66 research outputs found
Posterior Wall Isolation Improves Outcomes for Persistent AF With Rapid Posterior Wall Activity: A CAPLA Substudy
No full textAbstract not availableLouise Segan, David Chieng, Sandeep Prabhu, Andrew Hunt, Troy Watts, Brian Klys, Aleksandr Voskoboinik, Hariharan Sugumar, Liang-Han Ling, Geoff Lee, Joseph Morton, Rajeev K. Pathak, Deep Chandh Raja, Laurence Sterns, Matthew Ginks, Prashanthan Sanders, Jonathan M. Kalman, Peter M. Kistle
Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF
No full textAvailable online 27 September 2024BACKGROUND: Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation. OBJECTIVES: This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation. METHODS: CAPLA (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]) was a multicenter trial that randomized patients with PsAF to PVI plus PWI or PVI alone. Follow-up was 12 months. Outcomes were assessed after a 3-month blanking period. RESULTS: A total of 334 patients were included (median age 65.6 years, 23.1% female), 194 (58.1%) had PsAF at first AF diagnosis and 140 (41.9%) had PAF. Patients with PsAF at diagnosis were younger (age 64.0 vs 67.7 years, P = 0.005), had higher rates of heart failure (P < 0.001), and lower left ventricular ejection fraction (54.5% IQR: 40-60 vs 60% IQR: 50-61, P = 0.007). AF recurrence occurred in 85 (43.8%) with PsAF at diagnosis and 70 (50%) with PAF at diagnosis. PsAF at diagnosis was not associated with risk of recurrence on univariable (HR: 0.802; 95% CI: 0.585-1.101; P = 0.173) or multivariable analysis (HR: 0.922; 95% CI: 0.647-1.312; P = 0.650). Median AF burden was 0% in both groups (P = 0.125). There was no difference in left atrial size (P = 0.337) or bipolar voltage (P = 0.579) between the groups. CONCLUSIONS: In the CAPLA cohort of patients, pattern of AF at first diagnosis did not influence post-ablation rate of AF recurrence or AF burden. (Catheter Ablation for persistent atrial fibrillation: A Multicentre randomised trial of Pulmonary vein isolation [PVI] vs PVI with posterior Left Atrial wall isolation [PWI]; ACTRN12616001436460).Rose Crowley, David Chieng, Louise Segan, Jeremy William, Hariharan Sugumar, Sandeep Prabhu, Aleksandr Voskoboinik, MBBS, Liang-Han Ling, Joseph B. Morton, f Geoffrey Lee, Alex J. McLellan, Michael Wong, Rajeev K. Pathak, Laurence Sterns, Matthew Ginks, Prashanthan Sanders, Peter M. Kistler, Jonathan M. Kalma
Sex specific outcomes following catheter ablation in persistent AF
No full textAvailable online 8 February 2024BACKGROUND Sex-specific outcomes after catheter ablation (CA) for atrial fibrillation (AF) have reported conflicting findings. OBJECTIVE We examined the impact of female sex on outcomes in patients with persistent AF (PsAF) from the Catheter Ablation for Persistent Atrial Fibrillation: A Multicentre Randomized Trial of Pulmonary Vein Isolation vs PVI with Posterior Left Atrial Wall Isolation (CAPLA) randomized trial. METHODS A total of 338 patients with PsAF were randomized to pulmonary vein isolation (PVI) or PVI with posterior wall isolation (PWI). The primary outcome was arrhythmia recurrence at 12 months. Clinical and electroanatomical characteristics, arrhythmia recurrence, and quality of life were compared between women and men. RESULTS Seventy-ninewomen (23.4%; PVI 37; PVI1PWI 42) and 259 men (76.6%; PVI 131; PVI1PWI 128) underwent AF ablation. Womenwere older {median age 70.4 (interquartile range [IQR] 64.8–74.6) years vs 64.0 (IQR 56.7–69.7) years; P < .001} and had more advanced left atrial electroanatomical remodeling. At 12 months, arrhythmia-free survival was lower in women (44.3% vs 56.8% in men; hazard ratio 1.44; 95% confidence interval 1.02–2.04; log-rank, P 5 .036). PWI did not improve arrhythmia-free survival at 12 months (hazard ratio 1.02; 95% confidence interval 0.74–1.40; log-rank, P 5 .711). The median AF burden was 0% in both groups (women: IQR 0.0%–2.2% vs men: IQR 0.0%–2.8%; P 5 .804). Health care utilization was comparable between