Purpose
Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with ...atrial fibrillation undergoing pulmonary vein isolation (PVI).
Methods
Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up.
Results
In the total study cohort, the mean resting sinus heart rate at PRE mean 57.9 bpm (95% CI 57.1–58.7 bpm) increased by over 10 bpm to POST mean 69.4 bpm (95% CI 68.5–70.3 bpm);
p
< 0.001 followed by a slight decrease at 3 M mean 67.3 bpm (95% CI 66.4–68.2 bpm) but still remaining higher compared to PRE (
p
< 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both
p
< 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (
p
= 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32–2.49),
p
< 0.001 and HR 1.64 (95% CI 1.20–2.25),
p
= 0.002, respectively).
Conclusion
Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Atrial Tachycardia Incidence After RF versus Cryoballoon PVI
Background
Postablation atrial tachycardia (AT) is a significant complication following radiofrequency (RF) pulmonary vein isolation ...(PVI). Cryoballoon (CB) ablation is an alternative technique for PVI that appears to have a low incidence of AT. No direct comparison between AT risk in RF and CB ablation has been made.
Objective
To compare the incidence and characteristics of ATs after PVI with RF and with CB ablation in patients with paroxysmal atrial fibrillation (AF).
Methods
All patients who underwent their first PVI between January 2006 and September 2012 using either RF or CB ablation were included. When a repeat ablation procedure for AT was performed, the arrhythmia was classified as typical cavotricuspid isthmus (CTI) flutter or left atrial tachycardia (LA‐AT) based on invasive mapping procedure findings and ECG P‐wave morphology.
Results
The study population consisted of 415 and 215 consecutive patients in the RF and CB groups, respectively. After a mean follow‐up of 38 ± 21 months, 52 (8.3%) patients presented ATs (9.4% and 6% in the RF and CB groups, respectively; P = 0.15). Of those, 26 (4.1%) were classified as LA‐AT with 20 (4.8%) in the RF group and 6 (2.8%) in the CB group (P = 0.23). In patients without a history of typical CTI flutter or CTI line (n = 458), the incidence for this type of arrhythmia during follow‐up was 3.5%.
Conclusion
In patients with paroxysmal AF undergoing either RF or CB PVI as the sole ablation strategy, the incidence of postprocedural AT was low and there was no significant difference between the 2 techniques.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The preferential sites for focal atrial tachycardia (FAT) are mainly in the right atrium in both sexes. However, a limited number of studies have indicated that sex differences in the localization of ...FAT. This study investigated possible sex differences in the distribution of FAT in a large cohort of patients referred for ablation.
From 2004 to 2019, 487 patients (298 women) were referred to our institution for ablation of FAT. A standard electrophysiological study was conducted, and isoproterenol or atropine was given when needed. Conventional catheter mapping, electroanatomic contact mapping, and noncontact mapping were used to assess the origin of ectopic atrial tachycardia.
Overall, 451 foci were successfully ablated in 436 patients (90%). Although the foci located along the crista terminalis were more common in women than in men (42% vs. 29%; p=0.023), the opposite were found in the foci located along the tricuspid annulus (5% vs. 11%; p=0.032) and the right atrial appendage (RAA) (1% vs. 3%; p=0.032). Other locations were similarly distributed in men and women. In addition, the presence of persistent FAT was more frequent in men than in women (22% vs. 5%; p<0.001). Finally, the difference in the induction pattern of FAT was also remarkable between sexes.
The distribution of FAT in women and men is different. In addition, persistent FAT seems more often in men than in women. The different distribution, persistency, and induction pattern of FAT should be considered in the successful management of this type of tachycardia.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is an effective treatment for atrial flutter (AFL). However, RF may injure cardiac structures such as the atrio-ventricular node or the ...right coronary artery and is usually painful. This prospective, randomized study compares cryoablation (Cryo) with RF ablation regarding efficacy, safety, and perceived pain.
One-hundred and fifty-three patients (78 Cryo; 75 RF) with CTI-dependent AFL--median age 65 years (range 34-82), 140 men (91%)--were randomized to Cryo or RF. Primary endpoint was demonstration of long-term efficacy defined as no symptomatic recurrence of AFL at the 6-month follow-up. Radiofrequency ablation was performed with a 3.5 mm open-irrigated-tip catheter and Cryo with a 9 F, 8 mm tip catheter. Ablation endpoint was bidirectional CTI block. Pain was evaluated with a visual analogue scale (VAS; 0-10). The acute success rate was 92% for Cryo and 95% for RF (P = 0.58). Procedural time was longer in the Cryo group (152 ± 54 min) than the RF group (116 ± 41 min) (P < 0.001). Cryoablation was considerably less painful compared with RF (mean VAS-Cryo 0.7 ± 1.2 vs. VAS-RF 4.6 ± 2.0; P < 0.001). Success rate at 6-month follow-up was 93% (73 of 78) for Cryo and 97% (73 of 75) for RF (P = 0.86). No major adverse events occurred in any group.
