Recurrent Paroxysmal Atrial Fibrillation Research Articles

Risk factors for recurrence of paroxysmal atrial fibrillation after second-generation of cryoballoon ablation.

To analyze the risk factors for recurrence of paroxysmal atrial fibrillation (PAF) after the second-generation of cryoballoon ablation (CBA). A total of 67 patients with PAF, who underwent CBA treatment from March 2017 to June 2018, were selected from the Department of Cardiology, Second Xiangya Hospital of Central South University. The incidence rate of early recurrence (within 3 months) and late recurrence (after 3 months) in patients with PAF were analyzed retrospectively and the risk factors for recurrence were discussed. Among the 67 patients, 40 were males (59.7%). The patients were at 34-84 (58.91±10.49) years old and followed up for 4-15 (9.04±4.66) months. Fifteen (22.4%) patients suffered early recurrence, and 16 (23.9%) patients suffered late recurrence. Among the 16 patients with late recurrence, 12 suffered early recurrence. The results of univariate analysis showed that there were significant differences between the early recurrence group and the non-early recurrence group in the freezing temperature of right inferior pulmonary vein at 30 s and right superior pulmonary vein at 60 s, the nadir freezing temperature of right inferior pulmonary vein and the width of left inferior pulmonary vein (all P<0.05); there were significant differences between the late recurrence group and the non-late recurrence group in the left atrial diameter, early recurrence and the nadir temperature of left superior pulmonary vein (all P<0.05). Multivariate analysis found that the freezing temperature of right superior pulmonary vein at 60 s was an independent risk factor for early recurrence (OR=1.108, 95% CI 1.002 to 1.225, P=0.046); and early recurrence was an independent risk factor for late recurrence (OR=24.94, 95% CI 7.85 to 41.91, P=0.020). Freezing temperature of right superior pulmonary vein at 60 s is an independent risk factor of early recurrence, and early recurrence is an independent risk factor of late recurrence after the second-generation cryoballon ablation for PAF.

Study of the Effect of Proton Pump Inhibitors on the Development of Hypomagnesemia in Patients with Paroxysmal Atrial Fibrillation on the Background of Autonomic Sinus Node Dysfunction

Aim. To study the effect of proton pump inhibitors (PPIs) on the development of hypomagnesemia in patients with paroxysmal atrial fibrillation (AF) on the background of autonomic sinus node dysfunction (ASND).Material and methods. A prospective cohort study included 32 patients with an established diagnosis of ASND and often recurrent paroxysmal AF. The main group consisted of 17 patients who took pantoprazole at a dose of 20 mg 2 times a day as treatment of diagnosed duodenal erosions within 6 weeks from the time of the initial visit to an arrhythmologist. The remaining 15 patients did not take PPIs and were included in the control group. The determination of magnesium in whole blood, plasma and formed elements was carried out twice in all patients – at the initial visit and after 6 weeks. In addition, in the experiment, complex-forming activity of solutions of various PPIs (esomeprazole, pantoprazole, rabeprazole and omeprazole) with respect to magnesium ions was studied. The author’s method was used, based on turbidimitric determination of the light transmission during the heterogeneous reaction of the formation of magnesium phosphates in the presence of the analyzed drug or without it.Results. There were no significant differences in the magnesium content in the blood of patients of the main and control groups before taking PPIs. After taking of pantoprazole by the patients of the main group there were significant differences between main and control groups in magnesium in whole blood (0.48 [0.44-0.51] mmol/l vs 0.55 [0.5-0.61] mmol/l, p=0.01) and its values in formed elements (0.52 [0.45-0.67] mmol/l vs 0.75 [0.65-1.2] mmol/l, p=0.009). Analysis of magnesium content in patients of the main group before and after taking of pantoprazole also showed a significant decrease in intracellular concentrations of the element (0.6 [0.51-1.0] mmol/l vs 0.52 [0.45-0.67] mmol/l, p=0.002), as well as decrease in its total content in whole blood (0.51 [0.45-0.59] mmol/l vs 0.48 [0.44-0.51] mmol/l, p=0.04). To substantiate the observed effects it was experimentally proved the possibility of formation of strong complex compounds between the ions of magnesium and PPIs: the highest activity was demonstrated by rabeprazole and pantoprazole (coefficients of complex formation per unit of total organic carbon – 1.5 and 0.72, respectively) and the lowest – omeprazole and esomeprazole (0.04 and 0.09, respectively).Conclusion. A decrease of magnesium content in whole blood and formed elements in patients with paroxysmal AF on the background of ADSN was mediated by a six-week intake of pantoprazole in a dose of 20 mg 2 times a day for the treatment of concomitant erosion of the duodenum. When choosing PPIs for arrhythmological patients with concomitant gastro-duodenal pathology, it is advisable to be guided by the complexing activity of drugs with respect to magnesium ions: the most pronounced metal-ligand interaction with magnesium was shown by rabeprazole and pantoprazole, and the least – omeprazole and esomeprazole.

