Atrial Fibrillation Recurrence In Patients Research Articles

Influence of Sex-Based Differences in Cardiac Phenotype on Atrial Fibrillation Recurrence in Patients Undergoing Pulmonary Vein Isolation.

BackgroundPulmonary vein isolation (PVI) is a commonly engaged therapy for symptomatic atrial fibrillation (AF). Prior studies have documented elevated AF recurrence rates among females vs. males. Sex-specific mechanisms underlying this phenomenon are poorly understood. This prospective cohort study aimed to evaluate the sex-based differences in cardiac phenotype and their influence on (AF) recurrence following first-time PVI.MethodsA total of 204 consecutive patients referred for first-time PVI and 101 healthy subjects were prospectively studied by cardiovascular magnetic resonance (CMR) imaging. Multi-chamber volumetric and functional measures were assessed by sex-corrected Z-score analyses vs. healthy subjects. Patients were followed for a median of 2.6 years for the primary outcome of clinical AF recurrence. Multivariable analyses adjusting for age and comorbidities were performed to identify independent predictors of AF recurrence.ResultsAF recurrence following first PVI occurred in 41% of males and 59% of females (p = 0.03). Females were older with higher prevalence of hypertension and thyroid disorders. Z-score-based analyses revealed significantly reduced ventricular volumes, greater left atrial (LA) volumes, and reduced LA contractility in females vs. males. Multivariable analysis revealed each of LA minimum and pre-systolic volumes and booster EF Z-scores to be independently associated with AF recurrence, providing respective hazard ratios of 1.10, 1.19, and 0.89 (p = 0.001, 0.03, and 0.01).ConclusionAmong patients referred for first time PVI, females were older and demonstrated significantly poorer LA contractile health vs. males, the latter independently associated with AF recurrence. Assessment of LA contractile health may therefore be of value to identify female patients at elevated risk of AF recurrence. Factors influencing female patient referral for PVI at more advanced stages of atrial disease warrant focused investigation.

Left atrial strain and recurrence of atrial fibrillation after thoracoscopic surgical ablation: a subanalysis of the AFACT study

To assess transthoracic echocardiographic (TTE) left atrial (LA) strain parameters and their association with atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation (SA) in patients in sinus rhythm (SR) or in AF at baseline. Patients participating in the Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery trial were included. All patients underwent thoracoscopic pulmonary vein isolation with LA appendage exclusion and were randomized to ganglion plexus (GP) or no GP ablation. In TTEs performed before surgery, LA strain and mechanical dispersion (MD) of the LA reservoir and conduit phase in all patients, and of the contraction phase in patients in SR were obtained. Recurrence of AF was defined as any documented atrial tachyarrhythmia lasting > 30 s during one year of follow-up. Two hundred and four patients (58.6 ± 7.8 years, 73% male, 57% persistent AF) were included. At baseline TTE 121 (59%) were in SR and 83 (41%) had AF. Patients with AF recurrence had lower LA strain of the reservoir phase (13.0% vs. 16.6%; p = < 0.001) and a less decrease in strain of the conduit phase (−9.0% vs. −11.8%; p = 0.006), regardless of rhythm. MD of the conduit phase was larger in patients with AF recurrence (79.4 vs. 43.5 ms; p = 0.012). Multivariate cox regression analysis demonstrated solely an association between LA strain of the reservoir phase and AF recurrence in patients in SR (HR 0.95, p = 0.046) or with AF (HR 0.90, p = 0.038). A reduction in LA strain of the reservoir phase prior to SA predicts recurrence of AF in both patients with SR or AF. Left atrial strain assessment may therefore add to a better patient selection for SA.

Low left atrial appendage emptying velocity is a predictor of atrial fibrillation recurrence after catheter ablation.

