The impact of left atrial size on long-term outcome of catheter ablation of chronic atrial fibrillation.
ABSTRACT The left atrial (LA) size is an important predictor of atrial fibrillation (AF) procedural termination and the long-term outcome. We sought to evaluate the long-term outcome in regard to the LA size and procedural termination.
Eighty-seven consecutive chronic AF patients (72 males, 53 +/- 10 years) underwent 3D mapping (NavX) and ablation. A stepwise approach including circumferential pulmonary vein (PV) isolation, linear ablation, and continuous complex-fractionated electrogram (CFE) ablation (targeting fractionation intervals of < 50 ms). Electrical cardioversion was applied to those without any procedural termination. The freedom from AF was defined as the maintenance of sinus rhythm without the use of any class I or III antiarrhythmic drugs after the blanking period.
Among the 87 patients, all received a circumferential PV isolation, 93% a linear ablation, and 59% a continuous CFE ablation. Those with AF procedural termination (n = 30) had a better long-term outcome when compared with those without termination during a follow-up of 21 +/- 12 months. Moreover, a Kaplan-Meier analysis showed that in those with an LA diameter of less than 45 mm (n = 49), the freedom from AF rate was higher when procedural termination was achieved (P = 0.004). On the contrary, the outcome was comparable in those with an LA diameter of >or= 45 mm (n = 38), whether AF procedural termination occurred or not (P = 0.658).
AF procedural termination was related to the long-term success during chronic AF ablation, especially in those with an LA diameter of less than 45 mm. The favorable effect of termination decreased when the LA diameter was >or= 45 mm.
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ABSTRACT: Left atrial (LA) size has been related to the success of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). However, potential predictors after a repeated procedure are unknown. We evaluate predictive factors related to successful AF ablation after a first and a repeated RFCA. A total of 154 patients with AF were treated with RFCA. LA size and function were assessed with three-dimensional echocardiography (3D Echo) before RFCA. The effectiveness of RFCA was evaluated after 6 months. Recurrence of the arrhythmia was defined as any documented (clinically or by 24-h Holter recording) atrial tachyarrhythmia lasting >30 s after 12 weeks following RFCA. Of 154 patients, 103 (67%) underwent a first ablation (Group 1) and 51 (33%) a repeated RFCA (Group 2). At follow-up, arrhythmias were eliminated in 56 of 103 (54%) patients after a first RFCA and in 20 of 51 (40%) after a repeated ablation. In Group I, hypertension and LA expansion index derived from 3D Echo were independent predictors of arrhythmia elimination. In Group 2, only age predicted persistence of sinus rhythm; and only in younger patients (≤54 year old), though 3D LA maximal volumes were significantly smaller in those without when compared with those with AF recurrences. A combination of the analysis of LA function with 3D Echo and clinical data predicts elimination of AF after a first ablation procedure for AF, beyond LA size. Among patients undergoing a repeated procedure, age and 3D echocardiographic LA maximum volume in younger patients predict the success of RFCA.European heart journal cardiovascular Imaging. 10/2013;
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ABSTRACT: Catheter ablation of atrial fibrillation (AF) has become an important treatment method. Electrical isolation of the pulmonary veins is the cornerstone of most AF ablation procedures, and is defined by an entrance block observed on a circular multipolar electrode catheter. The safety and efficacy of AF ablation is best established in middle-aged patients with paroxysmal AF. Current guidelines recommend AF ablation with a level Ia indication in this group of patients. The long-term efficacy of AF ablation is well established in patients with paroxysmal AF, but less so in patients with longstanding persistent AF. In this population, current guidelines recommend AF ablation with a level IIb indication. The efficacy of catheter ablation in other patient populations, particularly elderly people and those with concomitant conditions, is also poorly defined. AF ablation is reasonably effective and safe at 12 months of follow-up, but recurrence of AF ≥1 year after ablation is not uncommon. Fortunately, the techniques and tools used for AF ablation continue to evolve. These developments include novel ablation catheters designed to increase safety, efficacy, and precision of the procedure, ablation strategies to target both pulmonary vein and nonpulmonary vein AF triggers, and improved imaging and electrical mapping to guide ablation procedures.Nature Reviews Cardiology 08/2013; · 10.40 Impact Factor
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ABSTRACT: Although catheter ablation can effectively eliminate atrial fibrillation (AF), the progression of atrial remodeling increases the risk of recurrence. We, therefore, examined the possibility of determining the postablation prognosis of patients with AF using biomarkers of atrial structural remodeling and serum connective tissue growth factor (CTGF) level, and measured its changes after catheter ablation. Subjects were 400 consecutive patients (308 with paroxysmal AF and 92 with nonparoxysmal AF [persistent and long-standing persistent AF]) who underwent catheter ablation for drug-resistant AF. Serum CTGF levels were measured before and 2 months after ablation. During the follow-up period of 20.5 ± 6.9 (8-30) months, 61 patients (66%) with nonparoxysmal AF and 95 patients (31%) with paroxysmal AF had recurrence after catheter ablation. Recurrence was associated with higher "baseline CTGF level" in patients with nonparoxysmal AF (936.5 ± 93.1 ng/mL vs 746.3 ± 56.9 ng/mL, P = 0.007) instead of patients with paroxysmal AF (851.6 ± 97.6 ng/mL vs 807.6 ± 99.1 ng/mL, P = 0.921). In nonparoxysmal AF, the recurrence subgroup also had larger left atrial diameter (LAD; 47.1 ± 5.2 mm vs 39.5 ± 4.3 mm, P = 0.035) compared with the nonrecurrence subgroup, and "baseline serum CTGF" and LAD were shown to be independent predictors for postablation recurrence by a Cox proportional hazards model. However, the 2-month postablation elevations of CTGF in patients with recurrence were not significantly different from that in patients without recurrence in nonparoxysmal AF. Our finding indicates that "baseline serum CTGF level" is an independent predictor for recurrence in patients with nonparoxysmal AF following catheter ablation. Two-month postablation elevation in CTGF has no association with recurrence.Pacing and Clinical Electrophysiology 01/2014; · 1.75 Impact Factor