P338 The road to zero-fluoroscopy catheter ablation in recurrent paroxysmal atrial fibrillation using ICE: training, learning, getting closer

Abstract INTRODUCTION Catheter ablation is the treatment of choice for patients with recurrent paroxysmal atrial fibrillation (AF) in which antiarrhythmic drug therapy has failed to maintain sinus rhythm. Since its first introduction, intracardiac echocardiography (ICE) has proved to increase the efficacy and reduce complications in AF catheter ablation. One of the main advantages of ICE in the electrophysiology laboratory is the reduction of radiation exposure, for both the patient and the physician. Multiple recent studies have shown the feasibility and safety of zero or near-zero fluoroscopy AF ablation, including transseptal puncture, and outlined the importance of using ICE under the support of 3D mapping systems in reducing radiation exposure. PURPOSE The aim of this study was to show whether the use of ICE reduced the radiation exposure and total procedure time in recurrent paroxysmal AF patients undergoing radiofrequency catheter ablation. METHODS Forty patients that undergone radiofrequency catheter ablation for recurrent paroxysmal AF between January 2018 and May 2019 were included. They were divided in two groups: Group 1 – 20 patients in which ICE was performed and Group 2 – 20 patients in which ablation was performed without ICE guidance. We compared the total ablation time and fluoroscopy dose and time between the two groups. The total ablation time was defined as the time from the groin puncture until the withdrawal of all catheters. RESULTS Among the 40 patients included, 28 were men (70%) and the mean age was 57 years old. The mean procedure time was similar between the two groups (175 ± 52.0 for group 1 and 193 ± 49.9 for group 2, p = 0.33). The difference between the two groups was observed in fluoroscopy dose (9914.13 ± 5018.14 vs. 14561.43 ± 7446.1, p = 0.02) and time (26.04 ± 12.5 vs. 40.52 ± 12.6, p = 0.001). We found that in both groups higher fluoroscopy dose was correlated with higher fluoroscopy time (R = 0.74, p = 0.0001 vs. R = 0.57, p = 0.008) and higher total procedure time (R = 0.63, p = 0.002 vs. R = 0.46, p = 0.03). Furthermore, there was also a correlation between higher fluoroscopy dose and time (R = 0.59, p = 0.005 vs. R = 0.58, p = 0.006). No severe procedure-related complications were recorded. CONCLUSIONS This study shows that the use of ICE for recurrent paroxysmal AF catheter ablation reduces radiation exposure by lowering the fluoroscopy dose and the time of exposure. As a result, by increasing the training and learning curve in low-experienced centers it may finally get us closer to the ideal zero or near-zero fluoroscopy ablation. Abstract P338 Figure. ICE-guided transseptal puncture

Effect of RAAS genes polymorphism for recurrence of paroxysmal atrial fibrillation among patients with coronary heart disease combined with hypertension

Effect of RAAS genes polymorphism for recurrence of paroxysmal atrial fibrillation among patients with coronary heart disease combined with hypertension

Paroxysmal atrial fibrillation recurrence after redo procedure-ablation modality impact.