women (36.7%) and men (30.1%) (P 5 .241); however, women were more likely to undergo a repeat procedure (17.7% vs 6.9%; P 5 .007). Women reported more severe baseline anxiety (average Hospital Anxiety and Depression Scale [HADS] anxiety score 7.5 6 4.9 vs 6.3 6 4.3 in men; P 5 .035) and AF-related symptoms (baseline Atrial Fibrillation Effect on Quality-of-Life Questionnaire [AFEQT] score 46.7 6 20.7 vs 55.96 23.0 inmen; P5 .002), with comparable improvements in psychological symptoms (change in HADS anxiety score 23.864.6 vs23.064.5; P5.152 (change inHADS depression score22.965.0 vs22.664.0; P5.542) and greater improvement in AFEQT score compared with men at 12 months (change in AFEQT score 145.9 6 23.1 vs 139.2 6 24.8; P 5 .048). CONCLUSION Women undergoing CA for PsAF report more significant symptoms and poorer quality of life at baseline than men. Despite higher arrhythmia recurrence and repeat procedures in women, the AF burden was comparably low, resulting in significant improvements in quality of life and psychological well-being after CA in both sexes.Louise Segan, David Chieng, Rose Crowley, Jeremy William, Hariharan Sugumar, Liang-Han Ling, Joshua Hawson, Sandeep Prabhu, Aleksandr Voskoboinik, M Joseph B. Morton, Geoffrey Lee, Laurence D. Sterns, Matthew Ginks, Prashanthan Sanders, Jonathan M. Kalman, Peter M. Kistle
Impact of Posterior Left Atrial Voltage on Ablation Outcomes in Persistent Atrial Fibrillation: CAPLA Substudy
No full textBACKGROUND Pulmonary vein isolation (PVI) is less effective in patients with persistent atrial fibrillation (PsAF). Adjunctive ablation targeting low voltage areas (LVAs) may improve arrhythmia outcomes. OBJECTIVES This study aims to compare the outcomes of adding posterior wall isolation (PWI) to PVI, vs PVI alone in PsAF patients with posterior wall LVAs. METHODS The CAPLA (Effect of Catheter Ablation Using Pulmonary Vein Isolation With vs Without Posterior Left Atrial Wall Isolation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation) study was a multicenter, randomized trial involving PsAF patients randomized 1:1 to either PVI alone or PVI with PWI. Voltage mapping performed during pacing pre-ablation was reviewed offline, with LVA defined as bipolar voltage of 30 seconds off antiarrhythmic medication at 12 months after a single ablation procedure in patients with posterior LVA. RESULTS A total of 210 patients (average 64.6 ± 9.2 years,73.3% males, median atrial fibrillation duration 4.5 months [IQR: 2 to 8 months]) underwent multipolar left atrial mapping during coronary sinus pacing with posterior LVA present in 69 (32.9%). Patients with posterior LVA were more likely to have LVA in other atrial regions (91.7% vs 57.1%; P < 0.01), larger left atrial diameter (4.8 cm vs 4.4 cm; P < 0.01), and significantly increased risk of atrial arrhythmia recurrence at 12 months (LVA: 56.5% vs no LVA: 41.4%; HR: 1.51; 95% CI: 1.01-2.27; P 1/4 0.04) compared to no posterior LVA. However, the addition of PWI to PVI did not significantly improve freedom from atrial arrhythmia recurrence over PVI alone (PVI with PWI: 44.8% vs PVI: 41.9%; HR: 0.95; 95% CI: 0.51-1.79; P = 0.95). CONCLUSIONS In patients with PsAF undergoing catheter ablation, posterior LVA was associated with a significant increase in atrial arrhythmia recurrence. However, the addition of PWI in those with posterior LVA did not reduce atrial arrhythmia recurrence over PVI alone.David Chieng, Hariharan Sugumar, Andrew Hunt, Liang-Han Ling, Louise Segan, Ahmed Al-Kaisey, Joshua Hawson, Sandeep Prabhu, Aleksandr Voskoboinik, Geoffrey Wong, Joseph B. Morton, Geoffrey Lee, Matthew Ginks, Laurence Sterns, Prashanthan Sanders, Jonathan M. Kalman, Peter M. Kistle
Incidence, characteristics, and prognostic significance of early recurrences after different ablation approaches for persistent atrial fibrillation
