Search

Atrial fibrillation (AF), the most common arrhythmia, is a major cause of stroke and systemic embolism. Left atrial appendage closure (LAAC) has been proved to be noninferior to traditional Vitamin K antagonists (VKAs) as well as novel oral anticoagulants (NOACs), which is becoming an important alternative to prevent stroke in non-valvular AF. Catheter-based AF ablation (CA) is recommended to be a standard of care in patients with AF refractory to drug therapy due to a better rhythm control and improvement of life quality than antiarrhythmic drugs. Theoretically, the one-stop combination with LAAC and CA tends to bring more benefits in patients with AF, as it not only relieves symptoms, but also reduces the risk of stroke significantly. However, several important questions still need to be considered in the combination procedure although quite a few attempts have already been made in clinical practice. This review provides a comprehensive update on the concept, technique, perioperative management, benefits and other critical issues of the "one-stop" procedure., (© 2021 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.)

Background: Catheter ablation (CA) is a promising option in most patients with refractory atrial fibrillation (AF). However, data on over 5 years' outcomes with larger numbers in hypertrophic cardiomyopathy (HCM) patients with AF have not been reported. We assessed the outcome of 120 HCM patients following CA compared with a non-CA group and general patients without AF matched by HCM type with a 61.9 ± 31.6-month follow-up., Methods and Results: A total of 120 patients (age 61 ± 9.8 years, female n = 43, 35.8%) with paroxysmal AF (n = 60, 50%) and persistent AF (n = 60, 50%) were enrolled. Of the 120 patients, 48 (40%) required redo procedures, and 82 (68.3%) were in sinus rhythm at the last evaluation. The composite clinical events rate following the initial CA was lower than that in the non-CA group (P = .023) and was also comparable to that in general patients without AF matched by HCM type (P = .729). Female (HR 2.358, 95% CI, 1.151-4.831; P = .019), NYHA functional class III-IV (HR 2.422, 95% CI, 1.032-5.685; P = .042) and left atrial diameter ≥50 mm (HR 3.319, 95% CI, 1.469-7.499; P = .004) were predictors of AF recurrence after multiple procedures., Conclusions: CA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF especially for those patients with small atrial size and mild symptoms. In addition, CA may contribute to the prevention of major clinical adverse events in the long-term clinical course., (© 2020 Wiley Periodicals, Inc.)

Background: Catheter interventional treatment of pulmonary vein stenosis or occlusion (PVS/O) following radiofrequency ablation (RFA) for atrial fibrillation (AF) remains a challenging field due to lacking randomized data and there are limited data about stenting., Methods: All patients at our center who underwent pulmonary vein stenosis (PVS) stenting for PVS/O induced by RFA were retrospectively assessed. Clinical presentation, anatomic site of stenosis and hemodynamic information, as well as follow-up data, were collected and analyzed., Results: From January 2010 to June 2018, 56 patients with PVS/O secondary to RFA were treated with 113 stents. Procedural success rate was 95.8%. Pressure gradients significantly reduced (p < 0.001) and vessel caliber markedly increased (p < 0.001) in all the stenotic sites, with immediate symptoms significantly improved. The overall in-stent restenosis (ISR) rate was 21.8% after a median follow-up period of 26 months (interquartile range: 16 to 35.5 months). The incidence of ISR was higher in patients treated with stent diameter ≤ 8 mm than those with stent diameter >8 mm (HR: 3.91; 95% CI 1.74-8.81; p = 0.001)., Conclusions: PVS stenting is a safe and effective procedure for PVS/O secondary to RFA. Long-term patency and good clinical outcomes are gained after bigger-diameter stent implantation., (Copyright © 2019. Published by Elsevier B.V.)

Aims: Frequent premature atrial contractions (PACs) are associated with increased risk of atrial fibrillation (AF), stroke, and death. This study aimed to explore the electrophysiological features of PACs with and without inducing AF and to evaluate the effectiveness of catheter ablation for PACs., Methods and Results: Thirty-five consecutive patients with symptomatic, frequent, and drug-refractory PACs in the absence of AF (group A) and 35 patients with PACs-induced AF (group B) were enrolled. Coupling intervals (CoIs) of PACs were compared. Premature atrial contractions were mapped by the point-by-point and/or circular mapping technique. Focal ablation or pulmonary vein/superior vena cava isolation was applied as appropriate. A total of 35 ectopic foci were identified in group A. The majority of them were at pulmonary vein (PV) (n = 7), crista terminalis (n = 6), and para-Hisian area (n = 6). In group B, ectopic foci were in left-sided PVs in 21 patients, in right-sided PVs in 13 patients, and in SVC in 1 patient. There was significant difference in CoIs of PACs triggering AF and those from PVs and non-PV areas but without causing AF (362.8 ± 23.0 ms vs. 470.6 ± 60.1 ms vs. 515.6 ± 77.2 ms, P< 0.001). Premature atrial contractions were abolished in 32 of 35 patients from group A and in all patients from group B. At the end of follow-up, 29 patients in group A and 28 patients in group B were free of recurrence (off antiarrhythmic drugs) after the initial ablation (P =0.97)., Conclusions: Frequent PACs in the absence of AF were characterized as having their predilection sites and longer CoIs than those inducing AF. Catheter ablation was effective to eliminate symptomatic, frequent, and drug-refractory PACs., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.)