Atrial fibrillation recurrence (AFR) is common after pulmonary vein isolation (PVI), and the rate does not differ between radiofrequency (RF) and cryoballoon (CB) ablation. The aim of this study was to assess the impact of the ablation modality used at the index PVI on the outcome after redo PVI in patients with paroxysmal AF. In this prospective, single-center, non-randomized study, consecutive patients with paroxysmal AF who have undergone the index PVI with either RF ablation (RF group) or 2nd-generation CB (CB group) were included. The primary endpoint was freedom from recurrence of atrial arrhythmia lasting > 30s. A total of 105 patients undergoing redo PVI for paroxysmal AF were included (median age 61years; 24% female; left ventricular ejection fraction (LVEF) 57 ± 8%; left atrial volume index (LAVI) 34 ± 11mm). Index PVI was done either with focal RF (n = 81) or with CB (n = 24) and redo PVI only with focal RF. Total procedure time (139 vs. 113min, p = 0.10) and RF delivery time (1017 vs. 870s, p = 0.33) of the redo PVI were not significantly different. After a median follow-up of 371 (185-470) days, there were no differences between the RF and CB groups regarding the AFR rate after the second PVI (24 vs. 23%, p = 0.89). The Kaplan-Meier analysis showed no difference between the groups regarding AFR freedom time (p = 0.81). In multivariable logistic regression, only coronary artery disease was identified as an independent long-term predictor of AFR (OR 4.15, 95% CI 1.17-14.71, p = 0.027). The ablation modality used at the index PVI has no impact on long-term outcome after redo PVI in patients with paroxysmal AF.

Clinical and methodological aspects in the diagnosis of magnesium deficiency in patients with paroxysmal atrial fibrillation

Aim. To determine magnesium deficiency in patients with paroxysmal atrial fibrillation using a comprehensive clinical and laboratory approach. Methods. The prospective cohort study included 35 patients of the cardiology department of the Medical association «Novaya bolnitsa». The main group consisted of 22 patients with frequently recurrent paroxysmal atrial fibrillation, the control group - 13 patients without cardiac arrhythmias. The clinical status, Holter-monitoring of the electrocardiogram, the results of the clinical test for magnesium deficiency, laboratory parameters of calcium, magnesium in blood plasma and formed elements, magnesium in whole blood, free fatty acids and plasma osmolarity were evaluated. Results. The clinical score of magnesium deficiency was significantly higher in patients from the main group compared to the control [16.5 (11÷21) vs 13 (8÷15), p &lt;0.001]. In the main group, there was a decrease of magnesium in the whole blood [0.55 (0.5÷0.59) vs 0.61 (0.58÷0.54), p=0.002] and inside the blood cells [0.68 (0.53÷1.29) vs 1.38 (1.29÷1.44), p &lt;0.001]. In patients with atrial fibrillation there is a shift of the ratio of calcium to magnesium in blood plasma [2.5 (2.5÷3) vs 2.9 (2.8÷3.15), p=0.029] and intracellularly [4.85 (2.62÷9.3) vs 1.7 (1.4÷1.95), p=0.002]. The redistribution of calcium and magnesium is influenced not only by the initial concentration of cations, but also by free fatty acids. The best redistribution was obtained when the concentration of free fatty acids was 900 µmol/l, magnesium 1 mmol/l, and calcium 3 mmol/l, which is consistent with the optimal value of cations in the blood plasma. Conclusion. Patients with paroxysmal atrial fibrillation had a significantly lower magnesium content in whole blood and inside the blood cells; magnesium concentration in the cells and in whole blood closely correlated with the results of the clinical test for evaluating magnesium deficiency; intracellular magnesium content can be influenced by the complexing interaction with free fatty acids.

