Predictor Of Long-term Success Research Articles

Abstract 4136869: Time Course and Predictors of PVC Recurrence After Acutely Successful Catheter Ablation

Introduction: In prior studies, predictors of long-term success following acutely successful radiofrequency (RF) ablation have included female-sex, single-PVC morphology and EGM-QRS > 24ms. Time course and predictors of PVC recurrence following acutely successful ablation has been less well documented. Use of extended ambulatory monitoring in the immediate post-procedural period can help to identify those with early recurrence. Goals: To define time to recurrence and predictors of recurrence of PVCs after RF ablation following acutely successful ablation. Methods: Consecutive patients from January 1 st , 2016 through December 31 st , 2023 undergoing PVC ablation with available post-ablation extended ambulatory monitoring (Zio, iRhythm, San Francisco, CA) were retrospectively analyzed. Recurrence was defined as an increase in PVC burden to >5% during monitoring after acute success or failure to have sustained reduction in PVC burden of >80%. Acute success was defined as elimination of the targeted PVC after the last ablation lesion. Long-term succes was defined as absence of targeted PVC's during all follow-up visits and PVC-burden < 5% on follow-up monitoring. Results: Among 121 patients who underwent successful PVC ablation, 101 (83.4%) had long-term success and 20 (17%) had recurrence. Patients with recurrence were older (62.4 ± 12 vs 55 ± 13., p = 0.019), had a higher incidence of CAD (13 (13%) vs 9 (45%), p = 0.001) and CHF (40 (40%) vs 15 (75%), p = 0.004). At time of ablation, the recurrence group was also more likely to have >1 PVC morphology (6 (6%) vs 8 (40%), p = <0.001). Location and earliest activation time of the predominant PVC were not assocated with likelihood of recurrence. Within the recurrence group, 13 (65%) had recurrence in the immediate 2 week post-procedural period with an average time to recurrence of 3.9 days. Conclusion: Recurrence occured in slightly less than 20% of cases with a relatively high proportion of those occuring within the immediate 2 week post-procedural period during extended ambulatory monitoring. The presence of greater than 1 PVC morphology at time of ablation is a risk factor for recurrence suggesting a higher likelihood of acute suppression without durable resolution in those instances.

Predictors of long-term success after successful explantation of continuous flow left ventricular assist device support.

Predictors and evaluations of continuous flow left ventricular assist device (cf-LVAD) explantation in recovered patients remains under discussion due to lack of evidence on long-term safety and efficacy. This study summarized our experiences regarding cf-LVAD explantation in non-ischaemic dilated cardiomyopathy patients and estimated a predictor for sufficient myocardial recovery allowing LVAD explant. We retrospectively identified 135 adult patients with cf-LVAD therapy as bridge to heart transplant due to non-ischaemic dilated cardiomyopathy. Of those, 13 patients underwent device explantation (recovery group) after myocardial recovery. 12 (92%) of the explanted patients were evaluated using our weaning protocol, and underwent surgical explantation. Meanwhile, the remaining 122 continued with cf-LVAD therapy (non- recovery group). Multivariate logistic regression analysis revealed time interval between the first heart failure event and cf-LVAD implantation as an independent predictor for successful explantation. The optimal time interval cutoff value to predict cf-LVAD explantation was 7 months, with a sensitivity of 91.0% and specificity of 84.6%. Echocardiography in patients with successful cf-LVAD explantation showed significant improvement of left ventricular function and dimensions at six months postoperatively. The 13 explanted patients are currently alive at a median of 30 (IQR; 18-58) months after explantation. The survival rate free from rehospitalization due to heart failure following explantation was 100%. Left ventricular function and remodelling after explantation were also preserved. In non-ischaemic dilated cardiomyopathy patients with a short interval between the first heart failure event and cf-LVAD therapy, left ventricular myocardium may recover in an early phase after device implantation.

Endoscopic third ventriculostomy with choroid plexus cauterization: predictors of long-term success and comparison with shunt placement for primary treatment of infant hydrocephalus.

Endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) can avoid ventriculoperitoneal shunt (VPS) dependence in very young hydrocephalic children, although long-term success as a primary treatment in North America has not been previously reported. Moreover, optimal age at surgery, impact of preoperative ventriculomegaly, and relationship to prior cerebrospinal fluid (CSF) diversion remain poorly defined. The authors compared ETV/CPC and VPS placement for averting reoperation, and they evaluated preoperative predictors for reoperation and shunt placement after ETV/CPC. All patients under 12 months of age who underwent initial hydrocephalus treatment via ETV/CPC or VPS placement at Boston Children's Hospital between December 2008 and August 2021 were reviewed. Analyses included Cox regression for independent outcome predictors, and both Kaplan-Meier and log-rank rank tests for time-to-event outcomes. Cutoff values for age and preoperative frontal and occipital horn ratio (FOHR) were determined with receiver operating characteristic curve analysis and Youden's J index. In total, 348 children (150 females) were included with principal etiologies of posthemorrhagic hydrocephalus (26.7%), myelomeningocele (20.1%), and aqueduct stenosis (17.0%). Of these, 266 (76.4%) underwent ETV/CPC and 82 (23.6%) underwent VPS placement. Treatment choice largely reflected surgeon preferences before practice shifted toward endoscopy, with endoscopy not considered for > 70% of initial VPS cases. ETV/CPC patients trended toward fewer reoperations, and Kaplan-Meier analysis estimated that 59% of patients would achieve long-term shunt freedom through 11 years (median 42 months of actual follow-up). Among all patients, corrected age < 2.5 months (p < 0.001), prior temporizing CSF diversion (p = 0.003), and excess intraoperative bleeding (p < 0.001) independently predicted reoperation. Among ETV/CPC patients, corrected age < 2.5 months (p = 0.031), prior CSF diversion (p = 0.001), preoperative FOHR > 0.613 (p = 0.011), and excessive intraoperative bleeding (p = 0.001) independently predicted ultimate conversion to VPS. The actual VPS insertion rates remained low in patients who were ≥ 2.5 months old at ETV/CPC either with prior CSF diversion (2/10 [20.0%]) or without prior CSF diversion (24/123 [19.5%]); however, the actual VPS insertion rates increased in patients who were < 2.5 months old at ETV/CPC with prior CSF diversion (19/26 [73.1%]) or without prior CSF diversion (44/107 [41.1%]). ETV/CPC successfully treated hydrocephalus in most patients younger than 1 year irrespective of etiology, averting observed shunt dependence in 80% of patients ≥ 2.5 months of age regardless of prior CSF diversion and in 59% of those < 2.5 months of age without prior CSF diversion. For infants aged < 2.5 months with prior CSF diversion, particularly those with severe ventriculomegaly, ETV/CPC was unlikely to succeed unless safely delayed.

Dietary Patterns in Adolescent Obesity as Predictors of Long-Term Success Following an Intensive Inpatient Lifestyle Programme

(1) Background: Lifestyle interventions for adolescents with obesity show minor long-term effects on anthropometric parameters. The persistence of dietary changes after obesity inpatient rehabilitation has not been sufficiently investigated. (2) Objectives: To analyse dietary patterns in German adolescents with obesity as predictors of long-term success following an intensive inpatient lifestyle programme regarding food choices as well as body weight and comorbidities. (3) Methods: Food consumption data of 137 German adolescents with obesity aged 10-17 years were collected by a nutrition interview. Cluster analysis was used to group the participants according to their food consumption. Dietary patterns, changes in body weight and insulin resistance were compared over a 2-year-period. (4) Results: Three dietary patterns were identified. Big Eaters (n = 32) consume high amounts of total sugar and meat, Moderate Eaters (n = 66) have a diet comparable to the national average, and Snackers (n = 39) have a particularly high consumption of total sugar. Big Eaters and Snackers significantly reduced the consumption of total sugar. Among Moderate Eaters, no persistent changes were observed. (5) Conclusion: Weight reduction interventions can induce long-lasting changes in the diet of adolescents with obesity. Therefore, the success of a weight reduction intervention should not be determined by weight reduction only.

