Incidence Of Atrial Fibrillation Recurrence Research Articles

The impact of peri-procedural imaging on safety and efficacy of atrial fibrillation ablation: insights from the Israeli AF Catheter Ablation Registry (ICAR).

Pulmonary vein isolation (PVI) is the most effective therapy to achieve rhythm control in atrial fibrillation (AF). Peri-procedural imaging is used in many but not all centers. However, the impact of imaging on safety and efficacy of PVI is not clear. The Israeli Catheter Ablation Registry (ICAR) is a great opportunity to explore this issue in real-world practice. To describe the real-world utilization of peri-procedural imaging technologies in a large cohort of patients undergoing ablation for AF. A prospective-multicenter cohort of AF patients who underwent PVI during the years 2019-2021. Peri-procedural imaging (CT, ICE, TEE) was utilized based on the center and operator discretion. The study endpoints were peri-procedural complications and AF recurrence at 12months follow-up among patients with and without peri-procedural imaging. Between January 2019 and December 2021, a total of 921 patients underwent PVI. Peri-procedural imaging (at least 1 modality of CT, TEE, and or ICE) was utilized in 753 (81.8%) and no imaging among 168 (18.2%) patients. Cryoablation was the dominant energy used for PVI in both groups (92.3% of the non-imaging group, and 95.3% among imaging group), while RF was used in the rest of the patients. Fluoroscopy time was not different between the 2 groups; however, procedure duration was longer among the imaging group (90min) compared to the non-imaging group (74.5min, p = 0.006). By 12months, the incidence of AF recurrence and repeated ablation were not different between the groups. Complications and re-hospitalization for cardiocerebrovascular reasons were not different among the 2 groups. Cox regression model demonstrated no association between preprocedural imaging and the risk of AF recurrence after ablation. This real-world multicenter prospective registry study demonstrated that the rate of complications and the rate of recurrence of AF during 1year follow-up were not different among patients who had PVI either with or without peri-procedural imaging.

Comparison of anterior mitral line and mitral isthmus line for ablation of mitral annular flutter.

Mitral annular flutter (MAF) is the most common left atrial macro-reentrant arrhythmia following catheter ablation of atrial fibrillation (AF). The best ablation approach for this arrhythmia remains unclear. This single-center, retrospective study sought to compare the acute and long-term outcomes of patients with MAF treated with an anterior mitral line (AML) versus a mitral isthmus line (MIL). Acute ablation success, complication rates, and long-term arrhythmia recurrence were compared between the two groups. Between 2015 and 2021, a total of 81 patients underwent ablation of MAF (58 with an AML and 23 with a MIL). Acute procedural success defined as bidirectional block was achieved in 88% of the AML and 91% of the MIL patients respectively (p = 1.0). One year freedom from atrial arrhythmias was 49.5% versus 77.5% and at 4 years was 24% versus 59.6% for AML versus MIL, respectively (hazard ratio [HR]: 0.38, confidence interval [CI]: 0.17-0.82, p = .009). Fewer patients in the MIL group had recurrent atrial flutter when compared to the AML group (HR: 0.32, CI: 0.12-0.83, p = .009). The incidence of recurrent AF, on the other side, was not different between both groups (21.7% vs. 18.9%; p = .76). There were no serious adverse events in either group. In this retrospective study of patients with MAF, a MIL compared to AML was associated with a long-term reduction in recurrent atrial arrhythmias driven by a reduction in macroreentrant atrial flutters.