Prediction of recurrence of paroxysmal atrial fibrillation based on RR interval

Atrial fibrillation (AF) is one of the most common arrhythmias, which does great harm to patients. Effective methods were urgently required to prevent the recurrence of AF. Four methods were used to analyze RR sequence in this paper, and differences between Pre-AF (preceding an episode of AF) and Normal period (far away from episodes of AF) were analyzed to find discriminative criterion. These methods are: power spectral analysis, approximate entropy (ApEn) and sample entropy (SpEn) analysis, recurrence analysis and time series symbolization. The RR sequence data used in this research were downloaded from the Paroxysmal Atrial Fibrillation Prediction Database. Supporting vector machine (SVM) classification was used to evaluate the methods by calculating sensitivity, specificity and accuracy rate. The results showed that the comprehensive utilization of recurrence analysis parameters reached the highest accuracy rate (95%); power spectrum analysis took second place (90%); while the results of entropy analyses and time sequence symbolization were not satisfactory, whose accuracy were both only 70%. In conclusion, the recurrence analysis and power spectrum could be adopted to evaluate the atrial chaotic state effectively, thus having certain reference value for prediction of AF recurrence.

Right phrenic nerve palsy following transcatheter radiofrequency current atrial fibrillation ablation: Case report

Phrenic nerve palsy (PNP) is a well-known complication of cardiac surgery or jugular/subclavian vein catheterization, presenting with cough, hiccups, dyspnoea/shortness of breath and, in some cases, ventilatory failure. Rarely, PNP is a complication of transcatheter radiofrequency ablation for atrial fibrillation. This report describes the case of a 72-year-old woman with a 2-year history of recurrent paroxysmal atrial fibrillation associated with occasional palpitations and shortness of breath who underwent routine transcatheter radiofrequency ablation. Three days after the procedure, the patient developed shortness of breath and progressive dyspnoea. Motor nerve conduction showed the absence of the right phrenic nerve compound motor action potential compared with the normal left side confirming the diagnosis of a right phrenic nerve palsy. This current case demonstrated the importance of undertaking an electrophysiological evaluation of phrenic nerve conduction after transcatheter radiofrequency ablation in patients presenting with palpitations and shortness of breath even if present a few days after the procedure.

Circadian rhythms of thyroid hormones in patients with ischemic heart disease, arterial hypertension, and atrial fibrillation

To evaluate the interrelationship between diurnal changes in thyrotropic hormone (TTH), free triiodothyronine (FT3), and clinical features of IHD in combination with AH and atrial fibrillation (AF). Levels of TTH, FT3, and plasma cortisol were measured in 133 patients with IHD and AH with or without paroxysmal AF. The studied indexes included duration ofIHD, AH, and AF; presence or absence of AF and AH; incidence rate of AF episodes per week; severity of exertional angina; systolic and diastolic BP; and EchoCG data. Morning and evening TTH levels were significantly different and reached high values in the morning and low values in the evening in most patients (n=91; 68.4%). A part of patients (n=42; 31.6%) showed anopposite tendency with high TTH values in the evening, i.e., inversion of the TTH fluctuations. Such patients more often had a history of myocardial infarction, a high class of exertional angina, and recurrence of paroxysmal AF. Patients with the TTH inversion had ashorter AH duration but somewhat higher BP. A part of IHD patients had inversed TTH circadian changes associated with more severe clinical manifestations of cardiovascular pathology.

Repeat ablation for paroxysmal atrial fibrillation – Does adenosine play a role in predicting pulmonary vein reconnection patterns?

BackgroundPulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. MethodsWe included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. ResultsFifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). ConclusionsIn repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.

