Recurrent Paroxysmal Atrial Fibrillation Research Articles

Superior vena cava isolation in paroxysmal atrial fibrillation - mind the phrenic

Abstract Background Pulmonary vein isolation (PVI) is the standard of care for patients with atrial fibrillation (AF), but medium-term success rates are far from ideal. Therefore, new methods are being developed, with emphasis on ectopic foci outside the pulmonary veins. Superior vena cava (SVC) is one of the most important non-pulmonary origins of AF and some studies suggested that empiric SVC isolation could improve outcomes in ablation of paroxysmal atrial fibrillation (PAF). Although complications have been reported in SVC ablation, most studies found complication rates of SVC ablation similar to conventional cryoballoon PVI. Aim This prospective, single-center study aimed to assess the complication rate and success rate of PVI followed by SVC isolation by cryoballoon application in comparison with conventional cryoballoon PVI. Methods We designed an unblinded, randomized clinical trial and recruited consecutive patients with PAF who were randomized to a conventional cryoballoon PVI or PVI and additional SVC cryoballoon isolation using single 180 s freeze. Results A total of 140 patients (61.4% male, mean age 62.1 years) with PAF were included and 67 (47.9%) were randomized to SVC isolation in addition to conventional ablation. Planned 180-s freeze in the SVC could be completed in 15 (22.4%) patients, while 27 (40.3%) patients received at least 120-s freeze. The mean time to SVC isolation was 40.2 ± 37.9 s. Real-time recording of SVC isolation was observed in 39 (58.2%) patients. Right phrenic nerve palsy (PNP), impending or transient, occurred in 6 (8.2%) patients in the PVI-only group and in 25 (37.3%) patients in the SVC-group (Chi-square test p < 0.001). There were no persistent PNP cases. Bradycardia or junctional rhythm was observed during a procedure in 15 (22.4%) patients who received SVC isolation. One patient eventually received a permanent AAI pacemaker due to a sinus node injury. Conclusion Our data suggest that SVC isolation can be successfully achieved in the majority of PAF patients using conventional cryoballoon. However, this significantly increases the rate of transient or impending PNP and sinus node injury in comparison to conventional cryoballoon PVI. Therefore, careful phrenic nerve function monitoring and attention to sinus bradycardia or junctional rhythm are important to mitigate this risk. Follow-up data are being collected to determine whether this risk could be outweighed by a lower rate of PAF recurrence.

Catheter ablation for persistent atrial fibrillation: patterns of recurrence and impact on quality of life and health care utilisation.

Patterns of atrial fibrillation (AF) recurrence post catheter ablation for persistent AF are not well described. This study aimed to describe the pattern of AF recurrence seen following catheter ablation for persistent AF (PsAF) and the implications for healthcare utilisation and quality of life. This was a post-hoc analysis of the CAPLA study, an international, multi-centre study that randomised patients with symptomatic PsAF to pulmonary vein isolation plus posterior wall isolation or pulmonary vein isolation alone. Patients underwent twice daily single lead ECG, implantable device monitoring or three monthly Holter monitoring. 154 of 333 (46.2%) patients (median age 67.3 years, 28% female) experienced AF recurrence at 12-month follow-up. Recurrence was paroxysmal in 97 (63%) patients and persistent in 57 (37%). Recurrence type did not differ between randomisation groups (p=0.508). Median AF burden was 27.4% in PsAF recurrence and 0.9% in paroxysmal AF (PAF) recurrence (p<0.001). Patients with PsAF recurrence had lower baseline left ventricular ejection fraction (PsAF 50% vs PAF 60%, p<0.001) and larger left atrial volume (PsAF 54.2±19.3 ml/m² vs PAF 44.8±11.6 ml/m², p=0.008). Healthcare utilisation was significantly higher in PsAF (45 patients [78.9%]) vs PAF recurrence (45 patients [46.4%], p<0.001) and lowest in those without recurrence (17 patients [9.5%], p<0.001). Patients without AF recurrence had greater improvements in quality of life as assessed by the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (Δ33.3±25.2 points) compared to those with PAF (Δ24.0±25.0 points, p=0.012) or PsAF (Δ13.4±22.9 points, p<0.001) recurrence. AF recurrence is more often paroxysmal after catheter ablation for PsAF irrespective of ablation strategy. Recurrent PsAF was associated with higher AF burden, increased healthcare utilisation and antiarrhythmic drug use. The type of AF recurrence and AF burden may be considered important endpoints in clinical trials investigating ablation of PsAF.

