Independent Predictor Of Atrial Fibrillation Recurrence Research Articles

El tejido adiposo epicárdico no es un predictor independiente de recurrencia de fibrilación auricular tras ablación con catéter

Introduction and objectivesPrevious studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. MethodsA total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. ResultsAfter a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). ConclusionsEAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation.

Genetic Polymorphism on Chromosome 4q25 (rs17570669) May Predict Recurrence After Successful Electrical Cardioversion in Patients with Persistent Atrial Fibrillation.

Direct current electrical cardioversion (DCCV) is an effective rhythm-control option for patients with atrial fibrillation (AF). Despite initial success, a high recurrence rate remains a significant challenge. There is limited data on the genetic predictors of AF recurrence following successful DCCV. In this study, we aimed to evaluate whether 11 single nucleotide polymorphisms (SNPs) previously associated with AF are also linked to recurrence after DCCV in the Turkish population. Seventy-five patients with persistent AF, who achieved stable sinus rhythm following DCCV, were included in the study. The patients were prospectively monitored for the onset of AF recurrence. Clinical characteristics and SNPs were analyzed and compared between patients who experienced recurrence and those who did not. The average age of the patients was 61.9 ± 11.5, and 33 (44%) were female. Over an average follow-up period of 17.0 (11.0-25.0) months, AF recurrence was observed in 38 patients (50.7%). A SNP in the PITX2 gene (rs17570669) (OR: 9.00, 95% Confidence Interval (CI): 1.28-63.02) and another in the ZFHX3 gene (rs2106261) (OR: 8.96, 95% CI: 1.03-77.66) were notably associated with AF recurrence in the additive model (P = 0.027 and 0.047, respectively). Multivariate Cox regression analysis revealed that the rs17570669 SNP was the sole independent predictor of AF recurrence (Hazard Ratio (HR): 3.59, 95% CI: 1.05-12.21, P = 0.040). The SNP in the paired-like homeodomain 2 (PITX2) gene (rs17570669) emerges as an independent predictor for AF recurrence after successful electrical cardioversion.

Impact of Coronary Artery Disease on The Outcomes of Catheter Ablation in Patients with Atrial Fibrillation.

The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF). Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed. A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P<0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P<0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P<0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome. CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.

Effectiveness of the systemic immune inflammation index to predict atrial fibrillation recurrence after cryoablation.

Background: We aimed to investigate the predictive role of systemic immune inflammation index(SII) on atrial fibrillation (AF) recurrence following cryoballoon-based AF ablation. Materials & methods: A total of 370 consecutive patients with symptomatic AF who underwent cryoablation were enrolled. The patients were divided into two groups according to recurrence development. Results: During the follow-up period of 25.0±6.7months, recurrence was observed in 77 patients (20.8%). Receiver operating characteristic analysis demonstrated that using a cutoff level of 532, SII had a sensitivity of 71% and specificity of 68%. In the multivariate Cox model, high SII was a significant predictor of the recurrence. Conclusion: This study showed that higher SII level is an independent predictor of AF recurrence.

Development and validation of a novel risk model for predicting atrial fibrillation recurrence risk among paroxysmal atrial fibrillation patients after the first catheter ablation.

Several models have been developed to predict the risk of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). However, these models are of poor quality from the start. We, therefore, aimed to develop and validate a predictive model for post-operative recurrence of AF. In a study including 433 patients undergoing the first circumferential pulmonary vein isolation (CPVI) procedure, independent predictors of AF recurrence were retrospectively identified. Using the Cox regression of designated variables, a risk model was developed in a random sample of 70% of the patients (development cohort) and validated in the remaining (validation cohort) 30%. The accuracy and discriminative power of the predictive models were evaluated in both cohorts. During the established 12 months follow-up, 134 patients (31%) recurred. Six variables were identified in the model including age, coronary artery disease (CAD), heart failure (HF), hypertension, transient ischemic attack (TIA) or cerebrovascular accident (CVA), and left atrial diameter (LAD). The model showed good discriminative power in the development cohort, with an AUC of 0.77 (95% confidence interval [CI], 0.69-0.86). Furthermore, the model shows good agreement between actual and predicted probabilities in the calibration curve. The above results were confirmed in the validation cohort. Meanwhile, decision curve analysis (DCA) for this model also demonstrates the advantages of clinical application. A simple risk model to predict AF recurrence after ablation was developed and validated, showing good discriminative power and calibration.