Left atrium remodeling predicts late recurrence of paroxysmal atrial fibrillation after second generation cryoballoon ablation

BackgroundAtrial fibrillation (AF) is the most common arrhythmia worldwide. Nowadays, AF ablation is a valuable treatment option. It has been shown that the left atrium (LA) diameter is a predictor of AF recurrence after cryoballoon ablation (CBA). Since it does not reflect the true LA size, we compared the role of different LA anatomical parameters using echocardiography for the prediction of AF recurrence after CBA.MethodsWe retrospectively included 209 patients (mean age 56.1 ± 13.6 years, male 62%) with paroxysmal AF undergoing CBA. A transthoracic echocardiography was performed in all patients.ResultsAt a mean follow-up of 16.9 ± 6.3 months, AF recurred in 25.4% of the patients. LA anterior - posterior diameter (LAD), LA minimum volume (LAmin) and early AF recurrence were independent predictors of recurrence. Based on receiver operating characteristics, cut – off values for LAD and, LAmin were 41 mm, 23.69 mL, respectively. The negative predictive values for recurrence were 73% and 87.3% respectively. In patients with AF recurrence, a significant proportion (30.2%) showed LA longitudinal remodeling (LA superior – inferior diameter) even though classically measured LAD was normal.ConclusionsLongitudinal LA remodeling plays an additional role for predicting AF recurrence after CBA, in patients without LAD dilation. Moreover, LAmin had a high negative predictive value and was an independent predictor of AF recurrence. Therefore, a more complete LA anatomical assessment allows a better prediction of AF recurrences after CBA.

Second-generation cryoballoon ablation for recurrent atrial fibrillation after an index cryoballoon procedure: a staged strategy with variable balloon size

PurposeCurrently, information on the optimal approach of redo procedures for paroxysmal atrial fibrillation (PAF) is limited. Radiofrequency ablation is the preferred technique, with reported success rates of 50–70% at 1–2 years, whereas only few reports exist on redo cryoballoon (CB) ablations. We describe outcomes on a systematic approach of repeat procedures with a second-generation cryoballoon (CB-2) after a successful index CB ablation.MethodsCohort study of 40 consecutive patients with recurrent PAF (55% male), median CHA2DS2-VASc score 1 (IQR 0–3). Per protocol, a staged variable balloon size strategy was followed with a different balloon size during the redo as compared to the index procedure. Minimal follow-up was 12 months (median 17 months [IQR 14–39]).ResultsOverall, 120 pulmonary veins (PVs) (75%) showed chronic isolation: 64% (41/64) for first-generation cryoballoon (CB-1) and 82% (79/96) for CB-2 index procedures, respectively (p = 0.01). The overall mean number of reconnected PVs per patient was 1.0 (40/40): 1.4 for CB-1 and 0.7 for CB-2 index procedures (p = 0.008). Phrenic nerve palsies (n = 7) resolved before the end of the procedure. At 1 year, 70% of patients were free of recurrent AF. In multivariate analysis, the only independent predictor of recurrence was the number of prior cardioversions.ConclusionsA systematic approach of repeat procedures with a CB-2 using a different balloon size than during the index CB ablation is safe, with acceptable 1-year outcomes. Future comparative studies on the optimal redo technique and approach are warranted to further improve rhythm control in AF.

Transformation from persistent atrial fibrillation to paroxysmal type after initial ablation predicts success of repeated ablation

BackgroundIf transformation from persistent atrial fibrillation (AF) to paroxysmal AF after catheter ablation had impacts on the outcome of repeated ablation was unclear. This study aimed to explore whether the type of recurrent AF after ablation for persistent AF was associated with recurrence after repeated ablation. Methods and resultsThis was a retrospective cohort study. 116 persistent AF patients undergoing the second ablation due to a failed initial ablation were enrolled in our study. Patients with recurrent paroxysmal AF after initial ablation were categorized as Group A (47 patients) while those with recurrent persistent AF were categorized as Group B (69 patients). The study endpoint was defined as any episode of AF, atrial tachyarrhythmia or atrial flutter lasting for >30 s, after the 3 month blanking period following repeated procedure. After 3–72 months (median: 24 months) of follow-up from repeated ablation, 54 (47%) patients suffered from recurrence after repeated ablation. In univariate analyses, Group B suffered a higher risk for recurrence than those in Group A (hazard ratio: 2.05, 95% confidence interval: 1.14–3.70, P = 0.01). Besides recurrent AF type, larger left atrial dimension at repeated procedure and pulmonary vein reconnection also predicted success of repeated ablation. In multivariate analysis, patients in Group B still had a 1.91-fold higher risk for recurrence than those in Group A (HR: 1.91, 95% CI: 1.06–3.44, P = 0.03). ConclusionsAfter persistent AF ablation, transformation from persistent AF to paroxysmal AF is independently associated with success of repeat ablation.

