Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction

BACKGROUND Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF). OBJECTIVE The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF). METHODS Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (45% undergoing first AF ablation were included for a secondary analysis to evaluate the effect of ACEI treatment in normal ejection fraction. In group 1, ACEI therapy started >= 3 months before ablation and continued through follow-up. RESULTS Baseline characteristics were similar except for hypertension, which was significantly more prevalent in ACEI+ (71 /0 vs 51%, P <.001). At 24 +/- 7 months of follow-up, 109 nonparoxysmal AF patients in group 1 (76%) and 81 (64 /u) in group 2 (P =.015) were recurrence free. In multivariate analysis, ACEI therapy was an independent predictor of recurrence (hazard ratio for ACEI-, 1.7, 95% confidence interval 1.1-2.7; P =.026]. However, among PAF patients, ACEI use was not associated with ablation success (80% vs 77% in ACEI+ and ACEI, respectively; P =.82). In the normal-EF population, the success rates between ACEI+ and ACEI cohorts were similar (71% vs 74%, P =.31). After the index procedure, 17 patients (9.1%) in the ACEI+ group and 28 (17.7%) in the ACEI cohort (P=.02) required rehospitalization, for a 49% relative risk reduction (relative risk 0.51, 95% confidence interval 0.29-0.90). CONCLUSION Preablation use of an ACEI is associated with improvement in ablation outcome in patients with nonparoxysmal AF with low LVEF

Analysis of catheter contact force during atrial fibrillation ablation using the robotic navigation system : results from a randomized study

Purpose Contact with cardiac tissue is an important determinant of lesion efficacy during atrial fibrillation (AF) ablation. The Sensei X\u2122 robotic navigation system (RNS) (Hansen Medical, Mountain View, CA, USA) has been validated for contact force (CF) sensing expressed in grams (g). The Thermocool\uae SmartTouch\u2122 catheter enables the measurement of catheter tip CF and direction inside the heart. We aimed to investigate the catheter CF with and without RNS during pulmonary vein isolation (PVI) procedures. Methods Eighty patients with symptomatic AF (56 males, age 63\u2009\ub1\u200918) were enrolled in this study. Fifty-seven patients had paroxysmal AF and 23 early persistent AF. All procedures were performed with the Thermocool\uae SmartTouch\u2122 ablation catheter. Forty patients were randomized to perform PVI with the Sensei X\u2122 RNS (group 1), while in the other 40 patients (group 2), PVI was performed without the RNS. Results AF ablation was performed successfully in all patients without complications, while contact force was kept in the established 10\u201340 g range. A significantly higher CF was documented on the PVs in group 1 compared to group 2. The 1-year freedom from AF recurrence was higher in group 1 compared to group 2 (90 vs. 65 %, p\u2009=\u20090.04). Moreover, a significant reduction of fluoroscopy time was noted in the RNS group (13\u2009\ub1\u200910 vs. 20\u2009\ub1\u200910 min, respectively, p\u2009=\u20090.05). Conclusions The Sensei X\u2122 RNS permits a significantly higher CF during transcatheter AF ablation with a low rate of AF recurrence at clinical follow-up