Postoperative Atrial Fibrillation Recurrence Research Articles

Effect of peripheral blood neutrophil to lymphocyte ratio and high-sensitivity C-reactive protein on recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation

Objective To discuss the efficacy of NLR and hs-CRP levels on recurrence in patients with paroxysmal atrial fibrillation after radiofrequency catheter ablation. Methods Eighty-nine cases of paroxysmal atrial fibrillation treated by radiofrequency ablation in Chaoyang Central Hospital from May 2011 to October 2015 were selected and were divided into the recurrence group and non-recurrence group according to the recurrence.The preoperative NLR and hs-CRP levels were observed, and the correlation between NLR and hs-CRP was analyzed.Logistic regression analysis was used to analyze the risk factors of postoperative recurrence of atrial fibrillation. Results 27 cases were recurred after 1 year follow-up, the recurrence rate was 30.3% (27/89).27 cases in the recurrence group, 62 cases in the non-recurrence group.The disease duration of the recurrence group and the non-recurrence group were (7.6±3.4)years and (5.3±2.5) years respectively.The left atrial diameter (LAD) were (39.09±3.27) mm and (35.91±3.95) mm, NLR were(3.69±0.67) and (2.58±0.40), hs-CRP were (5.20±2.45) mg/L and (3.09±1.70) mg/L respectively in the two groups, the differences were statistically significant between the two groups (P=0.001, 0.002, 0.004, 0.001). Pearson correlation analysis showed that there was a positive correlation between NLR and hs-CRP (r=0.58, P<0.01). Logistic regression analysis showed that NLR, hs-CRP, LAD were risk factors of recurrence (OR(95%CI): 2.071(1.689~3.301), 1.760(1.096~4.286), 1.943(1.025~3.607))(P=0.019, 0.030, 0.035). Conclusion The levels of NLR and hs-CRP are associated with the recurrence of atrial fibrillation in patients with radiofrequency ablationts.NLR value and serum hs-CRP increased are the risk factors of recurrent atrial fibrillation after radiofrequency catheter ablation, which can be used as independent predictors of atrial fibrillation recurrence after radiofrequency ablation. Key words: Radiofrequency ablation; atrial fibrillation; Neutrophil to lymphocyte ratio; hs-CRP; Relapse

Predictive risk factors for recurrent atrial fibrillation after modified endoscopic ablation: A 2-year follow-up.

Our previous study reported a modified endoscopic procedure for nonvalvular atrial fibrillation (AF) that requires only 3 ports in the left chest wall. Certain preoperative variables might be predictive risk factors for AF recurrence among patients who underwent this procedure. From October 2010 to April 2014, 114 patients with either paroxysmal AF (PAF) or nonparoxysmal AF (non-PAF) underwent the procedure and completed postoperative cardiac-rhythm measurement via electrocardiography and Holter monitoring. Univariate and multivariate analyses of the possible AF-related risk factors were conducted. During 2-year follow-up, 99 of 114 patients (86.8%) were free from atrial tachyarrhythmia. Results from univariate analyses showed that AF duration, left atrial diameter (LAD), left atrial minimum volume, left atrial empty fraction, left atrial expansion index, and left atrial active empty fraction (LAAEF) were significantly associated with postoperative AF recurrence. Results from multivariate analyses showed that AF duration (odds ratio [OR]: 1.194, 95% CI: 1.063-1.340, P = 0.003), LAD (OR: 1.101, 95% CI: 1.005-1.205, P = 0.039), and LAAEF (OR: 0.490, 95% CI: 0.277-0.865, P = 0.014) were independent risk factors. There was no difference in AF recurrence between patients with PAF and non-PAF (P = 0.250). Our 2-year follow-up study suggested that low LAAEF, long AF duration, and large LAD might be potential predictive risk factors for AF recurrence. Patients with PAF and non-PAF had a similar AF recurrence rate after modified endoscopic ablation.

Thromboembolisms related to post-operative electrical cardioversions for atrial fibrillation in patients with surgical aortic valve replacement.

