Safety Of Catheter Ablation Research Articles

Efficacy and safety of catheter ablation for paroxysmal atrial fibrillation as first-line therapy vs. after drug failure -analysis from Japan Nationwide Ablation (J-AB) Registry-

Abstract Background Catheter ablation is an effective rhythm control therapy for atrial fibrillation (AF). Recent advancements in technology have improved the efficacy and safety of this procedure. Current European Society of Cardiology and Japanese Circulation Society guidelines recommend that catheter ablation (CA) for patients with paroxysmal AF (PAF) after failure of drug therapy is classified as Class I, and CA as first-line therapy is categorized as Class IIa. However, there are limited clinical studies directly comparing these groups. Objective This study aimed to compare the efficacy and safety of CA as first-line therapy vs. those after failed drug therapy using data from the Japan Nationwide Ablation (J-AB) Registry led by the Japanese Heart Rhythm Society. Methods Detailed data of patients who underwent catheter ablation for PAF extracted from the J-AB registry were analyzed. Patients were divided into two groups: those who underwent CA as first-line therapy (First-line group) or those who underwent CA after failed drug therapy (Drug failure group). Patients’ characteristics, efficacy and safety of CA were compared between the two groups. Efficacy was assessed by evaluating the recurrence rate of any atrial arrhythmia within one year after the 90-day blanking period, and major safety outcomes were set as severe bleeding complication, stroke, and gastrointestinal disorders during the perioperative period. Result This analysis included 5,011 cases with a median age of 69 years (range 61-75) and 35% females. Comparing patient characteristics between the first-line therapy group (n = 3,447) and the drug failure group (n = 1,564), there are no statistically significant differences between the two groups except in left atrium diameter in echocardiogram (LAD) (38 [34-42] mm vs. 38 [34-43] mm, P <0.001), serum creatinine levels (0.8 [0.7-1.0] mg/dl vs. 0.9 [0.7-1.0] mg/dl, P <0.001), and beta-blocker usage (38.2% vs. 46.7%, P <0.01). A total of 501 recurrence events were observed in this analysis during a median follow-up of 365 [254-390] days. Recurrence rates did not statistically differ between the two groups (log-rank P=0.49). After adjusting for contributing factors with age, gender, body mass index, LAD, and left ventricular ejection fraction in echocardiogram using a multivariate Cox proportional hazards model, efficacy outcomes showed no significant difference between the two groups (adjusted hazard ratio; 1.06 95% confidence interval; 0.88-1.28, P = 0.55). Besides, the two groups had no significant difference in major safety outcomes. Conclusions Catheter ablation as the first-line therapy for paroxysmal atrial fibrillation showed a similar recurrence rate of atrial arrhythmias and adverse events compared to those who underwent catheter ablation after drug failure.

Catheter ablation as first-line treatment for ventricular tachycardia in patients with structural heart disease and preserved left ventricular ejection fraction: a systematic review and meta-analysis

In this systematic review and meta-analysis, we aim to evaluate the efficacy and safety of catheter ablation as the first-line treatment of ventricular tachycardia (VT) in patients with structural heart disease (SHD) and preserved left ventricular ejection fraction (LVEF). Patients with SHD are particularly susceptible to VT, a condition that increases the risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICDs) can terminate VT and prevent SCD but do not prevent VT recurrence. The efficacy and safety of CA as a first-line treatment in SHD patients with preserved LVEF remain unclear. We searched PubMed/Medline, EMBASE, Web of Science, and Cochrane CENTRAL for studies reporting the outcomes of CA therapy in patients with VT and preserved LVEF, published up to January 19, 2023. The primary outcome was the incidence of SCD following catheter ablation as the first-line treatment of VT in patients with SHD and preserved LVEF. Secondary outcomes included all-cause mortality, VT recurrence, procedural complications, CA success rate, and ICD implantation after catheter ablation. We included seven studies in the meta-analysis, encompassing a total of 920 patients. The pooled success rate of catheter ablation was 84.6% (95% CI 67.2–93.6). Complications occurred in 6.4% (95% CI 4.0–9.9) of patients, and 13.9% (95% CI 10.1–18.8) required ICD implantation after ablation. VT recurrence was observed in 23.2% (95% CI 14.8–34.6) of patients, while the rate of sudden cardiac death (SCD) was 3.1% (95% CI 1.7–5.6). The overall prevalence of all-cause mortality in this population was 5% (95% CI 1.8–13). CA appears promising as a first-line VT treatment in patients with SHD and preserved LVEF, especially for monomorphic hemodynamically tolerated VT. However, due to the lack of direct comparisons with ICDs and anti-arrhythmic drugs, further research is needed to confirm these findings.

