Factor For Atrial Fibrillation Recurrence Research Articles

Surface electrocardiogram f wave analysis in patients with atrial fibrillation undergoing thoracoscopic epicardial ablation.

To investigate the predictive values of surface electrocardiogram-derived parameters in patients with atrial fibrillation who underwent thoracoscopic epicardial ablation. The present study included 102 patients with atrial fibrillation who underwent thoracoscopic epicardial ablation and whose baseline 12-lead electrocardiograms were available. Frequency domain analysis was performed to calculate the electrocardiogram-derived parameters. Cox proportional hazards regression was used to identify predictive risk factors for postoperative recurrence. At 36-month interval, the overall rate of freedom from atrial tachyarrhythmia without antiarrhythmic drugs was 58.5%. The results of the univariable and multivariable analyses showed that larger left atrial diameter (hazard ratio: 1.074, 95% confidence interval: 1.021-1.130, P = 0.006) was an independent risk factor for atrial fibrillation recurrence, while higher fibrillatory wave amplitude was a protective factor (hazard ratio: 0.292, 95% confidence interval: 0.157-0.542, P < 0.001). The associations were clarified by the restricted cubic splines. The dominant frequency and organization index were not identified as statistically significant parameters. The fibrillatory wave amplitude has the highest predictive value for atrial fibrillation recurrence in electrocardiogram-derived parameters. Together with left atrial diameter, it may help identify patients in whom thoracoscopic ablation is likely to be effective.

Catheter ablation in patients with atrial fibrillation and dilated cardiomyopathy.

Catheter ablation is an effective and safe strategy for treating atrial fibrillation patients. Nevertheless, studies on the long-term outcomes of catheter ablation in patients with dilated cardiomyopathy are limited. This study aimed to assess the electrophysiological characteristics of atrial fibrillation patients with dilated cardiomyopathy and compare the long-term clinical outcomes between patients undergoing catheter ablation and medical therapy. Patient baseline characteristics and electrophysiological parameters were examined to identify the predictors of atrial fibrillation recurrence following catheter ablation. The clinical outcomes of catheter ablation and medical therapy were compared using the propensity score matched method. A total of 343 patients were enrolled, with 46 in the catheter ablation group and 297 in the medical therapy group. Among the catheter ablation group, 58.7% (n = 27) had persistent atrial fibrillation. The recurrence rate of atrial arrhythmia was 30.4% (n = 14) after an average follow-up duration of 7.7 years following catheter ablation. The only predictive factor for atrial fibrillation recurrence after catheter ablation was the left atrial diameter. When compared to medical therapy, catheter ablation demonstrated significantly better outcomes in terms of overall survival, freedom from heart failure hospitalization, improvement in left ventricular ejection fraction, and a greater reduction in left ventricular diameter and left atrial diameter after propensity score matching. Therefore, catheter ablation proves to be effective in providing long-term control of atrial fibrillation in patients with dilated cardiomyopathy. In addition to standard heart failure care, catheter ablation significantly enhanced both morbidity and mortality outcomes and reversed structural remodeling when compared to heart failure medication alone.

Relationship between structural changes in the myocardium of the left atrium and the effectiveness of cryoablation in persistent atrial fibrillation

Introduction. High-resolution contrast-enhanced cardiac magnetic resonance imaging reveals left atrial fibrosis, the severity of which may be related to the effectiveness of catheter ablation.Aim. To study the structural changes of the left atrium myocardium according to magnetic resonance imaging with contrast in patients with persistent atrial fibrillation before balloon cryoablation and compare the results with the effectiveness of the intervention.Materials and methods. The study included 89 patients with persistent form of atrial fibrillation. The patients were randomized into two groups: in the 1st, the pulmonary veins cryoablation was performed (n = 39 (53.4%)); in the 2nd, the pulmonary veins and posterior wall of the left atrium cryoablation was performed (n = 34 (46.6%)). All patients before cryoablation underwent cardiac magnetic resonance imaging with delayed contrast using a high-resolution MR pulse sequence. The clinical efficacy of the intervention was evaluated after 12 months after the cryoablation.Results. The severity of fibrotic myocardial lesion of the left atrium before balloon cryoablation was 0.7% [0; 3,07]. Overall efficiency of the intervention rate was 57.1%. Cryoablation was most effective (59.5%) in patients severity of fibrosis less than 20% and least effective (50%) severity of fibrosis more than 20%. Risk factors for atrial fibrillation recurrence after cryoablation were: early atrial fibrillation recurrence, female sex, the maximum atrial fibrillation duration more than 3 months, stroke/TIA.Conclusion. The severity of left atrial fibrosis more than 20%, early recurrence of atrial fibrillation in the first 3 months after the cryoablation, female sex, the duration of the maximum atrial fibrillation episode more than 3 months, and a history of stroke/transient ischemic attack may be associated with recurrence of AF during the period observation 3–12 months.