No full textPublished November 2025BACKGROUND Early recurrence of atrial tachyarrhythmia (ERAT) is common after catheter ablation of atrial fibrillation (AF). The specific clinical and arrhythmia characteristics of ERAT influencing late recurrence risk in persistent AF are unclear. In addition, the impact of different ablation strategies on the incidence and prognostic significance of ERAT remains unknown. OBJECTIVE This study aimed to assess the incidence, characteristics, and prognostic impact of ERAT in patients with persistent AF undergoing pulmonary vein isolation alone or pulmonary vein isolation with posterior wall isolation. METHODS Trial participants monitored by implantable cardiac devices or twice-daily electrocardiogram transmissions were included. Atrial arrhythmia recurrences lasting ≥ 30 seconds were classified as ERAT (within 3 months after ablation) or late recurrence (between 3 and 12 months). RESULTS Of the 282 included patients, ERAT occurred in 124 (44.0%). ERAT portended an increased incidence of late recurrence (68.5% vs 32.9%; hazard ratio, 3.36; 95% confidence interval, 2.35–4.79) and significantly higher post–blanking period AF burden (median, 0.66% [interquartile range, 0–8.35%] vs 0% [0–0.55%]). The hazard ratio for late recurrence was 2.34 (1.48–3.71), 2.89 (1.63–5.12), and 6.00 (3.86–9.32) when the latest ERAT occurred in the first, second, and third month, respectively. Late recurrence risk was particularly elevated in patients with high-burden, frequent, or symptomatic ERAT. Ablation strategy did not affect the incidence, burden, arrhythmia characteristics, or prognostic significance of ERAT. CONCLUSION ERAT after radiofrequency ablation of persistent AF is an independent predictor of late recurrence and increased post–blanking period AF burden. An individualized assessment of early recurrences is warranted to critically evaluate their clinical significance.Sohaib A. Virk, David Chieng, Louise Segan, Joseph B. Morton, Geoffrey Lee, Paul Sparks, Alex J. McLellan, Hariharan Sugumar, Sandeep Prabhu, Liang-Han Ling, Aleksandr Voskoboinik, Rajeev K. Pathak, Laurence D. Sterns, Matthew Ginks, Prashanthan Sanders, Peter Kistler, Jonathan Kalma
Endocardial left ventricular pacing across the interventricular septum for cardiac resynchronization therapy: Clinical results of a pilot study
No full textBackground Cardiac resynchronization therapy (CRT) is an effective treatment for selected patients with heart failure, but it can be limited by the inability to place the left ventricular (LV) lead via the coronary sinus. Objective The purpose of this study was to develop an alternative approach, placing the LV lead endocardially via an interventricular septal puncture, and to assess the feasibility and safety of this technique. Methods All patients were anticoagulated with warfarin (international normalized ratio 2.5–3.5). A superior approach ventricular transseptal puncture using radiofrequency energy was performed. An active fixation pacing lead was delivered to the mapped site of latest electrical activation on the endocardial LV. Results Twenty patients were recruited, 15 with failed transvenous LV lead placement and 5 nonresponders to CRT. Mean (± SD) age was 67 ± 12, with 80% male, QRS duration 157 ± 14 ms, ischemic etiology 45%, New York Heart Association functional class 2.9 ± 0.4, and LV ejection fraction 28% ± 7%. The procedure was successful in all, with no serious complications. Clinical composite score improved at 6 months in 65% and worsened in 35%. LV ejection fraction improved >5% in 88%, from 28% ± 7% to 41% ± 9%. Six-minute walking distance improved >10% in 64%, from 248 ± 125 m to 316 ± 109 m. One patient suffered a lacunar ischemic stroke after 5 months with partial neurological recovery, associated with labile international normalized ratios. After 2.0 ± 1.0 years of follow-up, 3 patients died (2 pneumonia, 1 heart failure), and 2 patients suffered transient ischemic attacks. Conclusion LV endocardial pacing via interventricular septal puncture in patients for whom standard CRT is not possible is similarly effective and durable, with significant but potentially acceptable risks
