Early Recurrence Of Atrial Fibrillation Research Articles

Predictive value of early AF recurrence after cryoballoon ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Early recurrence of atrial fibrillation (ERAF) during a blanking period of 90 days after radiofrequency ablation has been associated with worse long-term outcome. However, the impact of ERAF after cryoballoon pulmonary vein isolation (cryoPVI) is less clear. Objective A prospective comparison of long-term ablation success after cryoPVI between patients who had ERAF during the blanking period and patients who remained free of AF recurrence during this period. Methods We analyzed consecutive patients who underwent cryoPVI in a single-center cohort between 2018 and 2020. Follow-up was performed at 3, 6, 12, 18 and 24 months after ablation. Primary endpoints were: symptomatic AF recurrence after a 90-day blanking period for efficacy and bleeding, phrenic nerve injury, stroke or death for safety. Results 472 consecutive patients with paroxysmal or persistent AF who underwent cryoPVI in a single-center cohort were analyzed. Mean follow-up time was 15 months. 64 patients presented with ERAF during blanking period (age 70 ± 8 years, 52% male gender, CHA2DS2-VASc 2.9 ± 1.5) while 408 patients demonstrated freedom from AF within the first 90 days after cryoPVI (age 69 ± 10 years, 57% male gender, CHA2DS2-VASc 2.7 ± 1.4). At 24 months, Kaplan-Meier estimates showed a significantly higher AF recurrence in patients with ERAF compared to patients without ERAF (74.6 % vs. 33.3%, P < 0.0001, Figure). Cox-regression analysis confirmed ERAF as independent predictor of impaired long-term ablation success after cryoPVI for both paroxysmal and persistent AF (P < 0.0001). Primary safety endpoint occurred in form of pericardial effusion or transient phrenic nerve palsy in one patient with ERAF (1.5%) and five patients without ERAF (1.2%). No deaths or strokes were observed. Conclusion ERAF during blanking period predicts long-term sucess of patients undergoing cryoPVI. Prospective studies addressing outcome optimisation in this particular cohort of patients are needed. Abstract Figure.

Autonomic nervous modulation after cryoballoon ablation for paroxysmal atrial fibrillation

Aim. Aim of our study was the assessment of autonomic nervous system (ANS) modulation by assessment of heart rhythm variation (HRV) using Holter monitoring after single second generation cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (AF).Methods. Patients who underwent the CBA for paroxysmal AF were include in this study. At the baseline the Holter monitoring after withdrawal of antiarrhythmic therapy (AAT) with assessment of HRV: SDNN, RMSSD, ln LF, ln LH, LH/HF, mean, minimal and maximal beats per minute (BPM) was perform. Follow-up was based on outpatient clinic visits at 3, 6, and 12 months including Holter monitoring.Results. Among 80 patients underwent CBA, HRV was assessed in 55 patients (65.5% male, age median 61 years, 97.7% of pulmonary vein have been successful isolated). One year after CBA all HRV parameters and the mean, minimal and maximal BPM was significantly different from baseline parameters (p<0.05). In the AF recurrence group ln LF was lower at 3-, 6and 12-month visits (p<0.05) and minimal HR was higher at 3 months (median 58 vs 55.5, p=0.033). Multivariate analysis demonstrated that early recurrence of AF was independent predictor of AF recurrence after CBA (HR 7,44, 95% CI 2,19-25,25, р=0,001).Conclusion. Our study demonstrated that CBA leads to modulation of ANS which persists for at least 12 months. The early recurrence of AF was only predictor of AF recurrence after CBA.

After Ablation of AF, Early Recurrence Matters

Early recurrences of atrial fibrillation (AF) after ablation are relatively common and have been thought to be due to inflammation related to the

Validating scores predicting atrial fibrillation recurrence post catheter ablation in patients with concurrent atrial fibrillation and pulmonary diseases.

