCM was defined as the development of heart failure in the presence of AF and an improvement of left ventricular fraction by at least 10% at 6months after ablation. A subgroup of patients underwent peripheral and left atrial blood samples [galectin-3, fatty acid-binding protein 4 (FABP4), and soluble receptor for advanced glycation end products (sRAGE)] at the time of the procedure. Of the 769 patients who underwent AF ablation, 135 (17.56%) met the criteria for AiCM. Independent predictors of AiCM included persistent AF, male gender, left atrial volume, QRS width, active smoking, and chronic kidney disease (CKD). Biomarker analysis revealed that sRAGE, FABP4, and galectin-3 levels were not predictive of AiCM development nor did they differ between groups or predict recurrence. There were no differences in AF recurrence between patients with and without AiCM (30.83% vs. 27.77%; P=0.392) during a median follow-up of 23.83months (inter-quartile range 9-36). In the subset of patients referred for AF ablation, the development of AiCM was associated with persistent AF and CKD. Biomarker analysis was not different between groups nor predicted recurrence. Patients with AiCM benefited from ablation, with a significant improvement in left ventricular ejection fraction and similar AF recurrence rates to those without AiCM.

Catheter ablation of atrial fibrillation in patients with and without hypertrophic cardiomyopathy: systematic review and meta-analysis.

Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM). There is limited data regarding the outcomes of AF catheter ablation in HCM patients. In this study, we aimed to synthesize all available evidence on the effectiveness of ablation of AF in patients with HCM compared to those without HCM. We systematically reviewed bibliographic databases to identify studies published through February 2023. We included cohort studies with available quantitative information on rates of recurrent atrial arrhythmias, anti-arrhythmic drug (AAD) therapy, and repeat ablation procedures after initial AF ablation in patients with vs without HCM. Estimates were combined using random-effects meta-analysis models and reported as risk ratios (RR) and 95% confidence intervals (CI). Eight studies were included in quantitative synthesis (262 HCM and 642 non-HCM patients). During median follow-up 13-54 months across studies, AF recurrence rates ranged from 13.3% to 92.9% in HCM and 7.6% to 58.8% in non-HCM patients. The pooled RR for recurrent atrial arrhythmia after the first AF ablation in HCM patients compared to non-HCM controls was 1.498 (95% CI = 1.305-1.720; P < 0.001). During follow-up, HCM patients more often required AAD therapy (RR = 2.844; 95% CI = 1.713-4.856; P < 0.001) and repeat AF ablation (RR = 1.544; 95% CI = 1.070-2.228; P = 0.02). The pooled RR for recurrent atrial arrhythmias after the last AF ablation was higher in patients with HCM than those without HCM (RR = 1.607; 95% CI = 1.235-2.090; P < 0.001). Compared to non-HCM patients, those with HCM had higher rates of recurrent atrial arrhythmias, AAD use, and need for repeat AF ablation after initial ablation of AF.

Safety of Catheter Ablation Therapy for Atrial Fibrillation in Cardiac Amyloidosis.

Background Despite the high burden of atrial fibrillation in cardiac amyloidosis (CA), the safety of catheter ablation therapy in CA is not well established. We sought to examine short-term safety outcomes following atrial fibrillation ablation in patients with CA compared with matched patients with dilated cardiomyopathy (DCM). Methods and Results Using data from the National Inpatient Sample, we identified all hospitalizations for atrial fibrillation ablation from the fourth quarter of 2015 through 2019. Admissions for CA and DCM were matched in a 1:5 ratio using propensity scores based on the following sociodemographics: age, sex, race or ethnicity, payor, median income, comorbidities, and hospital characteristics. We compared in-hospital outcomes between both cardiomyopathies. We identified 1395 unweighted hospitalizations (representing 6750 national hospitalizations) for atrial fibrillation ablation, out of which 45 (3.2%) were admissions for CA. Compared with DCM, patients with CA were older (72.9 versus 65.1 years), had a higher burden of prior stroke (20.0% versus 8.6%) and chronic kidney disease (53.3% versus 33.6%), and were less likely to have a prior implantable cardioverter-defibrillator (4.4% versus 23.0%). We successfully matched 42 CAs to 210 DCM hospitalizations. After matching, there was no difference in total complications (14.3% versus 10.5%, P=0.60), length-of-stay (3.1 versus 2.1 days, P=0.23), home disposition (97.6% versus 96.2%, P=0.65), and total charges ($137 250 versus $133 910, P=0.24). Conclusions In this nationally representative study of atrial fibrillation catheter ablation in CA, short-term safety outcomes and complication rates were similar to a propensity score-matched cohort of DCM. Further studies exploring long-term safety outcomes are needed.

