Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China
BackgroundPulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.ObjectiveThis study aims to investigate the incidence of PVI non-responders in patients undergo...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-12-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049414/full |
| _version_ | 1811297707887689728 |
|---|---|
| author | Zhoushan Gu Gang Yang Weizhu Ju Mingfang Li Hongwu Chen Kai Gu Hailei Liu Minglong Chen |
| author_facet | Zhoushan Gu Gang Yang Weizhu Ju Mingfang Li Hongwu Chen Kai Gu Hailei Liu Minglong Chen |
| author_sort | Zhoushan Gu |
| collection | DOAJ |
| description | BackgroundPulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.ObjectiveThis study aims to investigate the incidence of PVI non-responders in patients undergoing a repeat procedure, as well as the predictors for the recurrence of repeat ablation.MethodsA total of 276 consecutive patients who underwent repeat ablation from August 2016 to July 2019 in two centers were screened. A total of 64 (22%) patients with durable PVI were enrolled. Techniques such as low voltage zone modification, linear ablation, non-PV trigger ablation, and empirical superior vena cava (SVC) isolation were conducted.ResultsAfter the 20.0 ± 9.9 month follow-up, 42 (65.6%) patients were free from atrial arrhythmias. A significant difference was reported between the recurrent and non-recurrent groups in non-paroxysmal AF (50 vs. 23.8%, p = 0.038), diabetes mellitus (27.3 vs. 4.8%, p = 0.02), and empirical superior vena cava (SVC) isolation (28.6 vs. 60.5%, p = 0.019). Multivariate regression analysis demonstrated that empirical SVC isolation was an independent predictor of freedom from recurrence (95% CI: 1.64–32.8, p = 0.009). Kaplan-Meier curve demonstrates significant difference in recurrence between empirical and non-empirical SVC isolation groups (HR: 0.338; 95% CI: 0.131–0.873; p = 0.025).ConclusionAbout 22% of patients in repeat procedures were PVI non-responders. Non-paroxysmal AF and diabetes mellitus were associated with recurrence post-re-ablation. Empirical SVC isolation could potentially improve the outcome of repeat procedures in PVI non-responders. |
| first_indexed | 2024-04-13T06:09:09Z |
| format | Article |
| id | doaj.art-b5d758a23af3473591894e2573cb14c3 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-13T06:09:09Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b5d758a23af3473591894e2573cb14c32022-12-22T02:59:09ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-12-01910.3389/fcvm.2022.10494141049414Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in ChinaZhoushan Gu0Gang Yang1Weizhu Ju2Mingfang Li3Hongwu Chen4Kai Gu5Hailei Liu6Minglong Chen7Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaDepartment of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, ChinaBackgroundPulmonary vein isolation (PVI) is the standard ablation strategy for treating atrial fibrillation (AF). However, the optimal strategy of a repeat procedure for PVI non-responders remains unclear.ObjectiveThis study aims to investigate the incidence of PVI non-responders in patients undergoing a repeat procedure, as well as the predictors for the recurrence of repeat ablation.MethodsA total of 276 consecutive patients who underwent repeat ablation from August 2016 to July 2019 in two centers were screened. A total of 64 (22%) patients with durable PVI were enrolled. Techniques such as low voltage zone modification, linear ablation, non-PV trigger ablation, and empirical superior vena cava (SVC) isolation were conducted.ResultsAfter the 20.0 ± 9.9 month follow-up, 42 (65.6%) patients were free from atrial arrhythmias. A significant difference was reported between the recurrent and non-recurrent groups in non-paroxysmal AF (50 vs. 23.8%, p = 0.038), diabetes mellitus (27.3 vs. 4.8%, p = 0.02), and empirical superior vena cava (SVC) isolation (28.6 vs. 60.5%, p = 0.019). Multivariate regression analysis demonstrated that empirical SVC isolation was an independent predictor of freedom from recurrence (95% CI: 1.64–32.8, p = 0.009). Kaplan-Meier curve demonstrates significant difference in recurrence between empirical and non-empirical SVC isolation groups (HR: 0.338; 95% CI: 0.131–0.873; p = 0.025).ConclusionAbout 22% of patients in repeat procedures were PVI non-responders. Non-paroxysmal AF and diabetes mellitus were associated with recurrence post-re-ablation. Empirical SVC isolation could potentially improve the outcome of repeat procedures in PVI non-responders.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049414/fullatrial fibrillationrecurrencepulmonary vein isolatednon-PV triggersuperior vena cava |
| spellingShingle | Zhoushan Gu Gang Yang Weizhu Ju Mingfang Li Hongwu Chen Kai Gu Hailei Liu Minglong Chen Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China Frontiers in Cardiovascular Medicine atrial fibrillation recurrence pulmonary vein isolated non-PV trigger superior vena cava |
| title | Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China |
| title_full | Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China |
| title_fullStr | Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China |
| title_full_unstemmed | Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China |
| title_short | Empirical superior vena cava isolation improves outcomes of radiofrequency re-ablation in pulmonary vein isolation non-responders: A 2-center retrospective study in China |
| title_sort | empirical superior vena cava isolation improves outcomes of radiofrequency re ablation in pulmonary vein isolation non responders a 2 center retrospective study in china |
| topic | atrial fibrillation recurrence pulmonary vein isolated non-PV trigger superior vena cava |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1049414/full |
| work_keys_str_mv | AT zhoushangu empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT gangyang empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT weizhuju empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT mingfangli empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT hongwuchen empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT kaigu empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT haileiliu empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina AT minglongchen empiricalsuperiorvenacavaisolationimprovesoutcomesofradiofrequencyreablationinpulmonaryveinisolationnonrespondersa2centerretrospectivestudyinchina |