Recurrence of atrial fibrillation (AF) after catheter ablation (CA) remains common and studies have shown about 5%-9% annual recurrence rate after CA. We sought to assess the echocardiogram derived left atrial appendage (LAA) emptying velocity as a predictor of AF recurrence after CA. To determine if LAA emptying is a marker of recurrence of AF post-CA METHODS: A total of 303 consecutive patients who underwent CA for AF between 2014 and 2020 were included. Baseline clinical characteristics and echocardiographic data of the patients were obtained by chart review. LAA emptying velocities were obtained from transesophageal echocardiogram (TEE). LA voltage was obtained during the mapping for CA. Chi-square test and nominal logistic regression were used for statistical analysis. An receiver operator characteristic curve was used to determine LAA velocity cut-off. Mean patient age was 61.7 ± 10.5; 32% were female. Mean LAA emptying velocity was 47.5 ± 20.2. A total of 103 (40%) patients had recurrence after CA. In the multivariable model, after adjusting for potential confounders, LAA emptying velocity of ≥52.3 was associated with decreased AF recurrence postablation (odds ratio [OR]: 0.55; 95% confidence interval [CI]: 0.31-0.97; p = .03*). There were 190 (73%) patients in normal sinus rhythm during TEE and CA, and sensitivity analysis of these patients showed that LAA velocity ≥52.3 remained associated with decreased AF recurrence (OR: 0.35; 95% CI: 0.15-0.82; p = .01*). LAA emptying velocity measured during preprocedural TEE can serve as a predictor of AF recurrence in patients undergoing CA.

Prediction of Left Atrial Fibrosis and Success of Catheter Ablation by Speckle Tracking Echocardiography in Patients Imaged in Persistent Atrial Fibrillation.

BackgroundNon-invasive evaluation of left atrial structural and functional remodeling should be considered in all patients with persistent atrial fibrillation (AF) to optimal management. Speckle tracking echocardiography (STE) has been shown to predict AF recurrence after catheter ablation; however in most studies, patients had paroxysmal AF, and STE was performed while patients were in sinus rhythm.AimThe aim of this study was to evaluate the ability of STE parameters acquired during persistent AF to assess atrial fibrosis measured by low voltage area, and to predict maintenance of sinus rhythm of catheter ablation.MethodsA total of 94 patients (69 men, 65 ± 9 years) with persistent AF prospectively underwent measurement of Global Peak Atrial Longitudinal Strain (GPALS), indexed LA Volume (LAVI), E/e′ ratio, and LA stiffness index (the ratio of E/e′ to GPALS) by STE prior to catheter ablation, while in AF. Low-voltage area (LVA) was assessed by electro-anatomical mapping and categorized into absent, moderate (>0 to <15%), and high (≥15%) atrial extent. AF recurrence was evaluated after 3 months of blanking.ResultsMultivariable regression showed that LAVI, GPALS, and LA stiffness independently predicted LVA extent after correcting for age, glomerular filtration rate, and CHA2DS2-VASc score. Of all the parameters, LA stiffness index had the highest diagnostic accuracy (AUC 0.85), allowing using a cut-off value ≥0.7 to predict moderate or high LVA with 88% sensitivity and 47% specificity, respectively. In multivariable Cox analysis, both GPALS and LA stiffness were able to significantly improve the c statistic to predict AF recurrence (n = 40 over 9 months FU) over CHARGE-AF (p < 0.001 for GPALS and p = 0.01 for LA stiffness) or CHA2DS2-VASc score (p < 0.001 for GPALS and p = 0.02 for LA stiffness). GPALS and LA stiffness also improved the net reclassification index (NRI) over the CHARGE-AF index (NRI 0.67, 95% CI [0.33–1.13] for GPALS and NRI 0.73, 95% CI [0.12–0.91] for LA stiffness, respectively), and over the CHA2DS2-VASc score (NRI 0.43, 95% CI [−0.14 to 0.69] for GPALS and NRI 0.52, 95% CI [0.10–0.84], respectively) for LA stiffness to predict AF recurrence at 9 months.ConclusionSTE parameters acquired during AF allow prediction of LVA extent and AF recurrence in patients with persistent AF undergoing catheter ablation. Therefore, STE could be a valuable approach to select candidates for catheter ablation.

