Conduction recovery following catheter ablation in patients with recurrent atrial fibrillation and heart failure. in International journal of cardiology / Int J Cardiol. 2017 Aug 1;240:240-245. doi: 10.1016/j.ijcard.2017.02.067. Epub 2017 Feb 22.
2017
ASL Asti
ASL Vercelli
Tipo pubblicazione
Multicenter Study
Autori/Collaboratori (10)Vedi tutti...
Ferraris F
Cardiology Division, Department of Medical Sciences, University of Turin, Turin, Italy.
Neumann T
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Qian P
Department of Cardiology, Westmead Hospital, University of Sydney, Australia.
et alii...
Abstract
BACKGROUND: Atrial fibrillation (AF) catheter ablation is increasingly proposed for patients suffering from AF and concomitant heart failure (HF). However, the optimal ablation strategy remains controversial. We performed this study to assess the prevalence of pulmonary vein (PV) or linear lesion reconnection in HF patients undergoing repeated procedures. METHODS AND RESULTS: At seven high-volume centres, 165 patients with HF underwent a repeat procedure after a first AF ablation including PV isolation alone (47 patients, group A) or PV isolation plus left atrial lines (118 patients, group B). Group A patients presented more often paroxysmal AF (p<0.001), less enlarged left atrium (p<0.001) and less left ventricular systolic dysfunction (p=0.031) compared to Group B, that more commonly had atypical atrial flutter (p<0.001). Forty-one (87%) patients in Group A and 69 (58%) in Group B presented at least one reconnected PV (p<0.001). Sixty-one (52%) patients in Group B presented at least one reconnected atrial line (left isthmus or roof). Patients without any reconnected PV (n=54, 33%) more frequently experienced persistent AF (p<0.001), had longer AF duration (p=0.047) and larger left atrial volume (p<0.001). Twenty-five patients (15%) with no PV and/or line reconnection did not significantly differ, concerning baseline characteristics, compared to those with at least one reconnected ablation site. CONCLUSION: As in the general AF population undergoing catheter ablation, PV reconnection is frequent in patients with HF and symptomatic recurrence. However, one third of patients presented arrhythmic recurrences even in the absence of PV reconnection, highlighting the importance of the underlying atrial substrate.
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PMID : 28258848
DOI : 10.1016/j.ijcard.2017.02.067
Keywords
Treatment Outcome; Retrospective Studies; Recurrence; Recovery of Function/physiology; Middle Aged; Male; Humans; Heart Failure/epidemiology/physiopathology/surgery; Heart Conduction System/physiology; Female; Catheter Ablation/trends; Transcatheter ablation; Pulmonary veins; Heart failure; Linear lesions; Atrial fibrillation; Atrial Fibrillation/epidemiology/physiopathology/surgery; Aged; Adult;