Fibrillation Recurrence In Patients Research Articles

Left atrial stiffness index correlates with atrial fibrillation recurrence in patients who underwent electrical cardioversion

Left atrial stiffness index correlates with atrial fibrillation recurrence in patients who underwent electrical cardioversion

Myeloperoxidase and N-terminal proatrial natriuretic peptide as predictors for atrial fibrillation recurrence in patients undergoing redo ablation

BackgroundAtrial fibrillation (AF) is a progressively developing arrhythmia. Electroanatomic remodeling may play an important role, both in the development of the disease as well as in the perpetuation and thus in the recurrence of AF. ObjectiveThis study aimed to investigate potential biomarkers Myeloperoxidase (MPO), N-terminal pro-atrial natriuretic peptide (NT-proANP), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloproteinase-2 (MMP-2) and their predictive value for AF recurrence in patients undergoing redo ablation. MethodsIn this single-center prospective cohort study 50 consecutive patients underwent ultra-high-density mapping and redo ablation. Biomarkers were determined before ablation and at 6 months follow-up. Seven-day Holter was conducted to check for AF recurrence (>30 seconds). ResultsEleven (22%) patients showed AF recurrence after redo ablation. ROC analysis revealed venous MPO and NT-proANP (AUC 0.755, 95% CI 0.599 – 0.912, p=0.010 and AUC 0.752, 95% CI 0.551 – 0.953, p=0.011) as acceptable predictors for intermediate AF recurrence, whereas MMP-2, ICAM-1, and established cardiovascular biomarkers such as NT-proBNP, Troponin T, and C-reactive protein were not (all AUC <0.600). MPO and NT-proANP correlated with AF burden (ρ 0.365, p=0.005 and ρ 0.362, p=0.005). While MPO was associated with atrial fibrosis in the endocardial map (ρ 0.280, p=0.024), NT-proANP correlated with left atrial volume index (ρ 0.256, p=0.037). There were no significant differences in biomarkers concentrations with regard to venous and coronary sinus samples. ConclusionMPO and NT-proANP are of predictive value for AF recurrence in patients undergoing redo ablation. While MPO correlated with endocardial fibrosis, NT-proANP was associated with left atrial volume.

Study of P wave dispersion in patients with paroxysmal atrial fibrillation and its role in prediction of atrial fibrillation recurrence

BackgroundIt has been known that increased P wave duration and P wave dispersion reflect prolongation of intra-atrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. The objective of this study was assessment of P wave dispersion value in cases with paroxysmal atrial fibrillation and its role in predicting recurrence.ResultsForty-eight patients with documented paroxysmal AF were subjected to clinical evaluation, electrocardiogram and routine Doppler echocardiogram. We found that a statistically significant association was detected between P wave dispersion and older age, diabetic and hypertensive cases with positive correlation also detected with left atrial dimension (LAD), left ventricle size and diastolic dysfunction grade. Mean corrected P wave dispersion and corrected QT interval were higher among cases using sotalol, ca channel blockers, among cases using nitrates and among cases with Morris index > 0.04. Higher mean value of corrected QT was associated with biphasic P v1 shape. Old age, female sex, P wave dispersion and QT wave dispersion are statistically significant predictors of PAF recurrence.ConclusionP wave dispersion in patients with paroxysmal atrial fibrillation was strongly correlated to older age, diabetic and hypertensive patients and also with left atrial dimension (LAD), left ventricle size and diastolic dysfunction grade. Also, mean corrected P wave dispersion can predict atrial fibrillation recurrence in patients with Morris index > 0.04, old age, female sex, and QT wave dispersion.

Association between estimated glucose disposal rate and atrial fibrillation recurrence in patients undergoing radiofrequency catheter ablation: a retrospective study