Innovations in arrhythmia management in pregnant woman: catheter ablation without using fluoroscopy

Abstract Background The latest data of effectiveness and safety of catheter ablation without using fluoroscopy in general population suppose wide using of this technology. However, data on pregnant population is limited. Purpose To investigate efficacy and safety of catheter ablation without using fluoroscopy in pregnant women with analyzing obstetric and neonatal outcomes. Methods We studied 47 cases of catheter ablation in pregnant (mean age 25.3±3.9 years, mean gestation age 23.7 ±3.1 weeks) within 24 month follow-up. Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) without using fluoroscopy in all cases. Results The most common arrhythmia was atrioventricular nodal reentrant tachycardia (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Ablation without using fluoroscopy was successful in all cases, mean procedural time was 71.9±14.5 minutes. There was one case of complication after ablation procedure: ileofemoral thrombosis, which was treated successfully without termination of gestation (2.1%). We found increased uterine contractile activity and placental abruption in pregnant after ablation in 4.54% and 2.3% cases respectively. Cases of uterine blood flow violation was more frequent: in 15.9% cases. Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term: in 76.6% and 95.7% cases. There were live births in all pregnant women with normal range of fetal birth weight and Apgar score (3207.4±485 grams and 8.4±1.6 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up. Conclusions Catheter ablation without using fluoroscopy can be effectively and safety performed during gestation with good neonatal and obstetric outcomes.

Electrophysiological characteristics of tachyarrhythmia and effects of catheter ablation in patients with Fontan circulation

Abstract Introduction Incidence of arrhythmia in complex congenital heart disease is higher than general population. Characteristics of arrhythmia in patients with functional single ventricle is not known. Methods Total 18 patients (age, 22.1 8.5 years, 9 men) with Fontan circulation who had undergone catheter ablation for tachyarrhythmia were retrospectively consecutively included. Characteristics of congenital heart disease, mechanisms of tachyarrhythmia, and efficacy and safety of catheter ablation were analyzed. Results Congenital heart diseases of the patients were as follows: double outlet right ventricle, 9; common atrioventricular septal defect, 5; and pulmonary atresia, 4. Fontan types were as follows: lateral tunnel Fontan, 9; extracardiac conduit Fontan 9. Fontan conduit puncture was successful in all patients. Mechanisms of tachyarrhythmia were as follows: intraatrial macroreentrant tachycardia, 8; focal atrial tachycardia, 4; atrioventricular nodal reentrant tachycardia, 3; twin atrioventricular nodal reciprocating tachycardia, 2; unknown, 2. Success rate of catheter ablation, recurrence rate, and complication rate were 16 of 18 patients, 2 of 18 patients, and 0 of 18 patients, respectively. Conclusion Intraatrial macroreentrant tachycardia is the most common tachycardia mechanism in patients with Fontan circulation. Catheter ablation for tachyarrhythmia is effective and safe in these population.

Safety and feasibility of atrial fibrillation ablation after left atrial appendage closure: A single-center experience of the left atrial appendage closure first strategy.