Several scores were available for predicting atrial fibrillation (AF) recurrence post radiofrequency ablation. However, the role of different scores predicting AF recurrence after ablation in patients with concurrent AF and pulmonary diseases (PDs) remained obscure. Herein, we aimed to investigate their predicting values and differences in patients with concurrent AF and PDs. From January 2008 to April 2015, 304 patients with concurrent AF and PDs treated with catheter ablation were divided into 2 groups according to whether they experienced AF recurrence in our centers. Factors related with AF recurrence were explored using Cox regression and scores predicting recurrent AF were compared in these patients using ROC curves. During a median of 6-month of follow-up, factors correlating with late AF recurrence included heart failure (HF) history [hazard ratio (HR): 2.79; 95% confidence interval (CI): 1.49-5.22, P=0.001], current smoking (1.73; 1.13-2.68, P=0.01) and early AF recurrence (3.85; 95% CI: 2.62-5.66, P<0.001) according to univariate Cox regression analysis. When analyzed using multivariate Cox model, HF history (2.21; 1.12-4.37, P=0.02), hypertension history (1.54; 1.02-2.33, P=0.04) and early AF recurrence (3.90; 2.60-5.85, P<0.001) were related to late AF recurrence. The BASE-AF2 score had higher c-index than the MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores when compared using ROC curves analysis (all P<0.05). The optimal point for predicting AF recurrence of the BASE-AF2 score in the ROC analysis was 1 point with sensitivity of 69.03% and specificity of 60.21%. The predicting AF recurrence value of BASE-AF2 score was superior to MB-LATER, APPLE, CHADS2, CHA2DS2-VASc, CAAP-AF and HATCH scores in patients with concurrent AF and PDs, which can be an effective and helpful score for making AF treatment decisions.

EFFECT OF RENAL DENERVATION ON ATRIAL FIBRILLATION (ERDAF)

Objective: Renal sympathetic denervation (RDN) is a novel minimally invasive therapeutic option for patients with resistant arterial hypertension (AH). Recent data has shown that RDN with or without pulmonary vein isolation (PVI) may also have a positive impact on the management of patients with paroxysmal or persistent atrial fibrillation (AF). The purpose of the ERDAF study (Effect of Renal Denervation on Atrial Fibrillation) is to evaluate the renal sympathetic denervation in patients with resistant AH and symptomatic paroxysmal or persistent AF in order to show if there is a reduction in the AF-related symptoms, the AF recurrence rate, and the total burden (symptomatic and/or asymptomatic) of the arrhythmia. Design and method: This is a single-center, randomized study, in which thirty (30) consecutive patients &gt; 18 years with resistant hypertension and symptomatic paroxysmal or persistent AF will be included after the restoration of the sinus rhythm. Patients will be randomized in a 1:1 ratio to either sympathetic transcatheter RDN on top of drug therapy (n = 15) or only conservative management with drug therapy (n = 15)(Figure). An implantable loop recorder (ILR) will be implanted subcutaneously in all patients after their study enrollment for long cardiac rhythm monitoring. Symptoms of arrhythmia will be evaluated based on the EHRA score. Patients will be monitored for a period of 18 months after the ILR implantation. Results: The first three months after RDN will be excluded from our final analysis (blanking period). Follow-up visits will be scheduled for the first month and every three months thereafter for a period of 18 months. Conclusions: The primary endpoint will be the change in the total AF burden (Total time in AF during the follow-up period). Secondary endpoints will include the change in the symptomatic and asymptomatic burden of AF, the time to detect the first AF recurrence (symptomatic and/or asymptomatic)-early recurrence of AF after RDN, and the change in blood pressure (systolic, diastolic and mean blood pressure) during the follow-up period.

The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms.

Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.

Hydrochlorothiazide therapy: impact on early recurrence of atrial fibrillation after catheter ablation?