ObjectivePrevious studies have shown a clear link between insulin resistance (IR) and an elevated risk of atrial fibrillation (AF). However, the relationship between the estimated glucose disposal rate (eGDR), which serves as a marker for IR, and the risk of AF recurrence after radiofrequency catheter ablation (RFCA) remains uncertain. Therefore, this study aimed to examine the potential association between the eGDR and the risk of AF recurrence following RFCA.MethodsThis retrospective study was conducted at Nanchang University Affiliated Second Hospital. The study enrolled 899 patients with AF who underwent RFCA between January 2015 and January 2022. The formula used to calculate the eGDR was as follows: 19.02 − (0.22 * body mass index) − (3.26 * hypertension) − (0.61 * HbA1c). Cox proportional hazard regression models and exposure–effect curves were used to explore the correlation between the baseline eGDR and AF recurrence. The ability of the eGDR to predict AF recurrence was evaluated using the area under the receiver operating characteristic curve (AUROC).ResultsThe study observed a median follow-up period of 11.63 months, during which 296 patients experienced AF recurrence. K‒M analyses revealed that the cumulative incidence AF recurrence rate was significantly greater in the group with the lowest eGDR (log-rank p < 0.01). Participants with an eGDR ≥ 8 mg/kg/min had a lower risk of AF recurrence than those with an eGDR < 4 mg/kg/min, with a hazard ratio (HR) of 0.28 [95% confidence interval (CI) 0.18, 0.42]. Additionally, restricted cubic spline analyses demonstrated a linear association between the eGDR and AF recurrence (p nonlinear = 0.70). The area under the curve (AUC) for predicting AF recurrence using the eGDR was 0.75.ConclusionsThe study revealed that a decrease in the eGDR is associated with a greater AF recurrence risk after RFCA. Hence, the eGDR could be used as a novel biomarker for assessing AF recurrence risk.

Timing of detection of atrial fibrillation recurrence in patients with transient new-onset atrial fibrillation detected during hospitalization for noncardiac surgery or medical illness

Abstract Background Approximately one third of patients who experience transient new-onset atrial fibrillation (AF) during a hospitalization for noncardiac surgery or medical illness will have recurrent AF within 1 year. Purpose To estimate the expected rate of detection of AF recurrence using different durations of continuous ECG monitoring during follow-up of patients who have had AF occurring transiently during physiologic stress. Methods We used continuous ECG data from participants enrolled in the AFOTS Follow-up Study. Participants had transient new-onset AF while hospitalized for noncardiac surgery or medical illness and were discharged from hospital in sinus rhythm. We calculated the median time to detection of the first recurrent AF episode and the proportion of recurrent AF events that would be captured with an ECG monitor worn for 24 h, 48 h, 7 days and 14 days, and with a repeated 14-day monitor worn approximately 6 months after the first monitor. Results A total of 139 participants (41.0% female, median CHA2DS2-VaSC Score 3.0 (Interquartile Range [IQR] 2.0- 4.0)) wore at least one ECG monitor for a median of 13.5 days (IQR 11.7-13.8). A second ECG monitor was worn by 83 (59.7%) participants for a median of 12.9 days (IQR 10.0-13.9); the second monitor was worn a median of 175.0 days (IQR 153.0-216.0) after the first monitor. Among the study participants in whom recurrent AF was detected (n = 40, 28.8%), the median time to AF lasting at least 30 seconds was 128.0 hours (IQR 32.5-232.5). The proportion of AF recurrences detected after more than 24 hours of monitoring was 75.0% (n = 30). The yield of AF detection increased with longer monitoring times (Figure 1). AF was detected in 5.0% of participants at 24 hours, 5.8% at 48 hours, 6.5% at 72 hours, 12.2% at 7 days, 21.6% at 14 days and in 28.8% of participants by the end of the second 14-day monitor. Conclusions In patients who have experienced transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, the rate of capture of AF recurrence in follow-up increases with longer monitoring durations. 14-day monitors capture nearly 4 times as many AF events as 48 h monitors.

Atrial Fibrillation Recurrence in Patients With Transient New-Onset Atrial Fibrillation Detected During Hospitalization for Noncardiac Surgery or Medical Illness : A Matched Cohort Study.