Epicardial adipose tissue volume is not an independent predictor of atrial fibrillation recurrence after catheter ablation

Introduction and objectivesPrevious studies have suggested that epicardial adipose tissue (EAT) could exert a paracrine effect in the myocardium. However, few studies have assessed its role in the risk of atrial fibrillation (AF) recurrence. This study aimed to evaluate the association between EAT volume, and its attenuation, with the risk of AF recurrence after AF ablation. MethodsA total of 350 consecutive patients who underwent AF ablation were included. The median age was 57 [IQR 48-65] years and 21% had persistent AF. Epicardial fat was quantified by multidetector computed tomography using Syngo.via Frontier-Cardiac Risk Assessment software, measuring pericardial fat volume (PATV), EAT volume, and attenuation of EAT posterior to the left atrium. AF recurrence was defined as any documented episode of AF, atrial flutter, or atrial tachycardia more than 3 months after the procedure. ResultsAfter a median follow-up of 34 [range, 12-57] months, 114 patients (33%) had AF recurrence. Univariable Cox regression showed that patients with an EAT volume ≥ 80mL had an increased risk of AF recurrence (HR, 1.65; 95%CI, 1.14-2.39; P=.007). However, after multivariable adjustment, EAT volume did not remain an independent predictor of AF recurrence (HR, 1.24; 95%CI, 0.83-1.87; P=.3). Similar results were observed with PATV. Patients with lower attenuation of EAT did not have a higher risk of AF recurrence (log-rank test, P=.75). ConclusionsEAT parameters including the evaluation of EAT volume, PATV and EAT attenuation were not independent predictors of AF recurrence after catheter ablation.

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.

Higher coronary artery calcium score is associated with increased risk of atrial fibrillation recurrence after catheter ablation

BackgroundCoronary artery calcium score (CACS) is associated with an increased risk of atrial fibrillation (AF) development, but scarce data are available regarding the impact on AF recurrence. This study aims to assess the impact of CACS on AF recurrence following catheter ablation. MethodsRetrospective study of patients with AF undergoing cardiac computed tomography (CCT) before ablation (2017–2019). Patients with coronary artery disease (CAD), significant valvular heart disease and previous catheter ablation were excluded. A cut-off of CACS ≥ 100 was used according to literature. ResultsA total of 311 patients were included (median age 57 [48, 64] years, 65% men and 21% with persistent AF). More than half of the patients had a CACS > 0 (52%) and 18% a CACS ≥ 100. Patients with CACS ≥ 100 were older (64 [59, 69] vs 55 [46, 63] years, p ​< ​0.001), had more frequently hypertension (68% vs 42%, p ​< ​0.001) and diabetes mellitus (21% vs 10%, p ​= ​0.020). During a median follow-up of 34 months (12–57 months), 98 patients (32%) had AF recurrence. CACS ≥ 100 was associated with increased risk of AF recurrence (unadjusted Cox regression: hazard ratio [HR] 2.0; 95% confidence interval [CI], 1.3–3.1, p ​= ​0.002). After covariate adjustment, CACS ≥ 100 and persistent AF remained independent predictors of AF recurrence (HR, 1.7; 95% CI, 1.0–2.8, p ​= ​0.039 and HR, 2.0; 95% CI, 1.3–3.2, p ​= ​0.004, respectively). ConclusionAn opportunistic evaluation of CACS could be an important tool to improve clinical care considering that CACS ≥ 100 was independently associated with a 69% increase in the risk of AF recurrence after first catheter ablation.