Post-operative atrial fibrillation (POAF) is a frequent complication after open-heart surgery, and cardioversions (CV) are commonly performed to restore sinus rhythm. However, little data exists on thrombo-embolic risk related to early post-operative CV and on the recurrence of POAF after CV. CAREAVR study sought to assess the rate of strokes, transient ischaemic attacks (TIA), and mortality shortly after POAF-triggered CV in patients who underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis. Altogether 721 patients underwent isolated SAVR with a bioprosthesis at four Finnish university hospitals. During post-operative hospitalization, after patients with prior chronic AF were excluded, 309/634 (48.7%) of patients had at least one episode of POAF [median time (interquartile range) 3 (3) days], and an electrical CV was performed in 113/309 (36.6%) of them. The length of hospital stay was not affected by CV. At 30 days follow-up, the rate of stroke, TIA or mortality was higher in those AF patients who underwent CV vs. those who did not (9.7% vs. 3.6%, P = 0.04, respectively; adjusted hazard ratio 2.63, 95% confidence interval 1.00-6.92, P = 0.05). Similar proportion of patients in both groups were in AF rhythm at discharge (32.7% vs. 35.7%, P = 0.18); and at 3 months (25.0% vs. 23.6%, P = 0.40), respectively. In this real-world population of patients undergoing isolated SAVR, the rate of POAF was nearly 50%. One-third of these patients underwent an electrical CV, and they exhibited over two-fold risk for thromboembolisms and mortality. Cardioversion did not affect the short-term prevalence of AF.

Incidence of postoperative atrial fibrillation recurrence in patients discharged in sinus rhythm after cardiac surgery: a systematic review and meta-analysis.

Postoperative atrial fibrillation (POAF) is associated with increased stroke risk and mortality post-discharge. POAF is often considered transient; however, recurrence is likely under-recognized as symptoms are an unreliable guide. Surveillance post-discharge may identify asymptomatic POAF recurrences in patients discharged in sinus rhythm. Therefore, we performed a systematic review and meta-analysis of studies investigating POAF recurrence post-discharge, in patients with new-onset POAF following cardiac surgery who reverted to sinus rhythm prior to discharge. Two independent reviewers searched medical databases, clinical trial registries, reference lists and the Internet. After screening from 6525 studies, 8 studies were identified (n = 1157 participants, mean age 66 ± 10 years and 73% men). Monitoring methods included the following: telemetry during twice-daily exercise sessions (n = 2), continuous telemetry for 3 weeks (n = 1), daily 20-s electrocardiography (ECG) using wearable event recorder (n = 1), 30-s single-lead ECG, 4 times/day (n = 1) and implanted continuous monitoring (n = 2). The incidence rate of POAF recurrence identified through non-invasive monitoring in the first 4 weeks post-discharge was 28.3% [confidence interval (CI) 23.0-33.6%]; recurring 12 ± 5 days (mean ± SD) post-surgery. The incidence rate identified through implanted continuous monitoring was 61-100% within 2 years. Between 40% and 93% of episodes were asymptomatic. In one small study reporting stroke risk, 8 of 10 patients with recurrence were guideline-indicated (CHA2DS2-VASc score ≥2) for oral anticoagulation for stroke prevention. Monitoring for POAF recurrence post-hospital discharge identifies significant numbers of early asymptomatic recurrences in patients at high risk of stroke who may benefit from anticoagulation for stroke prevention. More intense monitoring is more likely to identify POAF recurrence. Future research is required to investigate the prognostic significance of POAF recurrence, especially stroke and mortality risk.

Self-monitoring for atrial fibrillation recurrence in the discharge period post-cardiac surgery using an iPhone electrocardiogram

Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery. Patients with POAF following cardiac surgery were eligible for participation if they had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm. Participants were provided with an iECG and asked to record a 30-s iECG, four times per day for 4 weeks post-discharge. iECGs were automatically transmitted to a secure server, and reviewed for the presence of AF by the research team and a validated algorithm. All participants also received brief education on AF. Forty-two participants completed the intervention (mean age 69 ± 9 years, 80% male). Self-monitoring for POAF recurrence using an iECG was feasible and acceptable, and participants felt empowered. Self-monitoring identified 24% (95% confidence interval, 12-39%) with an AF recurrence within 17 days of hospital discharge. These participants were significantly younger than those without AF recurrence (64 ± 7 vs 70 ± 10 years; P = 0.025), and had a significantly lower CHA2DS2-VASc score (2.3 ± 1.2 vs 3.7 ± 2.3; P = 0.007). However, 80% were at high enough stroke risk to warrant consideration of anticoagulation, i.e. CHA2DS2-VASc score ≥2. Only 30% of recurrences were associated with palpitations. Participation also improved AF knowledge from 6.4 ± 1.8 to 7.3 ± 1.8 (P = 0.02), of a total score of 10. Providing patients with an iECG is a non-invasive, inexpensive, convenient and feasible way to monitor for AF recurrence in post-cardiac surgery patients. It also provides a mechanism to provide knowledge about the condition and also potentially reduce anxiety. The success of patients using this technology also has implications for extending the use of iECG self-monitoring to other patient groups such as those undergoing antiarrhythmic interventions for AF.