A multicenter evaluation of repeat ablation for atrial fibrillation in patients with isolated pulmonary veins: a Netherlands Heart Registration study

Abstract Background Of the 25-50% atrial fibrillation (AF) ablation patients who undergo repeat ablation, approximately 15-30% have all pulmonary veins (PVs) isolated at the repeat procedure. Currently, there is limited evidence and a lack of consensus on the appropriate treatment strategy for patients with isolated PVs. Purpose Our aim was to characterize and compare the effectiveness of repeat AF ablation strategies to reduce AF recurrences in patients with isolated PVs using a real-world multicenter registry. Methods All AF patients referred for repeat AF ablation with all PVs isolated at 8 hospitals in the Netherlands were included (Netherlands Heart Registration; 2016-2019). Medical record reviews were conducted for all patients referred for repeat AF ablation to determine study eligibility, the presence of PV reconnection, ablation strategy used, and the outcome of AF recurrence. Patients referred for repeat AF ablation, with PVI only conducted during previous ablations, and all PVs isolated were eligible. Effectiveness of repeat AF ablation strategies were assessed with multivariable Cox models comparing individual ablation strategies, number of ablation strategies performed, and presence of persistent AF. Results Of 2,311 repeat AF ablations performed, 274 (11.9%) were eligible and had all PVs isolated (Figure 1). Patients with isolated PVs were a median age of 66 (IQR 58-70) years, 44.2% were women, 45.6% had persistent or long-standing persistent AF, and the median CHA2DS2-Vasc score was 2 (IQR 1-3). Ablation was not performed in 33 (12.0%) patients with isolated PVs (Figure 2a). A single ablation strategy was performed most often (41.2%; Figure 2a). Posterior box ablation was the most frequent (58.4%) ablation strategy performed, followed by antralization of the PVs (26.3%). Over a median follow-up of 2.0 (1.0-3.3) years, 147 (59.8%) patients with isolated PVs had an AF recurrence >3 months after repeat ablation and 30 (12.7%) patients had another repeat AF ablation within 1 year of repeat procedure. After multivariable adjustment, no difference in AF recurrences was detected between ablation strategies [p>0.05 for all; Figure 2b]. Further, there was no difference detected in AF recurrences for the number of ablation strategies performed (Figure 2c), the individual ablation strategy conducted, and persistent AF (p>0.05 for all). Among patients with isolated PVs, patients with larger left atrial size had a higher risk of AF recurrences [adjusted HR 1.03 (95% CI 1.01-1.05)]. Conclusion Among the 2,311 repeat AF ablations performed, 11.9% had all PVs isolated. Despite multiple ablation strategies performed for isolated PVs, 59.8% of patients had an AF recurrence over follow-up and no difference in the incidence of AF recurrences was detected between repeat ablation strategies. Further evidence is warranted to determine an effective treatment strategy to reduce AF recurrences in AF patients with isolated PVs.

Lower Recurrence Rates of Atrial Fibrillation and MACE Events After Early Compared to Late Ablation: A Danish Nationwide Register Study.

Guidelines recommend prioritizing treatment with antiarrhythmic drugs before referral of patients with atrial fibrillation to ablation, delaying a potential subsequent ablation. However, delaying ablation may affect ablation outcomes. We sought to investigate the impact of duration from diagnosis to ablation on the risk of atrial fibrillation recurrence and adverse events. Using Danish nationwide registries, all patients with first-time ablation for atrial fibrillation were identified and included from 2010 to 2018. Patients were divided into 4 groups by diagnosis-to-ablation time: <1.0 year (early ablation), 1.0 to 1.9 years, 2.0 to 2.9 years, and >2.9 years (late ablation). The primary end point was atrial fibrillation recurrence after the 90-day blanking period, defined by admission for atrial fibrillation, cardioversions, use of antiarrhythmic drugs, or repeat atrial fibrillation ablations. The secondary end point was a composite end point of heart failure, ischemic stroke, or death, and each event individually. The study cohort consisted of 7705 patients. The 5-year cumulative incidence of atrial fibrillation recurrence in the 4 groups was 42.9%, 54.8%, 55.9%, and 58.4%, respectively. Hazard ratios were 1.20 (95% CI, 1.07-1.35), 1.29 (95% CI, 1.13-1.47), and 1.40 (95% CI, 1.28-1.53), respectively, with the early ablation group as reference. The hazard ratio for the combined secondary end point was 1.22 (95% CI, 1.04-1.44) in the late ablation group compared with the early ablation group. In patients undergoing ablation for atrial fibrillation, early ablation was associated with a significantly lower risk of atrial fibrillation recurrence. Furthermore, the associated risk of heart failure, ischemic stroke, or death was significantly lower in early-compared with late-ablation patients.