Durability of CLOSE-Guided PulmonaryVein Isolation in Persistent Atrial Fibrillation: A Prospective Remapping Study.

Recurrence of paroxysmal atrial fibrillation (AF) following pulmonary vein isolation (PVI) is presumably caused by pulmonary vein (PV) reconnections. However, there is little data available on the durability of PVI and incidence of arrhythmia recurrence in patients with persistent AF. To evaluate the lesion durability by means of an a priori planned remapping procedure in patients with persistent AF undergoing CLOSE-guided PVI. In a prospective study, we included patients with symptomatic, persistent AF undergoing CLOSE-guided radiofrequency ablation. Irrespective of AF recurrence, a redo procedure was mandated 6months following the index procedure to evaluate PV reconnections. The outcome of AF ablation was based on clinical recurrence and 7-day Holter electrocardiogram 3 and 6months after the index procedure and 3, 6, and 12months after the redo procedure. Of 30 patients included, 26 (81% men; median age 68 years) underwent the planned remapping study a median of 6months after the index procedure, whereas 4 patients without recurrence refused a repeat procedure. In total, 78 of 102 (76%) PVs showed durable isolation and 15 patients (58%) presented complete isolation of all PVs. Beyond the blanking period, 6 of 26 patients (23%) had arrhythmia recurrence before the redo procedure. Recurrence had occurred in 33% of patients with complete isolation of all veins and in 9% of patients with PV reconnections (P = 0.197). After re-PVI in patients with PV reconnections and additional ablation in patients with recurrence but durable PVI, 17 of 26 patients (65%) were free of arrhythmia after 12months. In patients with persistent AF, CLOSE-guided PVI resulted in durable rate of PVI on a per-vein and per-patient level of 76% and 58%, respectively. Arrhythmia recurrence was numerically higher in patients with durable PVI compared with patients without.

Correlation Analysis of Pulmonary Vein Anatomy and Paroxysmal Atrial Fibrillation Recurrence after Cryoballoon Ablation

Background: Cryoballoon ablation (CBA) is a reliable therapy for paroxysmal atrial fibrillation (pAF). However, the relatively high recurrence rate poses a perplexing challenge for clinicians; thus, a more detailed understanding of the pulmonary vein anatomy and the left atrial (LA)-pulmonary vein (PV) conjunction mode is needed. This study aimed to explore the correlation between the PV anatomy and pAF recurrence in patients who underwent the index CBA. Methods: We included 274 consecutive pAF patients (men: 60%, mean age: 58.8 ± 11.5 years, median AF history: 25 (8, 63) months) with pAF who underwent their first cryoballoon ablation between October 2019 and March 2022. All data were collected from the patient’s medical records. Subsequent post-procedural long-term follow-up and statistical analysis were conducted. Results: Amongst the total patients, 220 (80%) remained AF-free. Multivariate analysis showed that the right inferior PV (RIPV) vertical angle (hazard ratio (HR): 1.097, 95% CI: 1.071–1.124, p &lt; 0.001) and PV variation (HR: 1.905, 95% CI: 1.079–3.362, p = 0.026) correlated with postoperative AF recurrence. The study investigated the effectiveness of the RIPV vertical angle, either alone or in combination with other recognized factors. Conclusions: In patients with pAF who underwent the index CBA, the RIPV vertical angle and PV variation served as reliable prognostic predictors. Specifically, the RIPV vertical angle, either alone or in combination with recognized factors, demonstrated effective predictive performance.