Background Hypokalemia has been linked to electrocardiogram changes and afterdepolarization-mediated arrhythmias. However, the association between hypokalemia and atrial fibrillation (AF) has not been well studied. Hydrochlorothiazide (HCT) diuretic therapy was shown to be associated with hypokalemia in multiple studies. We aimed to determine whether HCT therapy is associated with early recurrence of AF after radiofrequency (RF) catheter ablation during a 3-month follow-up. Methods We performed a retrospective registry analysis of our internal AF ablation registry, containing 807 consecutive patients that underwent RF ablation for symptomatic AF. Propensity score matching was used to match 156 patients on HCT therapy with 156 controls. Furthermore, we performed propensity score matching between the first and the fourth quartile of baseline serum potassium (K) concentrations in the initial population (N.=807). Results We observed a small but statistically significant difference in baseline mean potassium levels between the HCT group and the control group (4.03 mmol/L vs. 4.19 mmol/L respectively, P=0.001). There was no difference in short term recurrence of atrial fibrillation in the HCT group compared to the propensity score matched control group (41.0% [N.=64] vs. 45.5% [N.=71], P=0.424). In the comparison between the first and the fourth quartile of baseline serum potassium values, no difference in AF recurrence (38.2% [N.=63] vs. 37.0% [N.=61], P=0.820) during a 3-month follow-up after ablation was observed between both groups. Conclusions Patients on HCT therapy showed no difference in short term recurrence of AF after ablation compared to propensity matched controls.

Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation

This study aimed to compare the risk of late recurrence in patients with and without early recurrence. Early recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation (RFCA) in AF patients is known to be a transient phenomenon. The theoretical basis of the blanking period is based on such observations. However, the clinical implications of early recurrence need further validation. Consecutive RFCA cases in a tertiary hospital were analyzed. Early recurrence was defined as any AT or AF event occurring within 90-days post-RFCA. Early recurrence as AT and AF were also analyzed separately. A total of 3,120 patients underwent RFCA. Early recurrence occurred in 751 patients (24.1%). Patients who experienced early recurrence had a larger left atrium, worse hemodynamics in the left atrial appendage, and a higher prevalence of nonparoxysmal AF and heart failure. Among patients who experienced early recurrence, 69.6% of patients eventually had late recurrence. Early recurrence was associated with a 4.3- and 3.6-fold increase in the risk of late recurrence after single and multiple procedures, respectively. After multivariate adjustment, early recurrence was an independent risk factor for late recurrence with 3.6- and 2.8-fold increase in the risk of late recurrence after single and multiple procedures, respectively. Early recurrence AT had a lower risk of late recurrence compared with early recurrenceAF. Early recurrence was a reliable predictor for late recurrence. The clinical significance of the blanking period in the current guidelines may need to be revisited.

Left atrial hypertension invasively measured during pulmonary vein isolation predicts atrial fibrillation recurrence

The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation.Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg.A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). Older age, LA volume and LAH were significantly associated with early AF recurrence during the blanking period. However, only LAH independently remained a significant predictor of late AF recurrence (HR 3.02, 1.36-6.72, p=0.007).Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences.

Novel Score to Predict Very Late Recurrences After Catheter Ablation of Atrial Fibrillation

Various predictors of atrial fibrillation (AF) recurrence have been shown based on the baseline characteristics before catheter ablation (CA). This study aimed to develop a novel scoring system for predicting very late recurrences of AF (VLRAFs) after an initial CA, taking the postprocedural clinical data into account and reassessing VLRAFs in 12-month patients' condition using previously known preprocedural predictors of AF recurrences. We retrospectively studied 327 patients who underwent an initial CA with freedom from AF for over 12 months. We elucidated the predictors of VLRAFs and created a new score to predict VLRAFs in the discovery AF cohort (n = 181). Thereafter, we investigated whether the new scoring system could accurately predict VLRAFs in the validation AF cohort (n = 146). In the discovery AF cohort, VLRAFs were observed in 53 patients (29%) during the follow-up period (mean follow-up duration: 55 months). The univariate and multivariate Cox proportional-hazards model demonstrated that non-pulmonary vein foci, early recurrences of AF (ERAFs), atrial premature contraction (APC) burden ≥ 142/24 hours, and minimum prematurity index of the APCs ≤ 48% were associated with VLRAFs after CA. We created a new scoring system to predict VLRAFs, the n-PReDCt score (non-pulmonary vein: 1 point, early recurrences of AFs (Recurrences of AF in early phase after CA): 1 point, APC burden ≥ 142/24 hours: 1 point, and minimum prematurity index (= Coupling interval) of the APCs of ≤ 48%: 1 point). The n-PReDCt score was significantly associated with VLRAFs by a Kaplan-Meier analysis in the discovery AF and validation AF cohorts (p < 0.0001 and p < 0.0001, respectively).

