Safety Of Catheter Ablation For Atrial Fibrillation Research Articles

Long-term outcomes of catheter ablation for atrial fibrillation in octogenarians

Abstract Background Catheter ablation is superior to standard medical therapy in controlling atrial fibrillation (AF). There is limited data on the long-term outcomes of AF ablation in octogenarians. Purpose This study aims to rigorously evaluate the efficacy and safety of AF catheter ablation in octogenarians, compared to non-octogenarians. Methods In this retrospective, multicentre, international study in 13 centres in the United Kingdom, France, and Switzerland, the long-term outcomes of 473 consecutive octogenarian patients undergoing catheter ablation for AF were compared to 473 propensity-matched non-octogenarian controls (median age 81.3 [80.0, 83.0] vs 64.4 [56.5, 70.7] years, 54.3% vs 35.1% females; p-value for both <0.001). The primary endpoint was the recurrence of atrial arrhythmia during 365 days' follow-up after an initial blanking period of 90 days (median follow-up time 322 [153, 365] days. Results Acute success of the ablation was achieved in 97% of octogenarians. When comparing non-octogenarians vs octogenarians, there were more complications in the octogenarians group (11.4% vs 7.0%, p=0.018), with the most common adverse events being vascular complications (3.8% vs 2.7%). The median follow-up time was 322 [153, 365] days. Through day 365, 131 (27.7%) octogenarians had a recurrence of atrial arrhythmia as compared to 111 (23.5%) non-octogenarians (odds ratio 1.49; 95% confidence interval 1.16-1.92; p=0.002). In a multivariable regression model including gender, previous AF ablation, vascular disease, chronic kidney disease, CHA2DS2-VASc score, left atrial dilatation, and indwelling cardiac implantable electronic device, age above 80 remained an independent predictor of recurrence of atrial arrhythmias throughout 365 days' follow-up. Conclusion Age over 80 is associated with higher rates of recurrence of atrial arrhythmia on 365 days' follow-up post-catheter ablation for atrial fibrillation. Arrhythmia recurrence on follow-up

Atrial fibrillation catheter ablation in endurance athletes: systematic review and meta-analysis.

Atrial fibrillation (AF) management in endurance athletes (EA) is challenging due to the paucity of data, especially on the efficacy and safety of catheter ablation (CA). The hypothesis is that the efficacy and safety of AF CA in EA are comparable to the non-EA. Databases from EMBASE, Medline, PubMed, and Cochrane were searched from inception through February 2023. Studies with available information on efficacy and safety profiles were included. Effect estimates from the individual studies were extracted and combined using random effect and generic inverse variance method of DerSimonian and Laird. Nine observational studies with a total of 1129 participants were identified, of whom 51% were EA. Our analysis found that rate of atrial arrhythmia (AA) recurrences following AF CA was not statistically different between EA and non-EA (RR 1.04, I2 = 57.6%, p = 0.54). The AA survival rates after a single ablation in EA was 60.2%, which improved upto 77% after multiple ablations during the follow-up period. Infrequent complication rates ranging from 0 to 7.6% were observed, with no mortality. Our meta-analysis suggests that AF CA is as effective and safe in EA as in non-EA. In the future, AF CA should be considered as a first-line therapeutic choice in this patient group.

Safety of catheter ablation for atrial fibrillation in patients with cancer: a nationwide cohort study

ABSTRACT Background Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers. Objective We aimed to assess the outcomes and peri-procedural safety of CA for AF in patients with certain types of cancer. Methods The NIS database was queried between 2016 and 2019 to identify primary hospitalizations with AF and CA. Hospitalizations with secondary diagnosis of atrial flutter and other arrhythmias were excluded. Propensity score matching was used to balance the covariates between cancer and non-cancer groups. Logistic regression was used to analyze the association. Results During this period, 47,765 CA procedures were identified, out of which 750 (1.6%) hospitalizations had a diagnosis of cancer. After propensity matching, hospitalizations with cancer diagnosis had higher in-hospital mortality (OR 3.0, 95% CI 1.5–6.2, p = 0.001), lower home discharge rates (OR 0.7, 95% CI 0.6–0.9, p < 0.001) as well as other complications such as major bleeding (OR 1.8, 95% CI 1.3–2.7, p = 0.001) and pulmonary embolism (OR 6.1, 95% CI 2.1–17.8, p < 0.001) but not associated with any major cardiac complications (OR 1.2, 95% CI 0.7–1.8, p = 0.53). Conclusion Patients with cancer who underwent CA for AF had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism. Further larger prospective observational studies are needed to validate these findings.