Case of spontaneous hematoma of the renal compartment resulting in hemorrhagic shock: A unique presentation in urology

Hemorrhagic shock from spontaneous retroperitoneal hematoma of renal origin is a rare condition, and there are few publications on this subject. We present the case of a 60-year-old obese patient who experienced hemorrhagic shock from a right renal subcapsular hematoma that had ruptured into the retroperitoneum after initiation of anticoagulant treatment for acute pulmonary edema in the context of recurrent paroxysmal atrial fibrillation. The CT scan revealed a retroperitoneal hematoma and a possible hemorrhagic cyst in the right kidney. An emergency nephrectomy was necessary for hemostasis. The histology of the nephrectomy specimen confirmed the diagnosis of renal cell carcinoma.

The impact of MicroRNA-155 on the effect of cryoablation in paroxysmal atrial fibrillation.

Elevated plasma MicroRNA-155 (miR-155) levels are strongly associated with cardiac fibrosis and chronic inflammation processes. However, the relationship between miR-155 and paroxysmal atrial fibrillation (PAF) recurrence following cryoablation remains poorly explored. We aimed to evaluate whether elevated miR-155 is related to long-term AF recurrence following cryoablation. Preoperative miR-155 levels were determined in PAF patients undergoing initial cryoablation. Multivariate-adjusted Cox models were constructed to determine the relationship between miR-155 levels and PAF recurrence. Multivariate logistic regression analyses were performed to determine predictors of PAF recurrence. Of the 66 enrolled patients, 13 patients (19.7%) had recurrence at the 12-month following-up. These patients had significantly higher baseline miR-155 levels than those without PAF recurrence ((AAA ± BBB) vs. (AAA ± BBB), P < 0.05). The study results showed that miR-155 expression levels were significantly higher in the experimental group than in the control group. Additionally, logistic regression analysis revealed that miR-155 expression was positively correlated with PAF recurrence after cryoablation. Elevated preoperative miR-155 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following cryoablation.

Circulating circRNA expression profile and its potential role in late recurrence of paroxysmal atrial fibrillation post catheter ablation

Circulating circRNA expression profile and its potential role in late recurrence of paroxysmal atrial fibrillation post catheter ablation

Baroreceptor Reflex Sensitivity in Patients with Atrial Fibrillation

Purpose: Persistent atrial fibrillation decreases baroreflex sensitivity (BRS), which is considered an indicator of cardiac autonomy. Furthermore, atrial fibrillation ablation has also been found to reduce the BRS. The baseline BRS of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PeAF) was compared and the BRS-modifying effect of ablation was investigated. Methods: The BRS was measured before and after the procedure and the presence or absence of atrial fibrillation recurrence was assessed. Results: Pre-operative BRS was significantly lower in patients with PeAF compared with those with PAF. The BRS was significantly reduced postoperatively in all patients, with a particularly large reduction in PAF patients. The BRS decreased to a lesser extent with ablation in patients with recurrent PAF. Conclusions: Baseline BRS was lower in patients with PeAF. Atrial fibrillation ablation reduced BRS in both PAF and PeAF patients but had a stronger reduction effect in PAF patients.

Pulmonary vein anatomy evaluated prior to atrial fibrillation ablation through multicentre electronic medical records: clinical decision support from a real-world multicentre observational study