Atrial fibrillation (AF) is often detected for the first time in patients who are hospitalized for another reason. Long-term risks for AF recurrence in these patients are unclear. To estimate risk for AF recurrence in patients with new-onset AF during a hospitalization for noncardiac surgery or medical illness compared with a matched population without AF. Matched cohort study. (ClinicalTrials.gov: NCT03221777). Three academic hospitals in Hamilton, Ontario, Canada. The study enrolled patients hospitalized for noncardiac surgery or medical illness who had transient new-onset AF. For each participant, an age- and sex-matched control participant with no history of AF from the same hospital ward was recruited. All participants left the hospital in sinus rhythm. 14-day electrocardiographic (ECG) monitor at 1 and 6 months and telephone assessment at 1, 6, and 12 months. The primary outcome was AF lasting at least 30 seconds on the monitor or captured by ECG 12-lead during routine care at 12 months. Among 139 participants with transient new-onset AF (70 patients with medical illness and 69 surgical patients) and 139 matched control participants, the mean age was 71 years (SD, 10), the mean CHA2DS2-VASc score was 3.0 (SD, 1.5), and 59% were male. The median duration of AF during the index hospitalization was 15.8 hours (IQR, 6.4 to 49.6 hours). After 1 year, recurrent AF was detected in 33.1% (95% CI, 25.3% to 40.9%) of participants in the transient new-onset AF group and 5.0% (CI, 1.4% to 8.7%) of matched control participants; after adjustment for the number of ECG monitors worn and for baseline clinical differences, the adjusted relative risk was 6.6 (CI, 3.2 to 13.7). After exclusion of participants who had electrical or pharmacologic cardioversion during the index hospitalization (n = 40) and their matched control participants and limiting to AF events detected by the patch ECG monitor, recurrent AF was detected in 32.3% (CI, 23.1% to 41.5%) of participants with transient new-onset AF and 3.0% (CI, 0% to 6.4%) of matched control participants. Generalizability is limited, and the study was underpowered to evaluate subgroups and clinical predictors. Among patients who have transient new-onset AF during a hospitalization for noncardiac surgery or medical illness, approximately 1 in 3 will have recurrent AF within 1 year. Peer-reviewed grants.

Biomarkers of Atrial Fibrillation Recurrence in Patients with Paroxysmal or Persistent Atrial Fibrillation Following External Direct Current Electrical Cardioversion.

Atrial fibrillation (AF) is associated with atrial remodeling, cardiac dysfunction, and poor clinical outcomes. External direct current electrical cardioversion is a well-developed urgent treatment strategy for patients presenting with recent-onset AF. However, there is a lack of accurate predictive serum biomarkers to identify the risks of AF relapse after electrical cardioversion. We reviewed the currently available data and interpreted the findings of several studies revealing biomarkers for crucial elements in the pathogenesis of AF and affecting cardiac remodeling, fibrosis, inflammation, endothelial dysfunction, oxidative stress, adipose tissue dysfunction, myopathy, and mitochondrial dysfunction. Although there is ample strong evidence that elevated levels of numerous biomarkers (such as natriuretic peptides, C-reactive protein, galectin-3, soluble suppressor tumorigenicity-2, fibroblast growth factor-23, turn-over collagen biomarkers, growth differential factor-15) are associated with AF occurrence, the data obtained in clinical studies seem to be controversial in terms of their predictive ability for post-cardioversion outcomes. Novel circulating biomarkers are needed to elucidate the modality of this approach compared with conventional predictive tools. Conclusions: Biomarker-based strategies for predicting events after AF treatment require extensive investigation in the future, especially in the presence of different gender and variable comorbidity profiles. Perhaps, a multiple biomarker approach exerts more utilization for patients with different forms of AF than single biomarker use.

Clinical efficacy and safety of Cox-maze IV procedure for atrial fibrillation in patients with aortic valve calcification.

Atrial fibrillation is associated with a high incidence of heart valve disease. There are few prospective clinical research comparing aortic valve replacement with and without surgical ablation for safety and effectiveness. The purpose of this study was to compare the results of aortic valve replacement with and without the Cox-maze IV procedure in patients with calcific aortic valvular disease and atrial fibrillation. We analyzed one hundred and eight patients with calcific aortic valve disease and atrial fibrillation who underwent aortic valve replacement. Patients were divided into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox-maze operation (no Cox-maze group). After surgery, freedom from atrial fibrillation recurrence and all-cause mortality were evaluated. Freedom from all-cause mortality after aortic valve replacement at 1 year was 100% in the Cox-maze group and 89%, respectively, in the no Cox-maze group. No Cox-maze group had a lower rate of freedom from atrial fibrillation recurrence and arrhythmia control than those in the Cox-maze group (P = 0.003 and P = 0.012, respectively). Pre-operatively higher systolic blood pressure (hazard ratio, 1.096; 95% CI, 1.004-1.196; P = 0.04) and post-operatively increased right atrium diameters (hazard ratio, 1.755; 95% CI, 1.182-2.604; P = 0.005) were associated with atrial fibrillation recurrence. The Cox-maze IV surgery combined with aortic valve replacement increased mid-term survival and decreased mid-term atrial fibrillation recurrence in patients with calcific aortic valve disease and atrial fibrillation. Pre-operatively higher systolic blood pressure and post-operatively increased right atrium diameters are associated with the prediction of recurrence of atrial fibrillation.

Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association

Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.

