Accesso libero

Arrhythmia Termination During Radiofrequency Delivery Improves Outcomes after Catheter Ablation for Persistent and Long Standing Persistent Atrial Fibrillation

Alexandrina Nastasa
Alexandrina Nastasa
, 
Corneliu Iorgulescu
Corneliu Iorgulescu
, 
Stefan Bogdan
Stefan Bogdan
, 
Silvia Deaconu
Silvia Deaconu
, 
Stefan Petre
Stefan Petre
, 
Viviana Gondos
Viviana Gondos
, 
Maria Dorobantu
Maria Dorobantu
 e 
Radu Gabriel Vatasescu
Radu Gabriel Vatasescu
   | 03 mag 2022
Romanian Journal of Cardiology's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
Articolo precedente
Articolo Successivo
Cita
Article Category: Original Article
Pubblicato online: 03 mag 2022
Pagine: 335 - 342
DOI: https://doi.org/10.47803/rjc.2021.31.2.335
Parole chiave
© 2021 Alexandrina Nastasa et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Procedural protocol. PVAI=pulmonary vein antral isolation, CFAE=complex fractionated atrial electrograms, AAD=antiarrhythmic drugs, E=electrical cardioversion, OP=overdrive pacing, AF=atrial fibrillation, SR=sinus rhythm.
Procedural protocol. PVAI=pulmonary vein antral isolation, CFAE=complex fractionated atrial electrograms, AAD=antiarrhythmic drugs, E=electrical cardioversion, OP=overdrive pacing, AF=atrial fibrillation, SR=sinus rhythm.

Figure 2

Frequencies of different methods used for conversion to sinus rhythm; AAD=antiarrhythmic drugs.
Frequencies of different methods used for conversion to sinus rhythm; AAD=antiarrhythmic drugs.

Figure 3

A)- Frequencies of ablation sites in the subgroup with TT, note in ~ 23% of the cases SR conversion took place during isolation of the pulmonary veins, cases in which no further substrate ablation was performed, only completion of the PVAI; B) Frequencies of regions targeted for substrate elimination in the lot without TT; TT=tachyarhythmia termination; CFAE=complex fractionated atrial electrograms; LSPV=left superior pulmonary vein, LIPV=left inferior pulmonary vein; RSPV=right superior pulmonary vein, RIPV right inferior pulmonary vein, PWBI=posterior wall box isolation; CS= coronary sinus; LAA=left atrial appendage; RAA=right atrial appendage; LApw=posterior wall of the left atrium.
A)- Frequencies of ablation sites in the subgroup with TT, note in ~ 23% of the cases SR conversion took place during isolation of the pulmonary veins, cases in which no further substrate ablation was performed, only completion of the PVAI; B) Frequencies of regions targeted for substrate elimination in the lot without TT; TT=tachyarhythmia termination; CFAE=complex fractionated atrial electrograms; LSPV=left superior pulmonary vein, LIPV=left inferior pulmonary vein; RSPV=right superior pulmonary vein, RIPV right inferior pulmonary vein, PWBI=posterior wall box isolation; CS= coronary sinus; LAA=left atrial appendage; RAA=right atrial appendage; LApw=posterior wall of the left atrium.

Figure 4

Kaplan Meier plot showing time to arrhythmic relapse in the group with tachyarrhythmia termination during RF delivery (green line) vs group in which that was not possible (blue line).
Kaplan Meier plot showing time to arrhythmic relapse in the group with tachyarrhythmia termination during RF delivery (green line) vs group in which that was not possible (blue line).

Figure 5

Kaplan Meier plot-arrhythmia free survival time was not significantly influenced by the administration of antiarrhythmic drugs after the procedure; AAD = antiarrhythmic drugs.
Kaplan Meier plot-arrhythmia free survival time was not significantly influenced by the administration of antiarrhythmic drugs after the procedure; AAD = antiarrhythmic drugs.