Natriuretic peptides like B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro BNP) are reported to be increased in atrial fibrillation (AF) patients. However, the prognostic roles of BNP and NT-pro BNP in post-ablation AF recurrence remain inconclusive. We performed this meta-analysis to investigate the potential role of baseline natriuretic peptides in predicting AF recurrence after catheter ablation.Electronic databases were searched for studies that evaluated the potential relationship between AF recurrence and baseline BNP or NT-pro BNP levels. The pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to quantify differences in BNP or NT-pro BNP levels between patients with and without AF recurrence.Ten studies on BNP and 8 studies on NT-pro BNP were included, in which 411 of 1300 patients and 256 of 846 patients experienced AF recurrence, respectively. Overall, the pooled SMD of studies on BNP was 0.55 (95% CI: 0.260.84, P < 0.001) while the pooled SMD of studies on NT-pro BNP was 0.96 (95% CI: 0.62-1.30, P < 0.0001). Meta-regression was conducted by AF type, AF duration, follow-up period, left atrial dimension (LAD), and concomitant heart failure, after which subgroup analysis demonstrated only follow-up period (3 months or > 3 months) in the NT-pro BNP group might account for the heterogeneity. Sensitivity analyses indicated both the results were stable.Meta-analysis of current eligible studies suggested that both increased baseline BNP and NT-pro BNP levels are associated with greater risk of AF recurrence after catheter ablation, which could be biomarkers for predicting AF recurrence.

Background: The most effective approach for long-standing persistent atrial fibrillation (LPAF) ablation remained undetermined. Our goal was to explore the heterogeneous left atrial substrate in patients with LPAF and to evaluate the effectiveness of a novel individualized substrate modification (ISM) approach in LPAF ablation., Methods: One hundred and twenty-four patients with LPAF were randomized to ISM group (n=64) or stepwise ablation (SA) group (n=60). After pulmonary vein isolation, ISM was performed in the ISM group and SA was applied in the SA group. The clinical effectiveness after a single and a repeated procedure was compared., Results: The total procedural time was significantly shorter in ISM than that in SA. In the ISM group, mild left atrial substrate was observed in 17 (27.4%), moderate in 26 (41.9%) and severe in 19 (30.6%) patients after successful cardioversion of the 62 patients. The intention-to-treat analysis showed that sinus rhythm was maintained in 65.5% of patients in the ISM group and in 45.0% of patients in the SA group after a single procedure, P=0.04. Atrial tachycardia (AT) recurred in 5 of 22 in the ISM group and in 20 of 33 in the SA group, P=0.01. After a repeated procedure, 75% of patients in the ISM group and 63.3% of patients in the SA group were free of further recurrence, P=0.16., Conclusions: Left atrial substrate varied noticeably in patients with LPAF. The ISM approach was superior to SA approach in terms of procedural time, recurrence rate of AT and clinical effectiveness after a single procedure. However, they yielded comparable outcomes after a repeated procedure., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Frequent premature ventricular complexes (PVCs) are associated with a reversible form of LV dysfunction., Objective: We performed a meta-analysis to evaluate the effects of catheter ablation on improvement of LV function in patients with frequent PVCs., Methods: We searched MEDLINE for cohort studies of patients who underwent catheter ablation of frequent PVCs. LVEF both before and postablation was reported. The endpoints were changes from baseline in both LVEF and LV end-diastolic diameter (LVEDd) postablation. Quantitative analysis of continuous variables was performed according to random effect methods by MetaAnalyst Beta 3.13 software. Association between site of origin (SOO) of PVCs and degree of LVEF improvement was evaluated by meta-regression using STATA V.12.0 software. Subgroup analysis of patients with LV dysfunction at baseline was performed., Results: Fifteen studies with a total of 712 patients were included. The mean PVC burden before catheter ablation was 24% (95% CI 19% to 29%). The long-term success rate of PVC ablation ranged from 66% to 90%. The overall mean increase from baseline in LVEF postablation was 7.7% (95% CI 6.1% to 9.4%) and the overall mean decrease in LVEDd was -4.6 mm (95% CI -6.0 to -3.1 mm). Meta-regression showed no significant association of SOO of PVCs with the degree of postablation LVEF improvement. Subgroup analysis showed that the overall mean increase from baseline in LVEF postablation was 12.4% (95% CI 8.1% to 16.6%) and the overall mean decrease in LVEDd was -4.8 mm (95% CI -6.2 to -3.4 mm) in patients with LV dysfunction at baseline., Conclusions: Ablation of frequent PVCs improves cardiac function, especially for patients with LV dysfunction.