Comparison of outcomes with low-power long duration versus high-power short duration of ablation: the role of the acute change in sinus rhythm after the ablation as a predictor of long-term success.

Different results are described after atrial fibrillation ablation and multiple predictors of recurrence are well established. Evaluate and analyze if heart rate increase (HRI) during a first atrial fibrillation (AF) ablation with low-power long-duration (LPLD) and subsequently with high-power short-duration (HPSD) can impact. Retrospectively analyzed 340 consecutive patients (pts) undergoing first AF ablation. There were 158 pts in LPLD group: 113 (71.5%) paroxysmal AF with ablation with a power of 30/20w, on anterior and posterior left atrial (LA) wall, respectively, and contact force of 10-30g for 30s. There were 182 pts in HPSD group: 106 (58.2%) paroxysmal AF, who underwent ablation with 45/50w, contact force of 8-15g/10-20g and 35mL/min flow rate on anterior and posterior left atrial wall, respectively. Median follow-up was 32 ± 16months. Success was observed in 94 (59.5%) patients in LPLD and 152 (83.5%) in HPSD, in LPLD group we documented a median HRI of 4.3bpm (8%), compared to preablation heart rate, while a higher HRI in HPSD group of HRI 13.5bpm (27.2%) was noted. Heart rate increase was associated with a higher success rate in both ablation techniques and independently showed an important impact on the success rate after AF ablation. HPSD compared to LPLD showed a higher proportion of HRI and also demonstrated a superiority in maintaining sinus rhythm at a long-term follow-up.

Abstract 12935: Predictors of Long-term Success After Catheter Ablation of Premature Ventricular Complexes

Introduction: Some patients(pts) have late recurrence after acutely successful radiofrequency catheter ablation(RFCA) of premature ventricular complexes (PVC). Hypothesis: The aim of this study was to evaluate predictors of long term success following acutely successful PVC ablation. Methods: From 2016-19, we identified consecutive pts at our institution with frequent PVCs undergoing RFCA and reviewed procedural data and medical records. Earliest local activation on the intracardiac bipolar and unipolar electrogram was measured using digital calipers. Acute success was defined as elimination of targeted PVC for at least 30 mins after RFCA. Long term success was defined as absence of PVC on 12 lead ECG during all follow up (f/u) visits and PVC burden reduction &gt;80% or PVC burden &lt;5% on f/u monitoring at 1 year. Results: Among 241 pts, 161 (66.8%) pts had long term success with mean f/u of 17.6±5.8 months.In univariate analysis, diabetes mellitus and alcohol use were associated with PVC recurrence while age, female sex, acute success, ablation time, right ventricular PVC origin, single PVC morphology (sPVC), and earliest bipolar activation&gt;24msec pre-QRS were associated with long-term success. In multivariate analysis, female sex, sPVC and earliest activation &gt;24 msec preQRS were independent predictors of long term success at 1 year. The positive predictive value of earliest bipolar onset preQRS of PVC&gt;24msec for long term success was 0.77(P&lt;0.001). Negative predictive value of earliest onset preQRS &lt;15msec for long term success was 0.86(P=0.003), suggesting that ablation when the local bipolar electrogram preceded the QRS by &lt;15ms was unlikely to result in long term success. Conclusions: Female gender, sPVC, and earliest onset of bipolar electrogram preQRS&gt;24msec were predictors of long term success in patients with PVC undergoing RFCA. If local onset is &lt;15ms, RF ablation is not worthwhile. The reason for improved outcome in females requires further study.

Predictors of successful complex catheter ablation for persistent atrial fibrillation despite failure of targeted procedural arrhythmia termination.