Patients with atrial fibrillation (AF) who are not suitable for long-term anticoagulant therapy undergo percutaneous left atrial appendage closure (LAAC). The safety and feasibility of left atrial catheter ablation (CA) procedures after LAAC remain unclear. This study aimed to clarify the feasibility and safety of CA after LAAC, including in the early phase within 180 days. Characteristics and clinical outcomes of 46 patients with AF who had undergone both CA and LAAC within 2 years (mean age, 72 years; 29 men) were compared between those who had undergone CA-first (31 patients) and LAAC-first (15 patients). The mean CHA₂DS₂-VASc and HAS-BLED scores were 4.8 and 3.3 points, respectively. The LAAC-first strategy was often used in patients with prior major bleeding and LAA thrombosis or sludge. In the LAAC-first group, the mean duration between both procedures was 212 days, and all LAAC-first patients, including seven patients in the early phase, could undergo CA without LAAC device-related complications; moreover, no cardiovascular adverse events were reported after both procedures (mean periods: 420 days). After CA post-LAAC, no device-related adverse events (device-related thrombosis, new peri-device leak appearance, peri-device leak increase, or device dislodgement) were observed, whereas, after LAAC post-CA, 3 new peri-device leak appearance events and 1 peri-device leak increase event were observed, especially patients who underwent LAAC in the early phase post-CA. Based on single-center experience, left atrial CA in the presence of an LAAC device implanted including the early phase was safe and feasible.

Safety of catheter ablation in patients with recently implanted cardiac implantable electronic device: A 5-year experience.

Catheter ablation (CA) can interfere with cardiac implantable electronic device (CIED) function. The safety of CA in the 1st year after CIED implantation/lead revision is uncertain. This single center, retrospective cohort included patients who underwent CA between 2012 and 2017 and had a CIED implant/lead revision within the preceding year. We assessed the frequency of device/lead malfunctions in this population. We identified 1810 CAs in patients between 2012 and 2017, with 170 CAs in 163 patients within a year of a CIED implant/lead revision. Mean age 68±12 years (68% men). Time between the CIED procedure and CA was 158±99 days. The CA procedures included AF ablation (n=57, 34%), AV node ablation (n=40, 24%), SVT ablation (n=37, 22%), and PVC/VT ablations (n=36, 21%). The cumulative frequency of lead dislodgement, significant CIED dysfunction, and/or CIED-related infection following CA was (n=1/170, 0.6%). There was a single atrial lead dislodgement (0.6%). There were no instances of power-on-reset or CIED-related infection. Following CA, there was no significant difference in RA or RV lead sensing (p=0.52 and 0.84 respectively) or thresholds (p=0.94 and 0.17 respectively). The RA impedance slightly decreased post-CA from 474±80 Ohms to 460±73 Ohms (p=0.002), as did the RV impedance (from 515±111 Ohms to 497±98 Ohms, p<0.0001). CA can be performed within 1 year following CIED implantation/lead revision with a low risk of CIED/lead malfunction or lead dislodgement. The ideal time to perform CA after a CIED remains uncertain.

Efficacy and safety of catheter ablation for atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis.