Circulating Galectin-3 and Aldosterone for Predicting Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation.

Background Circulating galectin-3 (Gal-3) and aldosterone (ALD) are involved in fibrosis and inflammation. However, their potential value as predictors of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA) is unknown or controversial. Therefore, the aim of this study was to assess the relationship between baseline Gal-3, ALD levels, and AF recurrence in patients performing RFCA. Methods 153 consecutive patients undergoing RFCA were included. Gal-3 and ALD were measured at baseline. Univariate and multivariate Cox regressions were performed to determine the predictors of AF recurrence. Receiver operating characteristic (ROC) curve and Kaplan-Meier (K-M) curve were used to assess the value of predictors. Results There were 35 (22.88%) cases of AF recurrence after RFCA. The recurrence group had significantly higher preoperative serum levels of Gal-3 and ALD than the nonrecurrence group. Univariate and multivariate analysis showed that Gal-3 (HR = 1.28, 95% CI: 1.04-1.56, p = 0.02) and ALD (OR = 1.02, 95% CI: 1.00-1.03, p < 0.03) were significantly associated with AF recurrence after RFCA. The area under the curve (AUC) of preoperative serum Gal-3, ALD, and 2 combined to predict the recurrence of AF patients after RFCA was 0.636, 0.798, and 0.893, respectively, while sensitivity was 65.32%, 71.69%, and 88.61%, respectively and specificity was 77.46%, 78.53%, and 86.0%, respectively. Patients with Gal-3 above the cutoff value of 14.57 pg/ml had higher frequent AF recurrence than the patients with Gal − 3 ≤ 14.57 pg/ml (35% vs. 12%, p < 0.001) during a follow-up. Meanwhile, patients with ALD above the cutoff value of 243.61 pg/ml also had a higher AF recurrence rate than those with ALD ≤ 243.61 pg/ml (37% vs. 11%, p < 0.001) during a follow-up. The recurrence rate in patients with Gal − 3 > 14.57 pg/ml + ALD > 243.61 pg/ml was higher than that in patients with baseline Gal − 3 > 14.57 pg/ml or ALD > 243.61 pg/ml and patients with Gal − 3 ≤ 14.57 pg/ml + ALD ≤ 243.61 pg/ml (57% vs. 14% vs. 9%, p < 0.01, respectively). Conclusion AF recurrence after RFCA had higher baseline Gal-3 and ALD levels, and higher preoperative circulating Gal-3 and ALD levels were independent predictors of AF recurrence for patients undergoing RFCA, while combination of preoperative Gal-3 and ALD levels has higher prediction accuracy.

Change in health related quality of life is different in obese versus non-obese patients with atrial fibrillation after thoracoscopic ablation