Procedural atrial fibrillation (AF) termination is considered as a predictor of long-term success after catheter ablation for persistent AF (persAF). However, some patients remain free of arrhythmia recurrences despite failure to achieve AF termination. The objective of this study was to assess long-term outcome and prognostic factors in patients undergoing complex ablation without procedural AF termination. This study comprised 419 patients (63.8 ± 10.2 years, 63.4% male) undergoing complex ablation for persAF. Patients without procedural AF termination (n = 137, 64.2 ± 9.7 years, 63.5% male) were categorized into patients who remained in sinus rhythm (SR) in long-term outcome (SR-group) and patients with recurrence of AF or atrial tachycardia (AT) (AR-group). During a follow-up (FU) of 19.6 ± 14.6 months, the SR-group consisted of 65 (47.5%) and the AR-group of 69 (50.4%) patients. Three patients (2.2%) were lost to FU. Left atrial appendage (LAA) flow velocity and left atrium volume index (LAVI) could be identified as predictors for long-term success. LAA flow velocity and baseline AF cycle length (AFCL) were significantly associated with the type of arrhythmia recurrence (AF vs AT), ie, higher values of both are predictive for AT rather than AF recurrences. Patients with a LAVI < 34.4 mL/m² and significant AFCL increase during the ablation procedure had rather AT than AF recurrences. Patients with an arrhythmia-free outcome despite failure of procedural AF termination during complex ablation for persAF are characterized by specific morphological and functional properties that are easy to obtain.

Prospective evaluation of left atrial function and late gadolinium enhancement with 3T MRI in patients with atrial fibrillation before and after catheter ablation.

In a prospective, randomized study we performed left atrial (LA) functional imaging and late gadolinium enhancement (LGE) in patients undergoing pulmonary vein isolation with ablation of the anterior mitral line to evaluate LA function and visibility of the anterior mitral line and to explore the relationship of these factors to short- and long-term procedural success. Functional imaging of the LA and LGE-visualization 15min post i.v. administration of gadobutrol was performed on a 3T MRI system before and after ablation. Patients were grouped in (a) subjects with sinus rhythm, and (b) subjects without sinus rhythm at the follow-up-MRI. Eight patients were excluded due to poor image quality. 37 patients were allotted to group a, 4 patients to group b. Group a showed a significant improvement in ejection fraction (22.3 ± 7.1% vs. 27.2 ± 5.5%; p < 0.001), end-systolic volume (111.6 ± 48.3ml vs. 96.9 ± 37.2ml; p = 0.002), stroke volume (30.2 ± 12.6ml vs. 35.6 ± 12.6ml; p = 0.003) and LGE (12.5% vs. 83.7%; p < 0.001). Group b showed no significant changes in functional parameters or LGE. Patients with successful therapy at 12months showed significantly lower volumes in the baseline MRI. Scarring along the ablation pathways could be visualized with LGE. Patients with successful CA showed a significant improvement in LA cardiac parameters. Pre-ablation atrial volume seems to be a predictor for long-term success.

P1518Early recurrence of atrial fibrillation is a negative predictor of long-term success after a first pulmonary vein isolation

P1518Early recurrence of atrial fibrillation is a negative predictor of long-term success after a first pulmonary vein isolation

Functional Outcomes and Accuracy of Patient-Specific Instruments for Total Knee Arthroplasty.

Patient-specific instruments (PSIs) were developed to improve mechanical axis alignment for patients undergoing total knee arthroplasty (TKA) as neutral alignment (180°) is a predictor of long-term success. This study examines alignment accuracy and functional outcomes of PSI as compared with standard instruments (SIs). We retrospectively reviewed a consecutive series of TKA procedures using PSI. A total of 85 PSI procedures were identified, and these were compared with a matched cohort of 85 TKAs using SI. Intraoperative decision-making, estimated blood loss, efficiency, Knee Society Scores, and postoperative radiographs were evaluated. One hundred and seventy patients with comparable patient demographics were reviewed. Eighty-one percent of the PSI procedures were within target (180 ± 3°) mechanical alignment, while the SI group had 70% of cases within the target plane ( P = .132). Mean target alignment (2.0° PSI vs 2.2° SI, P = .477) was similar between groups. Twenty-seven percent of patients in the PSI group had surgeon-directed intraoperative recuts to improve the perceived coronal alignment. The change in hematocrit was reduced in the PSI group (8.89 vs 7.21, P = .000). Procedure time and total operating room time were equivalent. Knee Society Scores did not differ between groups at 6 months or at 1 year. Patient-specific instrumentation decreased change in hematocrit, though coronal alignment and efficiency were equivalent between groups. Surgeons must evaluate cuts intraoperatively to confirm alignment. Functional outcomes are equivalent for PSI and SI groups.