Catheter ablation (CA) effectively treats atrial fibrillation (AF) in heart failure (HF) with reduced ejection fraction (HFrEF), improving clinical outcomes. However, its benefits for AF patients with heart failure with preserved ejection fraction (HFpEF) are still unclear. We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, and Scopus for studies investigating outcomes of CA in AF patients with HFpEF. Efficacy indicators included freedom from AF and antiarrhythmic drugs (AAD) free AF elimination. Safety indicators comprised total complications, HF admission, all-cause admission, and all-cause mortality. Sixteen studies with 20,796 patients included in our research. The comprehensive analysis demonstrated that, when comparing CA with medical therapy in HFpEF, no significant differences were observed in terms of HF admissions, all-cause admissions, and all-cause mortality [(OR: 0.42; 95% CI: 0.12-1.51, P = 0.19), (HR: 0.78; 95% CI: 0.48-1.27, P = 0.31), and (OR: 1.10; 95% CI: 0.83-1.44, P = 0.51)], while freedom from AF was significantly higher in CA (OR: 5.88; 95% CI: 2.99-11.54, P < 0.00001). Compared with HFrEF, CA in HFpEF showed similar rates of freedom from AF, AAD-free AF elimination, total complications, and all-cause admission were similar [(OR:0.91; 95% CI: 0.71,1.17, P =0.47), (OR: 0.97; 95% CI: 0.50-1.86, P = 0.93), (OR: 1.27; 95% CI: 0.47-3.41, P = 0.64), (OR: 1.11; 95% CI: 0.72, 1.73; P = 0.63)]. However, CA in HFpEF was associated with lower rates of HF admission and all-cause mortality [(OR: 0.35; 95% CI: 0.20, 0.60; P = 0.0002), (OR: 0.40; 95% CI: 0.18, 0.85; P = 0.02)]. Compared with patients without HF, CA in HFpEF patients exhibited lower rates of AAD-free AF elimination (OR: 0.48; 95% CI: 0.30, 0.75; P = 0.001). However, their rates of freedom from AF and total complications were similar [(OR: 0.70; 95% CI: 0.48, 1.02; P = 0.06), (OR: 0.60; 95% CI: 0.19, 1.90; P = 0.38)]. This meta-analysis conducted provided a comprehensive evaluation of the efficacy and safety of CA in patients with AF and HFpEF. The results suggest that CA may represent a valuable treatment strategy for patients with AF and HFpEF. https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024514169).

Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life

Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied.&#x0D; The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD.&#x0D; Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure.&#x0D; Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p &gt; 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p &gt; 0.05).&#x0D; Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.

Catheter ablation of atrial fibrillation in elderly and very elderly patients: safety, outcomes, and quality of life.

Atrial fibrillation (AF) risk increases with age. We aim to assess the efficacy and safety of catheter ablation in the older population. All patients undergoing AF ablation (2013-2021) at our institution were enrolled in a prospectively maintained registry. The primary endpoint was AF recurrence. Patients were divided into 3 groups: non-elderly (< 65 years), elderly (65-75 years), and very elderly (> 75 years). Patient surveys at baseline and during follow-up were used to calculatequality of life (QoL)metrics: the AF severity score as well as the AF burden. A total of 7020 patients were included (42% non-elderly, 42% elderly, and 16% very elderly). Periprocedural major complications were low (< 1.5%) and similar in all groups besides pericardial effusion which was more frequent with older age and similar between the elderly and very elderly. At 3 years, AF recurrence for persistent AF (PersAF) was highest in the very elderly group (48%), followed by the elderly group (42%), and was the lowest in the non-elderly group (36%). In paroxysmal AF (PAF), there was no difference in AF recurrence between the elderly and non-elderly, while the very elderly remained associated with a significantly increased risk. Multivariable Cox analysis confirmed these findings (PersAF; elderly: HR = 1.23, P = 0.003; very elderly: HR = 1.44, P < 0.001) (PAF; elderly: HR = 1.04, P = 0.62; very elderly: HR = 1.30, P = 0.01). Catheter ablation resulted in a significant improvement in quality of life, irrespective of age group. Catheter ablation in elderly and very elderly patients is safe, efficacious, and associated with QoL benefits. Overall, major complications were minimal and did not differ significantly between age groups, with the exception of pericardial effusions which were higher in the elderly and very elderly compared to non-elderly adults. Very elderly patients had a higher rate of AF recurrence when compared with elderly or non-elderly patients. Nevertheless, ablation resulted in a remarkable improvement in QoL and a reduction of AF burden and AF symptoms with a similar magnitude, irrespective of age.

Catheter ablation of concomitant atrial fibrillation improves survival of patients undergoing transcatheter edge-to-edge mitral valve repair.