Background: Substrate abnormality in pulmonary vein (PV) antrum plays a critical role in mechanism of atrial fibrillation (AF). The present study compares the strategy of PV antrum radial-linear (PAR) ablation to encircling PV isolation for paroxysmal AF., Methods and Results: A total of 86 patients with paroxysmal AF were randomly assigned to PAR ablation group or PV isolation group. The average procedure time was 161±21 minutes in PAR ablation group and 199±39 minutes in PV isolation group (P<0.01). The average fluoroscopy time was 25±5 minutes in PAR ablation group and 32±9 minutes in PV isolation group (P<0.001). At 14 (15-12) months of follow-up after single procedure, 31 of 42 (74%) patients in PAR ablation group and 22 of 44 patients (50%) in PV isolation group had no recurrence of AF off antiarrhythmic drug (P=0.0249); and 36 of 42 patients (86%) in PAR ablation group and 26 of 44 patients (59%) in PV isolation group had no recurrence of AF with antiarrhythmic drug (P=0.006). In addition, PAR ablation resulted in greater reduction of left atrial diameter than encircling PV isolation. Multivariable Cox regression analysis showed that only ablation strategy was independently associated with AF recurrence (hazard ratio, 0.31; 95% confidence interval, 0.12-0.78; P=0.013). No major adverse event related to the procedures occurred., Conclusions: This study suggests that PAR ablation is a potentially effective strategy for treatment of paroxysmal AF warranting further investigation., Clinical Trial Registration: URL: http://www.chictr.org; Unique identifier: ChiCTR-TRC-11001191.

Aims: Frequent premature atrial contractions (PACs) are associated with increased risk of atrial fibrillation (AF), stroke, and death. This study aimed to explore the electrophysiological features of PACs with and without inducing AF and to evaluate the effectiveness of catheter ablation for PACs.Methods and Results: Thirty-five consecutive patients with symptomatic, frequent, and drug-refractory PACs in the absence of AF (group A) and 35 patients with PACs-induced AF (group B) were enrolled. Coupling intervals (CoIs) of PACs were compared. Premature atrial contractions were mapped by the point-by-point and/or circular mapping technique. Focal ablation or pulmonary vein/superior vena cava isolation was applied as appropriate. A total of 35 ectopic foci were identified in group A. The majority of them were at pulmonary vein (PV) (n = 7), crista terminalis (n = 6), and para-Hisian area (n = 6). In group B, ectopic foci were in left-sided PVs in 21 patients, in right-sided PVs in 13 patients, and in SVC in 1 patient. There was significant difference in CoIs of PACs triggering AF and those from PVs and non-PV areas but without causing AF (362.8 ± 23.0 ms vs. 470.6 ± 60.1 ms vs. 515.6 ± 77.2 ms, P< 0.001). Premature atrial contractions were abolished in 32 of 35 patients from group A and in all patients from group B. At the end of follow-up, 29 patients in group A and 28 patients in group B were free of recurrence (off antiarrhythmic drugs) after the initial ablation (P =0.97).Conclusions: Frequent PACs in the absence of AF were characterized as having their predilection sites and longer CoIs than those inducing AF. Catheter ablation was effective to eliminate symptomatic, frequent, and drug-refractory PACs. [ABSTRACT FROM AUTHOR]

Key Clinical Message Coughing could induce symptomatic, frequent atrial premature contractions ( APCs), and episodes of atrial tachycardia ( AT) in a rare case. If multiple arrhythmic drugs therapy failed to control the symptoms, catheter ablation was an effective therapeutic option for abolishing such atrial tachyarrhythmias guided by the electroanatomic mapping systems. [ABSTRACT FROM AUTHOR]