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

Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF). The CHA2DS2-VASc score is a well-established predictor of AF-related stroke. Whether the CHA2DS2-VASc score can also be useful in predicting the long-term clinical outcomes following PVI-C is still unsettled. The aim of this analysis was to evaluate the role of the CHA2DS2-VASc score in predicting AF recurrence after PVI-C. Patients with symptomatic AF underwent an index PVI-C. Data were collected prospectively in the framework of the 1STOP ClinicalService project. Patients were categorized into two groups: low risk (LR) and high risk (HR) based on CHA2DS2-VASc score (0-1 and ≥ 2, respectively). Out of 3313 patients, 1910 (57.6%) had a CHA2DS2-VASc score between 0 and 1, while 1403 (42.3%) had CHA2DS2-VASc > = 2. Patient characteristics were significantly different between the two cohorts, including age, sex, BMI, paroxysmal AF, history of stroke, diabetes, and ischemic cardiomyopathy. On the contrary, procedural times and acute complications were comparable. 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% (95% CI: 62.3-69.2) in the HR score group (HR: 1.26, 95% CI: 1.08-1.47, p = 0.001). After 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). 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 considered during the clinical management after the index procedure.

Some Echocardiographic Indicators as Probable Predictors of Atrial Fibrillation Recurrence in Patients with Arterial Hypertension after Catheter Ablation

The work is devoted to the study of possible predictors of atrial fibrillation (AF) recurrence after interventional procedures.&#x0D; Purpose: to study the echocardiographic predictors of AF recurrence in patients with arterial hypertension after pulmonary veins catheter ablation.

Mitral Annular Plane Systolic Excursion (MAPSE) as a Predictor of Atrial Fibrillation Recurrence in Patients after Pulmonary Vein Isolation.

Introduction Catheter ablation (CA) with pulmonary vein isolation (PVI) has become widely used in the past years for the treatment of atrial fibrillation (AF). Mitral annular plane systolic excursion (MAPSE) is the parameter that measures left ventricular longitudinal function, and it appears to be a good early marker of LV dysfunction. It is practically independent of poor image quality. The aim of our study was to analyse the role of echocardiographic variables, especially MAPSE in predicting the outcome of CA in patients with AF. Materials and Methods We prospectively included 40 patients with paroxysmal and persistent AF that were referred for CA. All patients underwent radiofrequency CA with PVI. Standard transthoracic two-dimensional echocardiography was conducted one day after CA. Demographic data and the patients' characteristics were noted. The endpoint of our study was to estimate the AF recurrence rate diagnosed by ECG within 6 months of the follow-up period. Results 40 patients, mainly male (67.5%) with an average age of 61.43 ± 8.96 years were included in our study. The majority of patients had paroxysmal AF prior to ablation (77.5%). The AF recurrence rate was 20% after 6 months of follow-up. Lateral MAPSE in the AF-free group was greater than those who relapsed (1.57 ± 0.24 vs. 1.31 ± 0.25; p = 0.012). Patients who remained AF-free after a 6-month follow-up period had a significantly smaller left ventricular volume index (LAVI) than those who relapsed (34.29 ± 6.91 ml/m2 vs. 42.90 ± 8.43 ml/m2; p = 0.05). We found a significant reverse relationship between LAVI and MAPSE (p = 0.020). Conclusion MAPSE and LAVI present risk factors for AF recurrence, specifically reduced MAPSE and larger LAVI, are related to AF recurrence after CA. In the future, MAPSE could play a significant role when predicting the CA outcome in patients with AF.

Predictors of atrial fibrillation recurrence in patients with metabolic syndrome after pulmonary vein isolation