Atrial fibrillation (AF) is the most common concomitant disease in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) and detrimentally affects their outcome. While there is increasing evidence for prognostic improvement and safety of catheter ablation (CA) of AF in the overall cohort of heart failure patients, corresponding data in TEER patients are lacking. To investigate the impact of treatment regimens for concomitant AF on survival of TEER patients. In a multicenter observational cohort study consecutive patients successfully undergoing TEER were analyzed and survival of patients receiving CA of concomitant AF was compared with that of patients on pharmacological AF treatment and with that of patients without a history of AF, using propensity score matching (PSM). A total of 821 patients were analyzed. Of these, 608 (74.1%) had concomitant AF, of whom 48 patients received CA. Patients with CA in AF showed significantly higher 3-year-survival after TEER compared to PSM-patients on pharmacological AF treatment (75.5% [36/48] vs. 49.4% [166/336], p = 0.009). The 3-year-survival after TEER of patients with concomitant AF treated with CA was not significantly different from PSM-patients without AF (75.5% [36/48] vs. 68.3% [98/144], p = 0.36). CA of AF is superior to pharmacotherapy as it significantly improves the survival of TEER patients in a PSM analysis. CA even offsets the prognostic disadvantage of coexisting AF in TEER patients. Given the growing evidence of prognostic benefits in the overall cohort of HF patients, our data point out the importance of treating concomitant AF and support CA as an essential part of a holistic management of TEER patients.

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.

Case series of catheter-based arrhythmia ablation in pregnant women

Abstract Funding Acknowledgements Type of funding sources: None. Background Antiarrhythmic drugs (AADs) should be used with caution in treating arrhythmias during pregnancy because of side effects, but catheter ablation is a rarely used procedure. Aim To investigate the efficacy and safety of catheter ablation in cardiac arrhythmias during pregnancy. Methods A double-center retrospective case series study was performed. We studied a population of patients undergoing catheter ablation for cardiac arrhythmias during pregnancy between April 2014 and September 2021 in two cardiovascular centers in Hungary. Results 14 procedures [14 electrophysiology studies (EPS), 13 ablations] performed on 13 gravid women (age 30.3±5.2 years, primipara n=6) were studied. The mean gestation period was 24.0 (20.0-27.0) weeks at the time of intervention, and the mean duration of arrhythmia was 44.0±53.0 months. Of the pregnant women 38.5% had comorbidities and 15.4% had structural heart disease. During EPS, 12 patients had inducible arrhythmias. Focal atrial tachycardia was confirmed in 3, AVRT via manifest accessory pathway (AP) in 3 (WPW syndrome) AVRT via counceled AP in 1 case. AVNRT was confirmed in 3, sustained ventricular tachycardia in 2 cases (25-25-8.3-25-16.6%). 11 radiofrequency ablations (RFA) (84.6%) and 2 cryoablations (15.4%) were performed. The electroanatomical mapping system was CARTO in 11 cases (84.6%) and NavX-EnSite in 2 cases (15.4%). Intracardiac echocardiography (ICE) was used in 5 cases (38.5%). Transseptal puncture was performed in 2 cases (15.4%) due to left lateral AP. The average procedure time was 76.0±33.0 min. All the procedures (100.0%) were performed without fluoroscopy. No complications occurred during the procedures. In the long term, arrhythmia-free survival was achieved in all cases (100.0%), but in two patients, we used AADs to achieve freedom of arrhythmia. With AADs, the mean birth weight was lower than that of fetuses of gravidas not taking drugs (2110±1314 vs. 3253±458 g). APGAR was within the normal range in all cases [9.0/10.0 (IQR) (9.0-10.0/9.3-10.0)]. Conclusions Zero-fluoroscopic catheter ablation during pregnancy is an effective and safe treatment method when needed. Catheter ablation for persistent maternal arrhythmias has a more beneficial effect on fetal development than the use of AADs. Indeed, long-term outcome and safety need to be investigated in a larger patient population.