AB-452666-1 EFFICACY AND OUTCOMES OF CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH END-STAGE RENAL DISEASE: ANALYSIS OF NATIONWIDE READMISSION DATABASE

End-stage renal disease (ESRD) is an independent risk factor for atrial fibrillation (AF). Catheter ablation (CA) for AF is a well-established, safe treatment option and is increasingly utilized. However, there is a paucity of current data on the efficacy and safety of CA for AF in patients with ESRD. To investigate the efficacy of AF ablation in patients with ESRD. We conducted a retrospective analysis of the Nationwide Readmission Database (NRD) from January 2016 to December 2019. Patients with AF and ESRD were identified using ICD-10-CM codes. The study cohort was further divided into two groups based on CA. Any admission within 180 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcome was AF readmission and secondary outcomes were mortality readmission, ischemic stroke readmission, heart failure readmission, major bleeding readmission and all cause readmission. We identified 200,555 ESRD patients admitted with AF during the study period. Out of these, 786 (0.4%) patients underwent CA for AF. Patients who underwent CA for AF were younger (median age in years, 67 vs 71, p<0.001), less likely to be females (32.2% vs 41.5%, p<0.001). After adjusting for confounders, patients with ESRD who underwent AF ablation had a significantly lower risk of readmission for AF (adjusted HR 0.88, 95% CI 0.80-0.97, p=0.01). Patients who underwent CA for AF also had a lower risk of readmission for HF (aHR 0.83, 95% CI 0.74-0.92, p=0.01), major bleeding (aHR 0.59, 95% CI 0.41-0.85, p=0.005), and all-cause readmission (aHR 0.87, 95% CI 0.79-0.95, p=0.02). Lastly, patients in AF ablation group also had lower all-cause in-hospital mortality (aHR 0.74, 95% CI 0.57-0.96, p=0.02). In patients with ESRD and AF, catheter ablation was associated with a lower risk of AF, HF, and all-cause readmission compared to patients who did not undergo ablation. AF ablation was also associated with significantly lower all-cause mortality. Further research is needed to establish CA's efficacy and long-term outcomes in patients with ESRD and AF.

PO-667-08 OUTCOMES AND SAFETY OF CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH CANCER: A NATIONWIDE ANALYSIS OF 57,730 PROCEDURES

Atrial fibrillation (AF) is the most common arrythmia in patients with cancer and management includes antiarrhythmic drugs (AAD) as well as catheter ablation (CA). There is a high risk of drug interactions in this patient population and long-term efficacy of AAD is not well defined. Catheter ablation (CA) is a well-established and safe treatment option in healthy patients with symptomatic and AAD resistant AF. However, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers.

Atrial fibrillation in the cardiometabolic patient.

Prevalence of obesity, metabolic syndrome (MetS) and type 2 diabetes (T2D) is growing alarmingly, and the number of affected people continues to escalate. Such cardiometabolic states exert many deleterious effects on the heart as they are associated with adverse left ventricular (LV) remodeling and, most notably, with a marked increase in the risk of developing atrial fibrillation (AF) and subsequent stroke. Epidemiological studies clearly show a strong association between obesity and AF, with a 4-5% increase in AF risk for every unit increase in BMI. The increased risk of developing AF in cardiometabolic patients is explained by changes in volume status, energy substrate utilization, tissue metabolism and systemic inflammation, all factors promoting elevation in left atrial and systolic blood pressure, LV systo-diastolic dysfunction, with subsequent atrial stretch and "triggers" for AF. In the present review, we critically discuss available evidence on AF risk in the cardiometabolic patient. Specific aspects will be discussed: 1) epidemiology and prognosis of AF in patients with obesity, MetS and T2D; 2) molecular mechanisms involved in the pathophysiology of metabolic cardiomyopathy and left atrial remodeling; 3) advances in medical therapy including weight loss strategies and lifestyle changes; 4) new oral anticoagulants and stroke risk in obese and diabetic patients; 5) effectiveness and safety of AF catheter ablation. Taken together, these novel insights point to the development of new therapeutic strategies to combat the burden of AF in patients with cardiometabolic disturbances.

Catheter ablation for atrial fibrillation on uninterrupted direct oral anticoagulants: A safe approach.

