Presence of sinus rhythm at time of ablation in patients with persistent atrial fibrillation undergoing pulmonary vein isolation is associated with improved long-term arrhythmia outcomes.

Autor: Eberly LA; Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, University of Pennsylvania, Philadelphia, USA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, USA., Lin A; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Park J; Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA., Khoshnab M; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Garg L; Electrophysiology Section, Division of Cardiology, University of Colorado Anschutz, Aurora, USA., Chee J; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Kallan MJ; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA., Walsh K; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Supple GE; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Schaller RD; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Santangeli P; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Riley MP; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Nazarian S; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Arkles J; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Hyman M; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Lin D; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Guandalini G; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Kumareswaran R; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Deo R; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Zado ES; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Epstein A; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Frankel DS; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Callans DJ; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Marchlinski FE; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA., Dixit S; Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Gates, 3400 Spruce St, Philadelphia, PA, 19104, USA. Sanjay.Dixit@pennmedicine.upenn.edu.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2023 Sep; Vol. 66 (6), pp. 1455-1464. Date of Electronic Publication: 2022 Dec 16.
DOI: 10.1007/s10840-022-01441-4
Abstrakt: Background: Adverse structural and electrical remodeling underlie persistent atrial fibrillation (PersAF). Restoration of sinus rhythm (SR) prior to ablation in PersAF may improve the underlying substrate, thus improving arrhythmia outcomes. The aim of this study was to evaluate if the presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of a limited catheter ablation (CA) strategy in PersAF.
Methods: Patients with PersAF undergoing pulmonary vein isolation at our institution from 2014-2018 were included. We compared patients who presented for ablation in SR (by cardioversion and/or antiarrhythmic drugs [AADs]) to those who presented in AF. Primary outcome of interest was freedom from atrial arrhythmias (AAs) on or off AADs at 1 year after single ablation. Secondary outcomes included freedom from AAs on or off AADs overall, freedom from AAs off AADs at 1 year, and time to recurrent AF.
Results: Five hundred seventeen patients were included (322 presented in AF, 195 SR). The primary outcome was higher in those who presented for CA in SR as compared to AF (85.6% vs. 77.0%, p = 0.017). Freedom from AAs off AAD at 12 months was also higher in those presenting in SR (59.0% vs. 44.4%; p = 0.001) and time to recurrent AF was longer (p = 0.008). Presence of SR at CA was independently associated with the primary outcome at 12 months (OR 1.77; 95% CI 1.08-2.90) and overall (OR 1.89; 95% CI 1.26-2.82).
Conclusions: Presence of SR at time of ablation is associated with improved long-term arrhythmia outcomes of limited CA in PersAF.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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