Unveiling the Role of Endothelial Dysfunction: A Possible Key to Enhancing Catheter Ablation Success in Atrial Fibrillation.

Atrial fibrillation, a prevalent type of arrhythmia, is increasingly contributing to the economic burden on healthcare systems. The development of innovative treatments, notably catheter ablation, has demonstrated both impressive and promising outcomes. However, these treatments have not yet fully replaced pharmaceutical approaches, primarily due to the relatively high incidence of atrial fibrillation recurrence post-procedure. Recent insights into endothelial dysfunction have shed light on its role in both the onset and progression of atrial fibrillation. This emerging understanding suggests that endothelial function might significantly influence the effectiveness of catheter ablation. Consequently, a deeper exploration into endothelial dynamics could potentially elevate the status of catheter ablation, positioning it as a primary treatment option for atrial fibrillation.

One-year outcomes of anterior–posterior vs. anterior-lateral method of cardioversion for atrial fibrillation: a tertiary center experience

This retrospective cohort study aimed to compare the one-year outcomes of anterior–posterior (AP) and anterior—lateral (AL) methods of cardioversion for atrial fibrillation (AF). A total of 2168 patients were included, with 1125 patients in the AP cardioversion group (Group 1) and 1043 patients in the AL cardioversion group (Group 2). Baseline characteristics, primary and secondary outcomes, safety outcomes, and logistic regression predictors of sinus rhythm were analyzed. The results showed comparable rates of maintaining sinus rhythm at the one-year follow-up between the two groups (65.8% in Group 1 vs. 65.7% in Group 2, p = 0.042). There were no significant differences in the incidence of AF recurrence or safety outcomes between the groups. Logistic regression analysis identified the duration of AF and the presence of coronary artery disease as significant predictors of sinus rhythm maintenance. Additionally, the use of the AL method was associated with a higher likelihood of AF recurrence compared to the AP method (p = 0.043). These findings suggest that both the AP and AL methods of cardioversion are effective in achieving and maintaining sinus rhythm in AF patients. The duration of AF and the presence of coronary artery disease should be considered when selecting the cardioversion approach. These results contribute to the understanding of optimal treatment strategies for AF and support personalized management decisions based on individual patient characteristics.

Ablation Versus Antiarrhythmic Drugs as First-Line Therapy for Treatment-Naive Atrial Fibrillation: A Systematic Review and Meta-Analysis

Evidence on the relative safety and efficacy of atrial fibrillation catheter ablation and antiarrhythmic drugs (AADs) as the first-line therapy for patients with treatment-naive atrial fibrillation (AF) remains disputed. Digital databases were queried to identify relevant randomized controlled trials. The incidence of recurrent AF, major adverse cardiovascular events, and its components (all-cause death, nonfatal stroke, and bleeding) were compared using the DerSimonian and Laird method under the random-effects model to calculate pooled unadjusted risk ratio (RR) with 95% confidence intervals (CIs). A total of 6 randomized controlled trials consisting of 1,120 patients (574 ablation and 549 AADs) were included in the final analysis. Over a median follow-up of 1year, the risk of any AF recurrence (RR 0.54, 95% CI 0.39 to 0.75) was significantly lower in patients receiving ablation than in patients receiving AADs. However, there was similar risk of major adverse cardiovascular events (RR 2.65, 95% CI 0.61 to 11.46), trial-defined composite end point of adverse events (RR 0.71, 95% CI 0.28 to 1.80), stroke (RR 2.42, 95% CI 0.22 to 26.51), all-cause mortality (RR 1.98, 95% CI 0.28 to 13.90), and procedure/medication failure (RR 2.65, 95% CI 0.61 to 11.46) with both therapies. In conclusion, in patients presenting with treatment-naive AF, ablation as a first-line therapy lowers the risk of AF recurrence with no associated increase in major adverse events, stroke, and mortality compared with AADs.

Association between the systemic immune-inflammation index and outcomes among atrial fibrillation patients with diabetes undergoing radiofrequency catheter ablation.