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Received research grants (through institution) from Atricure Inc, Bayer, Boston Scientific, Daiichi Sankyo, Johnson&amp;Johnson, Medtronic Received honoraria/speaker/consultancy fees from Abbott, AtriaN Medical, Atricure Inc, Bayer, Biotronik, CVOI, Daiichi Sankyo, IPP Med, Itreas, Medtronic, Novartis, Servier Background Obesity is an important risk factor for atrial fibrillation (AF), and negatively affects health-related quality of life (QoL) and treatment efficacy. The impact of obesity on the improvement of QoL and on AF recurrence in patients undergoing thoracoscopic AF ablation is unknown. Purpose To assess the change in QoL and the risk of AF recurrence in obese and non-obese patients with atrial fibrillation undergoing thoracoscopic ablation Methods Patients undergoing thoracoscopic AF ablation were prospectively included. Holters were performed before and at 3, 6, 9 and 12 months after the procedure. AF recurrence was defined as any atrial tachyarrhythmia episode &amp;gt;30 seconds during one year of follow-up. QoL and AF recurrence rate were assessed for normal weight (BMI ≤ 24,9 kg/m2), overweight (25,0 – 29,9 kg/m2) and obese (≥ 30,0 kg/m2) patients. QoL was measured by the Short Form 36 questionnaire at baseline and at one year follow-up. Results Four hundred and eight patients were included for analysis. Six out of eight QoL domains scored lower in obese versus non-obese patients before the procedure. In all patients, six out of eight domains increased after the procedure (p&amp;lt;0.01 for most domains). Obese patients showed a larger improvement of emotional related QoL (p=0.01) and a trend towards a larger improvement of mental QoL (p=0.07), while physical QoL increased similarly to non-obese patients (figure). In obese patients, QoL increased similarly for those with and without AF recurrence (p=0.78), whereas in non-obese patients, AF recurrence was associated with less improvement in mental QoL. AF recurrence at 1-year was similar in all groups (normal weight 72.4%, overweight 68%, obese 70.4%, p=0.692). Conclusion After thoracoscopic ablation, obese patients have a similar AF freedom rate as non-obese patients, but a greater improvement in mental quality of life, irrespective of AF recurrence status, after thoracoscopic ablation.

The role of CHA2DS2-VASc score in predicting atrial fibrillation recurrence in patients undergoing pulmonary vein isolation with cryoballoon ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF) with high safety and efficacy profiles. The CHA2DS2 -VASc score is also a well-established predictor of AF stroke. Importantly, the role of CHA2DS2-VASc score is still unknown regarding the long-term clinical outcomes following PVI-C. Purpose The aim of this analysis is to evaluate the role of CHA2DS2-VASc score in predicting AF recurrence during long term follow up after PVI-C. Methods Patients with recurrent and symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were categorized into two groups Low risk (LR) and high risk (HR) (CHA2DS2-VASc score = 0-1 and CHA2DS2 -VASc score ≥2, respectively). Results Out of 3313 patients, 1910 (57.6%) had CHA2DS2-VASc score = 0-1, while 1403 (42.3%) were in the HR score group (CHA2DS2 -VASc score ≥2). As expected, patient baseline characteristics were significantly different between the two cohorts including: age, sex, BMI, percentage of paroxysmal AF, history of stroke, diabetes, ischemic cardiomyopathy. On the contrary, procedural times and the incidence of acute complications were comparable between the two groups. The 36-month freedom from AF after a single procedure was 72.5% (95% CI 69.8% - 75.0%) in the LR group and 65.9% (62.3% - 69.2%) in the HR score group (HR: 1.26, 95% CI 1.08-1.47, p= 0003, Figure 1). At multivariate analysis, higher CHA2DS2 -VASc score was still a significant predictor of the risk of AF recurrence [HR: 1.33 (1.10 - 1.60, p=0.003] Conclusions PVI-C is highly effective in the treatment of AF over the long term. A CHA2DS2 -VASc score ≥2 is an independent predictor of AF recurrence during the follow-up and should be taken into account in the clinical management after the index procedure.