Cryoablation of isthmus-dependent AFL is not inferior to RF but with significantly less procedure-related pain.
Abstract
Aim. Pulmonary vein isolation (PVI) is an established method for treatment of drug refractory atrial fibrillation. The aim of this study was to evaluate whether a more active regular supply ...of analgesic and sedative drugs reduces pain and discomfort. We also wanted to evaluate gender differences in pain perception and to compare standard radiofrequency (RF) with cryo balloon ablation (Cryo) from this perspective. Methods. A total of 80 patients, 40 men, median age 58 (range 23-76) years, who underwent PVI under conscious sedation were studied. They were randomized to either standard treatment with morphine and diazepam (control group, C) or to a more active analgesic strategy (A) with pre-medication with oral midazolam mixture and intravenous alfentanil and midazolam regularly administrated during the procedure. Forty patients were treated with RF and 40 with Cryo. Results. The majority of the patients experienced pain during the procedure. The maximal pain assessed with numerical rating scale (NRS), was lower in the active group compared with that in controls (p = 0.02). Women experienced more pain than men (p = 0.01). RF was more painful than Cryo (p < 0.001). Conclusion. An active regular supply of analgesic and sedative drugs reduce pain and discomfort during PVI. Women experience more pain than men during this procedure and PVI performed with Cryo is less painful than with RF.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Surgical ventricular restoration (the Dor procedure) is an option in patients with coronary artery disease and postinfarction left ventricular aneurysm. The procedure can be extended to treat ...ventricular tachycardia (VT). The aim of this study was to evaluate the Dor procedure including VT surgery in our institution.
From July 1997 to December 2003, 53 consecutive patients with left ventricular aneurysm and VT underwent surgical ventricular restoration including nonguided endocardiectomy and cryoablation. Twenty-four patients had at least one preoperative episode of spontaneous VT, of which 8 were survivors of sudden cardiac death. Twenty-nine patients had inducible-only VT. In 45 patients, who underwent preoperative programmed stimulation, sustained uniform VT could be initiated. Arrhythmia control was evaluated by programmed stimulation or analysis of events registered by implanted defibrillators and by review of patient’s records.
Early mortality was 2 of 53 (3.8%). Mean follow-up was 3.7 years. At 1, 3, and 5 years overall actuarial survival was 94%, 80%, and 59%, respectively. Surgical success rate in patients with preoperative spontaneous VT was 91%. Inducible VT was found in 5 of 35 patients who underwent postoperative programmed stimulation. There was no arrhythmia-related late death and there was no loss to follow-up.
The Dor procedure including VT surgery is an effective treatment for postinfarction left ventricular aneurysm and VT and eliminates the need for an implantable defibrillator in most patients. Early and long-term results are good in terms of survival and arrhythmia control.
Abstract
Aims
Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing ‘real-world’ data on efficacy and safety are lacking. Using Swedish national registry ...data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.
Methods and Results
Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff–Parkinson–White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7–7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%).
Conclusion
Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.
Purpose
Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have ...found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation.
Methods
This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3–89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization.
Results
A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (
P
= 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (
P
= 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (
P
< 0.001).
Conclusion
The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Gender differences in symptoms and perceived health-related quality of life (HRQOL) in patients with atrial fibrillation (AF) referred to pulmonary vein isolation (PVI) have been reported previously. ...Women experience a lower HRQOL, faster heart rate, and more symptoms such as palpitation and dyspnea than men. Furthermore, they experience worse physical functioning independently of other heart diseases or age. This study evaluates referral patterns and symptoms, morbidity, functional impairment, and HRQOL from a gender perspective in patients with AF before and 6 months after PVI. The study includes 242 patients (121 men), mean age 62 ± 9 years, referred for PVI. Symptoms were assessed with the Symptom Checklist: Frequency and Severity (SCL), HRQOL with Short Form 36 (SF-36), and the functional impairment with Sickness Impact Profile (SIP). The patients' own experiences of the referral process and history of their disease were evaluated with a supplementary questionnaire. The results showed that women improved more than men in HRQOL, SIP, and SCL 6 months post PVI. There were no sex differences in proportion of paroxysmal and persistent AF or ablation outcome. At baseline, women scored higher than men in both scales of the SCL (p < 0.001), scored lower in all components in SF-36, and scored higher in five categories of the SIP. Women were not more reluctant to accept referral for ablation when offered. The conclusion is that women with AF undergoing PVI are more symptomatic but also improve more in HRQOL and in symptom burden than men.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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