Restoration of sinus rhythm and atrial transport function after the maze procedure: U lesion set versus box lesion set

ObjectiveIn a U lesion set, the left atrium (LA) roof between the right and left superior pulmonary veins is not ablated, to allow activation to propagate across the posterior LA and to recruit this segment as a contractile atrial component. In contrast, the box lesion set isolates the entire posterior LA. MethodsTo compare the two lesion sets, postoperative freedom from atrial fibrillation (AF) and LA transport function were examined in 402 patients who underwent surgery for AF with a U lesion (n = 329) or box lesion (n = 73) set. Patients who underwent pulmonary vein isolation alone or other simplified procedures were excluded from the study. LA transport function was quantified at 20 ± 33 months postoperatively by the ratio of peak velocity of the A wave to the E wave (peak A/E) of the transmitral Doppler flow. ResultsIn patients with long-standing persistent AF, freedom from AF was 85% with the U lesion set and 77% with the box lesion set at 5 years after the maze procedure, and 82% and 77%, respectively, at 10 years after the procedure. There was no significant difference between the U lesion set and box lesion set in patients with long-standing persistent AF (P = .30) and those with paroxysmal or persistent AF (P = .90). Proportional hazards analysis identified increased LA diameter (P = .003) and long-standing persistent AF (P = .03), but not the type of lesion set (P = .51), as predictive of postoperative AF recurrence. The postoperative peak A/E was significantly greater after the U lesion set than after the box lesion set (0.42 ± 0.22 vs 0.23 ± 0.17), and multiple regression analysis demonstrated that the type of lesion set and preoperative LA diameter significantly affected postoperative A/E. ConclusionsThe U lesion set restores sinus rhythm frequently as the box lesion set and provides better LA transport function. A dilated LA is a risk factor for postoperative recurrence of AF and poor postoperative LA transport function.

Comparison of the effects of bepridil and aprindine for the prevention of atrial fibrillation after cardiac and aortic surgery: A prospective randomized study

BackgroundApproximately one-third of the patients undergoing cardiovascular surgery reportedly experience paroxysmal atrial fibrillation (AF) during the postoperative period. However, the usefulness of antiarrhythmic drugs for preventing postoperative AF recurrence in the Japanese population has not been extensively studied. MethodsFrom a total of 118 patients who developed postoperative paroxysmal AF between April 2009 and March 2011, 72 patients (45 men, mean age 68±8 years) requiring treatment for postoperative AF due to symptoms lasting ≥30min were enrolled to prospectively investigate the efficacy of oral bepridil (100mg/day, n=37) or aprindine (40mg/day, n=35). ResultThe AF recurrence-free survival rates at 1, 3, 7, and 14 days were 100%, 94%, 57%, and 49%, respectively, in the aprindine group, and 100%, 97%, 86%, and 76%, respectively, in the bepridil group (P=0.028, aprindine vs. bepridil). ConclusionBepridil, at a fixed dose of 100mg/day, was considered to be more effective than a routine dose of aprindine for the prevention of postoperative AF recurrence.

Identifying postoperative atrial fibrillation in cardiac surgical patients posthospital discharge, using iPhone ECG: a study protocol

IntroductionPostoperative atrial fibrillation (AF) occurs in 30–40% of patients after cardiac surgery. Identification of recurrent postoperative AF is required to initiate evidence-based management to reduce the risk of subsequent stroke....

