Abstract 13597: Association Between Antiarrhythmic Drug Therapy Prescription in the Blanking Period and Recurrent Atrial Arrhythmias After First-time Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chaitanya L Malladi ◽  
Michael Eskander ◽  
Florentino Lupercio ◽  
Frederick Han ◽  
Kurt S Hoffmayer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Limited Data ◽  
Antiarrhythmic Drug Therapy ◽  
Reduce Risk ◽  
Artery Disease ◽  
First Time ◽  
Multivariable Adjustment

Introduction: Antiarrhythmic drugs (AAD) are often prescribed in the blanking period (BP) after catheter ablation of atrial fibrillation (AF) to reduce risk of early recurrence (ER) and late recurrence (LR). There are limited data on which AAD to use during the BP. Hypothesis: We hypothesize that specific AADs may be associated with reduced risk of ER and/or LR after ablation. Methods: A total of 478 consecutive patients (mean age 64.2 years, 67.2% male) undergoing first-time pulmonary vein isolation (PVI) ablation at a single institution were included. Outcomes of interest were: freedom from ER, freedom from LR, initial discontinuation of AAD less than 90 days after ablation, and freedom from second ablation. ER was defined as AF, atrial flutter (AFL), or atrial tachycardia (AT) > 30 seconds within the BP. LR was defined as AF/AFL/AT > 30 seconds occurring after the BP. Results: Of 478 patients, 14.9% (n = 71) were on no AAD, 26.4% (n = 126) were on propafenone/flecainide, 34.5% (n = 165) were on sotalol/dofetilide, 10.7% (n = 51) were on dronedarone, and 13.6% (n = 65) were on amiodarone. Patients on amiodarone were older, had higher BMI, and were more likely to have persistent AF, hypertension, diabetes, heart failure, and coronary artery disease. In unadjusted analyses, there were no differences between groups with regards to the risk of ER (log rank P = 0.171), discontinuation of AAD before ninety days post-ablation (log rank P = 0.235), or freedom from second ablation (log rank P = 0.147). After multivariable adjustment, patients on amiodarone or dronedarone were more likely to experience LR than those on no AAD [Adjusted Hazard Ratio (AHR) 1.83, 95% CI 1.10-3.04, p=0.02 for amiodarone; AHR 1.79, 95% CI 1.05-3.05, p=0.03 for dronedarone]. Conclusions: Following first-time AF catheter ablation, there were no differences between the presence or absence of AAD and risk of ER, while those prescribed amiodarone or dronedarone in the BP were more likely to experience LR than those on no AAD.

scholarly journals Association between specific antiarrhythmic drug prescription in the post-procedural blanking period and recurrent atrial arrhythmias after catheter ablation for atrial fibrillation

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253266
Author(s):  
Chaitanya L. Malladi ◽  
Douglas Darden ◽  
Omar Aldaas ◽  
Praneet S. Mylavarapu ◽  
Michael Eskander ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Drug Prescription ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Atrial Arrhythmias ◽  
Confounding By Indication ◽  
Single Institution ◽  
First Time ◽  
Multivariable Adjustment

Purpose To evaluate if specific AADs prescribed in the blanking period (BP) after catheter ablation of atrial fibrillation (AF) may be associated with reduced risk of early recurrence (ER) and/or late recurrence (LR) of atrial arrhythmias. Methods A total of 478 patients undergoing first-time ablation at a single institution were included. Outcomes were: ER, LR, discontinuation of AAD less than 90 days post-ablation, and second ablation. ER was defined as AF, atrial flutter (AFL), or atrial tachycardia (AT) > 30 seconds within BP. LR was defined as AF/AFL/AT > 30 seconds after BP. Results Of 478 patients, 14.9% were prescribed no AAD, 26.4% propafenone/flecainide, 34.5% sotalol/dofetilide, 10.7% dronedarone, and 13.6% amiodarone. Patients prescribed amiodarone were more likely to have persistent AF, hypertension, diabetes, and other comorbidities. In unadjusted analyses, there were no differences between groups in relation to ER (log rank P = 0.171), discontinuation of AAD before ninety days post-ablation (log rank P = 0.235), or freedom from second ablation (log rank P = 0.147). After multivariable adjustment, patients prescribed amiodarone or dronedarone were more likely to experience LR than those prescribed no AAD [Adjusted Hazard Ratio (AHR) 1.83, 95% CI 1.10–3.04, p = 0.02; AHR 1.79, 95% CI 1.05–3.05, p = 0.03, respectively]. Conclusion Following first-time catheter ablation, there were no differences between specific AAD prescription and risk of ER, while those prescribed amiodarone or dronedarone in the BP were more likely to experience LR than those prescribed no AAD, which may represent an association due to confounding by indication.

scholarly journals 12-Month Single-Procedure Outcomes after Atrial Fibrillation Catheter Ablation in Phramongkutklao Hospital: A Single Center 10-Year Experience

2021 ◽  
Vol 72 (2) ◽  
pp. 114-120
Author(s):  
Sarawuth Limprasert
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Posterior Wall ◽  
Efficacy And Safety ◽  
Related Complication ◽  
Single Procedure ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack ◽  
First Time