Predictors of the paroxysmal atrial fibrillation recurrence following cryoballoon-based pulmonary vein isolation: Assessment of left atrial volume, left atrial volume index, galectin-3 level and neutrophil-to-lymphocyte ratio

BackgroundCryoballoon-based pulmonary vein isolation (PVI) is a treatment option for atrial fibrillation (AF). Left atrial volume (LAV) and left atrial volume index (LAVi) are important parameters for long term success of PVI. Galectin-3 (Gal-3) and neutrophil to lymphocyte ratio (N/L ratio) are biomarkers to demonstrate the cardiac fibrosis and remodelling. Methods50 patients with symptomatic PAF despite ≥1 antiarrhythmic drug(s), who underwent PVI were enrolled. LAV, LAVi, Gal-3 and N/L ratio were calculated before ablation and after ablation at 6 and 12 months. According to AF recurrence patients were divided into two groups, recurrent AF (n = 14) and non-recurrent AF (n = 36). ResultsIn both groups (recurrent and non-recurrent), initial and 12 months follow-up LAV values were 41.39 ± 18.13 ml and 53.24 ± 22.11 ml vs 48.85 ± 12.89 ml and 42.08 ± 13.85 (p = 0.037). LAVi were 20.9 ± 8.91 ml/m2 and 26.85 ± 11.28 ml/m2 vs 25.36 ± 6.21 and 21.87 ± 6.66 (p = 0.05) for recurrent and non-recurrent AF groups, respectively. In both groups PVI had no significant effect on serum Gal-3 levels and N/L ratio during 12 months follow-up. The comparison between two groups at the end of 12th month showed Gal-3 values of 6.66 ± 4.09 ng/ml and 6.02 ± 2.95 ng/ml (p = 0.516), N/L ratio values of 2.28 ± 1.07 103/μl and 1.98 ± 0.66 103/μl (p = 0.674). ConclusionLAV and LAVi are useful to predict the remodelling of the left atrium and AF recurrence after cryoballoon-based PVI. However, biomarkers such as Gal-3 and N/L ratio are not associated with AF recurrence.

Assessment of left atrial function and dyssynchrony by real time three-dimensional echocardiography predicts recurrence of paroxysmal atrial fibrillation after radiofrequency ablation.

Left atrial volume and function are associated with recurrence of paroxysmal atrial fibrillation (AF) after radiofrequency ablation. A relationship between left atrial mechanical dyssynchrony and AF recurrence is presently unclear. The aim of this study was to investigate whether left atrial volume, function, and dyssynchrony were associated with AF recurrence in patients with normal left ventricular function, and normal or mildly enlarged left atrium, if assessed by the Real-time three-dimensional echocardiography (3DE). We included 88 patients with AF who had their first pulmonary vein isolation. There were 67 patients without and 21 patients with AF recurrence after radiofrequency ablation. Real-time 3DE was performed in the sinus rhythm the day before radiofrequency ablation. Left atrial volumes (maximum, minimum and preA), functions (passive, active and reservoir) and dyssynchrony were calculated. The latter was quantified by the standard deviation of time to minimum systolic volume (Tmsv-SD) from the end-diastole. There was no difference between left atrial volume and function in patients with or without AF recurrence. However, significant differences in left atrial Tmsv-SD were observed in patients with AF recurrence. In patients with normal left ventricular function, and normal/mildly enlarged left atrium, left atrial Tmsv-SD assessment by Real-time 3DE is a useful predictor of AF recurrence after radiofrequency ablation.

The correlation of pulmonary arterial hypertension with late recurrence of paroxysmal atrial fibrillation after catheter ablation.