Medical and Economic Interest of the Use of Cryosurgery in the Instrumental Treatment of Atrial Fibrillation

Introduction: In order to definitively integrate cryosurgery for the surgical treatment of atrial fibrillation (AF) into the therapeutic armamentarium, the medical and economic impact of its use on a population of patients with a high risk of recurrence of postoperative AF must be evaluated. Method: An observational study of patients who benefited from cryosurgery between July 2006 and December 2008 was performed. The cost of consumables and hospitalization was determined and compared to that of a control group of 27 patients with preoperative AF that had not benefited from cryosurgery. Results: Twenty-nine patients benefited from cryosurgery during a mitral (65.5%) or aortic intervention (37.9%) to treat a paroxystic (44.8%) or permanent AF (55.2%). More than half of them (58.6%) had a 12-month follow-up; 82.4% of these patients showed a permanent sinus rhythm and 32.6% had stopped their antiarrhythmic medication. There was no significant difference between the duration and cost of hospitalization for the 2 groups. Conclusion: Cryosurgery provides a clear clinical and economic advantage with no recurrence of AF, and it reduces antiarrhythmic medication treatment.

The influence of postoperative mitral valve function on the late recurrence of atrial fibrillation after the maze procedure combined with mitral valvuloplasty

Although a number of reports have identified risk factors for postoperative recurrence of atrial fibrillation after the maze procedure, no studies have investigated the influence of postoperative mitral valve disease on atrial fibrillation recurrence after mitral valvuloplasty combined with the maze procedure. Between January 1999 and October 2006, 228 patients underwent the maze procedure and concomitant mitral valve repair. There were 4 early deaths. Of the early survivors, 206 patients with restored sinus rhythm were chosen for analysis. During a median follow-up of 50.8 months (range, 0.6-122.8 months), there were 35 patients who had mitral regurgitation (n = 26) or mitral stenosis (n = 9). Patients who had postoperative mitral valve disease (disease group, n = 35) were compared with those who did not (control group, n = 171) for late recurrence of atrial fibrillation. Twenty-eight patients experienced late recurrence of atrial fibrillation. The disease group had a higher atrial fibrillation recurrence rate than the control group (5-year atrial fibrillation-free rates were 65.2% +/- 10.3% and 85.8% +/- 3.4%, respectively; P = .014). Univariate and multivariate analyses of a range of variables revealed that a larger preoperative left atrial size (hazard ratio, 2.61; P = .041), the use of microwave ablation rather than cryoablation (hazard ratio, 2.33; P = .041), the presence of early (<3 months) postoperative atrial fibrillation events (hazard ratio, 3.75; P = .001), and the presence of postoperative mitral valve disease (hazard ratio, 3.67; P = .005) were independent predictors for late atrial fibrillation recurrence. Maze procedure outcomes were negatively affected by postoperative mitral valve disease after mitral valvuloplasty, as evidenced by greater atrial fibrillation recurrence.

Predictive factors of sustained sinus rhythm and recurrent atrial fibrillation after a radiofrequency modified Maze procedure

Preoperative atrial fibrillation (AF) in patients scheduled for elective open-heart surgery is a well-known phenomenon. The cut and sew Maze procedure or variant Maze procedures abolish AF in 45-95% of patients during short- to intermediate-term follow-up. We determined preoperative and postoperative factors predictive of sustained sinus rhythm (SR) and recurrent AF in an elderly cohort of patients with structural heart disease who underwent cardiac surgery. From November 1995 to November 2003, 285 patients with structural heart disease and permanent AF were scheduled for elective cardiac surgery. All patients underwent a radiofrequency (RF) modified Maze procedure as an adjunct to the open-heart operation. Patients were followed in the outpatient clinic or follow-up data were obtained from attending doctors. Patients are being followed in an ongoing registry; however for the patients who are the subject of this paper follow-up ended November 2006. Preoperative factors predicting recurrent AF postoperatively were assessed, as were factors associated with sustained SR. Two hundred and eighty-five patients (mean age 68.0+/-9.6 years) underwent a total of 655 open-heart procedures and concomitant RF Maze surgery. In-hospital mortality was 4.6% (13 patients). Mean and median duration of AF were 60.9+/-68.7 months and 26 months (range 6-396), respectively. Median follow-up was 36.5 months (range 27-114 months). Sustained SR, including atrial rhythm or an atrial-based paced rhythm was present in 59% of patients at 1 year, in 54.4% at 3 years, in 53.4% at 5 years and in 57.1% of patients at the latest follow-up. Stroke was reported in six patients (2.1%). Factors predictive of postoperative AF recurrence were duration of permanent AF, preoperative atrial fibrillation wave and preoperative left atrial (LA) size. Postoperative angiotensin converting enzyme (ACE) inhibitor therapy was associated with SR during follow-up. LA size decreased during follow-up in patients with sustained SR, whereas LA size increased in case of recurrent AF. In this group of elderly patients with permanent AF in the setting of structural heart disease who underwent cardiac surgery and a RF Maze procedure as a concomitant procedure, the duration of AF, preoperative atrial fibrillation wave and preoperative LA size were predictive of recurrent AF, whereas left ventricular ejection fraction, left ventricular diameters and invasive hemodynamic parameters were not. Postoperative ACE inhibitor therapy was associated with sustained SR. Furthermore, sustained SR after RF Maze surgery was associated with decreased LA dimensions.