Objective: This study aimed to report the efficacy and safety of 1-year outcome for single-procedure radiofrequency catheter ablation (RFCA) at Phramongkutklao Hospital. Methods: Review of medical records was carried out on consecutive patients with symptomatic atrial fibrillation (AF) who had undergone first-time RFCA in Phramongkutklao Hospital between January 2009 and December 2018. The efficacy and safety of outcomes after 1 year of RFCA were collected, analyzed, and validated using descriptive data. Results: 61 patients underwent RFCA for the first time. 77.05% were male, with a mean age of 58.31 ± 10.83 years. Paroxysmal AF presented in 65.57%. 49.18% had hypertension, 9.84% had a history of ischemic stroke or transient ischemic attack, 6.56% had diabetes, 6.56% had coronary artery disease, and 4.92% had heart failure. 96.72% of RFCA procedures were performed under local anesthesia and conscious sedation. Pulmonary vein isolation was performed in all patients. Roofline, mitral isthmus line, and posterior wall isolation were created in 27.87%, 13.11%, and 3.28%, respectively. Additional complex fractionated atrial electrograms (CFAEs) were targeted in 19.67%. After 12 months, 45.45% remained in sinus rhythm, with only one patient experiencing a procedure-related complication with cardiac tamponade. Conclusion: The 1-year results of single-procedure RFCA for treating AF at our center, while not highly successful in our first decade, were comparable to other series. Notably, there was a relatively low rate of complications.

scholarly journals Predictors of early and late recurrence of atrial fibrillation after catheter ablation: two sides of the same coin?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Ribeiro Da Silva ◽  
G Santos Silva ◽  
P Ribeiro Queiros ◽  
R Teixeira ◽  
J Almeida ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Catheter Ablation ◽  
Independent Predictor ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Multivariate Logistic Regression ◽  
Funding Sources ◽  
Early And Late Recurrence ◽  
Af Recurrence

Abstract Background Recurrence of atrial fibrillation (AF) after catheter ablation (CA) is estimated to be between 20% and 45%. Recurrent AF early after ablation is generally classified as benign as a part of a blanking period, but recently has been associated with later recurrent AF. The prediction of early and late AF recurrence after CA remains challenging as well as the predictive value of early AF recurrence in the blanking period. Purpose We aimed to determine the clinical and procedural factors associated with early and late recurrence of AF after CA. Methods Single-centre retrospective study that included all patients who underwent AF CA between January 2017 and October 2019. Ablation procedures included radiofrequency and second-generation cryoballoon CA. Early recurrence of AF (ERAF) was defined as any recurrence of AF >30 seconds within 90 days after CA and late recurrence (LR) was defined as any recurrence of AF >30 seconds after 90 days of CA. The independent association between clinical and procedural variables and AF recurrence was evaluated with logistic regression analysis. Results We included 399 patients, 64,7% male, with a mean age of 56,8±11,6 years, most of them had paroxysmal AF with a mean duration until CA of 3,5±3,4 years. Early recurrence of AF occurred in 51 patients (12,8%). After multivariate logistic regression, we identify left atrium (LA) diameter [odds ratio (OR) 1,1, 95% confidence interval (CI) 1,03–1,18; p=0,007] as the only independent predictor associated with recurrent AF. Late recurrence of AF was observed in 104 patients (26,1%), on average, 12,8±8,7 months after CA. After multivariable adjustment, LA diameter (OR 1,1, 95% CI 1,01–1,12; p=0,032) and intraprocedural electric cardioversion (OR 1,8, 95% CI 1,03–3,12; p=0,040) were independently associated with recurrent AF. Regarding patients with ERAF, most of them also had late recurrent AF (64,7%), whereas in patients without ERAF, only 20,4% had LR (p<0,001). After including ERAF in the multivariate logistic regression, we identify ERAF as the only independent predictor of late recurrence of AF (OR 5,23, 95% CI 2,56–10,72; p<0,001). Conclusions In our cohort, late recurrence of AF after catheter ablation was significantly higher in patients with recurrence within the blanking period, which was the only independent predictor of AF late recurrence. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

2021 ◽  
Author(s):  
Miruna A. Popa ◽  
Marc Kottmaier ◽  
Elena Risse ◽  
Marta Telishevska ◽  
Sarah Lengauer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antiarrhythmic Drugs ◽  
De Novo ◽  
Persistent Atrial Fibrillation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Transient Phenomenon ◽  
Future Studies

Abstract Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. Conclusion ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies. Graphic abstract

scholarly journals Catheter Ablation of Atrial Fibrillation – Techniques and Technology

2012 ◽  
Vol 1 ◽  
pp. 29 ◽  
Author(s):  
George Katritsis ◽  
Hugh Calkins ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
The Elderly ◽  
Late Recurrence ◽  
Aged Patients ◽  
Antiarrhythmic Drug Therapy ◽  
Patient Groups ◽  
Maintain Sinus Rhythm

For certain patients with atrial fibrillation (AF) catheter ablation is now an important, therapeutic, intervention. It is established that catheter ablation is more effective than antiarrhythmic drug therapy at maintaining middle-aged patients with paroxysmal AF in sinus rhythm. However, the role of catheter ablation in other patient groups is not yet well defined. Particularly in patients with long-standing persistent AF, heart failure and the elderly, the efficacy of catheter ablation remains uncertain. At experienced centers catheter ablation for AF can be performed with reasonable safety and efficacy. However, major complications can occasionally occur. Late recurrence of AF is not uncommon and many patients will require a further procedure to maintain sinus rhythm. Fortunately, there are promising developments in the techniques and technology used for AF ablation that are likely to improve the outcomes of the procedure.

scholarly journals Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation

2021 ◽  
Author(s):  
Douglas Darden ◽  
Omar Aldaas ◽  
Chaitanya L. Malladi ◽  
Praneet S. Mylavarapu ◽  
Muhammad Bilal Munir ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prognostic Significance ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Atrial Tachyarrhythmia ◽  
Af Ablation ◽  
Poor Area ◽  
First Time

Abstract Purpose Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation. Methods A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively. Results ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523–1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57–3.74, p < 0.001; month 2: HR 2.01, CI 1.13–3.83, p = 0.02; month 3: HR 1.46, CI 0.5–3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64). Conclusion Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.

Sign in / Sign up

Export Citation Format

Share Document