Paroxysmal atrial fibrillation (PAF) is one of the most common clinical arrhythmias. Although radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation has continuously matured and developed in recent years, some patients treated with RFCA continued to have atrial fibrillation recurrence, and the recurrence rate was high. Determining indicators to predict the recurrence of PAF after RFCA is significantly important for improving the surgical success rate and guiding clinical work. This study aimed to investigate the influence of pulmonary arterial hypertension (PAH) on the late recurrence of PAF after RFCA. A total of 300 patients with PAF, who underwent RFCA for the first time at the Department of Cardiology of Fujian Union Medical College Hospital from January 2013 to October 2016, were retrospectively studied. These patients were regularly followed-up from 3 months at least to 3 years and clinical data were collected. In order to observe the 100 PAF patients with PAH were assigned into the observation group, and 200 PAF patients without PAH were assigned as the control group. PAH and its related clinical characteristics were evaluated by univariate analysis of variance (ANOVA) and logistic regression analysis. The follow-up results revealed that 34 patients had early recurrence, and the early arrhythmia recurrence rate was 11.3%. Furthermore, 22 patients had late recurrence, including 19 patients with atrial fibrillation and three patients with atrial flutter; and the late recurrence rate was 7.3%. The univariate ANOVA revealed that PAH (P=0.001), early recurrence (P=0.014) and Left atrial diameter (LAD) (P=0.023) had significant effects on late recurrence after PAF ablation. Furthermore, logistic regression analysis revealed that PAH (P=0.049, OR =1.053, 95% CI: 1.000-1.109) was independently correlated to late recurrence of PAF. PAH is a predictive factor for late recurrence of PAF after RFCA.

OP-96 - Predictors of the Paroxysmal Atrial Fibrillation Recurrence Following Cryoballoon-Based Pulmonary Vein Isolation: Assessment of Left Atrial Volume, Left Atrial Volume Index, Galectin-3 Level and Neutrophil-to-Lymphocyte Ratio

OP-96 - Predictors of the Paroxysmal Atrial Fibrillation Recurrence Following Cryoballoon-Based Pulmonary Vein Isolation: Assessment of Left Atrial Volume, Left Atrial Volume Index, Galectin-3 Level and Neutrophil-to-Lymphocyte Ratio

Transesophageal echocardiography measures left atrial appendage volume and function and predicts recurrence of paroxysmal atrial fibrillation after radiofrequency catheter ablation.

Paroxysmal atrial fibrillation (PAF) commonly recurs after radiofrequency catheter ablation (RFCA). This study aimed to assess left atrial appendage (LAA) volume and function by transesophageal echocardiography (TEE) and to explore its value in predicting PAF recurrence after RFCA. Eighty patients with PAF were recruited. The left atrial (LA) and LAA volume and function were measured by transthoracic echocardiography (TTE) and TEE before ablation. Patients were followed up for 12months after RFCA, and recurrence was recorded. Odds ratios of candidate risk indicators were determined by logistic regression analysis. Prediction model was constructed using logistic regression with backward selection. Receiver operating characteristic (ROC) curve with area under curve (AUC) was performed to evaluate the prediction efficiency. Twenty-four (30%) PAF patients had recurrence (R group), and 56 (70%) patients had no recurrence (NR group). Compared to NR group, LA dimension (LAD), LA volume index (LAVI), LAA maximum volume (LAAVmax), and LAA minimum volume (LAAVmin) were significantly higher in R group, while LAA peak emptying flow velocity (LAAeV), LAA peak filling flow velocity (LAAfV), and LAA ejection fraction (LAAEF) significantly declined in R group. According to multivariate analysis and backward selection, LAVI, LAAEF, and LAAeV were significant risk factors for PAF recurrence. The LAVI+LAAEF+LAAeV joint model could effectively predict PAF recurrence with AUC of 0.893 (95% confidence interval=0.816, 0.970), sensitivity of 0.75, and specificity of 0.929. This study demonstrated that LAVI, LAAEF, and LAAeV were significant predictors of PAF recurrence after RFCA.