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary vein (PV) isolation is a cornerstone ablation strategy in the management of patients with atrial fibrillation (AF). PV frequently display anatomical variants, which may compromise the results of cryoballoon ablation (CBA). Purpose We aimed to determine PV variation patterns in real-world patients undergoing CBA for AF and their impact on procedural success using a multicentre electronic medical records (Casiopea) sharing cardiac computed tomography (CT) scan studies performed in the referring centres and evaluated prior to the procedure in the EP reference hospital. Methods We included consecutive patients with paroxysmal or persistent AF who referred for CBA to a EP reference hospital in Spain from 2017 to 2021. All patients underwent systematic standardized CBA. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by CT- scan. Blinded data were analysed by a imaging Core Lab. PV and LA anatomy were evaluated in 3-dimensional reconstructions using EnSite NavX electroanatomic mapping system. Ablation procedure was performed using either 23 or 28 mm cryoballoon according to the operator's criteria and potential predictors for AF recurrence were recorded. Results 104 patients were included (mean age 58±8 year-old, 85% male). 76 patients (73%) had recurrent paroxysmal AF, failure of antiarrhythmic drugs was present in 96% and prior radiofrequency ablation in 4%. Conventional PV anatomy consisting in 4 veins was present in 83 patients (80%), left or right common vein in 13 (13%) and accessory veins in 8 (7%). Figure. 61 patients (59%) showed left atria enlargement (&amp;gt; 40 mm or area &amp;gt; 20 cm2). CBA was performed using a 28 mm cryoballoon in 98 patients (94%). Temperature achieved during ablation was below -40°C in all the veins in 80% of the procedures. Procedural-related complications occurred in 6 patients (5%), transient phrenic nerve palsy in 2 patients and vascular damage in 4. All patients were under antiarrhythmic drugs and continued for at least 6 months after the procedure. After 19±9 months of follow-up, freedom from AF recurrence after the blanking period was 73%. Univariate analyses identified the following baseline characteristics predicted AF recurrence: prior ablation (OR = 3.6 p=0.03; 95% CI 1.1-12.3), complete PV isolation with temperature below -40°C (OR = 0.16 p = 0.001; 95% CI 0.05-0.48) and AF recurrence during the blanking period (OR = 6.3, p &amp;lt;0.001; 95% CI 2.9-13.8). PV anatomy was not a limitation nor a predictor for AF recurrences in the long-term follow-up (OR = 0.56 p = 0.17; 95% CI 0.24-1.28). Conclusion This evaluation of multicentre electronic medical records sharing CT scan studies prior CBA showed that the procedure was safe and effective with regard to the PV anatomy. The presence of anatomical variants of PV should not discourage about efficacy and it is not a limitation for CBA.

Beat to beat P wavelet analysis in addition to standard P wave indices as correlates of left atrial extent of low voltage areas in patients with PAF undergoing catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. BACKROUND Left atrium (LA) fibrosis has been shown to be an important factor associated with atrial fibrillation recurrence after catheter ablation (CA). Morphological features of the P wave have been related to the extent of atrial fibrosis as identified with electroanatomic mapping (EAM) in patients with paroxysmal atrial fibrillation (PAF) undergoing catheter ablation (CA). The ability to assess, by means of non-invasive markers, the electroanatomical substrate of the LA and the likelihood of PAF recurrence after CA, could be very useful in PAF management, patient selection for CA and improving outcomes. Purpose In the current prospective cohort study we aimed at establishing a pathophysiological basis of beat-to-beat (B2B) P-wave morphological and wavelet analysis, showing that it is associated with areas of considerable fibrosis, as identified with EAM in patients with PAF. Methods 44 patients with symptomatic paroxysmal AF, diagnosed at least 6 months before, were enrolled. 12-lead electrocardiogram (ECG) recordings, as well as 12 min vectorcardiogram (VCG) recordings were obtained from all patients, while EAM of left atrium (LA) was performed in all patients before radiofrequency CA. B2B P-wave morphological and wavelet analysis was performed according to a methodology described in previous publications. Results The 35 patients who were valid for statistical analysis were divided into 2 groups: in Group A the total low-voltage (&amp;lt;0.5 mV in EAM) area was greater than the median value of 5.55% (large low-voltage area), while in Group B the total low-voltage area was &amp;lt;5.55% (small low-voltage area). From the correlation between standard P-wave indices derived from 12-lead ECG and low-voltage areas only P-wave duration was significantly different between the two groups. From orthogonal ECG parameters analysis X axis was the most representative of low-voltage areas. B2B P-wave analysis revealed 3 features which showed a statistically significant difference between the 2 groups and no collinearity (Table 1). Logistic regression analysis of the non correlated variables for the prediction of low-voltage areas is shown in Table 2. It seems that a longer distance between the P-wave peak and the P-wave end, as well as a more «flattened» P-wave (small area with long duration) is associated with larger low-voltage areas and consequently more extensive LA fibrosis. Conclusions In patients with PAF and no overt atrial myopathy, B2B wavelet analysis may be a useful non-invasive tool for the prediction of low-voltage areas, representing fibrosis in the LA. Further studies in larger cohorts of patients are needed in order to confirm these findings and enable the use of B2B wavelet analysis in clinical practice.