Abstract 10880: Left Atrial Epicardial Adipose Tissue Predicts Atrial Fibrillation Recurrence Following Catheter Ablation

Introduction: Atrial fibrillation (AF) recurrence following catheter ablation (CA) remains high. Epicardial adipose tissue (EAT) is increasingly recognized for its significant role in promoting AF arrhythmogenesis due to its proinflammatory properties and anatomic proximity to the myocardium. We sought to assess whether left atrial (LA) EAT volume is associated with AF recurrence following CA. Methods: EAT was assessed via cardiac MRI using a 3D Dixon sequence (Panel A) in 101 patients undergoing radiofrequency or cryoballoon CA for AF. Patients were followed for AF recurrence. Results: During an average follow-up period of 300 days, post ablation AF recurrence occurred in 31 (30.7%) patients. The median time for AF recurrence following CA was 136 days. LA EAT index was higher in those with recurrence (20.7 [16.9, 30.4] vs 13.7 [10.5, 20.1] mL/m 2 , p &lt; 0.001), and so was LA volume index (66.6 [53.8, 77.5] vs 49.9 [37.7, 62.8] mL/m 2 , p &lt; 0.001). The ROC curve for LA EAT index in the prediction of AF recurrence had an AUC of 0.77 (95% CI 0.68-0.86, p&lt;0.001) and showed an optimal cutoff value of 14.29 mL/m 2 to identify patients at risk of AF recurrence post ablation (Youden’s J statistic = 0.446). Integrating LA EAT with clinical risk factors (age, BMI, AF type and hypertension) provided a better discriminatory performance in predicting AF recurrence than clinical risk factors alone (AUC 0.79 vs 0.65, DeLong test p = 0.044) (Panel B). Cox regression analysis showed LA EAT (HR: 1.088; 95% CI: [1.047-1.13], p &lt;0.001) to be an independent predictor of post ablation AF recurrence. The Kaplan-Meier curve for recurrence free survival showed a significant difference between 2 groups of patients identified by the optimal LA EAT index cut-off of 14.29 mL/m 2 (log rank = 14.79; p &lt; 0.001) (Panel C). Conclusion: EAT quantified using cardiac MRI, a reproducible and widely accessible imaging parameter, is a strong and independent predictor of AF recurrence following CA.

Left atrial strain for predicting recurrence in patients with non-valvular atrial fibrillation after catheter ablation: a single-center two-dimensional speckle tracking retrospective study

BackgroundAlthough catheter ablation (CA) is an effective treatment for non-valvular atrial fibrillation (AF), a good many of patients still have a recurrence following post-operation. Prediction of AF recurrence by evaluating left atrial (LA) phase function with speckle tracking echocardiography (STE) may be helpful for risk stratification and clinical management for AF patients. Therefore, the current study aimed to assess the prognostic value of LA strains in non-valvular AF patients after CA.MethodsA total of 95 non-valvular AF patients (70.5% paroxysmal AF, 56.8% males, mean age 63.2 ± 9.7 years) were included in this retrospective study between October 2019 and August 2020. Transthoracic echocardiography was performed in all the subjects and STE was used to analyze the LA reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) during different phases before CA. Patients were followed up with until January 2022. The endpoint was AF recurrence.ResultsOver a median follow-up period of 26.0 months (interquartile range, 24.7–26.7 months), 26 patients experienced recurrence and 69 stayed in sinus rhythm. Compared with no-recurrence group, maximum volume of LA (LAVmax), minimum volume of LA (LAVmin) and LA volume index (LAVI) were increased in the recurrence group, while LAEF, LASr and LASct were worsened (P < 0.05). Multivariable logistic regression analysis revealed that LASct was an independent predictor of AF recurrence (odds ratio, 0.89; 95% confidence interval (CI), 0.82–0.97; P = 0.007) and receiver operating characteristic (ROC) curve analysis showed an area under the curve of LASct<8% was 0.70 (95% CI, 0.59–0.79; P = 0.0008).ConclusionsLASct was of independent predictive value of AF recurrence. LA function assessed by STE may contribute to the risk stratification for AF patients and selection of suitable patients for CA.