Sex differences in catheter ablation for ventricular tachycardia in structural heart disease: a single center 10-years experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Women are underrepresented in studies concerning ventricular tachycardia (VT) catheter ablation (CA). Different etiologies and type of structural heart diseases (SHD) are well established in women; nonetheless conflicting results about efficacy and safety of CA in women have been reported. Purpose To evaluate acute and long-term outcome of VT CA in SHD in women compared to men in a high-volume tertiary Center. Methods All consecutive procedures were included from January 2010 to December 2021. Clinical characteristics, VT etiologies and procedure data of female patients were compared to male population. Catheter ablation was performed according to standard protocol in our center. In mappable VTs, the reentry circuit was characterized, and ablation aimed at VT interruption during radiofrequency (RF); otherwise, a substrate modification approach aiming at late potentials abolition or ablation at sites of slow conduction during sinus rhythm was performed. Following ablation, prevention of any VT inducibility and substrate modification was considered ablation endpoint. Acute results, complications, and VT recurrences during follow up were analyzed comparing the two groups. Results Among 1608 overall VT CA procedures, 141 procedures were performed in 117 women. Female were younger, with less comorbidities, less ischemic VT etiology and higher left ventricular ejection fraction (LVEF) as compared to men (Table 1). They were also less likely ICD carriers. No significant differences were found with regards to: epicardial approach (39.7% vs 35.3%, p=0.68); VT inducibility at baseline (57.4% vs 67.6%, p=0.14), VT termination during RF (87.6% vs 77.6%, p=0.51), and prevention of any VT inducibility at the programmed electrical stimulation (PES) after ablation (79.5% vs 78.1%, p=0.7). Major complications occurred in 4.9% of females as compared to 4.3% of male patients. At median follow-up of 25 months, VT recurrences occurred in 24.7% of female population and 27.5% of male group (p=0.42). Cumulative VT-free survival was comparable in both groups (Figure 2). Conclusions Women with SHD have favorable acute and long-term outcome of VT ablation, despite a high prevalence of non-ischemic etiologies. VT recurrence rate and procedure safety is comparable to male patients, suggesting that catheter ablation can be offered as an effective treatment to women with refractory ventricular arrhythmias.

PO-01-227 CATHETER ABLATION OUTCOMES OF ATRIAL FIBRILLATION IN ELDERLY AND VERY ELDERLY PATIENTS

Age is a non-modifiable risk factor of atrial fibrillation (AF). To assess the efficacy and safety of catheter ablation in the Elderly and Very Elderly population. All patients undergoing AF ablation (2013-2021) with available data on follow-up were analyzed. Primary endpoint was AF recurrence based on patients reported outcomes and electrocardiographic documentation. Patients were divided into 3 groups according to age at ablation; Non-Elderly (<65 years), Elderly (≥65 <75 years) and Very Elderly (≥75 years). Baseline and 1-year patient surveys were used to estimate AF severity score (AFSS) as well as AF burden (mean of AF duration score and AF frequency score; scale 0: no AF to 10: continuous with 9 frequencies/durations in between). A total of 7020 patients were included (42% Non-Elderly, 42% Elderly and 16%Very Elderly). Periprocedural major complications were low (<1%). Pericardial effusion was very uncommon but more frequent with older age (Non-Elderly 3 (0.1%); Elderly 15 (0.5); Very Elderly 6 (0.5%); p<0.05). In all patients, a direct relationship was seen between AF recurrence and increase in age. However there was an interaction between age group and AF type. At 3 years, AF recurrence after ablation for persistent atrial fibrillation (PersAF) was the highest in very elderly group (36%), followed by the Elderly group (30%) and was the lowest in the non-Elderly group (23%; lower right Figure). In paroxysmal AF (PAF), there was no difference in recurrence between Elderly and Non-Elderly, while Very Elderly remained associated with a significant increased risk (lower left Figure). Multivariate logistic regression comparing Elderly and Very Elderly to non-Elderly confirmed these findings (PersAF: Very Elderly: HR=1.44, p<0.0001, Elderly: HR=1.23, p=0.03; PAF: Very Elderly HR=1.29, p=0.017; Elderly: HR=1.04, p=0.62) (Table). Catheter ablation resulted in improvement in AFSS irrespective of age group at one year follow up (Non-Elderly:12→5., Elderly:11.5→4.5 and Very Elderly:11.5→5; p<0.001). At one year, AF duration was minimal in all groups but was the highest in the Very Elderly (7.4 vs 1.1 at 1 year) followed by Elderly (6.9 vs 0.7) and Non-Elderly (6.5 vs 0.6). Catheter ablation in Elderly and Very Elderly patients appears to be safe and efficacious. Very Elderly patients have a higher rate of AF recurrence when compared with Elderly or Non-Elderly. Nevertheless, ablation significantly improved AF burden and symptoms at one year in all age groups.Tabled 1Table - Logistic Regression Analysis Predicting AF Recurrence by Age Groups:GroupHR95% CIP valueMultivariable AnalysisAll PatientsNon-Elderly (<65 years)ReferenceElderly (≥65 <75)1.1461.03-1.270.009Very Elderly (≥75 years)1.3811.21-1.57<0.001ParoxysmalNon-Elderly (<65 years)ReferenceElderly (≥65 <75)1.040.89-1.210.62Very Elderly (≥75 years)1.2931.04-1.590.017Non-Elderly (<65 years)ReferenceElderly (≥65 <75)1.231.07-1.410.003Very Elderly (≥75 years)1.4431.22-1.70<.0001Models were adjusted for sex, age, prior ablation, prior cardioversion, prior use of antiarrhythmic drugs (AADs), prior AAD failure, use of Cryoballoon, posterior wall isolation. Open table in a new tab