Ablation index guide pulmonary vein isolation can reduce early recurrence of atrial fibrillation: a propensity score-matched analysis

Abstract Background Ablation index (AI) is a novel marker of ablation lesion quality for radiofrequency ablation (RFA). It has been reported that AI guided pulmonary vein isolation (PVI) reduced pulmonary vein reconnection and late recurrence of atrial fibrillation (AF). However, little is known about the impact of AI guided PVI on early recurrence of AF (ERAF). Purpose The aim of this study is to clarify whether AI guided PVI can reduce ERAF. Methods From September 2014 to August 2019, consecutive AF patients who underwent 1st session PVI were enrolled. We compared prevalence of ERAF between AI guided PVI group (AI group) and conventional contact force guided PVI group (CF group) using propensity score-matched analysis, which adjusted patient backgrounds (age, sex, and body mass index (BMI)), type of AF, the history of heart failure, hypertension, diabetes and stroke, laboratory findings including estimated glomerular filtration rate (eGFR) and b-type natriuretic peptide (BNP), and echocardiographic parameters including left ventricular ejection fraction (LVEF) and left atrial diameter. Results Total 711 patients were enrolled. AI group comprised 233 patients and CF group comprised 233 patients. Prevalence of ERAF were significantly lower in AI group than in CF group significantly (21.5% vs 36.1%, p=0.001, Table). Conclusions AI guided PVI can reduce ERAF as compared to conventional method. Funding Acknowledgement Type of funding source: None

Difference of myocardial injury, inflammation and early recurrence after pulmonary vein isolation among laser balloon ablation, radiofrequency catheter ablation and cryoballoon ablation

Abstract Background Pulmonary vein isolation (PVI) has become well-established as the main therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF) and various isolation methods including radiofrequency ablation (RFA), cryoballoon ablation (CBA) and laser balloon ablation (LBA) were available. Pathological findings in each ablation methods such as myocardial injury and inflammation are thought to be different. High sensitive cardiac troponin I (hs-TnI), subunit of cardiac troponin complex, is a sensitive and specific marker of myocardium injury. High-sensitive C-reactive protein (hs-CRP) is a biomarker of inflammation and is elevated following cardiomyocyte necrosis. Relationship between myocardial injury and inflammation after ablation using RFA, CBA and LBA and early recurrence of atrial fibrillation (ERAF) remains unclear. Methods We enrolled consecutive PAF patients from Osaka Rosai Atrial Fibrillation (ORAF) registry who underwent PVI from January 2019 to October 2019. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters including left ventricular dimensions, left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between RFA, CBA and LBA groups. We investigated the difference of relationship between myocardial injury marker (hs-TnI), inflammation markers (white blood cell change (DWBC) from post to pre PVI, neutrophil-to-lymphocyte ratio change (DNLR) from after to before PVI and hs-CRP) at 36–48 hours after PVI and ERAF (&amp;lt;3 months after PVI) between each group. Results We enrolled 187 consecutive PAF patients who underwent PVI. RFA, CBA and LBA groups comprised 108, 57 and 22 patients, respectively. There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, CHADS2Vasc score, renal function, serum BNP level and echocardiographic parameters between each group. Serum hs-TnI in RFA group and LBA group were significantly lower than in CBA group (2.643 ng/ml vs 5.240ng/ml, 1.344 ng/ml vs 5.240 ng/ml, p&amp;lt;0.001, p=0.002, respectively, Figure). DWBC was significantly higher in LBA group than CBA group (1157.3/μl vs 418.4/μl, p=0.045). DNLR did not differ between each group. Hs-CRP in RFA group and LBA group were significantly higher than in CBA group (1.881 mg/dl vs 1.186 mg/dl, 2.173 mg/dl vs 1.186 mg/dl, p=0.010, p=0.003, respectively, Figure). Incidence of ERAF was significantly higher in LBA group than RFA group (36.4% vs 16.7%, p=0.035). Incidence of ERAF tended to be higher in LBA group than CBA group (36.4% vs 19.3%, p=0.112). Conclusion LBA may cause less myocardial injury than RFA and CBA, on the contrary LBA may cause more inflammation than CBA. Incidence of ERAF in LBA was highest between each procedure. Inflammation markers and ERAF Funding Acknowledgement Type of funding source: None

