A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation.

Autor:	Wesselink R; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Vroomen M; Department of Cardiac Surgery, Robert Bosch Hospital, Stuttgart, Germany., Overeinder I; Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium., Neefs J; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., van den Berg NWE; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Meulendijks ER; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Piersma FR; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Al-Shama RFM; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., de Vries TAC; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Verstraelen TE; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Luermans J; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands., Maesen B; Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands., de Asmundis C; Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium., Chierchia GB; Heart Rhythm Management Centre, Universitair Ziekenhuis Brussels, Vrije Universiteit Brussel, Brussels, Belgium., La Meir M; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium., Pison L; Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium., van Boven WJP; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., Driessen AHG; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands., de Groot JR; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Heart Center, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands. Electronic address: j.r.degroot@amsterdamumc.nl.
Jazyk:	English; Spanish; Castilian
Zdroj:	Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2023 Jun; Vol. 76 (6), pp. 417-426. Date of Electronic Publication: 2022 Sep 22.
DOI:	10.1016/j.rec.2022.09.006
Abstrakt:	Introduction and Objectives: Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation. Methods: We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution. Results: A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m 2 , P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers. Conclusions: Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation. (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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