Impact of sleep apnea treatment with CPAP on recurrence of atrial fibrillation after catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): None Background Sleep apnea, as well as other risk factors such as obesity and high blood pressure, increase the risk of recurrence of atrial fibrillation after catheter ablation. But the true impact of sleep apnea treatment on recurrence of atrial fibrillation is less well defined. Purpose Assess the impact of untreated sleep apnea and treatment with CPAP (continuous positive airway pressure) on the risk of atrial fibrillation recurrence in patients undergoing catheter ablation. Methods We performed a retrospective analysis of 160 patients undergoing catheter ablation of paroxysmal or persistent atrial fibrillation in our institution, in a period between November of 2015 and November of 2021. We compared two groups: with atrial fibrillation recurrence and without atrial fibrillation recurrence, in a follow-up period of eighteen months. We analysed the clinical characteristics, diagnosis of sleep apnea, treatment with CPAP, echocardiographic findings (indexed volume of left atrium and left ventricular ejection fraction), cardiovascular risk factors and other comorbidities (table 1). Survival analysis of atrial fibrillation recurrence was performed using a Cox Regression analysis (figure 1). Results During a mean follow-up time of 22,8 ± 19,9 months, 46 patients (28,8%) had atrial fibrillation recurrence and none died. The recurrence was associated with hypertension, alcohol habits and untreated sleep apnea. Untreated sleep apnea was associated with a 4-fold increased risk of atrial fibrillation recurrence (HR 3,74; 95% CI 1,89-7,42; p &amp;lt;0,001). In patients with sleep apnea (n = 41), CPAP treatment was associated with a 74% decreased risk of recurrence (HR 0,26; 95% CI 0,10-0,72; p = 0,009). Conclusions Treatment with CPAP was associated with lower risk of recurrence of atrial fibrillation after catheter ablation in patients with sleep apnea.

PO-669-01 LONG-TERM ADHERENCE TO FLECAINIDE AS A RHYTHM CONTROL THERAPY IN RECURRENT ATRIAL FIBRILLATION - A RETROSPECTIVE COHORT STUDY

The choice of rhythm control drugs for recurrent atrial fibrillation (AF) remains empirical and is based on the safety profile rather than predicted efficacy. Flecainide is recommended for prevention of AF recurrence in patients without structural heart disease however predictors of treatment success are insufficiently studied.

The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta-analysis of randomized controlled trials.

BackgroundPosterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation.ObjectiveTo assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long‐term follow‐ups when compared to conventional methods.MethodsWe conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI).ResultsEight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88–1.05, I 2 = 31.6%, p‐value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81–0.96, I 2 = 48.2%, p‐value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80–0.98, I 2 = 65.2%, p‐value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74–0.95, I 2 0.00%, p‐value .008).ConclusionOur study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population.

Influencing Factors of Recurrence of Nonvalvular Atrial Fibrillation after Radiofrequency Catheter Ablation and Construction of Clinical Nomogram Prediction Model.

Purpose This study sought to investigate the predictive factors for atrial fibrillation (AF) recurrence in patients after radiofrequency ablation (RFCA) and construct a nomogram prediction model for providing precious information of ablative strategies. Methods A total of 221 patients with AF who underwent RFCA were enrolled. Univariate and multivariate Cox regression were used to screen the predictors of recurrence. The receiver operating characteristic (ROC) curve and the Kaplan–Meier (K–M) curve were drawn to analyze the value of predictors. The nomogram model was further constructed to predict the recurrence of AF in patients after RFCA. Results There were 59 cases of AF recurrence after RFCA. Monocyte count/high-density lipoprotein cholesterol (MHR), AF course (COURSE), coronary heart disease (CHD), and AF type (TYPE) were the independent risk factors for predicting AF recurrence after RFCA. Accordingly, a nomogram prediction model based on MHR, COURSE, CHD, and TYPE was constructed with a C-index of 0.818 (95% CI: 0.681∼0.954), while the C-index of verification was 0.802 (95% CI: 0.658∼0.946). Conclusions Preoperative MHR, COURSE, CHD, and TYPE were independent risk factors for predicting recurrence of AF after RFCA. The nomogram model based on MHR, COURSE, CHD, and TYPE can be used to predict the recurrence of AF after RFCA accurately and individually.

Does left atrial epicardial conduction time reflect atrial fibrosis and the risk of atrial fibrillation recurrence after thoracoscopic ablation? Post hoc analysis of the AFACT trial

ObjectivesTo determine the association between left atrial epicardial conduction time (LAECT), fibrosis and atrial fibrillation (AF) recurrence after thoracoscopic surgical ablation of persistent AF.SettingSingle tertiary care centre in the Netherlands.ParticipantsPatients...

