4 research outputs found
Inducibility of atrial fibrillation after catheter ablation predicts recurrences of atrial fibrillation: a meta-analysis
Background
Pulmonary vein isolation (PVI) is a component of standard care for patients with symptomatic atrial fibrillation (AF). Procedural inducibility of AF following PVI has been suggested as predictor of AF recurrence but is discussed controversially. This meta-analysis aimed at evaluating the relevance of electrophysiological inducibility of AF following PVI for future AF recurrences.
Methods
A literature search of MEDLINE and Web of Science was performed until April 2020. Prospective trials of PVI in patients with AF and post-procedural atrial stimulation to test for inducibility of AF as well as adequate follow-up for AF recurrence (defined as AF >10 s to >10 min at follow-up) were included. Odds ratios (ORs) were analyzed using random-effects models.
Results
A total of 11 trials with 1544 patients (follow-up 7–39 months, age 56 ± 6 years, predominantly male 74 ± 6%) were included. Inducibility of AF post-PVI was predictive for AF recurrence during follow-up (OR 2.08; 95% CI 1.25 to 3.46). Prediction for AF recurrence at follow-up was better for patients with paroxysmal AF (OR 4.06; 95% CI 1.39 to 11.91), stimulation in the CS (OR 2.82, 95% CI 1.17 to 6.79). A trend towards higher ORs was seen without the use of isoproterenol (OR 2.43; 95% CI 1.17 to 5.07), as well as few stimulations during induction and a short definition of AF in meta-regression analyses.
Conclusions
Electrophysiological inducibility of AF following PVI was predictive for future recurrence of AF, in particular in patients with paroxysmal AF, stimulation in only CS and no use of isoproterenol
Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation
(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic
stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary
vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed
before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male,
left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After
PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score,
as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and
HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of
documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital
Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of
AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey
(SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in
HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to
rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in
patients with AF
Prediction of conduction disturbances in patients undergoing transcatheter aortic valve replacement
Aim Transcatheter aortic valve replacement (TAVR) can cause intraventricular conduction disturbances (ICA), particularly
left bundle branch block (BBB) and high-degree atrioventricular block (HAVB). The aim of this study was to investigate
clinical, anatomical, procedural, and electrophysiological parameters predicting ICA after TAVR.
Methods Patients with severe aortic stenosis (n=203) without pacing devices undergoing TAVR with a self-expanding
(n=103) or balloon-expanding (n=100) valve were enrolled. Clinical and anatomical parameters, such as length of the
membranous septum (MS) and implantation depth, were assessed. His-ventricular interval (HVi) before and after implantation was determined. 12-lead-electrocardiograms (ECG) before, during and after 3 and 30 days after TAVR were analyzed
for detection of any ICA.
Results Among 203 consecutive patients (aortic valve area 0.78±0.18 cm2
, age 80±6 years, 54% male, left ventricular
ejection fraction 52±10%), TAVR led to a signifcant prolongation of infranodal conduction in all patients from 49±10 ms
to 59±16 ms (p=0.01). The HVi prolongation was independent of valve types, occurrence of HAVB or ICA. Fifteen patients
(7%) developed HAVB requiring permanent pacemaker (PPM) implantation and 63 patients (31%) developed ICA within
30 days. Pre-existing BBB (OR 11.64; 95% CI 2.87–47.20; p=0.001), new-onset left BBB (OR 15.72; 95% CI 3.05–81.03;
p=0.001), and diabetes mellitus (OR 3.88; 95% CI 1.30–15.99; p=0.02) independently predicted HAVB requiring PPM.
Neither pre-existing right BBB, a prolonged postHVi, increases in PR duration, any of the TAVR implantation procedural
and anatomic nor echocardiographic characteristics were predictive for later HAVB.
Conclusions New-onset left BBB and diabetes mellitus independently predicted HAVB requiring PPM after TAVR and
helped to identify patients at risk. Electrophysiologic study (EPS) of atrioventricular conduction was neither specifc nor
predictive of HAVB and can be skipped.
Trial registration number NCT04128384 (https://www.clinicaltrials.gov)
Heart-Focused Anxiety, General Anxiety, Depression and Health-Related Quality of Life in Patients with Atrial Fibrillation Undergoing Pulmonary Vein Isolation
(1) Background: Atrial fibrillation (AF) is associated with anxiety, depression, and chronic stress, and vice versa. The purpose of this study was to evaluate potential effects of pulmonary vein isolation (PVI) on psychological factors. (2) Methods: Psychological assessment was performed before PVI as well as after six months. (3) Results: A total of 118 patients [age 64 ± 9 years, 69% male, left ventricular ejection fraction 57 ± 8%, 56% paroxysmal AF] undergoing PVI were included. After PVI, significant improvements were observed in the mean total heart-focused anxiety (HFA) score, as well as in the Cardiac Anxiety Questionnaire (CAQ) sub-scores: HFA attention, HFA fear, and HFA avoidance scores. Subgroup analyses showed an association of improvement with freedom of documented AF recurrence. Mean scores of general anxiety and depression evaluated by the Hospital Anxiety and Depression Scale (HADS) decreased significantly after PVI in all subgroups regardless of AF recurrence. Further, both physical and mental composite scores of the Short Form Health Survey (SF-12) increased significantly from baseline. (4) Conclusions: PVI results in a significant reduction in HFA. Improvements in general anxiety and depressive symptoms did not seem to be related only to rhythm control per se. Therefore, CAQ may represent a more specific evaluation tool as HADS in patients with AF