Impact of pericoronary adipose tissue attenuation on recurrence after radiofrequency catheter ablation for atrial fibrillation.

Inflammation plays a vital role in the occurrence and progression of atrial fibrillation (AF). The association between pericoronary adipose tissue attenuation (PCATA) and AF recurrence following ablation has not been fully clarified. We aimed to evaluate the association between PCATA and AF recurrence after radiofrequency catheter ablation(RFCA). Patients who underwent the first RFCA for AF and performed coronary computed tomography angiography before ablation between 2018 and 2021 were enrolled. The predictive values of PCATA for AF recurrence after ablation were investigated. The area under curve (AUC), relative integrated discrimination improvement (IDI), and categorical free net reclassification improvement (NRI) were used to assess the discrimination ability of different models for AF recurrence. During 1-year follow-up, 34.1% patients experienced AF recurrence. The multivariable analysis model revealed that PCATA of the right coronary artery (RCA) was an independent risk factor for AF recurrence. Patients with a high level of RCA-PCATA had a high risk of recurrence, after adjusting for other risk factors by restricted cubic splines. The performance in predicting AF recurrence was significantly improved by adding the marker of RCA-PCATA to the clinical model (AUC:0.724 vs. 0.686, p = .024), with a relative IDI of 0.043 (p = .006) and continuous NRI of 0.521 (p < .001). PCATA of RCA was independently associated with AF recurrence after ablation. PCATA may be helpful for risk classification for AF ablation patients.

Colchicine usage for prevention of post atrial fibrillation ablation pericarditis in patients undergoing high-power short-duration ablation.

Radiofrequency ablation (RFA) for atrial fibrillation (AF) has been associated with variable incidence (0.88%-10%) of pericarditis manifested as chest pain, possibly more prevalent with the advent of high-power short-duration (HPSD) ablation. This has led to the widespread use of colchicine in preventative protocols for postablation pericarditis. However, the efficacy of preventative colchicine has not been validated yet. To evaluate the efficacy of a routine postoperative colchicine regimen (0.6 mg twice a day for 14 days post-AF ablation) for prevention of postablation pericarditis in patients undergoing HPSD ablation. We retrospectively evaluated consecutive single-operator HPSD AF ablation procedures at our institution from June 2019 to July 2022. A colchicine protocol was introduced in June 2021 for the prevention of postablation pericarditis. All ablations were performed with 50 watts. Patients were divided into colchicine and noncolchicine groups. We recorded incidence of postablation chest pain, emergency room (ER) visit for chest pain, pericardial effusion, pericardiocentesis, any ER visit, hospitalization, AF recurrence, and cardioversion for AF within the first 30 days following ablation. We also recorded colchicine-related side effects and medication compliance. Two hundred and ninety-four consecutive HPSD AF ablation patients were screened for the study. After implementing the prespecified exclusion criteria, a total of 205 patients were included in the final analysis, yielding 101 patients in the colchicine group and 104 patients in the noncolchicine group. Both groups were well-matched for demographic and procedural parameters. There was no significant difference in postablation chest pain (9.9% vs. 8.6%, p = .7), pericardial effusion (2.9% vs. 0.9%, p = .1), ER visits (11.9% vs. 12.5%, p = .2), 30-day hospitalization for AF recurrence (0.9% vs. 0.96%, p = .3), and 30-day need for cardioversion for AF (3.9% vs. 5.7%, p = .2). Fifteen (15) patients had severe colchicine-related diarrhea, out of which 12 discontinued it prematurely. There were no major procedural complications in either group. In this single-operator retrospective analysis, prophylactic colchicine was not associated with significant reduction in the incidence of postablation chest pain, pericarditis, 30 day hospitalization, ER visits, or AF recurrence or need of cardioversion within first 30 days after HPSD ablation for AF. However, its usage was associated with significant diarrhea. This study concludes no additional advantage of prophylactic use of colchicine after HPSD AF ablation.