Effect of Insulin Resistance on Recurrence after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation.

Whether there are many risk factors for recurrence of atrial fibrillation (AF) after ablation is unclear. The aim of this study was to investigate the relationship between insulin resistance (IR) and AF recurrence in patients without diabetes who underwent catheter ablation. This retrospective study included patients who underwent AF ablation between 2018 and 2019 at the First Affiliated Hospital of Zhengzhou University. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated, and a value of ≥2.69 was defined as IR. The patients were divided into two groups (group 1 HOMA-IR < 2.69, n = 163; group 2 HOMA-IR ≥ 2.69, n = 69). AF recurrence was defined as the occurrence of atrial arrhythmias of more than 30s after the first 3 months. Univariate and multivariable Cox regression models were used to analyse the risk of AF recurrence. Overall, 232 patients were enrolled (mean age, 59.9 ± 10.2years old; female, 37.5%; paroxysmal AF, 71.6%). We found that dyslipidaemia, antiarrhythmic drug use, fasting blood glucose and fasting insulin were significantly higher in the IR group (P < 0.05). During the follow-up 1year after ablation, 62 (26.7%) patients experienced AF recurrence. After adjusting for traditional risk factors, multivariable analysis showed that the HOMA-IR value (HR 1.259, 95% CI 1.086-1.460, P = 0.002) and left atrial diameter (LAD; HR 1.043, 95% CI 1.005-1.083, P = 0.026) were independently associated with AF recurrence. The present results provide evidence that IR patients are more likely to experience AF recurrence. Improving IR status may be a potential target for reducing the postoperative recurrence rate.

Higher serum sST2 is associated with increased left atrial low-voltage areas and atrial fibrillation recurrence in patients undergoing radiofrequency ablation.

To conduct a comprehensive analysis of prospectively measuring the concentration of soluble suppression of tumorigenicity 2 (sST2) to predict left atrial (LA) low-voltage areas (LVAs) and atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFA). This was a prospective cohort study. A total of 84 patients, including 54 paroxysmal AF cases and 30 persistent AF cases who underwent RFA, were recruited. Electroanatomical voltage mapping determined the extent of LVAs. The serum level of sST2 was measured by enzyme-linked immunosorbent assay. All patients were followed for 12months after the RFA procedure to verify AF recurrence. The concentration of sST2 measured in the sample was 17.90-198.77pg/mL, and the range of LA LVAs was 0-85.6%. The sST2 level positively correlated with LVAs (r = 0.40; P = 0.005). When comparing the top and bottom quartile, sST2 is significantly associated with LA LVAs (OR = 1.833, 95% CI: 1.582-2.011, P = 0.004). When compared with the 1st quartile group, the multivariable adjusted hazard ratios for AF recurrence after RFA were 1.57 (95% CI: 1.182-1.795) for the 4th quartile group, 1.44 (95% CI: 1.085-1.598) for the 3rd quartile group, and 1.27 (95% CI: 0.954-1.318) for the 2nd quartile group. The AF-free survival rates of patients with 1st quartile and 4th quartile sST2 levels after ablation were 95% and 59.6%, respectively (Log Rank test, P = 0.027). Elevated sST2 levels of AF patients were associated with higher LA LVAs and a significantly increased risk of recurrence. The circulating sST2 concentration might be a pre-diagnostic marker of AF recurrence after RFA.

