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Special Issue "Current Practice and Future Perspectives in Ablation of Atrial Fibrillation—Volume II"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 31 October 2023 | Viewed by 2459

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Prof. Dr. Sebastien Knecht

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AZ Sint Jan Ziekenhuis, Brugge, Belgium
Interests: atrial fibrillation; catheter ablation; technology; pulmonary vein isolation
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Dear Colleagues,

Atrial Fibrillation (AF) is the most common cardiac arrhythmia and is responsible for increased stroke risk, heart failure and all-cause mortality. The role of the pulmonary veins in triggering AF is well known; however the mechanisms of AF persistence are still discussed. Catheter ablation of AF has emerged as the most efficacious treatment to maintain sinus rhythm and has to be considered in symptomatic patients, certainly after AF recurrence despite antiarrhythmic medication. Results of catheter ablation have dramatically improved in the last few years, in line with technological evolution and better understanding and judgement of the lesions performed during the procedure. This is particularly the case for Pulmonary Vein Isolation, which remains the gold standard for any AF procedure and which has been shown to be much more efficient and durable than before. This also seems to be the case for ablation outside PV isolation, which is sometimes necessary to potentially improve the outcome of some patients presenting with persistent AF or left sided flutters.

This special issue will discuss the different aspects of AF management, from comprehension of AF mechanisms to expectations from AF ablation.

Prof. Dr. Sebastien Knecht
Guest Editor

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Keywords

atrial Fibrillation;
pulmonary Vein Isolation;
atrial tachycardia technology;

Published Papers (4 papers)

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Open AccessFeature PaperArticle

Subclinical Dysfunction of Left Atrial Compliance after Cryoballoon versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

Ewa Pilichowska-Paszkiet

Agnieszka Sikorska

Ilona Kowalik

Krzysztof Smarż

Małgorzata Sikora-Frąc

and

J. Clin. Med. 2023, 12(15), 4974; https://doi.org/10.3390/jcm12154974 - 28 Jul 2023

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Abstract

It has been suggested that cryoballoon (CB) ablation for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency (RF) ablation; however, results are conflicting. We sought to address this issue using modern echocardiographic techniques estimating the LA function after successful CB and RF ablation for PAF. A total of 90 patients (66% males, mean age 57 ± 10 years) successfully treated (no AF recurrences confirmed in serial 4–7 day ECG Holter monitoring) with RF (51%) or CB (49%) ablation for PAF were retrospectively studied. Echocardiography with speckle tracking (STE) was performed before and 12 months after the procedure. The peak longitudinal LA strain (LAS) and strain rate (LASR) during the reservoir (r), conduit (cd), and contraction (ct) phases were measured in sinus rhythm. Analysis of covariance was applied to compare changes in the echocardiographic parameters over time with the baseline measurements as covariance and the type of ablation as the factor. The parallelism of the slopes of the covariance was tested. The LA diameter decreased (38.3 ± 4.1 mm vs. 36.8 ± 3.6 mm, p < 0.001) in the whole study group at 12 months after ablation. The LASRr and LASRcd increased (1.1 ± 0.3 s⁻¹ vs. 1.3 ± 0.3 s⁻¹, p < 0.001 and 1.1 ± 0.3 s⁻¹ vs. 1.2 ± 0.3 s⁻¹, p < 0.001, respectively) whereas other LA strain parameters remained unchanged in the whole study group at 12 months after ablation. In the analysis of LA function at 12 months after the procedure regarding the mode of ablation, the worsening of parameters reflecting LA compliance was observed in patients with better pre-served baseline values in the CB ablation subgroup. For baseline LAScd >28%, the difference ΔCB − ΔRF was −7.6 (11.7; −3.4), p < 0.001, and for baseline LAScd >16%, ΔCB − ΔRF was −1.8 (−3.2; −0.4), p = 0.014. The traditional Doppler-derived parameter e′ showed the same trend—for baseline e′ ≥12 cm/s, ΔCB − ΔRF was −1.7 (−2.8; −0.6), p = 0.003. We conclude that worsening of parameters reflecting LA compliance was observed 12 months after CB ablation compared to RF ablation for PAF in patients who underwent a successful procedure and had better-preserved baseline LA function. This might suggest subclinical dysfunction of LA after the CB ablation procedure. The clinical significance of these findings warrants further investigations. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation—Volume II)

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Open AccessArticle

CLOSE-Guided Pulmonary Vein Isolation to Treat Persistent Atrial Fibrillation: 1-Year Outcome

and

J. Clin. Med. 2023, 12(14), 4698; https://doi.org/10.3390/jcm12144698 - 15 Jul 2023

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Abstract

Background: CLOSE-guided pulmonary vein isolation (PVI) is based on contiguous and optimized (Ablation Index-guided) radiofrequency lesions. The efficacy of CLOSE-guided PVI in persistent atrial fibrillation (AF) treatment has been poorly evaluated. Methods: In two centers, 50 patients eligible for persistent AF ablation underwent CLOSE-guided PVI (Ablation Index ≥ 450 at the anterior wall, ≥300 at posterior wall, intertag distance ≤ 6 mm). If PVI failed to restore sinus rhythm (SR), electrical cardioversion (ECV) was performed. Atrial substrate modification (ASM) was performed only if PVI and ECV failed to restore SR. Recurrence was defined as any recorded episode of AF, atrial tachycardia (AT) or atrial flutter (AFL) > 30 s on Holter electrocardiographs at 3, 6 and 12 months. Results: From the 50 patients (64 ± 10 years, 14% long-standing persistent AF), SR was restored by ECV in 34 patients (68%) 56 ± 38 days prior to ablation. On the day of ablation, 42 patients (84%) were on class I-III anti-arrhythmic drug therapy (ADT) and the rhythm was AF in 23/50 patients. PVI was achieved in all patients; after PVI, ECV was required in 21 patients and ASM in 1 patient. The mean procedure time, radiofrequency time and fluoroscopy time were 141 ± 33 min, 23 ± 7 min and 7 ± 6 min, respectively. At 12 months, single-procedure freedom from AF/AT/AFL was 80%, with 19 patients (38%) receiving class I-III ADT. Conclusions: In a population of patients with persistent AF monitored with intermittent cardiac rhythm recordings, CLOSE-guided PVI resulted in high single-procedure arrhythmia-free survival at 1 year. Future large-scale studies involving continuous cardiac monitoring are necessary. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation—Volume II)