Impact of Pulmonary Vein Anatomy on Long-term Outcome of Cryoballoon Ablation for Atrial Fibrillation

Variant pulmonary vein anatomy (PVA) has been reported to influence the recurrence of atrial fibrillation (AF) after radiofrequency ablation. However, the effects of PVA on AF in patients undergoing cryoballoon ablation (CBA) remain unknown. The present study aimed to examine the impact of PVA on the long-term outcome of CBA for AF. A total of 78 patients (mean age 60.7±10.9 years, 64.1% males) with symptomatic and drug-refractory paroxysmal AF were enrolled in the study. Left atrium (LA) and PVA acquired at computed tomography angiography (CTA) were reconstructed with CARTO® 3 SYSTEM. Patients were routinely evaluated by 24-hour Holter monitoring following CBA. Cox regression was used to detect the predictors of AF recurrence after CBA. The results showed abnormal PVA in 30 patients (38.5%) and 18 patients (23.1%) had left common PV (LCPV). Electrical pulmonary vein isolation was achieved in all patients. After a mean follow-up of 689.5±103.8 days, it was found that patients with abnormal PVA had similar AF recurrence rate to those with normal PVA (26.7% vs. 25.0%, P=0.54), and there was no significant difference in AF recurrence rate between LCPV patients and non-LCPV patients (33.7% vs. 23.3%, P=0.29). Cox regression analysis showed that AF duration (72.9±9.0 vs. 42.3±43.2 months, HR 1.001; 95%CI 1.003-1.014; P<0.001) and cryo-applications of right-side PVs (3.0±1.6 vs. 4.7±1.7, HR 0.661; 95% CI 0.473-0.925; P=0.016) were independent predictors of freedom from AF, but PVA was not identified as a predictor of long-term success. In conclusion, the variant PVA cannot significantly influence the long-term outcome of AF patients undergoing CBA; longer AF duration and less cryo-applications of right-side PVs are associated with higher AF recurrent rate.

Predictors of Long-term Success After Concomitant Surgical Ablation for Atrial Fibrillation

According to guidelines, atrial fibrillation (AF) ablation success should be measured by 24-hour Holter electrocardiogram (ECG). However, information on long-term success, especially obtained by 24-hour Holter ECG, is rare. We therefore analyzed rhythm course and long-term outcomes of our patients undergoing concomitant surgical AF ablation. Between January 2003 and April 2011, 486 patients underwent concomitant surgical AF ablation in our institution. Patients with 24-hour Holter ECG rhythm status available between 5 and 10 years postoperatively were included in this retrospective data analysis (n = 155). Ablation lesions were limited to either a pulmonary vein isolation (n = 31, 20%), a more complex left atrial lesion set (n = 89, 57%), or biatrial lesions (n = 35, 23%). Primary end point of the study was freedom from AF during long-term follow-up. Mean patient age was 68.1 ± 8.4 years; 57.4% were male. Mean follow-up time was 5.9 years. Surgical AF ablation provided freedom from AF rate of 56.6% during long-term follow-up, with significantly better results in patients with paroxysmal than in those with persistent AF (67.2% vs 51.8% P = 0.03). A stable rhythm course was observed during follow-up, without statistically significant differences between 12 months and latest follow-up (63.2% vs 56.6%; P = 0.25). In multivariate analysis, preoperative paroxysmal AF, duration of AF, and left atrial diameter were predictors of long-term ablation success. Surgical AF ablation provided freedom from AF rate of 56.6% during long-term follow-up. Statistically significant predictors of ablation success at latest follow-up were preoperative paroxysmal AF, duration of AF, and a preoperative smaller left atrial diameter.