Predictor of atrial fibrillation recurrence in patients who underwent a tricuspid valve operation with modified Cox maze procedure

Recurrence of any atrial arrhythmia after surgical ablation is known as a negative predictor of cardiovascular events and total mortality. However, there have been no focused studies for atrial fibrillation (AF) recurrence prediction in patients with significant tricuspid regurgitation (TR), and the risk-benefit estimation of surgical ablation in tricuspid valve (TV) surgery is not fully established. We screened 385 patients who underwent a TV operation between 2001 and 2017. After excluding patients who did not undergo a maze operation, 158 patients were enrolled. Enrolled patients were divided by recurrence of AF. We analyzed the difference between the AF recurrence group and no AF recurrence group, and AF recurrence factors in terms of clinical risk factors and echocardiographic risk factors. The hazard ratio (HR) and 95% confidence intervals (CIs) were presented using a Cox proportional hazard model. Among 158 patients, AF recurred in 65 patients within 10 years. For AF prediction, age was most the important clinical factor and right atrium (RA) diameter was the most important echocardiographic parameters. In patients with a larger RA diameter over 49.2mm, the prevalence of AF recurrence was higher (HR 4.322, 95% CI [2.185-8.549], log rank p value<.001). In clinical outcome, there was no significant difference between the AF recurrence group and the no recurrence group in terms of death, TR recurrence, heart failure, and stroke. However, the risk of permanent pacemaker (PPM) insertion was higher in the AF recurrence group (HR 10.240, 95% CI [1.257-83.480], log rank p value .007) compared to the no recurrence group. Age and RA enlargement are key predictors of AF recurrence after TV operation with the CM procedure in patients with significant TR.

The systemic-immune-inflammation index predicts the recurrence of atrial fibrillation after cryomaze concomitant with mitral valve surgery

Background and aimsInflammation plays a key role in the initiation and progression of atrial fibrillation (AF). The systemic inflammation indexes are easily evaluated and predict AF development. However, it’s role in prediction of recurrence of AF is unknown. We aim to explore the association between the systemic inflammation indexes and recurrence of AF in patients underwent cryoablation (CryoMaze) concomitant with mitral valve surgery.MethodsWe examined systemic inflammation indexes during perioperative period in 122 patients between 2015 and 2018. Systemic inflammation indexes were developed by systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocytes to monocytes ratio. Univariate and multivariate analyses were performed to examine the association of each markers with recurrence of AF.ResultsOf the 122 patients included in this study, 22 patients (18%) experienced AF recurrence after CryoMaze concomitant with mitral valve surgery. There is no significant difference between each systemic inflammation indexes before surgery and recurrence of AF. In univariate analysis, MLR after surgery 3 days, PLR, MPLR, NLR, SII after surgery 7 days were able to predict recurrence of AF. In multivariate analyses, SII ≥ 1696 independently predicted recurrence (OR, 3.719; 95% CI, 1.417–9.760). Interestingly, baseline SII showed no significant in prediction of recurrence. It was sharply elevated after surgery and dropped slowly. In patients of recurrence, SII after 7 days of surgery increased again.ConclusionsThe raised SII again was associated with an increased risk of the postoperative recurrence of AF and independently predicted the late recurrence of AF after CryoMaze concomitant with mitral valve surgery.

Deep Learning-Based Recurrence Prediction of Atrial Fibrillation After Catheter Ablation.

Radiofrequency catheter ablation (RFCA) is an effective therapy for atrial fibrillation (AF). However, it the problem of AF recurrence remains. This study investigates whether a deep convolutional neural network (CNN) can accurately predict AF recurrence in patients with AF who underwent RFCA, and compares CNN with conventional statistical analysis. Three-hundred and ten patients with AF after RFCA treatment, including 94 patients with AF recurrence, were enrolled. Nine variables are identified as candidate predictors by univariate Cox proportional hazards regression (CPH). A CNNSurv model for AF recurrence prediction was proposed. The model's discrimination ability is validated by a 10-fold cross validation method and measured by C-index. After back elimination, 4 predictors are used for model development, they are N-terminal pro-BNP (NT-proBNP), paroxysmal AF (PAF), left atrial appendage volume (LAAV) and left atrial volume (LAV). The average testing C-index is 0.76 (0.72-0.79). The corresponding calibration plot appears to fit well to a diagonal, and the P value of the Hosmer-Lemeshow test also indicates the proposed model has good calibration ability. The proposed model has superior performance compared with the DeepSurv and multivariate CPH. The result of risk stratification indicates that patients with non-PAF, higher NT-proBNP, larger LAAV and LAV would have higher risks of AF recurrence. The proposed CNNSurv model has better performance than conventional statistical analysis, which may provide valuable guidance for clinical practice.