To investigate the relationship between the incidence of atrial fibrillation (AF) recurrence and the levels of the systemic immune-inflammatory index (SII, platelet × neutrophil/lymphocyte ratio) in patients with AFand diabetes mellitus (DM) undergoing after radiofrequency catheter ablation (RFCA). Preoperative SII levels were determined in AF patients with DM undergoing RFCA. Restricted cubic splines were used to determine the correlation between SII and the risk of AF recurrence. Multivariate-adjusted logistic regression models were constructed to determine the relationship between SII levels and AF recurrence. The predictive value of the clinical model and combined with the SII index was estimated by the area under the receiver-operating characteristic curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). A total of 204 patients with AF and DM who underwent RFCA in our hospital were included. Seventy-seven patients had AF recurred during a mean follow-up of 20 months. Restricted cubic spline analysis showed that when SII ≥ 444.77 × 109 /L, there was a positive correlation with the incidence of AF recurrence. In addition, adding the SII to the predictive model for AF recurrence after RFCA in patients with DM and AF could contribute to an increase in C-statistics (0.798 vs. 0.749, p = .034). After SII was incorporated into the clinical model, the comprehensive discrimination and net reclassification tended to improve (IDI and NRI > 0, p < .05). SII was independently and positively associated with recurrence after the first catheter ablation in patients with DMand AF.

Subclinical postoperative atrial fibrillation: a randomized trial.

Postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, requiring interventions and prolonging hospital stay. POAF is associated with increased mortality and a higher rate of systemic thrombo-embolism. The rates of recurrent AF, optimal follow-up and management remain unclear. We aimed to evaluate the incidence of recurrent atrial fibrillation (AF) events, during long term follow-up in patients with POAF following cardiac surgery. Patients with POAF and a CHA2DS2-VASc score of ≥2 were randomized in a 2:1 ratio to either implantation of a loop recorder (ILR) or ECG monitoring using periodic Holters. Participants were followed prospectively for 2 years. The primary end point was the occurrence of AF longer than 5 min. The final cohort comprised of 22 patients, of whom 14 received an ILR. Over a median follow up of 25.7 (IQR of 24.7-44.4) months, 8 patients developed AF, representing a cumulative annualized risk of AF recurrence of 35.7%. There was no difference between ILR (6 participants, 40%) and ECG/Holter (2 participants, 25% p = 0.917). All 8 patients with AF recurrence were treated with oral anticoagulation. There were no cases of mortality, stroke or major bleeding. Two patients underwent ILR explantation due to pain at the implantation site. The rate of recurrent AF in patients with POAF after cardiac surgery and a CHA2DS2-VASc score of ≥2 is approximately 1 in 3 when followed systematically. Further research is need to assess the role of ILRs in this population.

The long-term outcomes of surgical ablation for atrial fibrillation during redo left-sided valvular surgery.

This study evaluated the outcome of surgical ablation (SA) for atrial fibrillation (AF) concomitant with redo left-sided valvular surgery. The study enrolled 224 AF patients (paroxysmal: 13 patients, persistent: 76 patients, long-standing persistent AF: 135 patients) undergoing redo open heart surgery for left-sided valve disease. The early results and long-term clinical outcomes were compared between those who underwent concomitant SA for AF (SA group) and did not (NSA group). Propensity score adjusted Cox regression analysis of overall survival and competing risk analysis of the other clinical outcomes were performed. Seventy-three patients were classified as the SA group and 151 as the NSA group. The median follow-up duration was 124 (1.0-249.5) months. The median ages of the patients in the SA and NSA groups were 54.1±11.3 and 58.4±11.1 years, respectively. There were no significant differences between the groups in the early in-hospital mortality rate (5.5% vs. 9.3%, P=0.474) or postoperative complications, except for low cardiac output syndrome (11.0% vs. 23.8%, P=0.036). Overall survival was better in the SA group [hazard ratio, 0.452; 95% confidence interval (CI): 0.218-0.936, P=0.032]. The incidence of recurrent AF was significantly higher in the SA group on multivariate analysis [hazard ratio, 3.440; 95% CI: 1.987-5.950, P<0.001]. The cumulative incidence of the composite of thromboembolism and bleeding was lower in the SA than NSA group [hazard ratio, 0.338; 95% CI: 0.127-0.897, P=0.029]. The concomitant surgical arrhythmia ablation with redo cardiac surgery for left-sided heart disease resulted in a better overall survival, higher incidence of sinus conversion, and lower incidence of a composite of thromboembolism and major bleeding. Concomitant SA procedure should be considered in patients undergoing redo cardiac surgery.

Influence of the levels of thyroid hormones on the result of radiofrequency ablation for atrial fibrillation: literature review

Introduction. Atrial fibrillation is one of the most common, clinically significant cardiac arrhythmias and is associated with an increased risk of mortality, hospitalization, and deterioration in the quality of life. The prevalence of atrial fibrillation averages 1% and tends to increase with age. It is well known that aberrations of thyroid hormones have a proarrhythmogenic effect and increase the risk of cardiovascular disease. Currently, radiofrequency ablation is actively used to treat atrial fibrillation, which in most cases has high efficiency and lasting effect. However, recurrence of atrial fibrillation may occur in some patients even after radiofrequency ablation. It is known that thyroid function is closely related to the success of radiofrequency ablation and risk of relapse of atrial fibrillation after the procedure. The aim of this literature review is to determine what is already known about the effect of thyroid and thyroid-stimulating hormones levels on the outcome of radiofrequency ablation of atrial fibrillation and to analyze previous studies. Materials and methods. A complete review of the literature on atrial fibrillation and the relationship between thyroid and thyroid hormones and recurrence of atrial fibrillation after radiofrequency ablation was conducted to examine the effect of hormone levels on the success of radiofrequency ablation and recurrence of atrial fibrillation after the procedure. Results. Data from a significant number of studies suggest that the incidence of atrial fibrillation recurrence remains high after radiofrequency ablation and that thyroid hormones affect the success of radiofrequency ablation even within normal ranges. Evidence may also suggest that patients with thyroid dysfunction, even in the presence of subclinical forms, may require better monitoring of thyroid function prior to the procedure, which may reduce the incidence of atrial fibrillation recurrence. Conclusions. It should be noted that the assessment and correction of all modifying risk factors before radiofrequency ablation can prevent recurrence of supraventricular paroxysmal arrhythmias, improve the prognosis and overall quality of life in patients in this group.

Blunted atrial reverse remodeling a year after catheter ablation for atrial fibrillation and their long-term rhythm outcome

Abstract Background Although active rhythm control by atrial fibrillation (AF) catheter ablation (AFCA) reduces left atrial (LA) dimension, blunted atrial reverse remodeling can be observed in patients with significant atrial myopathy. We explored the characteristics and long-term outcomes of AF patients who showed blunted atrial reverse remodeling despite no AF recurrence within a year after AFCA. Methods Among a total of 2,756 patients with AFCA, we included 1,685 patients (74.8% male, 60.2±10.1 years old, 54.5% paroxysmal AF) who underwent both baseline and 1-year follow-up echocardiogram, baseline LA&amp;gt;40mm, and did not recur within a year. We divided them into tertile groups (T1–T3) based on one-year percent change of LA dimension after propensity matching for age, sex, AF type, and baseline LA dimension. We also investigated the patients' genetic characteristics with blunted LA reverse remodeling (T1) using a genome-wide association study (GWAS). Results Patients with blunted LA reverse remodeling (T1, n=424) were independently associated with body mass index (OR 1.082 [1.010–1.160], p=0.025), LA peak pressure (OR 1.010 [1.002–1.019], p=0.019), LA wall thickness (OR 0.448 [0.252–0.789], p=0.006), LA voltage (OR 0.651 [0.463–0.907], p=0.012), and pericardial fat volume (OR 1.004 [1.001–1.008], p=0.014). Throughout 65.9±37.4 months of follow-up, the incidence of AF recurrence a year after the procedure was significantly higher in the T1 group than in T2 or T3 groups (Log-rank p&amp;lt;0.001). Among 894 patients with GWAS, ATXN1, XPO7, KRR1_PHLDA1, ZFHX3, and their polygenic risk score were associated with blunted LA reverse remodeling. Conclusions Patients with blunted LA reverse remodeling after AFCA were independently associated with low LA voltage, thin wall thickness, high LA pressure, and fat volume, and have a genetic background. Long-term clinical recurrence a year after AFCA was higher in this patient group with suspicious atrial myopathy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health and WelfareNational Research Foundation of Korea