Current consensus guidelines suggest direct oral anticoagulants (DOACs) are interrupted periprocedurally for catheter ablation (CA) of atrial fibrillation (AF). However, this may predispose patients to thromboembolic complications. This study investigates the safety of CA for AF on uninterrupted DOACs compared to uninterrupted warfarin. This was a single-center, retrospective study of consecutive patients undergoing CA for AF. All patients were heparinized prior to transseptal puncture with a target-activated clotting time (ACT) of 300-350seconds. Patients who had procedures performed on continuous DOAC were compared to those on continuous warfarin. Clinical, procedural data, and complications occurring up to 3months were analyzed from a prospective registry with additional review of electronic health records. A total of 1,884 procedures were performed over 28months: 761 (609 patients) on uninterrupted warfarin and 1,123 (900 patients) on uninterrupted DOAC (rivaroxaban 64%, apixaban 32%, and dabigatran 4%). There was no difference in the composite endpoint of death, thromboembolism, or major bleeding complication (2.2%vs 1.4%, P=0.20). There was no difference in the complications comprising this, including tamponade, hematoma, pseudoaneurysm, and transfusion (P-values 0.28, 0.13, 0.45, and 0.36). There were no strokes, transient ischemic attacks, or other thromboembolic complications. There was no difference between groups in the proportion of tamponades requiring reversal of oral anticoagulation, the volume of blood lost, the proportion transfused, or the proportion drained percutaneously (P-values 0.50, 0.51, 0.36, and 0.38). Catheter ablation for AF can be performed safely and effectively in patients anticoagulated with DOACs and heparinized with a therapeutic ACT. There is no increased risk of periprocedural bleeding when compared to uninterrupted warfarin.

Outcomes of catheter ablation of atrial fibrillation in patients with hypertrophic cardiomyopathy: a systematic review and meta-analysis.

Over the past decade, catheter ablation (CA) has become an established therapy for symptomatic atrial fibrillation (AF). Atrial fibrillation is common in hypertrophic cardiomyopathy (HCM) patients, and restoring sinus rhythm is of great clinical benefit to them. Therefore, we conducted a systematic review and meta-analysis of the available data to evaluate the effectiveness and safety of CA for AF in patients with HCM. Six databases were searched to identify studies describing outcomes of CA of AF in HCM patients with a mean follow-up of ≥12 months after the index procedure. The following data were extracted: (i) single-procedure success, (ii) multiple-procedure success, and (iii) drug-free success. Fifteen studies involving 531 patients were included. Single-procedure freedom from atrial arrhythmia at the latest follow-up was 45.5% [95% confidence interval (CI): 34.8-56.2%]. With multiple procedures, the final success rate was 66.1% (95% CI: 55.3-76.9%) overall, 71.8% (95% CI: 61.6-82.0%) in paroxysmal AF, and 47.5% (95% CI: 36.0-59.0%) in non-paroxysmal AF. Without anti-arrhythmic drugs (AADs), single-procedure success rate at latest follow-up was 32.9% (95% CI: 21.7-41.1%); after multiple procedures, this raised to 50.4% (95% CI: 39.2-61.6%). The incidence of serious periprocedural complications was acceptable [5.1% (95% CI: 2.8-9.6%)]. Substantial heterogeneity (I(2)> 50%) was noted in the above groups. Catheter ablation of AF in patients with HCM is feasible, although more repeat procedures and AAD are needed to prevent AF recurrence.

Catheter Ablation of Atrial Fibrillation in Overweight and Obese Patients.

Obesity has reached epidemic proportions, and is associated with increased all-cause mortality. Atrial fibrillation(AF), the most common sustained arrhythmia in the clinical practice, is associated with an increased longterm risk of stroke, heart failure, and all-cause mortality. Accumulating data points out to an indispensable role of inflammation in both obesity and AF. Recent studies have documented an increasing risk of AF with increasing body mass index (BMI). The pathophysiological alterations associated with overweight and obesity lead to atrial stretch and atrial enlargement creating the substrate for AF development. Catheter ablation of AF has been widely accepted as an important therapeutic modality for the treatment of patients with symptomatic,drug-refractory AF. Previous studies assessing the impact of BMI on AF catheter ablation outcomes have given conflicting data. Given that overweight and obesity, as defined by BMI, and AF are closely linked,the present review sought to investigate the impact of BMI on the efficacy and safety of AF catheter ablation.