Healthcare utilization and clinical outcomes after ablation of atrial fibrillation in patients with and without insertable cardiac monitoring.

BackgroundCompared with short-term electrocardiogram (ECG) monitors, insertable cardiac monitors (ICMs) have been shown to increase atrial fibrillation (AF) detection rates and the opportunity to treat recurrent AF in patients postablation.ObjectiveTo examine healthcare utilization and clinical outcomes following AF ablation, in patients with vs without ICM.MethodsRetrospective analysis pooling Optum Clinformatics and Medicare Fee-for-service 5% Sample claims databases. Patients with an AF ablation between January 1, 2011, and March 31, 2018 who received an ICM implant within 1 year pre-/postablation were propensity score matched 1:3 to patients without ICM. Outcomes included AF-related healthcare utilization, medication use, and occurrence of composite severe cardiovascular events (stroke / transient ischemic attack, major bleeds, systemic embolism, AF- or heart failure–related hospitalization, or death).ResultsA total of 1000 ICM patients and 2998 non-ICM patients were included. During mean follow-up of 33 ± 16 months postablation, ICM patients experienced significantly fewer severe cardiovascular events (1.09 ± 2.22 vs 1.37 ± 4.19, P = .008) and associated costs ($20,757 vs $29,106, P = .0005). ICM patients had a greater number of AF-related clinic visits (16.8 vs 11.6 visits, P < .0001) and were more likely to receive a repeat ablation (38.7% vs 32.4%, P = .0003). Total all-cause costs during follow-up were not statistically different. Discontinuation of oral anticoagulation was higher in ICM patients at 1 year (44% vs 31%, P < .0001) and 2 years (73% vs 64%, P = .0012).ConclusionA shift from acute, reactive care to routine outpatient management was observed in patients with long-term ECG monitoring. Results suggest closer patient management in patients with long-term monitoring after an AF ablation and an improvement in outcomes, at similar overall cost.

Outcomes of posterior wall isolation with pulmonary vein isolation for paroxysmal atrial fibrillation

Prior studies have shown that addition of posterior wall isolation (PWI) may reduce atrial fibrillation recurrence in patients with persistent atrial fibrillation. No data on PWI in paroxysmal AF (pAF) patients with normal left atrial voltage is available, to date. This study sought to evaluate the efficacy of PWI in addition to pulmonary vein isolation (PVI) in patients presenting with pAF and normal left atrial voltage. Consecutive patient registry analysis was performed on all patients with pAF and normal left atrial voltage undergoing initial radiofrequency ablation from November 1, 2018 to November 15, 2019. Primary endpoint was recurrence of atrial arrhythmia including AF, atrial tachycardia (AT), or atrial flutter (AFL). A total of 321 patients were studied, 214 in the PVI group and 107 in the PWI + PVI group. Recurrence of any atrial arrhythmia occurred in 18.2% of patients in the PVI group and 16.8% in the PVI + PWI cohort (p = 0.58). At 1 year, recurrence was 14.0% in the PVI group and 15.0% in the PWI + PVI group (p = 0.96). There was a lower AT/AFL recurrence in the PVI + PWI group, not reaching significance (3.7% in the PWI + PVI group vs. 7.9% in PVI group, p = 0.31). Need for carina lesions predicted recurrence in the PVI-only group. Addition of PWI to PVI in pAF patients undergoing their first ablation did not reduce the frequency of atrial arrhythmia recurrence. This warrants further study in a prospective trial.

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation