Early Markers of Atrial Fibrillation Recurrence After Pulmonary Vein Isolation

Overview

Journal J Arrhythm

Publisher Wiley

Date 2020 Apr 8

PMID 32256879

Citations 1

Authors

Eva A H Lanters

Christophe P Teuwen

Thijmen Hokken

Sofie Rohde

David B Haitsma

Felix Zijlstra

Luc J L M Jordaens

Natasja M S de Groot

Affiliations

Soon will be listed here.

Abstract

Background: Postprocedural atrial extrasystole (AES) frequency predicts atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) in patients with paroxysmal AF. However, the predictive value of preprocedural AES frequency is unknown. We investigate whether preprocedural AES frequency is a feasible marker to predict (timing of) AF recurrence after PVI.

Methods: Patients (N = 684) with paroxysmal or persistent AF undergoing first-time PVI were evaluated for (a) the frequency of AES/day on Holter recordings without AF prior to PVI, (b) AF episodes during the 90 days blanking period, and (c) AF recurrences afterward. The correlation between AES/day and both development and timing of AF recurrences was tested.

Results: Preprocedural AES/day was similar in patients with paroxysmal (66 [20-295] AES/day) and persistent AF (115 [12-248] AES/day, = .915). During the blanking period, 302 (44.2%) patients showed AF episodes. AF recurred in 379 (55.4%) patients at 203 (105-400) days after PVI. AF recurred more frequently in patients with persistent (N = 104 [69.3%]) than in patients with paroxysmal AF (N = 275 [51.5%], < .001). Frequency of AES prior to PVI was not correlated with development ( = .203) or timing ( = .478) of AF recurrences. AF recurrences occurred both more frequently ( < .001) and earlier ( < .000) in patients with AF during the blanking period.

Conclusion: AES/day prior to PVI is not correlated with (timing of) AF during the blanking period or AF recurrences, and is therefore not a feasible marker for AF recurrences in patients with PAF. AF during the blanking period is correlated with AF recurrence.

Citing Articles

Early markers of atrial fibrillation recurrence after pulmonary vein isolation.

Lanters E, Teuwen C, Hokken T, Rohde S, Haitsma D, Zijlstra F J Arrhythm. 2020; 36(2):304-310.

PMID: 32256879 PMC: 7132191. DOI: 10.1002/joa3.12307.

References

DAscenzo F, Corleto A, Biondi-Zoccai G, Anselmino M, FERRARIS F, Di Biase L . Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis. Int J Cardiol. 2012; 167(5):1984-9. DOI: 10.1016/j.ijcard.2012.05.008. View

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38):2893-2962. DOI: 10.1093/eurheartj/ehw210. View

van der Velden H, Ausma J, Rook M, Hellemons A, van Veen T, Allessie M . Gap junctional remodeling in relation to stabilization of atrial fibrillation in the goat. Cardiovasc Res. 2000; 46(3):476-86. DOI: 10.1016/s0008-6363(00)00026-2. View

Ang R, Domenichini G, Finlay M, Schilling R, Hunter R . The Hot and the Cold: Radiofrequency Versus Cryoballoon Ablation for Atrial Fibrillation. Curr Cardiol Rep. 2015; 17(9):631. DOI: 10.1007/s11886-015-0631-7. View

Yamane T, Date T, Kanzaki Y, Inada K, Matsuo S, Shibayama K . Behavior of atrial ectopic beats before and after pulmonary vein isolation in patients with atrial fibrillation: a reduction in the number and arrhythmogenicity of ectopic firings. Heart Rhythm. 2006; 3(12):1421-7. DOI: 10.1016/j.hrthm.2006.08.023. View

Acharya T, Tringali S, Bhullar M, Nalbandyan M, Ilineni V, Carbajal E . Frequent Atrial Premature Complexes and Their Association With Risk of Atrial Fibrillation. Am J Cardiol. 2015; 116(12):1852-7. DOI: 10.1016/j.amjcard.2015.09.025. View

Chong B, Pong V, Lam K, Liu S, Zuo M, Lau Y . Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace. 2011; 14(7):942-7. DOI: 10.1093/europace/eur389. View

Miragoli M, Salvarani N, Rohr S . Myofibroblasts induce ectopic activity in cardiac tissue. Circ Res. 2007; 101(8):755-8. DOI: 10.1161/CIRCRESAHA.107.160549. View

Mugnai G, de Asmundis C, Hunuk B, Stroker E, Velagic V, Moran D . Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: Predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences. Heart Rhythm. 2016; 13(4):845-51. DOI: 10.1016/j.hrthm.2015.12.034. View

10.

Willems S, Khairy P, Andrade J, Hoffmann B, Levesque S, Verma A . Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Arrhythm Electrophysiol. 2016; 9(8). DOI: 10.1161/CIRCEP.115.003909. View

11.

Gang U, Nalliah C, Lim T, Thiagalingam A, Kovoor P, Ross D . Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2015; 8(3):569-74. DOI: 10.1161/CIRCEP.114.002052. View

12.

Ausma J, WIJFFELS M, Thone F, Wouters L, Allessie M, Borgers M . Structural changes of atrial myocardium due to sustained atrial fibrillation in the goat. Circulation. 1997; 96(9):3157-63. DOI: 10.1161/01.cir.96.9.3157. View

13.

Teuwen C, Korevaar T, Coolen R, van der Wel T, Houck C, Evertz R . Frequent atrial extrasystolic beats predict atrial fibrillation in patients with congenital heart defects. Europace. 2016; 20(1):25-32. DOI: 10.1093/europace/euw300. View

14.

Lin W, Tai C, Hsieh M, Tsai C, Lin Y, Tsao H . Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003; 107(25):3176-83. DOI: 10.1161/01.CIR.0000074206.52056.2D. View

15.

Oral H, Knight B, Tada H, Ozaydin M, Chugh A, Hassan S . Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002; 105(9):1077-81. DOI: 10.1161/hc0902.104712. View

16.

Inada K, Matsuo S, Tokutake K, Yokoyama K, Hioki M, Narui R . Predictors of ectopic firing from the superior vena cava in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2014; 42(1):27-32. DOI: 10.1007/s10840-014-9954-3. View

17.

Lanters E, Teuwen C, Hokken T, Rohde S, Haitsma D, Zijlstra F . Early markers of atrial fibrillation recurrence after pulmonary vein isolation. J Arrhythm. 2020; 36(2):304-310. PMC: 7132191. DOI: 10.1002/joa3.12307. View

18.

Brundel B, Ausma J, Van Gelder I, Van der Want J, van Gilst W, Crijns H . Activation of proteolysis by calpains and structural changes in human paroxysmal and persistent atrial fibrillation. Cardiovasc Res. 2002; 54(2):380-9. DOI: 10.1016/s0008-6363(02)00289-4. View

19.

Haissaguerre M, Jais P, Shah D, Takahashi A, Hocini M, Quiniou G . Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998; 339(10):659-66. DOI: 10.1056/NEJM199809033391003. View

20.

January C, Samuel Wann L, Alpert J, Calkins H, Cigarroa J, Cleveland Jr J . 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014; 64(21):e1-76. DOI: 10.1016/j.jacc.2014.03.022. View