Histopathological Features of the Resected Left Atrial Appendage as Predictors of Recurrence After Surgery for Atrial Fibrillation in Valvular Heart Disease

A histopathological assessment of left atrial appendages (LAA) resected during surgical treatment for atrial fibrillation (AF) was made, with the aim of improving the prediction of postoperative AF recurrence. This clinicopathological study involved 57 surgical cases of valvular AF and 34 age- and sex-matched control autopsy cases with a history of sinus rhythm. LAA from the cases with valvular AF showed greater hypertrophy of cardiomyocytes (p<0.0001), greater nuclear enlargement (p<0.0001), more bizarre nuclei (BN; p<0.0001), and more intercellular fibrosis (ICF; p<0.001). Partial disarray of cardiomyocytes and fatty infiltration were recognized in both the AF and control groups. Thirty-seven cases had maintained sinus rhythm after surgery from 7 months to 10 years. AF recurred within a month of surgery in 17 and after a month in 3; there was no significant difference in histopathological features between them. These 20 cases had more cellular hypertrophy (p<0.025), nuclear enlargement (p<0.025), BN (p<0.01), and ICF (p<0.025) than those who maintained sinus rhythm after surgery. The histopathological findings for LAA reflected the underlying valvular diseases; however, the most reliable predictors of postoperative AF recurrence were hypertrophy of cardiomyocytes, bizarre shaped nuclei, and extensive ICF.

Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed?

Atrial fibrillation (AF) persisting after mitral valve surgery reduces survival due to heart failure and thrombo-embolisms, and impairs quality of life. Arrhythmia surgery for AF shows today very satisfying results and therefore mitral valve surgery with AF surgery appears appealing. This study explores whether combined surgery in view of today's results of mitral valve surgery is indicated. An outcome analysis of the arrhythmia outcome of patients undergoing exclusive mitral valve surgery with or without tricuspid repair was done. Preoperative baseline characteristics including arrhythmia pattern, surgical methods and follow-up findings were reviewed. Postoperative management of AF was not protocolized. Between 1990 and 1993, 162 consecutive patients underwent mitral valve surgery; follow-up was a mean of 3.3+/-1.9 years. In-hospital and late mortality were 1 and 9%, respectively. Sinus rhythm was preserved in 40 of 57 (70%) patients with preoperative sinus rhythm whereas AF persisted in 58 of 68 (85%) of patients with preoperative chronic AF (>1 year present). Sinus rhythm without AF was observed in 10 of 29 (34%) patients with preoperative paroxysmal AF. The 4-year Kaplan-Meier survival did not differ between patients with preoperative sinus rhythm (95.2%), paroxysmal AF (89.2%) and chronic AF (82.9%) but AF persisting after surgery tended to determine survival (P=0.05). Gender, age and right ventricular pressure and tricuspid valve repair were risk factors for postoperative recurrence of AF in patients with sinus rhythm at discharge, relative risk 0.35, 1.06, 1. 04 and 2.9, respectively. Current mitral valve surgery with or without tricuspid valve repair does not eliminate preoperative paroxysmal or chronic AF. Secondly, because preoperative AF did not determine survival after mitral valve surgery, whereas postoperatively persisting AF was weakly associated with survival, atrial arrhythmia surgery primarily aims to reduce morbidity due to AF. Some characteristics can identify patients with increased propensity for persisting AF after surgery. Randomized studies of AF surgery are needed to identify suitable candidates for combined surgery.