Radiofrequency ablation of atrial fibrillation-50 W or 90 W?

This study sought to evaluate the short and midterm efficacy and safety of the novel very high power very short duration (vHPvSD) 90 W approach compared to HPSD 50 W for atrial fibrillation(AF) ablation as well as reconnection patterns of 90 W ablations. Consecutive patients undergoing first AF ablation with vHPvSD (90 W; predefined ablation time of 3 s for posterior wall ablation and 4 s for anterior wall ablation) were compared to patients using HPSD (50 W; ablation index-guided; AI 350 for posterior wall ablation, AI 450 for anterior wall ablation) retrospectively. A total of 84 patients (67.1 ± 9.8 years; 58% male; 47% paroxysmal AF) were included (42 with 90 W, 42 with 50 W) out of a propensity score-matched cohort. 90 W ablations revealed shorter ablation times (10.5 ± 6.7 min vs. 17.4 ± 9.9 min; p = .001). No major complication occurred. 90 W ablations revealed lower first pass PVI rates (40% vs. 62%; p = .049) and higher AF recurrences during blanking period (38% vs. 12%; p = .007). After 12 months, both ablation approaches revealed comparable midterm outcomes (62% vs. 70%; log-rank p = .452). In a multivariable Cox regression model, persistent AF (hazard ratio [HR]: 1.442, 95% confidence interval [CI]: 1.035-2.010, p = .031) and increased procedural duration (HR: 1.011, 95%CI: 1.005-1.017, p = .001) were identified as independent predictors of AF recurrence during follow-up. AF ablation using 90 W vHPvSD reveals a similar safety profile compared to 50 W ablation with shorter ablation times. However, vHPvSD ablation was associated with lower rates of first-pass isolations and increased AF recurrences during the blanking period. After 12 months, 90 W revealed comparable efficacy results to 50 W ablations in a nonrandomized, propensity-matched comparison.

Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation

Abstract Background Cryoballoon ablation (CBA) has emerged a one of the safest and efficient therapeutic options for atrial fibrillation (AF) [1]. However, AF recurrence rate after CBA remains as high as 25–30%, leading to increased rates of complications and repeated procedures [2]. Left atrial (LA) structural remodeling, defined as LA dilation has been proposed as a predictor of AF recurrence after CBA [2]. However, LA mechanical dysfunction might appear even before the LA enlargement and might be a more sensitive prognostic indicator of AF recurrence [3–5]. The early recognition of LA dysfunction might play a key role in identifying patients at higher risk of AF recurrence after CBA, even in patients without a dilated LA. Purpose The purpose of this study was to evaluate the additional value of LA function, assessed using speckle tracking echocardiography to predict AF recurrence after CBA. Methods Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period. Results One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤17% had the highest incremental predictive value for AF recurrence (HR=9.45, 95% CI: 3.17–28.13, chi-square to improve 37% increase, p&amp;lt;0.001) (Figure 1). In patients with non-dilated LA (119 (69.1%) patients), AF recurrence occurred in 24 (20.2%) patients. In this category of patients, PALS ≤17% remained an independent predictor of AF recurrence (HR=5.39, 95% CI: 1.66–17.52, p=0.005). Conclusions This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non-dilated LA, PALS remained an independent predictor of AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of the AF patients before CBA. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel - Wetenschappelijk Fonds Willy Geps of the UZ Brussel

Predictors of AF recurrence in patients with paroxysmal AF undergoing catheter ablation: new predictors coming?