Value of tissue doppler indices for prediction of early atrial fibrillation recurrence after cardioversion

Abstract Background Spectral tissue Doppler-derived E/e' ratio has been proposed as the best parameter in the prediction of atrial fibrillation (AF). Although relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. A new doppler index, E/(e'×s') ratio, combining an index of diastolic function (E/e') and marker of systolic LV function (s'), has been confirmed as a good predictor of new-onset AF, although value of E/(e'×s') ratio to predict AF recurrence was not evaluated. Purpose The aim of this study was to investigate whether E/(e'×s') may be better parameter than E/e' to predict AF recurrence after the electrical cardioversion (ECV) of persistent AF in patients with normal LV function. Methods The prospective study included 77 patients with persistent AF with preserved LV ejection fraction (&amp;gt;50%) and successfully performed ECV. Plasma level of NT-proBNP was measured for all the patients before the ECV. Transthoracic echocardiography was performed within the first 24 hours after successful ECV. Primary outcome was the early (at 1 month) recurrence of AF. Results At 1 month follow-up, 39 patients (50.6%) were in sinus rhythm. Binary logistic regression analysis showed that LV enddiastolic diameter &amp;gt;50 mm (HR 3.70, 95% CI 1.29–10.58, p=0.02), NT-proBNP &amp;gt;2000 ng/L (HR 3.28, 95% CI 1.01–10.71, p=0.04), E/e' (HR 1.74, 95% CI 1.27–2.39, p=0.001) and E/(e'×s') ratios (HR 8.17, 95% CI 1.57–42.4, p=0.01) were significant predictors of AF early recurrence after ECV. When we developed multivariate models using these potential confounding factors. To minimize the problem of collinearity E/e'and E/(e'×s') were included in 2 separate models. Multivariate analysis identified that E/(e'×s') ratio and E/e' ratio in combination with LV enddiastolic diameter &amp;gt;49.3 mm and NT-proBNP &amp;gt;2000 ng/L are able to predict early AF recurrence after ECV in 74% and 79% cases, respectively. E/(e'×s') ratio showed higher contribution in the model to predict AF recurrence compared to E/e' ratio (for E/(e'×s') ratio HR 18.94, 95% CI 2.39–149.66, p=0.005; for E/e' ratio HR 1.95, 95% CI 1.31–2.91, p=0.001). On ROC analysis, the diagnostic accuracy of E/(e'×s') and E/e' ratios were found to have the largest areas under the curve (E/(e'×s') ratio, AUC = 0.71, p=0.002 and E/e' ratio, AUC = 0.75, p&amp;lt;0.0001) with an optimal E/(e'×s') ratio cut-off value of 1.15 (sensitivity 97%, specificity 58%) and E/e' ratio value of 8.79 (sensitivity 89%, specificity 41%) for predicting early recurrence of AF after ECV. Conclusions Spectral tissue Doppler-derived ratios (E/(e'×s') and E/e') together with higher NTproBNP level and larger LV enddiastolic diameter predicted early AF recurrence after ECV. E/(e'×s') seems to be a more powerful predictor of AF early recurrence than E/e' ratio. Funding Acknowledgement Type of funding source: None

Predictive role of early recurrence of atrial fibrillation after cryoballoon ablation.