Prediction model of atrial fibrillation recurrence after Cox-Maze IV procedure in patients with chronic valvular disease and atrial fibrillation based on machine learning algorithm.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia, and Cox-maze IV procedure (CMP-IV) is a commonly employed surgical technique for its treatment. Currently, the risk factors for atrial fibrillation recurrence following CMP-IV remain relatively unclear. In recent years, machine learning algorithms have demonstrated immense potential in enhancing diagnostic accuracy, predicting patient outcomes, and devising personalized treatment strategies. This study aims to evaluate the efficacy of CMP-IV on treating chronic valvular disease with AF, utilize machine learning algorithms to identify potential risk factors for AF recurrence, construct a CMP-IV postoperative AF recurrence prediction model. A total of 555 patients with AF combined with chronic valvular disease, who met the criteria, were enrolled from January 2012 to December 2019 from the Second Xiangya Hospital of Central South University and the Affiliated Xinqiao Hospital of the Army Medical University, with an average age of (57.95±7.96) years, including an AF recurrence group (n=117) and an AF non-recurrence group (n=438). Kaplan-Meier method was used to analyze the sinus rhythm maintenance rate, and 9 machine learning models were developed including random forest, gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), bootstrap aggregating, logistic regression, categorical boosting (CatBoost), support vector machine, adaptive boosting, and multi-layer perceptron. Five-fold cross-validation and model evaluation indicators [including F1 score, accuracy, precision, recall, and area under the curve (AUC)] were used to evaluate the performance of the models. The 2 best-performing models were selected for further analyze, including feature importance evaluation and Shapley additive explanations (SHAP) analysis, identifying AF recurrence risk factors, and building an AF recurrence risk prediction model. The 5-year sinus rhythm maintenance rate for the patients was 82.13% (95% CI 78.51% to 85.93%). Among the 9 machine learning models, XGBoost and CatBoost models performed best, with the AUC of 0.768 (95% CI 0.742 to 0.786) and 0.762 (95% CI 0.723 to 0.801), respectively. Feature importance and SHAP analysis showed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-to-lymphocyte ratio, preoperative left atrial diameter, preoperative heart rate, and preoperative white blood cell were important factors for AF recurrence. Conclusion: Machine learning algorithms can be effectively used to identify potential risk factors for AF recurrence after CMP-IV. This study successfuly constructs 2 prediction model which may enhance individualized treatment plans.

Predictive value of the triglyceride-glucose index on atrial fibrillation recurrence after valvular surgery with concurrent Cox-maze Ⅳ ablation

Objective: To investigate the predictive value of preoperative triglyceride-glucose (TyG) index on atrial fibrillation recurrence after valvular surgery with concurrent Cox-maze Ⅳ ablation. Methods: The data of the patients who underwent valvular surgery with concurrent Cox-maze Ⅳ ablation from June 2017 to May 2022 in the Department of Cardiac Surgery, Beijing Anzhen Hospital were retrospectively collected, and the patients were divided into the recurrence group and non-recurrence group. Baseline clinical data and results of laboratory tests were collected and TyG index was calculated. The univariate and multivariate Cox proportional regression analysis were used to explore the risk factors of atrial fibrillation recurrence after Cox-maze Ⅳ ablation. The value of TyG index in predicting atrial fibrillation recurrence was obtained by plotting receiver operating characteristic (ROC) curve. Results: A total of 424 patients were in the final analysis, including 300 males and 124 females, with an average age of (58.2±13.4) years. The median follow-up time was 32.7 months (17.3-49.6 months). There were 117 and 307 patients in the recurrence and non-recurrence groups, respectively. Compared with the non-recurrence group, the TyG index in the recurrence group was higher (9.21±0.38 vs 8.34±0.72, P=0.011). The multivariate Cox regression analysis showed that TyG index (HR=2.021, 95%CI: 1.374-3.245, P<0.001), C-reactive protein level (HR=1.127, 95%CI: 1.007-1.535, P=0.026) and mitral stenosis (HR=1.038, 95%CI: 1.004-1.483, P<0.001) were risk factors for atrial fibrillation recurrence after Cox-maze Ⅳ ablation. In addition, TyG index was a predictor of atrial fibrillation recurrence according to ROC curve analysis [area under the curve (AUC)=0.847, 95%CI: 0.796-0.871, P<0.001]. Conclusion: The TyG index is an effective indicator to predict the recurrence of atrial fibrillation after valvular surgery with concurrent Cox-maze Ⅳ ablation.

Machine learning-based analysis of risk factors for atrial fibrillation recurrence after Cox-Maze IV procedure in patients with atrial fibrillation and chronic valvular disease: A retrospective cohort study with a control group.

To evaluate the efficacy of the Cox-Maze IV procedure (CMP-IV) in combination with valve surgery in patients with both atrial fibrillation (AF) and valvular disease and use machine learning algorithms to identify potential risk factors of AF recurrence. A total of 1,026 patients with AF and valvular disease from two hospitals were included in the study. 555 patients received the CMP-IV procedure in addition to valve surgery and left atrial appendage ligation (CMP-IV group), while 471 patients only received valve surgery and left atrial appendage ligation (Non-CMP-IV group). Kaplan-Meier analysis was used to calculate the sinus rhythm maintenance rate. 58 variables were selected as variables for each group and 10 machine learning models were developed respectively. The performance of the models was evaluated using five-fold cross-validation and metrics including F1 score, accuracy, precision, and recall. The four best-performing models for each group were selected for further analysis, including feature importance evaluation and SHAP analysis. The 5-year sinus rhythm maintenance rate in the CMP-IV group was 82.13% (95% CI: 78.51%, 85.93%), while in the Non-CMP-IV group, it was 13.40% (95% CI: 10.44%, 17.20%). The eXtreme Gradient Boosting (XGBoost), LightGBM, Category Boosting (CatBoost) and Random Fores (RF) models performed the best in the CMP-IV group, with area under the curve (AUC) values of 0.768 (95% CI: 0.742, 0.786), 0.766 (95% CI: 0.744, 0.792), 0.762 (95% CI: 0.723, 0.801), and 0.732 (95% CI: 0.701, 0.763), respectively. In the Non-CMP-IV group, the LightGBM, XGBoost, CatBoost and RF models performed the best, with AUC values of 0.738 (95% CI: 0.699, 0.777), 0.732 (95% CI: 0.694, 0.770), 0.724 (95% CI: 0.668, 0.789), and 0.716 (95% CI: 0.656, 0.774), respectively. Analysis of feature importance and SHAP revealed that duration of AF, preoperative left ventricular ejection fraction, postoperative heart rhythm, preoperative neutrophil-lymphocyte ratio, preoperative left atrial diameter and heart rate were significant factors in AF recurrence. CMP-IV is effective in treating AF and multiple machine learning models were successfully developed, and several risk factors were identified for AF recurrence, which may aid clinical decision-making and optimize the individual surgical management of AF.

Periprocedural decrease in tumor necrosis factor alpha is a risk factor for atrial fibrillation recurrence after ablation

Background: Concentration of tumor necrosis factor alpha (TNF-alpha) might be useful in selecting patients with paroxysmal atrial fibrillation (PAF) who will benefit the most from pulmonary vein isolation.