PO-04-079 FIRING EXTRA CHAMBERS: COR TRIATRIATUM SINISTER WITH ATRIAL FIBRILLATION

Cor triatriatum sinister (CTS) is a rare congenital defect in which the left atrium is divided into two chambers by a fenestrated fibromuscular septum. It is found in less than 0.1% of clinically diagnosed cardiomyopathy and 0.4% of autopsies of congenital heart disease patients. Dyspnea was reported as the most common symptom and atrial fibrillation (AF) was described in 30% of the published cases of CTS. We report a young patient with CTS who had recurrent paroxysmal atrial fibrillation (PAF) that underwent standard radiofrequency (RF) pulmonary vein isolation (PVI). 1. To recognize the relation of a rare congenital anomaly to AF 2. Effectiveness of standard PVI in CTS with AF NA A 39-year-old male was referred for symptomatic PAF with CHAD2VASc score of 3. Medical history was significant for CTS, tachybrady syndrome status post leadless pacemaker, diabetes, hypertension, HFpEF, and sleep apnea on CPAP. Pertinent medications were rivaroxaban, diltiazem and metoprolol. AF burden could not be determined. Echocardiogram revealed LA volume of 119 ml, CTS with volume index 52ml/m2 with an opening of 0.8 cm2 and moderate mitral regurgitation with valve area 2.9cm2, PHT 77 ms. Right heart cath showed PAP 50/30 mmHg, PCWP 30 mmHg and PVR 0.8 Woods unit. Cardiac index was 3.5L/min/m2. Despite optimization of rate control therapy and DC cardioversion, the patient had recurrent debilitating AF and decided to undergo RF AF ablation. Intracardiac echo showed the membrane to be attached to the posterolateral ridge laterally and to the interatrial septum medially. Voltage mapping revealed a healthy posterior wall. PVI was achieved successfully with first pass ablation. Patient maintained sinus rhythm at the 3 months follow up. CTS was first described in 1868 by Church. Development of AF from CTS in adults can be related to calcification of the membrane fenestrations leading to mitral stenosis and eventual development of mitral regurgitation with aging.

Development and Validation of a Novel Prognostic Tool to Predict Recurrence of Paroxysmal Atrial Fibrillation after the First-Time Catheter Ablation: A Retrospective Cohort Study

There is no gold standard to tell frustrating outcomes after the catheter ablation of paroxysmal atrial fibrillation (PAF). The study aims to construct a prognostic tool. We retrospectively analyzed 315 patients with PAF who underwent first-time ablation at the Second Xiangya Hospital of Central South University. The endpoint was identified as any documented relapse of atrial tachyarrhythmia lasting longer than 30 s after the three-month blanking period. Univariate Cox regression analyzed eleven preablation parameters, followed by two supervised machine learning algorithms and stepwise regression to construct a nomogram internally validated. Five factors related to ablation failure were as follows: female sex, left atrial appendage emptying flow velocity ≤31 cm/s, estimated glomerular filtration rate <65.8 mL/(min·1.73 m2), P wave duration in lead aVF ≥ 120 ms, and that in lead V1 ≥ 100 ms, which constructed a nomogram. It was correlated with the CHA2DS2-VASc score but outperformed the latter evidently in discrimination and clinical utility, not to mention its robust performances in goodness-of-fit and calibration. In addition, the nomogram-based risk stratification could effectively separate ablation outcomes. Patients at risk of relapse after PAF ablation can be recognized at baseline using the proposed five-factor nomogram.

Simultaneous bilateral shoulder arthroplasty: a case series.