The aims of this study were to determine the rate and the predictors of early recurrences of atrial fibrillation (ERAF) after cryoballoon (CB) ablation and to evaluate whether ERAF correlate with the long-term outcome. Three thousand, six hundred, and eighty-one consecutive patients (59.9 ± 10.5 years, female 26.5%, and 74.3% paroxysmal AF) were included in the analysis. Atrial fibrillation recurrence, lasting at least 30 s, was collected during and after the 3-month blanking period. Three-hundred and sixteen patients (8.6%) (Group A) had ERAF during the blanking period, and 3365 patients (Group B) had no ERAF. Persistent AF and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of ERAF. After a mean follow-up of 16.8 ± 16.4 months, 923/3681 (25%) patients had at least one AF recurrence. The observed freedom from AF recurrence, at 24-month follow-up from procedure, was 25.7% and 64.8% in Groups A and B, respectively (P < 0.001). ERAF, persistent AF, and number of tested anti-arrhythmic drugs ≥2 resulted as significant predictors of AF. In a propensity score matching, the logistic model showed that ERAF 1 month after ablation are the best predictor of long-term AF recurrence (P = 0.042). In patients undergoing CB ablation for AF, ERAF are rare and are a strong predictor of AF recurrence in the follow-up, above all when occur >30 days after the ablation.

The Predictive Value of Tissue Doppler Indices for Early Recurrence of Atrial Fibrillation After Electrical Cardioversion.

PurposeSpectral tissue Doppler-derived E/e’ ratio has been proposed as the best parameter for prediction of atrial fibrillation (AF). Relaxation and contraction are equivalent parts of a continuous cardiac cycle, where systolic and diastolic abnormalities have a variable contribution to the left ventricle (LV) failure. The aim of this study was to investigate whether the E/(e’xs’) ratio is a better index than E/e‘ to predict AF recurrence and to determine the changes of spectral tissue Doppler indices 1 month after the electrical cardioversion (ECV).Patients and MethodsThe study included 77 persistent AF patients with restored sinus rhythm (SR) after ECV. Only patients with normal LV ejection fraction (EF) were included. Echocardiography and NT-proBNP laboratory findings were performed. A primary outcome was the early (within 1 month) recurrence of AF.ResultsAfter a 1 month follow-up period, 39 patients (50.6%) were in SR. E/e′ (HR=1.74, P=0.001) and E/(e’×s’) ratios (HR=8.17, P=0.01) were significant predictors of AF recurrence. E/(e’×s’) in combination with LV end-diastolic diameter >49.3 mm and NT-proBNP >2000 ng/L demonstrated a higher contribution in the model to predict AF recurrence compared to the E/e’ ratio (18.94, P=0.005 vs 1.95, P=0.001). On ROC analysis, E/(e’×s’) and E/e′ showed similar diagnostic accuracy (E/(e’×s’), AUC=0.71, P=0.002 and E/e′, AUC=0.75, P<0.0001). Average e‘ value significantly decreased after 1 month in SR (from 10.76±1.24 to 8.96±1.47 cm/s, P=0.01), E wave did not change significantly and E/e′ ratio tended to improve. A decrease of average e‘ and an increase of average s‘ values led to significant improvement of E/(e’xs’) ratio.ConclusionE/(e’xs’) and E/e’ ratios are comparable to predict early AF recurrence after ECV in patients with persistent AF. The e’ value decreased significantly after 1 month follow-up period after ECV for persistent AF patients.

Hydrochlorothiazide therapy: impact on early recurrence of atrial fibrillation after catheter ablation?