Preprocedural characteritics of the studied patients

Group in which TT was obtained during RF delivery Group in which TT was not obtained by RF delivery p value
General characteristics & comorbidities
Age (years) 55.4±11.7 60±11.5 0.11
BMI (kg/m2) 28.63±3.5 28.61±3.7 0.85
AF history (years) 5.14±3.05 4.96±4.39) 0.5
AF type LS-Ps 7.4% 24.2% 0.16
Male sex (%) 70.4% 78.1% 0.55
Hypertension 54% 75.9% 0.14
Ischemic heart disease 21.7% 20.7% 1
Heart failure 50% 34.8% 0.5
Structural heart disease 19.2% 8.3% 0.26
Dyslipidemia 50% 75% 0.08
Type II diabetes 34.8% 20.7% 0.34
Obstructive sleep apnea 28.6% 33.3% 0.76
Smoking 16.7% 20% 0.8
Atrial flutter 77.3% 55.6% 0.14
PSVT associated 5% 7.1% 0.79
CHA2DS2VASC score 2.6±2 1.7±2.1 0.13
Laboratory tests
Cholesterol 171.11±39.01 165.98±39.36 0.69
Triglycerides 131.7±90.21 129.80±64.7 0.81
Serum creatinine level 0.99±0.2 0.83±0.2 0.09
NTproBNP 355.5±152.03 861.43±852.67 0.42
Serum hemoglobin 12.13±2.6 14.19±0.9 0.11
EKG measurements
P wave duration(ms) 117.7±16.9 111±22.7 0.22
PR interval (ms) 190.8±26.8 194.5±45.7 1
QRS duration (ms) 95.5±17.5 93.8±20.9 0.53
cQT interval (ms) 462.5±32.7 441.9±34.8 0.13
Echocardiography
LA(ap diam, mm) 45.7±4.5 42.7±7.8 0.04
LA area (cm2) 24.11±4.01 23.09±4.16 0.66
LA (volume, ml/m2) 44.69±11.9 47.27±6.88 0.88
RA (diam, mm) 43.2±6.8 43±8.2 0.8
LVEF (%) 54.87±6.14 49.96±10.59 0.09

Univariate predictors of arrhythmia recurrence

Recurrence group Arrhythmia free group P value
Age (years) 56.5±12.6 55.6±11 0.5
Weight (kg) 89±16.6 84.8±15.1 0.66
BMI 29.06±4.1 27.29±3.7 0.12
AF history (years) 5.95±3.86 5.6±3.63 0.69
LS-Ps AF type (%) 12.8% 7.4% 0.69
Males (%) 73.7% 85.2% 0.36
Hypertension 66.7% 48% 0.18
Ischemic heart disease 24.3% 12.5% 0.33
Heart failure 25.9% 44.4% 0.21
Dyslipidemia 52.8% 56% 1
LDL cholesterol 89.51±22.4 122.6±26.4 0.07
Type II diabetes 22.2% 19.2% 1
GFR(MDRD) 84.88±9.9 90.66±33 0.54
CHA2DS2Vasc 2.5±1.7 1.2±2.2 0.04
Pw duration 113.4±21.5 118±13.6 0.28
PR interval 188.1±40.2 194.7±22 0.37
cQTi 449.4±34.5 451.4±38 0.61
LA ap mm 42.1±5.1 43.9±5.8 0.26
LA diam1 52.1±10.1 50±9 0.54
LA area (cm2) 22.93±6.27 24.5±5.24 0.31
LA volume 92.5±26.7 79.5±23.5 0.07
E/A 2.03±0.65 1.75±0.7 0.4
TAPSE 20.7±8.7 25.8±4.8 0.43
Intraprocedural oganization 30.3% 71.4% 0.002
TT during RF delivery 22.2% 65.5% 0.02
CFAE ablation 71.9% 69.2% 1

Comparison of the subgroups with and without short term antiarrhythmic drugs (AAD) postablation

Patient characteristics with AAD without AAD P value
Age 54 ±11.6 55 ±11.5 0.9
BMI 29.3 ±3.9 29 ±3.8 1
Pwave (ms) 120 ±20 145 ±10 0.7
AF duration 5.6 ±2.3 5.7 ±4.5 0.9
LA-d 61 ±2.1 60.2 ±11.2 0.9
LA-area (cm2) 31 ±2.8 24 ±2.9 0.07
LAAfw (m/s) 0.5 ±0.57 0.36 ±0.13 0.2
AF term by ABLA 37.5% 45% 1

Procedural aspects and success rates

Procedural characteristics Freq %
Acute SR restoration 93.4%
CFAE ablation 60%
Lines/PWBI 23%
Atypical atrial flutter ablation 20.5%
Recurrence rate after first procedure 65.2%
Recurrence rate after all procedures 41%
eISSN:
2734-6382
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
Feed RSS della rivista