Staged bilateral shoulder arthroplasty procedures have been shown to have good functional outcomes. The next step is to explore the option of simultaneous bilateral shoulder arthroplasty (SBSA). We report on the first case series of SBSA in the United States. The purpose of this study was to examine the safety and postoperative complication profile of SBSA and provide a technique reference for surgeons considering performing or investigating this procedure. We conducted a retrospective record review of all the SBSA procedures performed by the senior author between 2007 and 2020. Patient demographic characteristics, surgical information, and postoperative data were collected. Data were compiled, and means, standard deviations, and ranges were calculated. Any readmissions or postoperative complications requiring revision were noted. A cohort of patients matched for age, sex, and body mass index with staged (sequential) bilateral total shoulder arthroplasty was analyzed for comparison. Thirteen patients were identified in the simultaneous group (SBSA). The mean age was 64±15 years, with 9 women (69%) and 4 men (31%); the mean body mass index was 29.1±7.5. The mean American Society of Anesthesiologists score was 2.55±0.7, average blood loss was 364±170 mL (range, 50-600 mL), 5 of 13 patients (38%) underwent blood transfusions, and the mean surgical time was 183±42 minutes. Postoperatively, the mean visual analog scale pain score on postoperative day 1 was 4±2 (range, 0-7), and the mean length of stay was 3.3 days. Postoperative complications included urinary tract infections in 2 patients, urinary retention in 2 patients, and recurrence of paroxysmal atrial fibrillation in 1 patient. No patient was readmitted within 90 days of surgery. One patient underwent a reoperation 2 years postoperatively for symptomatic hardware removal (cerclage cables around the tuberosities). A matched cohort of staged bilateral total shoulder arthroplasty patients was analyzed for comparison. Postoperative complications in the staged group included 1 reverse total shoulder arthroplasty patient with subjective instability that was managed with additional physical therapy. There were no documented readmissions within 90 days or revision arthroplasty procedures in either cohort. SBSA is a reasonable procedure that can be useful in select patients, with promising short-term safety noted in this series. Prospective randomized studies are needed to assess the long-term safety and efficacy of the procedure.

The Impact of Radiofrequency Wide Circumferential Pulmonary Vein Isolation on Left Atrial Geometry in Patients with Recurrent Atrial Fibrillation

Purpose: The aim of the study was to investigate the effect of wide area circumferential radiofrequency catheter ablation (WACA) pulmonary vein isolation on left atrium (LA) geometry. Methods: Seventy-one patients underwent WACA, for recurrent paroxysmal (n = 31) and persistent (n = 40) atrial fibrillation (AF). A three-dimension rotational angiography of the LA was obtained immediately prior to index and repeat procedure. Results: Significant reduction of LA volume (65.6 ± 14 mL/m² vs. 62.2 ± 15 mL/m², p < 0.001) and surface (74.4 ± 11.2 vs. 70.4 ± 11.2 cm²/m², p < 0.001) was noted. LA sphericity increased significantly (82 ± 2% vs. 83 ± 2%, p = 0.004) in all 71 patients. Patients with paroxysmal AF showed significant reduction of LA volume (121.8 ± 25.7 vs. 116 ± 32 mL, p = 0.008) and increase of LA sphericity (82.3 ± 2.1 vs. 83.1 ± 2%, p = 0.009). Patients with persistent AF showed significant decrease of LA volume (133.5 ± 32 vs. 126 ± 32 mL, p = 0.005) and LA surface area (76.3 ± 12.3 vs. 71.8 ± 12.4 cm²/m², p = 0.005). LA sphericity (82.4 ± 2.8 vs. 83 ± 2.4%, p = ns) remained unchanged. Conclusions: WACA results into significant reduction of LA volume and surface area. Increased LA sphericity is observed in paroxysmal AF only.

Application of dynamic display technology to identify gaps after pulmonary vein isolation in catheter ablation of atrial fibrillation

BackgroundThe identification of post pulmonary vein isolation (PVI) gaps by activation and voltage maps is time-consuming. This study aimed to investigate the characteristics, efficiency and accuracy of LiveView dynamic display module (EnSite™ Dynamic Display; Abbott, Abbott Park, IL, USA) in unmasking post PVI gaps and conduction block line. MethodTwenty four patients with paroxysmal atrial fibrillation (PAF) who failed to achieve first-pass PVI or with recurrent PAF were enrolled. Ninety-six pulmonary veins (PVs) were evaluated, and gaps were identified in 25 (26.0%) PVs. The gap location was confirmed by activation and propagation maps; 110 frames on gaps and 118 frames on block lines were analyzed by using LiveView module. We defined isochronal crowding in the local activation time (LAT) mode as three colors between two adjacent electrodes. Each frame was classified as with or without isochronal crowding in LAT mode and one/continuous color or isochronal discontinuity in reentrant mode. The gray color inside the PVs was considered to represent conduction block. ResultThe isochronal crowding could be found on both gap and block line in LAT mode, whereas isochronal discontinuity only presented on the block line in reentrant mode. The sensitivity and specificity of isochronal discontinuity or gray color in reentrant mode to identify block line were 61.0% and 100%, respectively. The sensitivity and specificity of isochronal crowding or gray color in LAT mode to identify block line were 71.2% and 71.8%, respectively. ConclusionReentrant mode in LiveView module is very specific in identifying block lines. We proposed an efficient, practical algorithm to differentiate the block line from PV gaps.