Hypokalemia has been linked to electrocardiogram changes and afterdepolarization-mediated arrhythmias. However, the association between hypokalemia and atrial fibrillation (AF) has not been well studied. Hydrochlorothiazide (HCT) diuretic therapy was shown to be associated with hypokalemia in multiple studies. We aimed to determine whether HCT therapy is associated with early recurrence of AF after radiofrequency (RF) catheter ablation during a 3-month follow-up. We performed a retrospective registry analysis of our internal AF ablation registry, containing 807 consecutive patients that underwent RF ablation for symptomatic AF. Propensity score matching was used to match 156 patients on HCT therapy with 156 controls. Furthermore, we performed propensity score matching between the first and the fourth quartile of baseline serum potassium (K) concentrations in the initial population (N.=807). We observed a small but statistically significant difference in baseline mean potassium levels between the HCT group and the control group (4.03 mmol/L vs. 4.19 mmol/L respectively, P=0.001). There was no difference in short term recurrence of atrial fibrillation in the HCT group compared to the propensity score matched control group (41.0% [N.=64] vs. 45.5% [N.=71], P=0.424). In the comparison between the first and the fourth quartile of baseline serum potassium values, no difference in AF recurrence (38.2% [N.=63] vs. 37.0% [N.=61], P=0.820) during a 3-month follow-up after ablation was observed between both groups. Patients on HCT therapy showed no difference in short term recurrence of AF after ablation compared to propensity matched controls.

Preoperative monocyte-to-HDL-cholesterol ratio predicts early recurrence after radiofrequency maze procedure of valvular atrial fibrillation.

BackgroundMonocyte‐to‐high‐density lipoprotein (M/H) ratio has emerged as a novel cardiovascular prognostic biomarker. We aimed to evaluate the prognostic values of M/H with early recurrence in persistent valvular atrial fibrillation (AF) patients after radiofrequency (RF) maze procedure.MethodsWe retrospectively analyzed 131 consecutive persistent AF patients with valvular heart diseases who were followed up 3 months after RF maze procedure. Their clinical data were recorded. Logistic regression analyses were performed for significant predictors. Receiver operating characteristic analysis was used for validation with corresponding area under the curve.Results70 (53.4%) patients experienced early recurrence after procedure. Patients with early recurrence were older, have longer AF duration history, larger left atria diameter (LAD), higher plasma C‐reactive protein (CRP), lower triglycerides (TG), lower cholesterol (TC), increased monocyte counts, lower HDL cholesterol, and increased M/H ratio. In multivariate analysis, age (OR 1.1 95% CI 1.0‐1.1 P = .003), LAD (OR 2.1, 95%CI 1.2‐3.5, P = .006), TG (OR 0.35, 95% CI 0.15‐0.84, P = .019), M/H (OR 6.1, 95% CI 2.9‐13.0, P < .001) were significantly independent predictors of AF early recurrence. M/H ratio demonstrated a significant predictive value (AUC = 0.77, sensitivity 89.0%, specificity 54%). Further, there was a positive correlation of M/H ratio with CRP and white blood cell.ConclusionPreoperative M/H ratio was an independent risk factor of AF early recurrence following RF maze operation. M/H ratio should be considered in prediction of early recurrence for valvular AF patients.

Correlation of pulmonary vein reconnection patterns after cryoballoon and duty-cycled ablation of atrial fibrillation with the time of arrhythmia recurrence.

BackgroundPulmonary vein isolation (PVI) is safe and effective in the treatment of atrial fibrillation (AF). We compare and correlate pulmonary vein (PV) reconnection patterns at repeat ablation in patients with recurrent AF after PVI using duty‐cycled radiofrequency (RF) technology (PVAC) or second‐generation cryoballoon (CB) with the time of AF recurrence.Methods and ResultsIn total, 85 PVAC and 66 CB patients undergoing a second ablation were enrolled 9.7 ± 3.4 months after initial PVI. PV reconnections were comparably high between both groups (93% PVAC and 92% CB patients). A mean of 2.79 ± 1.2 PVs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, P < .0001. 33% PVAC patients, but no CB patient had 4 reconnected PVs (P < .0001). Early AF recurrences were more frequently observed in PVAC patients with ≥2 reconnected PVs, in CB patients with ≥3 reconnected PVs (both P < .01) and patients without PV reconnection, irrespective of the ablation technique. One reconnected PV was associated with late AF recurrence only in CB patients. The correlation between number of reconnected PVs and time of AF recurrence was −0.32 for PVAC and −0.52 for CB.ConclusionsCB PVI was associated with greater durability and lesser PV reconnections/patient. There were negative correlations for both devices between extent of PV reconnections and time of AF recurrence. CB patients with early AF recurrences‐ although less frequently observed compared with PVAC patients had more reconnected PVs than PVAC patients, suggesting additional effects for AF prevention after CB PVI.