Abstract Introduction Recurrence of atrial fibrillation (AF) after catheter ablation (CA) is estimated to be between 20% and 45% and the prediction of recurrence AF in patients (pts) with paroxysmal AF undergoing CA remains challenging. Purpose To determine the clinical and procedural predictors of recurrence AF after CA in pts with paroxysmal AF. Methods Single-centre retrospective study that included all pts with paroxysmal AF who underwent AF CA between 2017 and 2019. Ablation procedures included radiofrequency and second-generation cryoballoon CA. All pts underwent cardiac computed tomography prior the procedure. AF recurrence was defined as any recurrence of AF, atrial flutter or atrial tachycardia &amp;gt;30 seconds (recorded in 12-lead electrocardiogram or Holter) after 90 days of CA. The independent association between clinical and procedural variables and AF recurrence was evaluated with Cox regression analysis. Results We included 351 pts, 63,5% male and with a mean age of 57,1±11,4 years. CHADSVASCscore ≥2 points were present in 43,7% of the pts, median duration of AF prior the intervention was 3 years (IQR 1–6) and most pts were treated with some antiarrhythmic drug at the time of CA (56,9%). Overall, median follow-up was 27 months (IQR 19–39). AF recurrence was present in 96 pts (27,4%), on average, 15,2±10,4 months after CA. Univariate logistic regression identified female gender, thyroid disease, left atrium (LA) enlargement (defined as LA indexed volume &amp;gt;34 mL/m2 or LA diameter &amp;gt;38mm for female or &amp;gt;40mm for male), coronary calcium score &amp;gt;100, epicardial adipose tissue volume, number of previous electric cardioversions, treatment with antiarrhythmic drugs prior CA and the extent of CA (only pulmonary vein isolation (PVI) or PVI and ablation of other lesions) as predictors of recurrence AF after CA in pts with paroxysmal AF (p&amp;lt;0,05 for all). Cox regression analysis identified female gender (OR 1,615, 95% CI 1,005–2,597; p=0,008), LA enlargement (OR 2,084, 95% CI 1,207–3,596; p=0,008) and coronary calcium score &amp;gt;100 (OR 1,958, 95% CI 1,133–3,385; p=0,016) as independent predictors of AF recurrence. Conclusions In our cohort, AF recurrence was significantly higher in pts with LA enlargement, with coronary calcium score &amp;gt;100 and female gender pts. Funding Acknowledgement Type of funding sources: None.

Atrial late potentials are associated with atrial fibrillation recurrence after catheter ablation.

Previous studies have identified noninvasive methods for predicting atrial fibrillation (AF) recurrence after catheter ablation (CA). We assessed the association between AF recurrence and atrial late potentials (ALPs), which were measured using P-wave signal-averaged electrocardiography (P-SAECG). Consecutive patients with paroxysmal AF who underwent their first CA at our institution between August 2015 and August 2019 were enrolled. P-SAECG was performed before CA. Two ALP parameters were evaluated: the root-mean-square voltage during the terminal 20 ms (RMS20) and the P-wave duration (PWD). Positive ALPs were defined as an RMS20 <2.2μV and/or a PWD >115 ms. Patients were allocated to either the recurrence or nonrecurrence group based on the presence of AF recurrence at the 1-year follow-up post-CA. Of the 190 patients (age: 65 ± 11 years, 37% women) enrolled in this study, 21 (11%) had AF recurrence. The positive ALP rate was significantly higher in the recurrence group than in the nonrecurrence group (86% vs. 64%, p=.04), despite the absence of differences in other baseline characteristics between the two groups. In the multivariate analysis, positive ALP was an independent predictor of AF recurrence (odds ratio: 3.83, 95% confidence interval: 1.05-14.1, p=.04). Positive ALP on pre-CA P-SAECG is associated with AF recurrence after CA.