Adding six short lines on pulmonary vein isolation circumferences reduces recurrence of paroxysmal atrial fibrillation: Results from a multicenter, single-blind, randomized trial.

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) is associated with a non-negligible long-term recurrence rate. The purpose of this study was to investigate whether PVI combined with 6 short ablation lines on the PVI circumferences (PVI+6L group) yields higher success rates than PVI alone (PVI group). In this multicenter, single-blind, randomized trial, a total of 390 patients with paroxysmal AF were randomly assigned to the PVI group (n = 193) or the PVI+6L group (n = 197). The primary endpoint was freedom from AF/atrial tachycardia recurrence between 91 and 365 days. Secondary endpoints included AF burden, procedural parameters, and complications. Freedom from atrial tachyarrhythmia was achieved in 160 of 197 patients (81.2%) in the PVI+6L group and 142 of 193 patients (73.6%) in the PVI group (hazard ratio 0.61; 95% confidence interval 0.39-0.97; P = .040). Mean AF burden tended to be lower in the PVI+6L group compared to the PVI group (1.95% vs 0.53%, P = .097). Procedural and ablation times were slightly longer in the PVI+6L group than in the PVI group (130 ± 25 minutes vs 121 ± 28 minutes; P = .002; and 46 ± 14 minutes vs 41 ± 16 minutes, P = .001, respectively). X-ray exposure was similar (60 ± 54 seconds vs 61 ± 60 seconds; P = .964). Complications occurred in 3 patients (1.6%) in the PVI group and 3 patients (1.5%) in the PVI+6L group. In patients with paroxysmal AF undergoing catheter ablation, adding 6 short ablation lines on the PVI circumferences could reduce the AF recurrence rate.

Prediction of Paroxysmal Atrial Fibrillation Recurrence after Catheter Ablation Using Deep Learning of 12-Lead ECG

Prediction of Paroxysmal Atrial Fibrillation Recurrence after Catheter Ablation Using Deep Learning of 12-Lead ECG

The influence of metabolic syndrome on atrial fibrillation recurrence: five-year outcomes after a single cryoballoon ablation procedure.

BACKGROUNDMetabolic syndrome (MetS) has been reported as a risk factor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation. This study aimed to investigate the long-term influence of MetS on paroxysmal AF recurrence after a single cryoballoon ablation procedure, which was scarcely investigated yet in Chinese population.METHODSIn total, 137 paroxysmal AF patients who had successfully completed a single cryoballoon ablation procedure at Fuwai Hospital, Beijing, China from December 2013 to October 2015 were enrolled. Excepting for patients with AF recurrence, all patients were followed up for no less than five years. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.RESULTSAmong 137 paroxysmal AF patients, 91 patients (66.4%) had successfully achieved overall five-year follow-up after a single cryoballoon ablation procedure, and 44 patients (32.1%) had MetS. Patients with MetS had a significant lower incidence of freedom from AF recurrence than those without MetS (50.0% vs. 74.2%, log-rank P < 0.01) during the five-year follow-up. MetS (HR = 1.95, 95% CI: 1.069−3.551, P = 0.030) was an independent predictor of AF recurrence after adjusting for multiple factors. After the second year post cryoballoon ablation procedure, the recurrence rate of AF gradually increased in patients with MetS, in contrast, decreased recurrence rate of AF in patients without MetS. CONCLUSIONSMetS is an independent predictor for five-year AF recurrence after a single cryoballoon ablation procedure in paroxysmal AF patients. Combination therapy of AF and MetS may improve the long-term outcomes of AF patients.