5 years incident stroke, heart failure, acute myocardial infarction, and death in patients having undergone atrial fibrillation ablation according to BMI

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Introduction Both atrial fibrillation (AF) and obesity have reached epidemic proportions. Obesity is an established risk factor in acute myocardial infarction (AMI), de novo AF, and AF recurrence after ablation. AF increase the risk of stroke, heart failure (HF), and death. The link between body mass index (BMI) and incident stroke, HF, AMI, or death in an AF ablation population is unknown. Purpose To examine incident stroke, HF, AMI, or death by BMI. Method Using Danish nationwide registries, all Danish patients above 18 years who underwent first-time AF ablation from January1st 2010 to December31st 2018 were identified and included at the date of ablation. Underweight patients (BMI &amp;lt; 18.5) were excluded. Exposure of interest was BMI and patients were stratified as normal-weight (BMI 18.5-24.9), overweight (BMI 25.0 – 29.9), obese (30.0 – 34.9), and morbidly obese (BMI ≥ 35.0). The primary endpoint was combined of either first-reached incident stroke, HF, AMI, or death. The 5-year cumulative incidence of the primary endpoint stratified by BMI, was estimated using the Aalen-Johansen estimator. The relative rates were examined using normal-weight as reference in both univariate- and multivariate-Cox models adjusted for prior HF, hypertension, age, diabetes, prior stroke, prior atherosclerotic vascular disease, and sex. Results The study cohort consisted of 7,701 patients. Median age [IQR] decreased from 64 [57, 70] to 60 [53, 66] in normal-weight and morbidly obese respectively. The prevalence of HF, ischemic heart disease, diabetes, and hypertension increased by BMI while prior stroke remained stable. Use of oral anticoagulants remained stable at around 98%. In total 1,285 patients reached the primary endpoint. By decreasing order, the most frequent endpoints were HF (564, 44%), AMI (431, 34%), stroke (199, 15%), and death (91, 7%). The cumulative incidence of the primary endpoint increased incrementally from 15%, 16%, 19%, and 21% from normal-weight to morbidly obese respectively (Figure 1). In the univariate analysis, the Hazard ratio (HR, [95% confidence interval]) increased incrementally from 1.03 [0.90 to 1.18], 1.28 [1.10 to 1.49], 1.43 [1.17 to 1.74] in overweight to morbidly obese respectively (Figure 2). In the multivariate analysis no significant differences were found. The HRs were 0.94 [0.82 to 1.08], 1.05 [0.89 to 1.23], 1.01 [0.82 to 1.24] in the overweight to morbidly obese respectively (Figure 2). Conclusion When identifying obese and morbidly obese AF ablation patients in clinical practice, the risk of either stroke, HF, AMI, or death is higher compared to normal-weight AF ablation patients, but only due to the underlying comorbidities.

CE-452776-3 IS RATE CONTROL EVER ADEQUATE? CATHER ABLATION IN RATE CONTROLLED ATRIAL FIBRILLATION WITH REDUCED EJECTION FRACTION