Cardiac 123I-mIBG scintigraphy for prediction of catheter ablation outcome in patients with atrial fibrillation

BackgroundPrevious studies show inconsistent results on the role of innervation imaging (with 123I-mIBG) in predicting late atrial fibrillation (AF) recurrence after catheter ablation (CA). These studies included patients with paroxysmal AF and studied prognostic value of post-CA I-123-mIBG parameters. Current study investigated the ability of pre CA 123-I-mIBG imaging to predict late AF recurrence in patients with persistent AF. Methods123I-mIBG cardiac imaging was performed before CA in 82 patients with persistent AF. Patient was followed for 12 months. ResultsMultivariable analysis demonstrated that late heart-to-mediastinum ratio (H/Mlate) and washout rate (WR) were independent predictors of AF recurrence. ROC-curve analysis data showed that H/Mlate <1.6 (sensitivity 73.53%, specificity 81.3%, AUC 0.792, P < .001) and WR > 25.11 (sensitivity 70.6%, specificity 70.8.3%, AUC 0.712, P < .001) indicate high probability of AF relapses during 12 months after CA. ConclusionPre-CA parameters of global cardiac sympathetic activity estimated by 123I-mIBG scintigraphy are associated with late AF relapses in persistent AF patients with normal LVEF and absence of significant CAD.

Algorithm for determining the fibrosis stage using high-density mapping

Aims. To develop an algorithm for assessing the stage of fibrosis based on high-density endocardial mapping. To study the effect of the stage of left atrial (LA) fibrosis on the results of atrial fibrillation (AF) catheter ablation.Methods. The study included 64 patients with paroxysmal or persistent AF, who underwent high-density LA mapping and catheter ablation. After the intervention procedure, we analyzed the electroanatomical maps of the left atrium, assessed the prevalence of low-voltage areas according to the developed algorithm. Patients were divided into 4 groups depending on the prevalence of areas of low voltage based on the Utah score.Results. The follow-up period was 14.5 ± 6.7 months. AF recurrence developed in 18 (28.1%) patients after the ablation procedure. AF recurrence after ablation was more frequent in patients with a low-voltage area of more than 20% than in patients with a low-voltage left atrial area of less than 20%, 6 (15.4%) versus 12 (48%), p=0.02. A logistic regression analysis was performed to identify AF recurrence predictors in the postoperative period. As a result, only widespread areas of low-amplitude activity were an independent predictor of AF recurrence after the pulmonary veins isolation, this predictive model was significant (p=0.026). Significant statistical differences between groups I, II and III,I V are the ejection fractions and the duration of the P-wave. Patients with low-voltage regions have lower left ventricular ejection fraction (62.8±6.9% versus 58.1±5.7%, p=0.01), and longer P-wave duration (84.7±8,2 ms versus 101.5±11.0 ms, p=0.01).Conclusion. LA high-density mapping before AF ablation makes it possible to determine the prevalence of low-voltage areas. After regression analysis, it was proved that common low-voltage areas are an independent predictor of AF recurrence after pulmonary vein isolation. Patients with low-voltage areas of more than 20% of the LA surface have longer P-wave duration and lower left ventricular ejection fraction.

The Predictive Value of the Left Atrial Kinetic Energy for Atrial Fibrillation Recurrence.

Background and aimDetermining which patients will experience recurrence of atrial fibrillation (AF) is crucial for treatment modification. This study aimed to investigate the predictive value of left atrial kinetic energy (LAKE) in AF recurrence.Materials and methodsA total of 120 consecutive patients who achieved sinus rhythm (SR) with electrical direct current cardioversion and met the inclusion criteria were included in the study. Transthoracic echocardiography (TTE) and LAKE values were calculated on the first day after cardioversion. Rhythm control was performed with 12-lead electrocardiography in the first-month follow-up.ResultsWhile 81 (67.5%) patients were in SR at one month, AF recurrence was detected in 39 (32.5%) patients. In the AF group, AF duration, cardioversion energy, number of diabetic patients, left atrium (LA) diameter, LA pre-mitral A wave volume, LA minimum volume, and pulmonary artery pressure values were significantly higher than in the SR group, while mitral A wave velocity and LAKE values were significantly lower. In multivariate regression analysis, AF duration (OR: 1.54; 95% CI: 1.22 - 1.93; p < 0.001), LA diameter (OR: 1.33; 95% CI: 1.10 - 1.61; p = 0.002), and LAKE (OR: 0.96; 95% CI: 0.94 - 0.99; p = 0.007) were determined to be independent predictors of AF recurrence at one month.ConclusionsLA diameter, AF duration, and LAKE were found to be significant predictors of AF recurrence after cardioversion.