Aim. To determine the role of biomarkers in predicting atrial fibrillation (AF) recurrence within 12 months after radiofrequency ablation (RFA) in patients with metabolic syndrome (MS).Material and methods. The study included 245 patients with AF aged 35 to 65 years: patients without MS components (n=32), with 1-2 MS components (n=62) and patients with 3 or more MS components (n=153). All patients underwent a comprehensive clinical and anamnestic, anthropometric, laboratory and echocardiographic examinations. The prospective follow-up for 12 months included 135 patients with AF who underwent RFA.Results. It was found that the presence of 3 or more MS components increased the risk of AF recurrence by 4,1 times within 12 months after RFA (relative risk (RR) =4,1, 95% CI 2,19-7,65, p&lt;0,0001). According to binomial logistic regression, epicardial fat thickness (EFT) (OR =3,71, 95% CI 2,12-6,73, p=0,00001), the severity of left atrial fibrosis (OR =1,48, 95% CI 1,03-1,78, p=0,0006), concentrations of galectin-3 (OR =1,31, 95% CI 1,12-1,51, p=0,0001) and GDF-15 (OR =1,11, 95% CI 1,02-1,18, p=0,0002) in patients with AF and MS increase the risk of AF recurrence after RFA. For galectin-3, GDF-15, and EFT, using ROC analysis, the following threshold values were established, the excess of which had the greatest effect on the risk of AF recurrence after RFA in patients with MS: galectin-3 &gt;11,0 ng/ml (RR =3,43, 95% CI 1,79-6,58, p=0,0001), GDF-15 &gt;1380,7 pg/ml (RR =2,84, 95% CI 1,81-4,46, p&lt;0,0001) and EFT &gt;6,4 mm (RR =4,50, 95% CI 2,32-8,71, p&lt;0,0001). In patients with excess of all three biomarker thresholds, the total risk of AF recurrence in patients with MS within 12 months after RFA increases by 3,2 times (RR =3,16, 95% CI 1,97-5,11, p&lt;0,00001).Conclusion. The risk of AF recurrence within 12 months after RFA in patients with three or more MS components is higher than in patients with 1-2 MS components. An increase in the blood concentration of profibrogenic biomarkers galectin-3, GDF-15 and an increase in the thickness of epicardial adipose tissue is associated with an increased risk of AF recurrence in patients with MS, and these biomarkers are likely to play a significant role in predicting recurrent episodes of AF after RFA.

Development and Validation of a Risk Nomogram Model for Predicting Recurrence in Patients with Atrial Fibrillation After Radiofrequency Catheter Ablation.

PurposeThis study aimed to develop and validate a risk nomogram model for predicting the risk of atrial fibrillation recurrence after radiofrequency catheter ablation.Patients and MethodsA retrospective observational study was conducted using data from 485 patients with atrial fibrillation who underwent the first radiofrequency ablation in our hospital from January 2018 to June 2021. All patients were randomized into training cohort (70%; n=340) and validation cohort (30%; n=145). Univariate and multivariate logistic regression analyses were used to identify independent risk factors. The predictive nomogram model was established by using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy by concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively.ResultsThe nomogram was established by four variables including left atrial diameter (OR 1.057, 95% CI 1.010–1.107, P=0.018), left ventricular ejection fraction (OR 0.943, 95% CI 0.905–0.982, P=0.005), type of atrial fibrillation (OR 2.164, 95% CI: 1.262–3.714), and systemic inflammation score (OR 1.905, 95% CI 1.408–2.577). The C-statistic of the nomogram was 0.741 (95% CI: 0.689–0.794) in the training cohort and 0.750 (95% CI: 0.670–0.831) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. Decision curve analysis and clinical impact curves indicated the clinical utility of the predictive nomogram.ConclusionThe nomogram model has good discrimination and accuracy, which can screen high-risk groups intuitively and individually, and has a certain predictive value for atrial fibrillation recurrence in patients after radiofrequency ablation.

Continuous Positive Airway Pressure Treatment Decreases the Risk of Atrial Fibrillation Recurrence in Patients with Obstructive Sleep Apnea after Radiofrequency Ablation.

This study aimed to determine the effect of continuous positive airway pressure (CPAP) therapy on patients with atrial fibrillation (AF) and obstructive sleep apnea (OSA) after radiofrequency ablation (RFCA).OSA predicts recurrence of AF in patients with AF and OSA after RFCA. However, the effect of CPAP therapy on recurrence of AF in these patients after RFCA is poorly known.All 122 patients who underwent RFCA from 2017 to 2020 were diagnosed OSA by polysomnography. A total of 62 patients were treated by CPAP, while the remaining 60 were not treated by CPAP. The recurrence of atrial tachyarrhythmia and use of antiarrhythmic drugs were compared between the two groups during a follow-up of 12 months. The outcome of these patients with OSA was compared to a group of 60 AF patients undergoing RFCA without OSA.Patients undergoing CPAP therapy had a higher AF-free survival rate compared to non-CPAP-treated patients (70.3% versus 31.5%; P = 0.02). LAD was associated with the risk of AF recurrence in patients with OSA (HR per mm increase: 1.0; 95% CI: 1.06-1.21; P = 0.01). The CPAP nonusers had more than two-fold increased risk of AF recurrence following pulmonary vein isolation (HR: 2.37; 95% CI: 1.21-4.96; P = 0.02).CPAP treatment highly increased arrhythmia-free survival in AF patients accompanied by OSA after RFCA and reduced recurrence of AF in these patients.

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.

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.

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.

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.