Scar Homogenization Versus Limited-Substrate Ablation in Patients With Nonischemic Cardiomyopathy and Ventricular Tachycardia

BackgroundScar homogenization improves long-term ventricular arrhythmia–free survival compared with standard limited-substrate ablation in patients with post-infarction ventricular tachycardia (VT). Whether such benefit extends to patients with nonischemic cardiomyopathy and scar-related VT is unclear. ObjectivesThe aim of this study was to assess the long-term efficacy of an endoepicardial scar homogenization approach compared with standard ablation in this population. MethodsConsecutive patients with dilated nonischemic cardiomyopathy (n = 93), scar-related VTs, and evidence of low-voltage regions on the basis of pre-defined criteria on electroanatomic mapping (i.e., bipolar voltage <1.5 mV) underwent either standard VT ablation (group 1 [n = 57]) or endoepicardial ablation of all abnormal potentials within the electroanatomic scar (group 2 [n = 36]). Acute procedural success was defined as noninducibility of any VT at the end of the procedure; long-term success was defined as freedom from any ventricular arrhythmia at follow-up. ResultsAcute procedural success rates were 69.4% and 42.1% after scar homogenization and standard ablation, respectively (p = 0.01). During a mean follow-up period of 14 ± 2 months, single-procedure success rates were 63.9% after scar homogenization and 38.6% after standard ablation (p = 0.031). After multivariate analysis, scar homogenization and left ventricular ejection fraction were predictors of long-term success. During follow-up, the rehospitalization rate was significantly lower in the scar homogenization group (p = 0.035). ConclusionsIn patients with dilated nonischemic cardiomyopathy, scar-related VT, and evidence of low-voltage regions on electroanatomic mapping, endoepicardial homogenization of the scar significantly increased freedom from any recurrent ventricular arrhythmia compared with a standard limited-substrate ablation. However, the success rate with this approach appeared to be lower than previously reported with ischemic cardiomyopathy, presumably because of the septal and midmyocardial distribution of the scar in some patients.

Predictors of long-term success after laparoscopic Roux-en-Y gastric bypass in African-American women

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) provides sustained weight loss. However, short-term studies have suggested that African Americans (AAs) are not as successful as Caucasians (CAs) after LRYGB. ObjectiveThe present study was designed to test the hypothesis that at longer term follow-up AAs are just as successful as CAs after LRYGB. SettingUniversity hospital, United States. MethodsA nested case-control study designed to examine the effect of race as covariate in the long-term success of women undergoing LRYGB. The study matched 3 controls per case subject, and the final numbers for analyses were 78 case patients (AA) and 204 control patients (CA). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression analysis. ResultsThe 2 cohorts (N = 282) were well matched for age (AA 40.3±9.1 years versus CA 41.1±8.9 years), preoperative body mass index (AA 50.6±7.5 kg/m2 versus CA 50.2±7.1 kg/m2), prevalence of type 2 diabetes (T2D) (AA 20.5% versus CA 21.1%), hypertension (AA 69.1% versus CA 52%), and sleep apnea (AA 35.9% versus CA 34.8%). In the AA group, the long-term curve for percentage of excess weight loss (EWL) was significantly (P<.001) lower than the CA group at any time-point. In the present model, diagnosis of T2D in the AA group (OR = 6.1 E8) significantly (P = .002) predicted adequate EWL at 3 years, after controlling for relevant confounders. ConclusionRace significantly affected the long-term EWL at 3 years for patients undergoing LRYGB at the authors’ institution. Future research should be directed at determining potential genetic reasons for these differences, including genes associated with T2D.

Comparison of left atrial dimensions in CT and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation

Left atrium (LA) size is a common predictor of ablation outcomes in atrial fibrillation (AF), but different LA diameters have not been adequately studied yet. We aimed to find the best predictor of ablation outcomes using single-linear LA dimensions by computed tomography (CT) or echocardiography. Patients (n = 103, 72 males, 59 ± 9 years) undergoing AF ablation were analyzed. LA diameter (LA-D) was measured by transthoracic echocardiography (parasternal long axis). After 3D reconstruction of CT data (EnSite Verismo, SJM, MN), maximal LA dimensions were measured on a coronal plane (superior-inferior, SI, and transversal, TV) and a sagittal plane (anterior-posterior, AP). Volume (LAV) was rendered after LA appendage and pulmonary vein exclusion. Patients with persistent AF (n = 40) had significantly larger LA size than those with paroxysmal AF (n = 63). After 26 ± 14 months, 31 (30 %) patients had AF recurrence. Univariate Cox regression analysis revealed that LA-D, LA-SI, LA-TV, LAV, and LAV-index (LAV/body surface area) were associated with AF recurrence. Multivariate Cox regression analysis revealed that LAV was the strongest independent predictor of AF recurrence (HR = 1.011 per ml, 95 % CI 1.003-1.020, p = 0.002). LA-TV had the best correlation with LAV (r = 0.69, p < 0.01) and was the strongest single-linear predictor (HR = 1.07 per mm, 95 % CI 1.022-1.121, p = 0.004). Independent of LA-D, an LA-TV>74.5 mm predicted AF recurrence similarly to LAV>126 ml. LA dilatation, especially on the coronal plane, is associated with reduced long-term success after catheter ablation. LA-TV is the best linear predictor of AF recurrence, stronger than the commonly used LA-D.

Comparison of left atrial diameters in computed tomography and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation

Comparison of left atrial diameters in computed tomography and echocardiography as predictors of long-term success after catheter ablation of atrial fibrillation

Denervation as a Common Mechanism Underlying Different Pulmonary Vein Isolation Strategies for Paroxysmal Atrial Fibrillation: Evidenced by Heart Rate Variability after Ablation

Backgrounds. Segmental and circumferential pulmonary vein isolations (SPVI and CPVI) have been demonstrated to be effective therapies for paroxysmal atrial fibrillation (PAF). PVI is well established as the endpoint of different ablation techniques, whereas it may not completely account for the long-term success. Methods. 181 drug-refractory symptomatic PAF patients were referred for segmental or circumferential PVI (SPVI = 67; CPVI = 114). Heart rate variability (HRV) was assessed before and after the final ablation. Results. After following up for 62.23 ± 12.75 months, patients underwent 1.41 ± 0.68 procedures in average, and the success rates in SPVI and CPVI groups were comparable. 119 patients were free from AF recurrence (SPVI-S, n = 43; CPVI-S, n = 76). 56 patients had recurrent episodes (SPVI-R, n = 21; CPVI-R, n = 35). Either ablation technique decreased HRV significantly. Postablation SDNN and rMSSD were significantly lower in SPVI-S and CPVI-S subgroups than in SPVI-R and CPVI-R subgroups (SPVI-S versus SPVI-R: SDNN 91.8 ± 32.6 versus 111.5 ± 36.2 ms, rMSSD 47.4 ± 32.3 versus 55.2 ± 35.2 ms; CPVI-S versus CPVI-R: SDNN 83.0 ± 35.6 versus 101.0 ± 40.7 ms, rMSSD 41.1 ± 22.9 versus 59.2 ± 44.8 ms; all P < 0.05). Attenuation of SDNN and rMSSD remained for 12 months in SPVI-S and CPVI-S subgroups, whereas it recovered earlier in SPVI-R and CPVI-R subgroups. Multivariate logistic regression analysis identified SDNN as the only predictor of long-term success. Conclusions. Beyond PVI, denervation may be a common mechanism underlying different ablation strategies for PAF.

Quantitative Analysis of Isolation Area and Rhythm Outcome in Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Antrum Isolation Using the Pace-and-Ablate Technique

We sought to determine the relationship between the size of the left atrial isolated surface area (ISA) after pulmonary vein antrum isolation for paroxysmal atrial fibrillation (AF) and rhythm outcome during a 12-month follow-up. One hundred one consecutive patients with paroxysmal AF (mean age, 59±11 years; median [range] AF history, 36 [24-96] months; mean left atrial size, 42±6 mm) were enrolled. The ISA was defined as the ratio of the total isolated antral surface area excluding the pulmonary veins to the sum of the total isolated antral surface area and the left atrial posterior wall surface area, while considering the individual characteristics of antral anatomy. All surface areas were assessed using the NavX system. Patients were divided into 4 groups according to ISA (group I: <50%; group II: 50 to <60%; group III: 60 to <70%; group IV: ≥70%). The average ISA for all patients was 59.2±11.6%. Subgroup analysis showed that ISA was 42.8±4.2% in group I (n=23), 54.2±3.0% in group II (n=23), 64.3±3.0% in group III (n=33), and 73.9±3.6% in group IV (n=22). After a 12-month follow-up period, 70% of patients in group I, 78% in group II, 97% in group III, and 100% in group IV were free from AF and atrial macroreentrant tachycardia. There was a significant difference between groups I and III, I and IV, II and III, and II and IV but not groups I and II and groups III and IV (log-rank test P=0.024, 0.016, 0.037, 0.044, 0.584, and 0.500, respectively). Receiver operating characteristic curve analysis yielded an optimal cutoff value of 55% for ISA. After 12 months, a larger ISA was associated with a significantly lower AF and macroreentrant tachycardia recurrence rate. ISA≥55% may thus serve as a predictor for long-term success after pulmonary vein antrum isolation.