Radiomic phenotype of epicardial adipose tissue in the prognosis of atrial fibrillation recurrence after catheter ablation in patients with lone atrial fibrillation.

BackgroundEpicardial adipose tissue (EAT) has been considered as one of the probable triggers of atrial fibrillation (AF). CT‐rediomics is a perspective noninvasive method of assessment of EAT. We evaluate the radiomic phenotype of EAT in patients with lone AF in the prognosis of AF recurrence after catheter ablation.MethodsA total of 43 patients with lone AF referred for CA and 20 out‐hospital patients without arrhythmia underwent multidetector computed tomography coronary angiography. Segmentation of EAT and extraction radiomic features were performed on calcium scoring series using by 3D‐Slicer. Clinical follow‐up was performed for 12 months period after the CA.ResultsEAT in patients with lone AF had a distinct radiomic phenotype. Thus, 45 of 93 calculated radiomic features, volume and attenuation of EAT were significantly different between patients with lone AF and persons without any arrhythmia. In addition, 17 radiomic features were significantly different in subgroups with and without AF recurrence. Multivariate regression analysis demonstrated that only gray level nonuniformity normalized (GLSZM) was an independent predictor of AF recurrence (OR 1.0027, 95%CI 1.0009–1.0044, p = 0.002). ROC analysis data showed that GLSZM >1227.4 indicates high probability of AF recurrence during 12 months (sensitivity 89.4%, specificity 70.8%, AUC: 0.809; p = 0.001).ConclusionThe radiomic parameter GLSZM is associated with late AF recurrence after CA in patients with lone AF. In current study GLSZM was a stronger predictor of lone AF recurrence in multivariate analysis comparing with other established risk factors and EAT volume and attenuation.

Ability of Left Atrial Distensibility After Radiofrequency Catheter Ablation to Predict Recurrence of Atrial Fibrillation

This study sought to assess the left atrial (LA) functional recovery after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) and to evaluate the determining factor of procedural success of RFCA, using a novel preload stress echocardiography. A total of 111 patients with AF were prospectively recruited. The echocardiographic parameters were obtained during the leg-positive pressure (LPP) maneuver, both at baseline and midterm after RFCA. As an index of LA distensibility, the LA expansion index was calculated as (LAVmax - LAVmin)×100 / LAVmin. During a median follow-up period of 14.2 months, AF recurrence was observed in 23 patients (20.7%). In LA functional parameters at baseline, only the Δ LA expansion index was significantly larger in the success group (16 ± 11% vs 4 ± 9%, p <0.05). At midterm follow-up, the Δ LA expansion index significantly increased to 32 ± 19% (p <0.05), together with structural LA reverse remodeling only in the success group. Moreover, the Δ stroke volume index during the LPP stress test significantly increased only in the success group (from 2.3 ± 1.3 ml/m2 to 3.1 ± 4.8 ml/m2, p <0.05). In a multivariate analysis, left ventricular ejection fraction (hazard ratio 0.911, p <0.05) and baseline Δ LA expansion index (hazard ratio 0.827, p <0.001) were independent predictors of AF recurrence. In conclusion, the baseline Δ LA expansion index during LPP stress is a reliable marker for predicting procedural success after RFCA. Moreover, maintenance of sinus rhythm resulted in an improvement of the preload reserve after RFCA.

A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience.

Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common. We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI. A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, a mean number of 1.50 ± 0.8 PVs/patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs/patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI (70.8% vs 10%, p < 0.001). At a 2-year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF-free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085-4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279-4.618, p = 0.007) were independent predictors of AF recurrence. The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation.