Atrial Fibrillation Ablation Failure Research Articles

P6576Use of atrioventricular nodal ablation after atrial fibrillation ablation failure: a nationwide cohort study

Abstract Atrial fibrillation (AF) catheter ablation is a validated therapy for patients with symptomatic AF after failure or intolerance to antiarrhythmic drug therapy. Despite improvements in ablation technique, 30 to 50% of the patients may have AF recurrences. The APAF-CRT trial recently demonstrated that atrio-ventricular node ablation (AVNA) and cardiac resynchronization pacing was superior to pharmacological therapy in reducing HF and hospitalization in patients with permanent AF. The purpose of the study was to quantify the use of AVNA after AF catheter ablation and to find independent predictors factors associated with AVNA in this setting. Methods This French longitudinal cohort study was based on the national hospitalization database covering hospital care from the entire population. The data for all patients admitted in France from January 2010 to December 2015 were collected from the national administrative database, the PMSI (Programme de Médicalisation des Systèmes d'Information). We included all patients, over 18 years old, with AF and at least one AF catheter ablation. Routinely collected medical information includes the principal or secondary diagnoses and procedures performed. Items from the baselines characteristics were pooled into a multivariate Cox model to identify predictors of AV node ablation. Results Of 1,663,284 patients identified with AF, 28,018 patients were treated with AF ablation (28% female, mean age 60±10 yo, 22,837 with 1 procedure, 4,576 with 2 procedures and 605 with 3 procedures). Of those 28,018 patients, there were only 369 patients (1.3%) treated with AVNA after a mean follow-up of 374±488 days (median 210, interquartile 15–798). AVNA was less commonly performed than redo AF ablation with 3 procedures, and among these latter patients, only 3.8% were treated with AVNA during follow-up. Most powerful independent predictors of AV node ablation (HR >1.7) were age≥75 yo, heart failure at baseline, abnormal renal function and valve disease. Other independent predictors for AV node ablation (HR 1.2–1.7) were age 65–74 yo, female gender, obesity, coronary artery disease, thyroid disorders, lung disease and hypertension. Conclusion Our findings indicate that AVNA is rarely used after AF ablation failure and is probably an underrated strategy in these patients for now. Considering evidence from the APAF-CRT trial indicating a beneficial effect on mortality of this treatment in symptomatic AF patients, a wider use of AVNA should be more widely proposed in these patients. Its optimal timing during rate and rhythm control management still remains to be established.

P6083Predictors of atrial fibrillation ablation failure: a French nationwide cohort study

P6083Predictors of atrial fibrillation ablation failure: a French nationwide cohort study

Abstract 20912: The Impact of Mitral Valve Disease on Atrial Fibrillation Ablation Outcome

Introduction: Mitral Valve Disease (MVD) is associated with atrial fibrillation (AF) and can worsen its prognosis. Left Atrial (LA) fibrosis is a known substrate for AF and its extent affects the management. Hypothesis: We hypothesize MVD increases LA fibrosis in AF patients and the chance of AF ablation failure. Secondly, even in patients with low levels of LA fibrosis that are optimal candidates for ablation, presence of MVD still worsens the outcome. Methods: Patients were categorized in two groups: 140 patients had coexisting MVD and AF, and 100 patients AF without MVD. MVD was defined as any dysfunctionality of mitral valve including mitral stenosis, mitral regurgitation, and history of previous mitral valve surgery . LA fibrosis was quantified by Late Gadolinium Enhancement MRI (LGE-MRI). Baseline characteristics were gathered through chart reviewing. Following ablation, patients were followed for median of 71 months for AF recurrence. Results: Patients were 76.4 ± 10.7 years of age in MVD+AF group and 64.2 ± 14.7 in AF group (p < 0.0001). Extent of LA fibrosis was 18.1% ± 9.3 and 10.3% ± 5.3 in MVD+AF and AF group, respectively (p < 0.0001). The result of our statistical model adjusted for possible cofounders showed that coexistence of MVD in AF patients result in presence of 6.4% more LA fibrosis (p < 0.00001) and lowered the chance of remaining AF free after the ablation (recurrence-free ratio of 0.554 vs 0.757 in MVD+AF and AF group respectively, P < 0.05) (Figure 1). In patients with LA fibrosis less than 20% who would be ideal AF ablation candidate, the presence of MVD decreased the chance to remain AF free (0.574 vs 0.775 in MVD+AF and AF respectively, p < 0.05) (Figure 2). Conclusions: MVD increases LA fibrosis in AF patients and the chance of AF recurrence post-ablation.

Arrhythmia recurrence after ablation of atrial fibrillation: should we be concerned about sleep apnoea?

This editorial refers to ‘Low efficacy of atrial fibrillation ablation in severe obstructive sleep apnoea patients’ by M. Matiello et al ., on page 1084. In recent years, cardiology research has learned to put its interest in some entities that have long been regarded more as annoyances than diseases that need aggressive treatment. Two examples are left bundle branch block in heart failure, which had been regarded merely as a bystander phenomenon indicating severe disease but now is regarded as an aggravating factor in the heart failure syndrome that should be corrected by resynchronization therapy. Another is atrial fibrillation (AF) which was once considered a benign arrhythmia but now is known to be associated with significant morbidity and mortality, and thus strong efforts are made to cure the arrhythmia by catheter ablation. The ‘new kid on the block’ seems to be sleep apnoea. Whereas ‘snoring’ has been regarded simply as something that sometimes frustrates spouses we now realize that both obstructive sleep apnoeas (OSA) and central sleep apnoea are associated with significant morbidity making them an important target for effective therapy. Matiello et al .1 study the influence of the severity of OSA on success of catheter ablation for AF. The results of this study implicate that (i) 24% (42 of 174) of all patients undergoing AF ablation have some degree of obstructive sleep apnoea and (ii) that the presence of severe OSA, together with an enlarged left atrial (LA) diameter, is an independent predictor of AF ablation failure. The seemingly high incidence of sleep disorders in patients undergoing … *Corresponding author. Tel: +49 521 581 3401; fax: +49 521 581 3498, Email: stellbrink{at}sk-bielefeld.de

Catheter Ablation of Atrial Tachycardia Following Atrial Fibrillation Ablation

Atrial tachycardias represent the second front of atrial fibrillation (AF) ablation. They are frequently encountered during the index ablation for patients with persistent AF and are common following ablation of persistent AF, occurring in half of all patients who have had AF successfully terminated. An atrial tachycardia is rightly seen as a failure of AF ablation, as these tachycardias are poorly tolerated by patients. This article describes a simple, practical approach to diagnosis and ablation of these atrial tachycardias.