Comparison of traditional radiofrequency ablation and high-power short-duration ablation in the treatment of atrial tachyarrhythmias

Atrial tachyarrhythmias are becoming more common in the population. The prevalence increases with age. Often, these arrhythmias lead to disability and reduced life expectancy (indirectly through strokes). Drug therapy of atrial tachyarrhythmias reduces symptoms but does not completely resolve issue of treatment. In this regard, surgical treatment (catheter ablation) is preferable. One of the methods of catheter ablation is ablation using radio frequency energy. The key parameters of radiofrequency catheter ablation are the energy delivered to the endocardium and the time of this energy delivery. According to the traditional method, it is customary to use energy of 30 Watts for 30 s at one point. This technique has a disadvantage – in 30 s the electrode can be displaced, and the application of energy has to be repeated. A new strategy was proposed – reducing the application time by increasing the energy to respond to the challenge of high probability of electrode displacement. The aim of this work was to determine the effectiveness of the рhigh-power short-duration protocol. Materials and methods. To carry out this work, we analyzed the surgical treatment of atrial fibrillation with the help of radiofrequency catheter ablation – isolation of the pulmonary veins. In patient group 1, ablation was performed using an irrigated ablation electrode with an energy of 30 Watts and an application time of 30 s, in group 2 – using the irrigated electrode with the energy of 70 Watts and the application time of 5 s. Ablations were performed under the control of radiography and electroanatomical mapping system. Full electrical isolation of the four pulmonary veins with confirmation of the entrance and exit block were considered as the criteria of efficiency. Results. When comparing the groups by the number of required application cycles during the procedure needed to achieve the clinical effect and time to the first recurrence in all positions of the electrode, group 2 showed a lower number of applications and shorter time to the first recurrence. Reducing the time to pulmonary vein isolation, the number of relapses and restarting the control time, as well as shortening the time spent on the need to rebuild the electroanatomical map have resulted in a significant decrease in the duration of the radiofrequency ablation procedure. Conclusions. The work has shown that the use of the new protocol is more effective and allows to achieve the criteria of success faster than the traditional technique; the number of the procedure complications was not higher compared to traditional methods. When using the ablation protocol with higher energy, a lower incidence of atrial fibrillation recurrence was recorded.

Plasma carbohydrate antigen-125 for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation

BackgroundElevated plasma carbohydrate antigen-125 (CA-125) levels are strongly associated with new-onset atrial fibrillation (AF) and heart failure, but the relationship between plasma CA-125 level and AF recurrence following radiofrequency catheter ablation (RFCA) remains poorly investigated. We aimed to assess whether elevated CA-125 levels are related to long-term AF recurrence following RFCA.MethodsPreoperative CA-125 levels were determined in AF patients undergoing initial RFCA. Multivariate-adjusted Cox models were constructed to determine the relationship between CA-125 levels and AF recurrence. Multivariate logistic regression analyses were performed to determine predictors of AF recurrence.ResultsOf the 353 enrolled patients, 85 patients (24.1%) had AF recurrence at the 12-month follow-up. These patients had significantly higher baseline CA-125 levels than those without AF recurrence [(18.71 ± 12.63) vs. (11.27 ± 5.40) U/mL, P < 0.001]. The incidence of AF recurrence across quartiles 1–4 of CA-125 was 11.5%, 13.3%, 21.6% and 50.0%, respectively (P-trend < 0.001). The adjusted hazard ratios (aHRs) for AF recurrence across quartiles 1–4 of CA-125 were 1.00 (reference), 1.085 (95% CI, 0.468–2.520), 1.866 (95% CI, 0.867–4.019), and 4.246 (95% CI, 2.113–8.533), respectively (P-trend < 0.001). A similar effect was obtained when CA-125 was studied as continuous data (aHR per unit increase in LnCA-125, 3.225, 95% CI, 2.258–4.606; P < 0.001). When a predefined CA-125 cut-off of 13.75 U/mL was established, patients with CA-125 ≥ 13.75 U/mL had a higher risk of recurrent AF than those with CA-125 < 13.75 U/mL (aHR, 3.540, 95% CI, 2.268–5.525, P < 0.001). Multivariate analysis revealed CA-125, high-sensitivity C-reactive protein, and left atrium anteroposterior diameter as independent risk factors for AF recurrence.ConclusionsElevated preoperative CA-125 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following RFCA.