Quantitative analysis of cardiac left ventricular variables obtained by MRI at 3 T : a pre- and post-contrast comparison
No full textShort-axis cine images are acquired during cardiac MRI in order to determine variables of cardiac left ventricular (LV) function such as ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and LV mass. In cardiac perfusion assessments this imaging can be performed in the temporal window between first pass perfusion and the acquisition of delayed enhancement images in order to minimise overall scanning time. The objective of this study was to compare pre- and post-contrast short-axis LV variables of 15 healthy volunteers using a two-dimensional cardiac-gated segmented cine true fast imaging with steady state precession sequence and a 3.0 T MRI unit in order to determine the possible effects of contrast agent on the calculated cardiac function variables. Image analysis was carried out using semi-automated software. The calculated mean LV mass was lower when derived from the post-contrast images, relative to those derived pre-contrast (102 vs 108.1 g, p<0.0001). Small but systematic significant differences were also found between the mean pre- and post-contrast values of EF (69.4% vs 68.7%, p<0.05), EDV (142.4 vs 143.7 ml, p<0.05) and ESV (44.2 vs 45.5 ml, p<0.005), but no significant differences in SV were identified. This study has highlighted that contrast agent delivery can influence the numerical outcome of cardiac variables calculated from MRI and this was particularly noticeable for LV mass. This may have important implications for the correct interpretation of patient data in clinical studies where post-contrast images are used to calculate LV variables, since LV normal ranges have been traditionally derived from pre-contrast data sets.Peer reviewe
35Power, lesion size index and oesophageal temperature alerts during atrial fibrillation ablation (PILOT-AF): a randomized study
No full textLeft ventricular pacing for gradient reduction and symptomatic relief in mid-cavity obstructive hypertrophic cardiomyopathy
No full textLong-term outcomes of catheter ablation for atrial fibrillation in octogenarians.
No full textBACKGROUND AND AIMS: Catheter ablation is superior to pharmacological therapy in controlling atrial fibrillation (AF). There are few data on the long-term outcome of AF ablation in octogenarian patients. This analysis aims to evaluate the outcome of AF ablation in octogenarians vs. younger patients. METHODS: In this retrospective study in 13 centres in the UK, France, and Switzerland, the long-term outcomes of 473 consecutive octogenarian patients undergoing ablation for AF were compared to 473 matched younger controls (median age 81.3 [80.0, 83.0] vs. 64.4 [56.5, 70.7] years, 54.3% vs. 35.1% females; p-value for both < 0.001). The primary endpoint was the recurrence of atrial arrhythmia after a blanking period of 90 days within 365 days of follow-up. RESULTS: Acute ablation success as defined as isolation of all pulmonary veins was achieved in 97% of octogenarians. Octogenarians experienced more procedural complications (11.4% vs 7.0%, p = 0.018). The median follow-up time was 281 [106, 365] days vs. 354 [220, 365] days for octogenarians vs. non-octogenarians (p < 0.001). Among octogenarians, 27.7% (131 patients) experienced a recurrence of atrial arrhythmia, in contrast to 23.5% (111 patients) in the younger group (odds ratio 1.49; 95% confidence interval 1.16-1.92; p = 0.002). In a multivariable regression model including gender, previous AF ablation, vascular disease, chronic kidney disease, CHA2DS2-VASc score, left atrial dilatation, and indwelling cardiac implantable electronic device, age above 80 remained an independent predictor of recurrence of arrhythmia. CONCLUSION: Ablation for AF is effective in octogenarians, but is associated with slightly higher procedural complication rate and recurrence of atrial arrhythmia than in younger patients
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