The Role of Anxiety in Patients With Persistent Atrial Fibrillation Undergoing Elective Cardioversion: An Observational Study.

Anxiety is often present among patients with atrial fibrillation (AF). This condition has been associated with greater symptom severity and worse quality of life in these patients. However, the influence of anxiety on the risk of AF recurrence is not well known. We aimed to define the level of anxiety in patients with persistent AF undergoing elective cardioversion (EC) and determine whether there is an association between anxiety and the risk of early AF recurrence after EC. Anxiety was measured before EC using the State-Trait Anxiety Inventory. Early AF recurrence was assessed with a control electrocardiogram at 30-day follow-up. We included 107 patients undergoing effective EC. Early AF recurrence was diagnosed in 40 patients (37.4%). Compared with those who remained in sinus rhythm, individuals with early AF recurrence had significantly higher levels of trait anxiety (23.1 [10.4] versus 17.9 [9.5]; p = .013) and larger left atrial volume index (45.8 [12.3] versus 37.9 [13.3] ml/m; p = .004). Both variables remained independently associated with early AF recurrence after multivariate analysis. A predictive model including trait anxiety score >20 and left atrial volume index >41 ml/m showed acceptable accuracy for the diagnosis of early AF recurrence (area under the curve = 0.733; 95% confidence interval = 0.634-0.832; p < .001). Our study shows that trait anxiety is an independent risk factor for early AF recurrence after EC. Further studies are warranted to assess the beneficial role of anxiety-reducing strategies on the outcomes of patients with AF.

Predictors of recurrence of atrial fibrillation within the first 3 months after ablation.

AimsFreedom from atrial fibrillation (AF) at 1 year can be achieved in 50–70% of patients undergoing catheter ablation. Recurrent AF early after ablation most commonly terminates spontaneously without further interventional treatment but is associated with later recurrent AF. The aim of this investigation is to identify clinical and procedural factors associated with recurrence of AF early after ablation.Methods and resultsWe retrospectively analysed data for recurrence of AF within the first 3 months after catheter ablation from the randomized controlled AXAFA–AFNET 5 trial, which demonstrated that continuous anticoagulation with apixaban is as safe and as effective compared to vitamin K antagonists in 678 patients undergoing first AF ablation. The primary outcome of first recurrent AF within 90 days was observed in 163 (28%) patients, in which 78 (48%) patients experienced an event within the first 14 days post-ablation. After multivariable adjustment, a history of stroke/transient ischaemic attack [hazard ratio (HR) 1.54, 95% confidence interval (CI) 0.93–2.6; P = 0.11], coronary artery disease (HR 1.85, 95% CI 1.20–2.86; P = 0.005), cardioversion during ablation (HR 1.78, 95% CI 1.26–2.49; P = 0.001), and an age:sex interaction for older women (HR 1.01, 95% CI 1.00–1.01; P = 0.04) were associated with recurrent AF. The P-wave duration at follow-up was significantly longer for patients with AF recurrence (129 ± 31 ms vs. 122 ± 22 ms in patients without AF, P = 0.03).ConclusionHalf of all early AF recurrences within the first 3 months post-ablation occurred within the first 14 days post-ablation. Vascular disease and cardioversion during the procedure are strong predictors of recurrent AF. P-wave duration at follow-up was longer in patients with recurrent AF.Trial registrationClinicaltrials.gov identifier NCT02227550