Impact of NLR on atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure

Objective: To investigate the predictive value of neutrophils-to-lymphocytes ratio (NLR) for atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure. Methods: This is a retrospective cohort study. Patients with atrial fibrillation and heart failure who received radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from January 2019 to June 2020 were included. Patient were followed up in the outpatient clinic at 3, 6, 9 and 12 months after radiofrequency ablation and were divided into recurrent and non-recurrent groups according to the absence or presence of atrial fibrillation. Demographic data, echocardiographic indices and inflammation-related indices including NLR were collected and compared between the two groups. Spearman rank correlation was performed to analyze the correlation of NLR with atrial fibrillation recurrence after radiofrequency ablation. Multivariate logistic regression analysis was used to determine independent risk factors of atrial fibrillation recurrence after radiofrequency ablation. The receiver operating characteristic (ROC) curve was used to evaluate the value of NLR in predicting the atrial fibrillation recurrence after radiofrequency ablation. Results: A total of 883 patients were included, of which 460 (52.1%) were male, mean age was (64.4±10.7) years old. There were 246 patients (27.9%) in the recurrence group and 637 patients (72.1%) in the non-recurrence group. Compared with the non-recurrent group, the duration of atrial fibrillation, NLR, neutrophil count, N-terminal B-type natriuretic peptide precursor (NT-proBNP) and body mass index levels were significantly higher, while lymphocyte count was significantly lower in the recurrence group than in the non-recurrent group (all P<0.05). Spearman rank correlation analysis showed that NLR was positively correlated with the atrial fibrillation recurrence (r=0.333, P<0.05). Multivariate logistic regression analysis showed that NLR was an independent risk factor for atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined heart failure (OR=1.634, P<0.001). The ROC curve showed that the area under the curve (AUC) of NLR in predicting the recurrence of atrial fibrillation after radiofrequency ablation was 0.715 (95%CI: 0.668-0.762, P<0.001), with a sensitivity of 55.61% and a specificity of 84.54%. Conclusion: NLR is a useful predictor of atrial fibrillation recurrence after radiofrequency ablation in atrial fibrillation patients combined with heart failure.

Cryoballoon ablation of persistent atrial fibrillation for de novo pulmonary vein isolation: a single-center follow-up study.

Pulmonary vein isolation (PVI) alone for persistent atrial fibrillation (PersAF) remains controversial. The characteristics of cryoballoon ablation (CBA) to treat PersAF and the blanking period recurrence are underreported. This study retrospectively analyzed patients with PersAF undergoing second-generation CBA for de novo PVI. The post-procedural efficacy and survival analysis were compared between patients with different PersAF durations. The multivariate Cox regression analysis was used to detect the risk factors for recurrence. Early and long-term recurrence were analyzed relative to each other. A total of 329 patients were enrolled, with a median PersAF duration of 4.0 months (interquartile range: 2.0-12.0 months); 257 patients (78.1%) were male. Kaplan-Meier analysis of freedom from atrial fibrillation recurrence at 12, 24, and 30 months showed 71.0%, 58.5%, and 54.9%, respectively. Early PersAF had a relatively favorable survival rate and a narrow P-wave duration of restoring sinus rhythm compared with that of PersAF lasting more than three months (P < 0.05). The multivariate Cox regression analysis revealed that PersAF duration and left atrial anteroposterior diameter ≥ 42 mm were the risk factors for atrial fibrillation recurrence after CBA [hazard ratio (HR) = 1.89, 95% CI: 1.01-1.4, P = 0.042; HR = 3.6, 95% CI: 2.4-5.4, P < 0.001, respectively]. The blanking period recurrence predicted the long-term recurrence (P < 0.0001). CBA of PersAF had safety and efficacy to reach de novo PVI. The PersAF duration and left atrial size were risk factors for atrial fibrillation recurrence after CBA. Blanking period recurrence was associated with long-term recurrence.