Impact of chronic kidney disease on atrial fibrillation recurrence following radiofrequency and cryoballoon ablation: A meta‐analysis

In observational studies, patients with chronic kidney disease (CKD) exhibited a controversial risk of atrial fibrillation (AF) recurrence following radiofrequency (RF) or cryoballoon ablation compared with non-CKD patients. This meta-analysis analysed the impact of CKD on AF recurrence following ablation. We searched the PubMed, Embase, ProQuest, ScienceDirect, Cochrane Library, ClinicalKey, Web of Science, and ClinicalTrials.gov databases for articles published between January 1, 2010, and May 31, 2020. In total, seven observational studies with 23468 patients were analysed. Data included demographics, AF classification, left atrial size, incidence of AF recurrence, and ablation method. The prevalence of CKD was 8.0% (7.6%-24.4%) in the AF ablation population. The CKD population was older and had a higher prevalence of diabetes mellitus, hypertension, and heart failure, a higher CHA2DS2-VASc score, larger left atrial dimension, and lower left ventricular ejection fraction compared with the non-CKD population. The CKD patients had a higher AF recurrence rate following ablation than non-CKD patients (odds ratio [OR], 3.71; 95% confidence interval (CI), 1.35-10.19). CKD was associated with higher AF recurrent risk after ablation in patients with only paroxysmal AF (OR=4.81, 95% CI 2.48-9.35). CKD was associated with higher AF recurrent risk in patients receiving radiofrequency ablation (OR=3.28, 95% CI 2.17-4.94) or cryoballoon ablation (OR=6.50, 95% CI 2.24-18.89) and in Asian region (OR=4.86, 95% CI, 2.69-8.78). CKD population had worse outcomes in terms of AF recurrence following RF or cryoballoon ablation.

Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p&lt;0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p&lt;0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p&lt;0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation.

The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation(PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF). Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation. The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n=55) versus PVI+PWI (n=55) using the cryoballoon were prospectively examined. Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11min). PWI was attained using 23 ± 8min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6min). Although left atrial dwell time (113 ± 31min vs. 75 ± 32min; p<0.001) and total procedure time (168 ± 34min vs. 127 ± 40min; p<0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p=0.04). Adverse events occurred in 5.5% in each group (p=1.00). However, the incidence of recurrent atrial fibrillation at 12months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p=0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p=0.006). In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.

Cardiac magnetic resonance imaging with contrast enhancement in treatment of atrial fibrillation

Catheter ablation is presently the main method for interventional treatment of atrial fibrillation (AF). Despite improvements of the method and accumulation of personnel's experience, incidence of recurrent AF following catheter interventions remains high. This review addresses a possibility of using contrast-enhanced cardiac magnetic resonance imaging to increase the effectiveness of interventional treatment of arrhythmia.

Impact of Preprocedural Serum Eicosapentaenoic Acid to Arachidonic Acid Ratio on Post-Ablation Recurrence of Atrial Fibrillation.