161 Catheter ablation of atrial fibrillation on uninterrupted warfarin using standard and duty cycled radiofrequency energy: safe and effective

Introduction Catheter ablation (CA) for atrial fibrillation (AF) is growing exponentially. Although ablation for paroxysmal AF (PAF) is associated with shorter procedure times and less extensive left atrial ablation vs persistent AF thromboembolic complications can occur in both sub-groups. Inadequate anticoagulation leads to thrombotic complications and excessive anticoagulation can lead to bleeding risks. Many centres adopt a policy of discontinuing warfarin in the immediate run-up to the procedure, covering the procedure with unfractionated heparin and “bridging” postoperative patients with low molecular weight heparins (LMWH) back onto warfarin. We wished to determine the safety of CA for AF with a therapeutic INR using both the single transseptal approach and duty cycled radiofrequency energy (RF) with non irrigated PVAC catheters and the double transseptal puncture technique using irrigated RF catheters and either CARTO or NAVX electroanatomical mapping. Methods A retrospective analysis of 173 patients who underwent CA for AF while taking uninterrupted warfarin. Procedural target International Normalised Ratio (INR) was 2–3 with a peri-procedural target ACT of 300–350 s. In sub therapeutic INR patients weight adjusted LMWH was used post procedure with warfarin until INR was >2. Standard technique employed was large area circumferential ablation using conventional RF energy or pulmonary vein isolation using duty cycled RF energy. Data was gathered for demographics, procedural INR, total dose of unfractionated heparin, fluoroscopy time, and type of radiofrequency energy used. Endpoints were minor bleeding, major bleeding (requiring transfusion), vascular complications, pericardial tamponade and stroke/TIA within 28 days of the procedure. Results There were 128/173 male patients, age range between 21 and 73 years (mean 57 years). 122 underwent ablation for PAF and 51 for persistent AF. Mean procedural INR was 2.4 (range 1.7–3.9). Mean unfractionated heparin dose was 6000 units (range 1000–14 500). Mean fluoroscopy time for the PVAC group was 23.4 mins (range 8.3–50.1 mins). Mean fluoroscopy time for CARTO/NAVX group was 31mins (range 14.10–58.44 mins). There were no major bleeding complications. There was 1 minor bleeding complication with a groin pseudoaneurysm. There were 2 cases of pericardial tamponade (2/173%–1.2%) both managed with percutaneous pericardial drainage. There were no stroke/TIAs. Conclusion These data demonstrate that CA for AF by both single and double transseptal technique using both standard RF and duty cycled RF while maintaining a therapeutic INR is a safe procedure. Maintaining a therapeutic INR reduces the risk of embolic events associated with “bridging” heparin without an increase in bleeding complications. This technique is convenient for patients and avoids switching between LMWH and warfarin and ensures patient safety by maintaining therapeutic anticoagulation before, during and after the procedure.

Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation

The purpose of this study was to conduct a worldwide survey investigating the methods, efficacy, and safety of catheter ablation (CA) of atrial fibrillation (AF). A detailed questionnaire was sent to 777 centers worldwide. Data relevant to the study purpose were collected from 181 centers, of which 100 had ongoing programs on CA of AF between 1995 and 2002. The number of patients undergoing this procedure increased from 18 in 1995 to 5050 in 2002. The median number of procedures per center was 37.5 (range, 1 to 600). Paroxysmal AF, persistent AF, and permanent AF were the indicated arrhythmias in 100.0%, 53.0%, and 20.0% of responding centers, respectively. The most commonly used techniques were right atrial compartmentalization between 1995 and 1997, ablation of the triggering focus in 1998 and 1999, and electrical disconnection of multiple pulmonary veins between 2000 and 2002. Of 8745 patients completing the CA protocol in 90 centers, of whom 2389 (27.3%) required >1 procedure, 4550 (52.0%; range among centers, 14.5% to 76.5%) became asymptomatic without drugs and another 2094 (23.9%; range among centers, 8.8% to 50.3%) became asymptomatic in the presence of formerly ineffective antiarrhythmic drugs over an 11.6+/-7.7-month follow-up period. At least 1 major complication was reported in 524 patients (6.0%). The findings of this survey provide a picture of the variable and evolving methods, efficacy, and safety of CA for AF as practiced in a large number of centers worldwide and may serve as a guide to clinicians considering therapeutic options in patients suffering from this arrhythmia.