Epicardial adipose tissue is associated with higher recurrence risk after catheter ablation in atrial fibrillation patients: a systematic review and meta-analysis

ObjectiveOur study aimed to investigate the association between epicardial adipose tissue (EAT) and atrial fibrillation (AF) recurrence risk after catheter ablation.MethodsWe searched PubMed, Embase, and Cochrane Library databases up to November 30, 2021 without language restrictions. Outcome was the relative risk (RR) of EAT contributes to AF recurrence after catheter ablation. The RR and 95% confidence interval (CI) was pooled by the random-effect model.Results10 studies that contained 1840 AF patients were included in our study. The result of this study showed that EAT amount was associated with higher risk of AF recurrence after catheter ablation (RR = 1.06, 95% CI 1.02–1.11, P = 0.005) and EAT related thickness was a risk factor for AF recurrence after catheter ablation (RR = 1.73, 95% CI 1.04–2.87, P = 0.040). Sub-analysis showed that EAT was strongly associated with higher risk of AF recurrence common in Asian population (RR = 1.25, 95% CI 1.10–1.43, P < 0.001), patients aged ≤ 60 years old (RR = 2.01, 95% CI 1.18–3.44, P = 0.010), and follow-up more than 1 year (RR = 1.06, 95% CI 1.01–1.11, P = 0.020).ConclusionThe meta-analysis demonstrated that EAT related thickness seems to be the marker most strongly associated with a greater risk of AF recurrences after catheter ablation. It should be included into risk stratification for predicting AF recurrent before catheter ablation.

Benefit of sleep study in all patients with atrial fibrillation and BMI&amp;gt; 28,0 Kg/m2 before catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): None Background Sleep apnea is a known risk factor for atrial fibrillation recurrence after catheter ablation. Despite this, in recent atrial fibrillation guidelines, it is unclear in which patients to test sleep apnea before catheter ablation. Purpose Evaluate if body mass index (BMI) has a good discriminative power to predict sleep apnea in patients with atrial fibrillation proposed to catheter ablation. Methods We retrospectively studied 160 consecutive patients undergoing catheter ablation of paroxysmal or persistent atrial fibrillation in our institution. We evaluated recurrence of atrial fibrillation after catheter ablation and analysed diagnosis of sleep apnea, body mass index, treatment with CPAP, echocardiographic findings (indexed volume of left atrium and left ventricular ejection fraction), cardiovascular risk factors and other comorbidities and clinical characteristics. Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of body mass index as predictor of sleep apnea. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value. 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 (HR 3,74; 95% CI 1,89-7,42; p &amp;lt;0,001). Optimal cut-point value for predicting sleep apnea in patients with atrial fibrillation proposed to catheter ablation was BMI of 28,0 Kg/m2 (AUC 0,733, p = 0,001, 95% CI 0,640-0,827). The group of patients with BMI of 28,0 Kg/m2 had a 4-fold increased risk of sleep apnea (OR 3,95, 95% CI 1,85-8,42, p =0,001) and 2-fold risk of atrial fibrillation recurrence (HR 1,96; 95% CI 1,10-3,51; p = 0,023). Conclusions In this group of patients undergoing catheter ablation of atrial fibrillation, a BMI ≥ 28,0 Kg/m2 was independent predictor of sleep apnea and recurrence of atrial fibrillation after catheter ablation. In patients with atrial fibrillation proposed to catheter ablation and BMI ≥ 28,0 Kg/m2 is reasonable to do a sleep study before catheter ablation.

Multicenter randomized study evaluating the outcome of ganglionated plexi ablation in maze procedure.

The benefit of adding ganglionated plexi ablation to the maze procedure remains controversial. This study aims to compare the outcomes of the maze procedure with and without ganglionated plexi ablation. This multicenter randomized study included 74 patients with atrial fibrillation associated with structural heart disease. Patients were randomly allocated to the ganglionated plexi ablation group (maze with ganglionated plexi ablation) or the maze group (maze without ganglionated plexi ablation). The lesion sets in the maze procedure were unified in all patients. High-frequency stimulation was applied to clearly identify and perform ganglionated plexi ablation. Patients were followed up for at least 6months. The primary endpoint was a recurrence of atrial fibrillation. The intention-to-treat analysis included 69 patients (34 in the ganglionated plexi ablation group and 35 in the maze group). No surgical mortality was observed in either group. After a mean follow-up period of 16.3 ± 7.9months, 86.8% of patients in the ganglionated plexi ablation group and 91.4% of those in the maze group did not experience atrial fibrillation recurrence. Kaplan-Meier atrial fibrillation-free curves showed no significant difference between the two groups (P = .685). Cox proportional hazards regression analysis indicated that left atrial dimension was the only risk factor for atrial fibrillation recurrence (hazard ratio: 1.106, 95% confidence interval 1.017-1.024, P = .019). The addition of ganglionated plexi ablation to the maze procedure does not improve early outcome when treating atrial fibrillation associated with structural heart disease.