The optimal rate control target for atrial fibrillation (AF) in the setting of heart failure with reduced ejection fraction (HFrEF) is not defined. Prior clinical trials have demonstrated benefits of AF ablation for patients with HFrEF, including recovery in left ventricular ejection fraction (LVEF). However, it is unknown if degree of rate control prior to ablation affects outcomes. To evaluate whether degree of pre-ablation rate control impacts LVEF recovery following AF ablation in patients with HFrEF. A single center, retrospective cohort study of 75 consecutive patients with LVEF ≤35% who underwent first-time ablation for persistent AF at NYU Langone Health between January 2014 and January 2021. Patients were classified as having a LVEF recovery if their post-ablation LVEF was >35%. Proportion of patients with LVEF recovery were compared between multiple rate control cutoffs: 110 bpm, 90 bpm, and 70 bpm. A binomial logistic regression analysis was then performed examining the relationship of pre-ablation HR on LVEF recovery. The mean pre-ablation HR was 90±25 bpm, baseline LVEF was 27±6%, and 64% (48/75) of patients had at least 3 months of maximal GDMT prior to ablation (Table 1A). Significant improvement in LVEF was observed in all patient subgroups irrespective of rate control status (Figure 1A) and regardless of prior GDMT (Figure 1B). Overall, LVEF recovery to >35% occurred in 59% (44/75) of patients. Compared to patients with pre-ablation HR faster than evaluated rate control cutoffs (Table 1B), there were no differences in frequency of LVEF recovery when using ≤110 bpm (controlled: 58% vs. not controlled: 63%, p=0.73) or ≤90 bpm (controlled: 52% vs. not controlled: 66%, p=0.21). In contrast, patients achieving rate control ≤70 bpm were significantly less likely to have LVEF recovery (41%) compared to those with HR above the cutoff (66%; p=0.04). Binomial logistic regression analysis did not reveal HR as a significant predictor of LVEF recovery (OR=1.01; CI 95%=0.99-1.03; p=0.16). Catheter ablation of persistent in AF in patients with HFrEF frequently resulted in improvement in LVEF, irrespective of achieved rate control. LVEF recovery >35% following catheter ablation was reduced only with rate control of HR 70bpm. Catheter ablation should be considered in HFrEF patients regardless of degree of rate control achieved. Heart rate 70bpm should be evaluated as a goal for adequate rate control in patients with HFrEF in whom rhythm control is not pursued.

PO-01-013 ABLATION IMPROVES PHYSICAL ACTIVITY IN PERSISTENT ATRIAL FIBRILLATION

There are many potential benefits to ablation of atrial fibrillation (AF), but the impact on functional status has not yet been thoroughly investigated. Activity sensors in implanted cardiac devices provide a novel opportunity for an investigation. In addition, there may be a difference between patients with paroxysmal or persistent AF. The purpose of this study was to examine the impact of AF ablation on objective behavioral data using physical activity sensor data in patients with implanted cardiac devices. Patients in the UNC Cardiac Device Surveillance Registry with a history of AF who underwent AF ablation and had their device implanted at least 90 days prior to ablation were included. Patients were stratified into paroxysmal or persistent groups based on clinical diagnosis codes. Included patients had continuous activity data from at least 60 days prior to and 90 days after ablation. Activity from hospitalized days were excluded. We used linear mixed-effects models with daily physical activity values (minutes per day) as the unit of analysis to estimate the association between AF ablation and physical activity. There were 45 persistent and 115 paroxysmal AF patients in the cohort. Mean age was 70.7 yrs (68.6 persistent, 71.6 paroxysmal) and 60 (37.5%) were female. Implanted devices included 54.9% pacemakers, 36.3% defibrillators, and 8.8% implantable loop recorders. Comorbidities included hypertension (95.7%), heart failure (74.8%), diabetes (40.9%), sleep apnea (33%), history of stroke (17.4%), and history of myocardial infarction (76.5%). There was no difference in age, device type, or comorbidity between paroxysmal and persistent patients. Persistent AF patients had a 14.6 minute increase in daily activity after ablation (p<0.001), while paroxysmal patients did not experience meaningful change in activity levels (-1.6 minutes, p=0.192). This study demonstrated an increase in objectively-measured physical activity after AF ablation in patients with implanted cardiac devices and persistent AF. No activity benefit was observed in devices patients with paroxysmal AF. Further research in larger samples is needed to replicate these findings and to determine whether improvement in functional tolerance may be an underappreciated benefit of ablation.