Efficacy and safety of catheter ablation as first-line therapy for the management of ventricular tachycardia

BackgroundVentricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy.MethodsData from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as “ablation first” vs “ICD first” groups and compared the clinical outcomes between groups.ResultsOne hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first‐line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths.ConclusionReal-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.

Efficacy and Safety of Catheter Ablation in Patients with Scar Related Ventricular Tachycardia

Efficacy and Safety of Catheter Ablation in Patients with Scar Related Ventricular Tachycardia

Clinical Efficacy of Catheter Ablation in the Treatment of Vasovagal Syncope.

Catheter ablation of ganglionated plexi (GPs) performed as cardioneuroablation in the left atrium (LA) has been reported previously as a treatment for vasovagal syncope (VVS). However, the efficacy and safety of catheter ablation in the treatment of VVS remains unclear. The objective of this study is to explore the efficacy and safety of catheter ablation in the treatment of VVS and to compare the different ganglion-mapping methods for prognostic effects. A total of 108 patients with refractory VVS who underwent catheter ablation were retrospectively enrolled. Patients preferred to use high-frequency stimulation (HFS) (n = 66), and anatomic landmark (n = 42) targeting is used when HFS failed to induce a positive reaction. The efficacy of the treatment is evaluated by comparing the location and probability of the intraoperative vagal reflex, the remission rate of postoperative syncope symptoms, and the rate of negative head-up tilt (HUT) results. Adverse events are analyzed, and safety is evaluated. After follow-up for 8 (5, 15) months, both HFS mapping and anatomical ablation can effectively improve the syncope symptoms in VVS patients, and 83.7% of patients no longer experienced syncope (<0.001). Both approaches to catheter ablation in the treatment of VVS effectively inhibit the recurrence of VVS; they are safe and effective. Therefore, catheter ablation can be used as a treatment option for patients with symptomatic VVS.

Catheter ablation for patients on hemodialysis with symptomatic atrial fibrillation.