Left Atrial Diameter as a Risk Factor for Atrial Fibrillation Recurrence after Surgical Ablation: A Systematic Review and Meta-analysis

Background: Surgical ablation (SA) is widely performed to eliminate atrial fibrillation (AF) and maintain atrial contraction. A larger left atrial diameter (LAD) has long been associated with the late recurrence of AF post-ablation. Objectives: We conducted a meta-analysis to assess the relationship between LAD and AF recurrence after SA and investigated the effect of LAD cut-off values on the probability of AF recurrence via subgroup analysis. Methods: The literature search was performed in the MEDLINE and Cochrane Central Register of Controlled Trials databases, from inception to July 2021. A random-effects model was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). From 401 initial articles, 16 studies, comprising a total of 4,291 patients, were included in this review. Results: A meta-analysis of 10 studies (2,599 patients) demonstrated that the predicted probability of AF recurrence was 7% greater with each 1 mm increase in LAD (OR: 1.07; 95% CI: 1.04–1.09; P&lt;0.01). Meanwhile, subgroup analysis revealed that the larger the cut-off value, the higher the risk of AF recurrence. The synthesis effect value (OR: 2.45; 95% CI: 1.77–3.39) was close to the OR when the LAD cut-off value was 55 mm (OR: 2.56; 95% CI: 1.22–5.38). Conclusions: In conclusion, a larger LAD is a significant risk factor for predicting AF recurrence after SA. More rigorously designed studies with larger sample sizes are needed to identify the best cut-off value of LAD when performing SA.

Human Tissue Analysis of Left Atrial Adipose Tissue and Atrial Fibrillation after Cox Maze Procedure.

Cardiac adipose tissue is a well-known risk factor for the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation, but its correlation with maze surgery remains unknown. The aim of this study was to investigate the correlation between the recurrence of AF and the adipose component of the left atrium (LA) in patients who underwent a modified Cox maze (CM) III procedure. We reviewed the pathology data of resected LA tissues from 115 patients, including the adipose tissue from CM-III procedures. The mean follow-up duration was 30.05 ± 23.96 months. The mean adipose tissue component in the AF recurrence group was 16.17% ± 14.32%, while in the non-recurrence group, it was 9.48% ± 10.79% (p = 0.021), and the cut-off value for the adipose component for AF recurrence was 10% (p = 0.010). The rates of freedom from AF recurrence at 1, 3, and 5 years were 84.8%, 68.8%, and 38.6%, respectively, in the high-adipose group (≥10%), and 96.3%, 89.7%, and 80.3%, respectively, in the low-adipose group (<10%; p = 0.002). A high adipose component (≥10%) in the LA is a significant risk factor for AF recurrence after CM-III procedures. Thus, it may be necessary to attempt to reduce the perioperative adipose portion of the cardiac tissue using a statin in a randomized study.

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation

Risk Factors for Atrial Fibrillation Recurrence in Patients Undergoing Ablation

Abstract 12160: Predicting Atrial Fibrillation Recurrence After Thoracoscopic Ablation by Left Atrium Appendage Emptying Velocity