The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study.

Aims: Catheter ablation of paroxysmal atrial fibrillation (PAF) has been shown to be effective and safe. However, recurrence of PAF varies between 10 and 30% for radiofrequency ablation. There have been no reports comparing long-term recurrence rates following radiofrequency ablation, cryoablation, and three-dimensional guided cryoablation plus radiofrequency ablation. The aim of this study was to observe the long-term recurrence rate of PAF when treated by these three catheter ablation methods, and to explore clinical factors that can potentially predict PAF recurrence following catheter ablation.Methods: There were 238 patients involved in this study, including 106 radiofrequency (RF) ablation cases (RF group), 66 cryoablation cases (Freeze group), and 66 cases treated by three-dimensional guided cryoablation combined with radiofrequency ablation (Freeze-plus-RF group). All patients underwent standardized follow-up. The recurrence rate of atrial fibrillation (AF) in the three groups was calculated. Predictive factors for the recurrence of AF were also investigated.Results: At 48 months (the median follow-up period), the sinus rhythm maintenance rate was 77.4% in the RF group, 72.7% in the Freeze group, and 81.8% in the Freeze-plus-RF group. The maintenance rate of sinus rhythm was highest in the Freeze-plus-RF group, but differences among the three groups were not statistically significant. Further analysis found that the preoperative left atrial appendage emptying velocity (LAAEV) (recurrence vs. no recurrence, 56.58 ± 18.37 vs. 65.59 ± 18.83, respectively, p = 0.003), left atrial (LA) anteroposterior dimension (recurrence vs. no recurrence, 36.56 ± 4.65 vs. 35.00 ± 4.37, respectively; p = 0.028), and LA vertical dimension (recurrence vs. no recurrence, 56.31 ± 6.96 vs. 53.72 ± 6.52, respectively; p = 0.035) were related to postoperative recurrence. Multiple Cox regression analysis showed that only LAAEV was predictive of postoperative recurrence of PAF (hazard ratio: 0.979; 95% confidence interval: 0.961–0.997).Conclusion: Our study found that there was no statistically significant difference in long-term recurrence rates among the RF, Freeze, and Freeze-plus-RF groups. Preoperative LAAEV is an independent predictor of postoperative recurrence of PAF.

An echocardiographic model for predicting the recurrence of paroxysmal atrial fibrillation after circumferential pulmonary vein ablation.

BackgroundAtrial fibrillation (AF) is a highly prevalent arrhythmia, with substantial associated morbidity and mortality. Circumferential pulmonary vein ablation (CPVA) is an effective rhythm control strategy, however, recurrence is an important factor influencing treatment decisions.HypothesisTo develop a predictive model based on left atrial (LA) structure and function, and evaluate its efficiency in predicting the recurrence of AF after CPVA.MethodsPatients with paroxysmal AF who underwent CPVA were enrolled in this study and randomly divided into a development set and a validation set. The clinical and echocardiographic data of each patient were collected. In the development set, a least absolute shrinkage and selection operator (LASSO) regression was used to establish a LA ultrasound feature. By combining that LA ultrasound feature with independent clinical risk factors, we established an echocardiographic model using multivariate logistic regression and plotted the corresponding nomogram.ResultsThe LA ultrasound feature established by LASSO regression included nine echocardiographic indicators related to LA structure and function. It also exhibited good predictive ability in both the development set and the validation set (AUC:0.944, 95%CI: 0.910–0.978; AUC:0.878, 95%CI: 0.816–0.942). Logistic regression analysis indicated that LA ultrasound feature and AF duration were independent predictors for AF recurrence. The combined model including LA ultrasound feature and AF duration also showed good discriminability in both the development set (AUC: 0.950, 95% CI:0.914–0.985) and the validation set (AUC: 0.890, 95% CI: 0.831–0.949). The calibration curve showed good agreement between the predicted value and observed value.ConclusionsOur model that is based on LA structure and function measured by echocardiography is a useful non‐invasive preoperative tool, which exhibits good accuracy in predicting the recurrence of AF after CPVA.