There are limited studies on the efficacy and safety of catheter ablation (CA) for patients with atrial fibrillation (AF) who receive intermittent hemodialysis (HD). This gap in the contemporary literature is notable as patients with AF receiving HD has higher incidence of AF and does not often tolerate medical management due to renal failure. From Mar 2015 and Jan 2018, 25 consecutive patients on regular HD from two cardiac centers who underwent CA were retrospectively enrolled. Another 100 patients without HD or renal impairment, matched by age, sex, and AF type, were enrolled from these cardiac centers as the control group. All patients were followed up at month 3, 6, and every 6 months after the first CAs for 4 years, and 2.5 years after a second CA (if applicable), unless endpoints were reached. The primary endpoint was AF recurrence after CA, and the secondary endpoints included symptomatic AF and all-cause mortality during the follow-up period. AF patients receiving intermittent HD had a higher prevalence of hypertension (P=0.005), and heart failure (P=0.041). During the mean follow-up period of 37.6±17.4 months after the first CA, 14 out of the 25 HD patients (56.0%) remained free from AF recurrence, compared with 77 in the control patients (77.0%; P=0.021). Twenty (80.0%) patients in the HD group did not experience symptomatic AF. Second CAs were performed on 5 HD patients and 11 control patients, consequently 4 out of 5 (80.0%) HD patients and 7 out of 11 (63.6%) control patients had no AF recurrence (P=0.626) within 21.1±12.0 months after the second CA. Tamponade was the only procedural complication documented in both groups. All-cause mortality was higher in the HD group (log-rank P=0.004); however, the observed mortality was not related to AF recurrence. CA is a potential efficacious and safe treatment of AF for HD patients. The AF recurrence rate is higher after a single ablation compared with the general population, but multiple ablations seem to improve outcomes for HD patients.

Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

BackgroundIn patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain. ObjectivesThis trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients with symptomatic ventricular tachycardias (VTs). MethodsThe SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) is a prospective, multicenter, randomized trial including patients with ischemic cardiomyopathy and appropriated ICD shock. Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). The primary outcome was a composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications. ResultsIn this trial, 144 patients (median age, 70 years; 96% male) were randomized to catheter ablation (71 patients) or AAD (73 patients). After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56; 95% CI: 0.23-1.35; P = 0.198). There was no difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929). ConclusionsIn ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD. (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [SURVIVE-VT]: NCT03734562)

Efficacy and Safety of Zero-Fluoroscopy Approach during Catheter Ablation of Accessory Pathway.

Background: Catheter ablation (CA) is a safe and efficient treatment in patients with an atrioventricular accessory pathway (AP). Electroanatomical mapping (EAM) systems are useful during CA of AP, especially for reducing fluoroscopy. There are limited data about the feasibility of CA procedures performed with the use of the EAM system entirely without fluoroscopy in adults with AP. The aim of the study is to assess the feasibility, efficacy and safety of CA with the use of EAM without fluoroscopy, compared to CA with EAM and fluoroscopy in patients with AP. Methods: The study included 83 consecutive patients (age 38.25 ± 15.8 years), who were subjected to CA for AP. In 40 patients CA was performed with the use of EAM without fluoroscopy (EAM group), and in 43 patients CA was performed with EAM and fluoroscopy (control group). Baseline characteristics, procedure parameters and complications were obtained from the medical records. Data on permanent success rate was obtained after the mean follow-up time of 1 year. Primary outcomes were acute procedural success rate, long term success rate at 1-year follow-up and complications. Secondary outcomes were the procedure time and number of applications. Results: There were no statistically significant differences in baseline characteristics between the groups, except for the AP locations. Right-sided AP was more common in the EAM group, while left-sided AP was more common in the control group (p = 0.007 and p = 0.004, respectively). Acute procedural success was achieved in 38 patients (95.0%) in the EAM group and in 39 patients (90.7%) in the control group (p = 0.449). Long term success rate was achieved in 36 patients (90.0%) in the EAM group and in 36 (83.7%) patients in the control group (p = 0.399). There was one minor complication in the form of RBBB in the EAM group (p = 0.138). The mean procedure time was shorter in the EAM group compared to the control group (93.0 ± 58.3 min vs. 127.6 ± 57.5 min; p = 0.009). Conclusions: CA of both right-sided and left-sided AP completely guided by EAM without the use of fluoroscopy is feasible, safe and effective.