Introduction: Totally thoracoscopic ablation (TTA) is the latest tool for in patient with persistent or long-standing atrial fibrillation (AF). Left atrium appendage (LAA) emptying velocity is known related with maintenance sinus rhythm after successful cardioversion and catheter ablation. There were no studies about the value of LAA emptying velocity in thoracoscopic ablation since now. Hypothesis: We assessed the hypothesis that LAA emptying velocity could predict AF recurrence also in patient who underwent TTA. Methods: Between February 2012 and March 2015, 150 patients underwent TTA in a tertiary center in South Korea. The primary outcome was AF recurrence detection in either 12-lead electrocardiogram or holter during 3 years after TTA, excluding initial 3 months of blanking period. After baseline characteristics comparison between no AF recurrence group and AF recurrence group, main contributing factor for AF recurrence was analyzed with multivariable cox regression. Additionally, time-dependent ROC (receiver operating characteristic) analysis was done to estimate predictive power of LAA emptying velocity for AF recurrence. Results: Proportion of paroxysmal AF and LAA emptying velocity were higher in no AF recurrence group. LA volume size was larger in AF recurrence group. Except these values, other clinical characteristics like age, sex, underlying disease, CHA 2 DS 2 -VASc score, history of RFCA, use of antiarrhythmic drug or surgical method were not significantly different. In multivariable cox regression, female sex (HR 2.474, 95% CI [1.036-5.905], p value=0.041) and LAA emptying velocity (HR 0.941, 95% CI [0.915-0.967], p value&lt;0.001) were meaningful contributing factor for AF recurrence. Also, LAA emptying velocity showed modest degree predictive performances for predicting AF recurrence (AUC 0.754, 95% CI [0.675 - 0.834])(figure 1). Conclusions: In conclusion, LAA emptying velocity could predict AF recurrence after TTA.

Catheter ablation of atrial fibrillation in Korea: results from the Korean Heart Rhythm Society Ablation Registry for Atrial Fibrillation (KARA)

BackgroundThis study aims to investigate the current status of AF (atrial fibrillation) catheter ablation in Korea.MethodsThe patients who underwent AF catheter ablation from September 2017 to December 2019 were prospectively enrolled from 37 arrhythmia centers. Demographic data, procedural characteristics, the extent of catheter ablation, acute success of the ablation lesion set, rate and independent risk factor for recurrence of AF were analyzed.ResultsA total of 2402 AF patients [paroxysmal AF (PAF) 45.7%, persistent AF (PeAF) 43.1% and redo AF 11.2%] were included. Pulmonary vein isolation (PVI) was performed in 2378 patients (99%) and acute success rate was 97.9%. Additional non-PV ablation (NPVA) were performed in 1648 patients (68.6%). Post-procedural complication rate was 2.2%. One-year AF-free survival rate was 78.6% and the PeAF patients showed poorer survival rate than the ones with other types (PeAF 72.4%, PAF 84.2%, redo AF 80.0%). Additional NPVA did not influence the recurrence of AF in the PAF patients (PVI 17.0% vs. NPVA 14.6%, P value 0.302). However, it showed lower AF recurrence rate in the PeAF patients (PVI 34.9% vs. NPVA 24.4%, P value 0.001). Valvular heart disease, left atrial diameter, PeAF, PVI alone, need of NPVA for terminating AF, and failed ablation were independent predictors of AF recurrence.ConclusionsAdditional NPVA was associated better rhythm outcome in the patients with PeAF, not in the ones with PAF. The independent risk factors for AF recurrence in Korean population were similar to previous studies. Further research is needed to discover optimal AF ablation strategy.

Impact of left atrial geometric remodeling on late atrial fibrillation recurrence after catheter ablation.

To quantitatively investigate the impact of left atrial geometric remodeling on atrial fibrillation recurrence after catheter ablation. A retrospective analysis of 105 patients with atrial fibrillation who underwent coronary computed tomographic angiography before catheter ablation. Risk factors for atrial fibrillation recurrence were identified by multivariable logistic regression analysis and used to create a nomogram. After at least 12 months of follow-up, 30 patients (29%) developed recurrent atrial fibrillation. Patients with recurrence had higher left atrial volume, left atrial sphericity, and lower left atrial ejection fraction (LAEF) (P < 0.05). There was no significant difference in asymmetry index between the two groups (P = 0.121). Multivariable regression analysis showed that left atrial minimal volume index (LAVImin) [odds ratio (OR): 1.026, 95% confidence interval (CI): 1.002-1.050, P = 0.034], left atrial sphericity (OR: 1.222, 95% CI: 1.040-1.435, P = 0.015) and CHADS2 score (OR: 1.511, 95% CI: 1.024-2.229, P = 0.038) were independent predictors of atrial fibrillation recurrence. The combined model of the left atrial sphericity to the LAVImin substantially increased the predictive power for atrial fibrillation recurrence [area under the curve (AUC) = 0.736, 95% CI: 0.627-0.844, P < 0.001], with a sensitivity of 80% and a specificity of 61%. A nomogram was generated based on the contribution weights of the risk factors; the AUC was 0.772 (95% CI: 0.670-0.875) and had good internal validity. The CHADS2 score, left atrial sphericity, and LAVImin were significant and independent predictors of atrial fibrillation recurrence after catheter ablation. Furthermore, the nomogram had a better predictive capacity for atrial fibrillation recurrence.