Left atrial quantitative ultrasonic analysis in predicting the recurrence of atrial fibrillation after ablation

Objective To evaluate the predictive value of radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation by measuring the left atrial structure and functional parameters with quantitative echocardiography. Methods One hundred and two patients with atrial fibrillation underwent radiofrequency ablation and 22 healthy cases as control group were enrolled in this study.Early diastolic strain(Se), global diastolic strain(Sg), late diastolic strain(Sa=Sg-Se), early diastolic strain rate(SRe), late diastolic strain rate(SRa), systolic strain rate (SRs) were measured. The standard deviations were calculated by time to peak of strain and strain rate.Left atrial maximum volume (LAVmax) and left atrial minimum volume (LAVmin) were measured. Left atrial stroke volume (LASV) and left atrial ejection fraction (LAEF) were calculated. The regression equation was obtained by binary logistic regression analysis. The individual probabilistic variables generated in the SPSS worksheet were selected to plot the multivariate ROC curve to determine the area undercurve (AUC) and the optimal cutoff point. Results In the group of paroxysmal atrial fibrillation: Sg, Se, Em decreased and TPSR-SD, TPSRs-SD increased significantly (P<0.05) in the relapsed patients; The logistic regression equation was P=1/[1+ e-(3.994+ 0.22×Se+ 0.115×Sg+ 0.04×TPSRe-SD-0.354×Em+ 0.02×TPSRsSD)]. With P≥0.202 as thecut-off, the sensitivity and specificity of recurrence were the highest, 88.9% and 89.4% respectively.In the group of persistent atrial fibrillation: the SRs, LAEF and LASV decreased and E/Em increased (P<0.05 ) in the relapsed patients. The logistic regression equation was P=1/[1+ e-(1.139-0.102LASV + 0.348×E/Em-3.266×LAEF-0.417×SRs)]. With P≥0.502 as thecut-off, the sensitivity and specificity of recurrence were the highest, 77.3% and 79.2% respectively. Conclusions Left atrial ultrasound quantitative analysis techniques to atrial fibrillation ablation recurrence have good predictive value. The recurrence of paroxysmal atrial fibrillation can be predicted by the strain rate and the standard deviation of time to peak of strain rate, and the persistent atrial fibrillation by LASV, LAEFand SRs. The multivariate analysis shows a higher predictive value. Key words: Echocardiograhy; Atrial fibrillation; Radiofrequency ablation; Two-dimensional speckle tracking imaging; Strain

Long-QT syndrome: to be or not to be iatrogenesis – a case report

Long-QT syndrome is a congenital or acquired disorder of the heart’s electrical activity, inducing delayed repolarization that can cause ventricular arrhythmias and sudden cardiac death. Acquired forms can occur as a result of various drugs and given the fact that most patients have multiple comorbidities, the risk of polymedication and iatrogenesis is increasingly high. We present the case of a 60-year-old female admitted to the Cardiology Department for an arrhythmic storm, associating QT interval prolongation. The patient had a known history of atrial fibrillation and was undergoing antiarrhythmic therapy with flecainide. The hypothesis of a drug-induced long-QT syndrome was raised. Multiple ventricular arrhythmias requiring defibrillation occurred and intubation with mechanical ventilation was needed, followed by temporary ventricular pacing. We decided the discontinuation of flecainide therapy but over the next days, the patient presented persistent QT interval prolongation, multiple recurrences of ventricular arrhythmias and recurrent paroxysmal atrial fibrillation. In this context, the initial hypothesis of a flecainide-induced long QT syndrome was invalidated and given the persistent QT interval prolongation (QTc > 480 ms); the hypothesis of a congenital long-QT syndrome was raised. An implantable cardioverter defibrillator implantation was performed. The ECG holter monitoring after implantation showed the disappearance of ventricular arrhythmias, with favorable clinical evolution.