The aim of this study was to examine the impact of the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio on recurrence after catheter ablation (CA) for atrial fibrillation (AF).A total of 192 patients who underwent first-time radiofrequency CA for AF were enrolled in this study. They were divided into two groups based on the median serum EPA/AA ratio before CA: a LOW group (< 0.30; n = 96) and a HIGH group (≥ 0.30; n = 96). Patients in the LOW group were younger and had smaller left atrial diameter (LAD) than those in the HIGH group. Although pulmonary vein triggers initiating AF were more frequently observed in the LOW group than the HIGH group (63% versus 46%, respectively; P = 0.021), no significant between-group difference was observed regarding the incidence of AF recurrence since the last procedure (17% versus 17%, P = 0.78; median follow-up, 37 months). Multivariate Cox regression analysis after adjustment for age and LAD revealed that EPA/AA of < 0.30 was not a significant predictor of AF recurrence (hazard ratio, 1.12; 95% confidence interval 0.53-2.37; P = 0.76). However, in the non-paroxysmal AF subgroup (n = 65), the incidence of AF recurrence was significantly higher in the LOW group than in the HIGH group (25.7% versus 6.7%, respectively; P = 0.031).In conclusion, a lower preprocedural EPA/AA ratio, which was associated with younger age and small left atrium, was not a predictor for the risk of AF recurrence after CA for AF. The potential impact of the ratio on recurrence in non-paroxysmal AF subgroups should be examined with larger samples.

P980Post-procedural plasma brain natriuretic peptide level early after catheter ablation predicts the future clinical outcome in patients with persistent atrial fibrillation and reduced ejection fraction

Abstract Background Successful restoration of sinus rhythm (SR) by catheter ablation (CA) for persistent atrial fibrillation (AF) improves cardiac function, resulting in decrease of plasma brain natriuretic peptide (BNP) level. The exact significance and prognostic implications of this change have yet to be determined. Purpose To examine the impact of pre- and post-procedural BNP level on the clinical outcome after CA in patients with persistent AF and reduced left ventricular ejection fraction (LVEF). Methods Out of 242 patients with LVEF &lt;50% who underwent first-time CA for persistent AF between March 2012 and September 2018 at our institute, we enrolled 137 patients (61±10 years, 83% male) whose plasma BNP level was available both at baseline and early after CA (during 1–3 month). We evaluated the impact of the BNP levels on future AF recurrence 3 months after CA as the primary endpoint. Additional secondary endpoints included heart failure (HF) hospitalization and cardiovascular death. Results All patients successfully restored SR at the end of CA. Within 3 months of a blanking period (BP), improvement of LVEF (from 39±10% to 65±12%, p&lt;0.001) and reduction of BNP levels (from 178 [107–332] pg/ml to 42.3 [21.1–78.6] pg/ml, p&lt;0.001) were observed. During the median follow-up of 21 months after BP, the incidence of AF recurrence, HF hospitalization, and cardiovascular death was 37% (n=50), 3% (n=4), and 1% (n=1), respectively. Cox proportional hazard regression analysis after adjustment for age and gender revealed that post-procedural BNP level was a significant predictor of the AF recurrence (hazard ratio [HR] per 100-pg/ml increase, 1.13; 95% confidence interval [CI], 1.02–1.25; p=0.023), but pre-procedural BNP level was not (1.02; 0.95–1.09; p=0.56). Receiver operating curve analysis determined the post-procedural BNP level of 55.5 pg/ml as the best cut-off value for predicting the AF recurrence, with area under the curve of 0.620 (95% CI, 0.534–0.702; p=0.018). The incidence of AF recurrence was significantly higher in patients with post-procedural BNP level &gt;55.5 pg/ml (n=50) than the others (50% vs. 29%; HR, 3.99; 95% CI, 2.07–7.68; p&lt;0.001). No patients with post-procedural BNP level ≤55.5 pg/ml experienced HF hospitalization and cardiovascular death (8% vs. 0% and 2% vs. 0%, p=0.006 and p=0.17, respectively) Conclusions Not pre-procedural but post-procedural BNP level early after CA predicted the future clinical outcome in patients with persistent AF and reduced LVEF. Decreased but still elevated BNP level after restoration of SR would identify the residual risk for developing unfavorable outcome.