Does merged three-dimensional mapping improve contact force and long-term procedure outcome in atrial fibrillation ablation? (MICRO-AF study): a prospective randomized controlled study.

Integration of electroanatomical map (EAM) with preacquired three-dimensional (3D) cardiac images provides detailed appreciation of the complex anatomy of the left atrium (LA) and pulmonary vein (PV). High-density (HD) multi-electrode mapping catheters have enabled creating more accurate EAM reflecting real-time volume-rendered LA-PV geometry during atrial fibrillation (AF) ablation. However, no study has compared the outcomes of AF ablation using HD-EAM versus 3D-merged map. We aimed to investigate the procedural and clinical outcomes of AF ablation with HD-EAM (HD-EAM group) versus 3D-merged map (Merge group). One hundred patients (59.5 ± 11.5 years, 53% with paroxysmal AF [PAF]) were randomly assigned (1:1) to HD-EAM or Merged group. HD multi-electrode mapping and contact force (CF)-sensing catheters were used to create virtual LA-PV chamber and to perform wide antral circumferential ablation (WACA), respectively. The two groups showed no significant differences in baseline characteristics and procedural data including ablation time, fluoroscopy time, LA voltage, and CF. PV isolation with a single WACA line was achieved in 21 (42%) and 27 (54%) patients in the Merge and HD-EAM groups, respectively (P = NS). CF was significantly lower in lesions with gap than lesions without gap after a single WACA (7.3 ± 7.3g vs. 16.0 ± 8.3, respectively, P < 0.001). During the 12-month follow-up, no significant difference in AF recurrence was observed between two groups, irrespective of AF type. In multivariate analysis, non-PAF was an independent risk factor for AF recurrence. Integration of 3D cardiac imaging did not improve procedural and clinical outcomes. HD-EAM provides an accurate real-time LA geometry.

Prediction of risk factors for recurrence of atrial fibrillation in patients with arterial hypertension.

This work aimed to assess the significance of risk factors for atrial fibrillation recurrence and predict the significance of these factors in the development of arterial hypertension in patients. For the first time, the authors performed prognostic analysis of atrial fibrillation recurrence probability taking into account the number and significance of risk factors. The study was conducted in 2018-2019 based on the Cardiovascular Department of Military Hospital 175, Ho Chi Minh City (Vietnam). A total of 200 patients were diagnosed with arterial hypertension of I-III degree, divided into 2 groups: Group 1 (84 patients) without recurrence of atrial fibrillation, Group 2 (116 patients) with recurrences. All patients underwent echocardiographic and veloergometric studies, as well as Holter monitoring. Group 2 consisted of a significantly higher number of overweight patients (p ≤ 0.05) compared to Group 1. Also, more patients with a prolonged period of arterial hypertension (p ≤ 0.05), high blood pressure (p ≤ 0.02), and diabetes mellitus (p ≤ 0.01) were found in Group 1. A history of atrial fibrillation was more typical for Group 2 (p ≤ 0.03). Among risk factors, arterial hypertension of III degree (0.01) and left ventricular myocardial mass index (0.02) had the highest level of significance. Maximum unfavorable prognosis of atrial fibrillation recurrence is released under the action of all three factors. Under one risk factor (arterial hypertension), the degree of risk is quite high (1.4 times), but minimal compared to the other factors. With the fibrillation, the risk of recurrence increases slightly (1.6 times, p ≤ 0.05). The risk of atrial fibrillation recurrence is maximal when all three factors are combined (with atrial dilatation attached), with the risk increasing almost 2-fold (2.2-fold, p ≤ 0.01).