Soft-Tissue Release for Hip Subluxation in Cerebral Palsy: What Is the Role in the Nonambulatory Patient?

In this Level-II study, the authors present a very large series of patients with hip subluxation due to cerebral palsy who were treated with soft-tissue releases. The surgery consisted of adductor lengthening, often combined with iliopsoas lengthening and phenol injection around the anterior branch of the obturator nerve. The authors defined failure of the treatment as either the need for further surgery or progression of the migration percentage beyond 50%. In 330 patients with a mean follow-up of 7.1 years, the Gross Motor Function Classification System (GMFCS) and the initial migration percentage were the best predictors of long-term success or failure. Their results are sobering: in the 242 patients who were classified as GMFCS level IV or V, the success rates were only 27% and 14%, respectively. This appears to be the first large study to examine the GMFCS classification as a predictor of success of soft-tissue hip surgery in patients with cerebral palsy. To be fair, if one considers level-IV and …

Predictors of long-term success after catheter ablation of atriofascicular accessory pathways

Electrophysiologic characteristics, mapping strategies, and acute success rates of radiofrequency catheter ablation of atriofascicular accessory pathways are well described. However, data on long-term prognosis and predictors for freedom from arrhythmias are lacking. To report our 20-year single-center experience on ablation of atriofascicular fibers. Between 1992 and 2010, 34 patients with atriofascicular accessory pathways underwent catheter ablation at our institution because of symptomatic antidromic atrioventricular reentrant tachycardias. Radiofrequency procedures were retrospectively analyzed, and patients were followed for recurrences of tachyarrhythmias. Electrocardiograms (before and after ablation and at follow-up) were analyzed for each patient. Successful catheter ablation of the atriofascicular fiber was achieved in 23 (68%) patients. Mechanical block during mapping occurred in 3 (9%) patients, and in 2 of them ablation was performed at the site of mechanical block. Mere modification of conduction properties of the pathway without complete block was achieved in 5 patients (15%). Fast pathway ablation was performed in 2 (6%) of the patients ablated in the early 1990s. During follow-up of 9.3 ± 5.5 years, 24 patients (71%) remained free of tachyarrhythmias, 7 reported significant improvement, and 3 (9%) had no change in symptoms after ablation. Long-term success was identical between patients from the first (1992-1999) and second (2000-2010) decade (12 of 17 [71%] vs 12 of 17 [71%]). It was 87% in those with complete block of the atriofascicular fiber while all patients with mechanical block during mapping reported recurrences. Fast pathway ablation was complicated by complete atrioventricular block in 1 patient, who required pacemaker implantation 18 years after ablation owing to loss of conduction properties of the atriofascicular fiber over the years. On analyzing patients with preexcitation before ablation (n = 16; 47%), we found that the PR interval after ablation was significantly longer only in those without recurrence (162 ± 21 ms vs 134 ± 21 ms; P = .042). None of the other analyzed electrocardiographic parameters, including PR, QRS duration, and preexcitation, had prognostic impact. Acute success of complete ablation of atriofascicular pathways is associated with excellent long-term success (87%). Mere modification of conduction properties of atriofascicular fibers or ablation at the sites of mechanical block are less promising end points of ablation with high recurrence rates. Technical innovations during decades may not further improve long-term outcome in these patients.