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Open AccessArticle

Cardioselective versus Non-Cardioselective Beta-Blockers and Outcomes in Patients with Atrial Fibrillation and Chronic Obstructive Pulmonary Disease

Dimitra Vlachopoulou

Charalampos Balomenakis

Anastasios Kartas

Athanasios Samaras

Andreas S. Papazoglou

Dimitrios V. Moysidis

Konstantinos Barmpagiannos

Melina Kyriakou

Anastasios Papanastasiou

and

J. Clin. Med. 2023, 12(9), 3063; https://doi.org/10.3390/jcm12093063 - 23 Apr 2023

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Abstract

Background: Atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD) have been independently associated with increased mortality; however, there is no evidence regarding beta-blocker cardioselectivity and long-term outcomes in patients with AF and concurrent COPD. Methods: This post hoc analysis of the MISOAC-AF randomized trial (NCT02941978) included patients hospitalized with comorbid AF. At discharge, all patients were classified according to the presence of COPD; patients with COPD on beta-blockers were classified according to beta-blocker cardioselectivity. Adjusted hazard ratios (aHRs) were calculated by using multivariable Cox regression models. The primary outcome was all-cause mortality, and the secondary outcomes were cardiovascular mortality and hospitalizations. Results: Of 1103 patients with AF, 145 (13%) had comorbid COPD. Comorbid COPD was associated with an increased risk of all-cause (aHR, 1.33; 95% confidence interval (CI), 1.02 to 1.73) and cardiovascular mortality (aHR 1.47; 95% CI, 1.10 to 1.99), but not with increased risk of hospitalizations (aHR 1.10; 95% CI, 0.82 to 1.48). The use of cardioselective versus non-cardioselective beta-blockers was associated with similar all-cause mortality (aHR 1.10; 95% CI, 0.63 to 1.94), cardiovascular mortality (aHR 1.33; 95% CI, 0.71 to 2.51), and hospitalizations (aHR 1.65; 95% CI 0.80 to 3.38). Conclusions: In recently hospitalized patients with AF, the presence of COPD was independently associated with increased risk of all-cause and cardiovascular mortality. No difference between cardioselective and non-cardioselective beta-blockers, regarding clinical outcomes, was identified. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation—Volume II)

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Open AccessSystematic Review

Three Ablation Techniques for Atrial Fibrillation during Concomitant Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Dudy Arman Hanafy

Wahyu Prima Erdianto

Theresia Feline Husen

Ilona Nathania

Ananda Pipphali Vidya

Ruth Angelica

Widya Trianita Suwatri

Pasati Lintangella

Priscillia Prasetyo

and

Sugisman

J. Clin. Med. 2023, 12(17), 5716; https://doi.org/10.3390/jcm12175716 - 01 Sep 2023

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Abstract

Atrial fibrillation (AF) ablation is a frequent procedure used in concomitant cardiac surgery. However, uncertainty still exists concerning the optimal extent of lesion sets. Hence, the objective of this study was to assess the results of various ablation techniques, aiming to offer a reference for clinical decision making. This review is listed in the prospective register of systematic reviews (PROSPERO) under ID CRD42023412785. A comprehensive search was conducted across eight databases (Scopus, Google Scholar, EBSCOHost, PubMed, Medline, Wiley, ProQuest, and Embase) up to 18 April 2023. Studies were critically appraised using the Cochrane Risk of Bias 2.0 for randomized control trials (RCTs) and the Newcastle Ottawa Scale adapted by the Agency for Healthcare Research and Quality (AHRQ) for cohort studies. Forest plots of pooled effect estimates and surface under the cumulative ranking (SUCRA) were used for the analysis. Our analysis included 39 studies and a total of 7207 patients. Both bi-atrial ablation (BAA) and left atrial ablation (LAA) showed similar efficacy in restoring sinus rhythm (SR; BAA (77.9%) > LAA (76.2%) > pulmonary vein isolation (PVI; 66.5%); LAA: OR = 1.08 (CI 0.94–1.23); PVI: OR = 1.36 (CI 1.08–1.70)). However, BAA had higher pacemaker implantation (LAA: OR = 0.51 (CI 0.37–0.71); PVI: OR = 0.52 (CI 0.31–0.86)) and reoperation rates (LAA: OR = 0.71 (CI 0.28–1.45); PVI: OR = 0.31 (CI 0.1–0.64)). PVI had the lowest efficacy in restoring SR and a similar complication rate to LAA, but had the shortest procedure time (Cross-clamp (Xc): PVI (93.38) > LAA (37.36) > BAA (13.89)); Cardiopulmonary bypass (CPB): PVI (93.93) > LAA (56.04) > BAA (0.03)). We suggest that LAA is the best surgical technique for AF ablation due to its comparable effectiveness in restoring SR, its lower rate of pacemaker requirement, and its lower reoperation rate compared to BAA. Furthermore, LAA ranks as the second-fastest procedure after PVI, with a similar CPB time. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives in Ablation of Atrial Fibrillation—Volume II)

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