Francesco Santoro1, Luigi Di Biase2, Chintan Trivedi3, John David Burkhardt3, Alessandro Paoletti Perini4, Javier Sanchez3, Rodney Horton3, Prasant Mohanty3, Sanghamitra Mohanty3, Rong Bai3, Pasquale Santangeli5, Dhanunjay Lakkireddy6, Madhu Reddy6, Claude Samy Elayi7, Richard Hongo8, Salwa Beheiry8, Steven Hao9, Robert A Schweikert9, Juan Viles-Gonzalez10, Gaetano Fassini11, Michela Casella11, Antonio Dello Russo11, Claudio Tondo11, Andrea Natale12. 1. Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 2. Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Electrophysiology Section, Montefiore Hospital, Albert Einstein College of Medicine, New York, New York. 3. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas. 4. Heart and Vessel Department, University of Florence, Florence, Italy. 5. Department of Cardiology, University of Foggia, Foggia, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Cardiovascular Division, Electrophysiology Section, University of Pennsylvania, Philadelphia, Pennsylvania. 6. Cardiovascular Division, University of Kansas Hospital and Medical Center, Kansas City, Kansas. 7. Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky. 8. Electrophysiology Section, California Pacific Medical Center, San Francisco, California. 9. Electrophysiology Section, Akron General Hospital, Akron, Ohio. 10. Electrophysiology Section, University of Miami, Miller School Of Medicine, Miami, Florida. 11. Department of Arrhythmology, Centro Cardiologico Monzino, IRCCS, Milan, Italy. 12. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Electrophysiology Section, California Pacific Medical Center, San Francisco, California; Division of Cardiology, Stanford University, Palo Alto, California; Interventional Electrophysiology Section, Scripps Clinic, San Diego, California. Electronic address: dr.natale@gmail.com.
Abstract
OBJECTIVES: The goal of this study was to evaluate the impact of hypertension on the outcome of atrial fibrillation (AF) ablation. BACKGROUND: Hypertension is a well-known independent risk factor for incident AF. METHODS: A total of 531 consecutive patients undergoing AF ablation were enrolled in this study and divided into 3 groups: patients with uncontrolled hypertension despite medical treatment (group I, n = 160), patients with controlled hypertension (group II, n = 192), and patients without hypertension (group III, n = 179). Pulmonary vein (PV) antrum and posterior wall isolation was always performed, and non-PV triggers were identified during isoproterenol infusion. All patients underwent extensive follow-up. RESULTS: Three groups differed in terms of left atrial (LA) size, non-PV triggers, and moderate/severe LA scar. Non-PV triggers were present in 94 (58.8%), 64 (33.3%), and 50 (27.9%) patients in groups I, II, and III, respectively (p < 0.001). After 19 ± 7.7 months of follow-up, 65 (40.6%), 54 (28.1%), and 46 (25.7%) patients in groups I, II, and III had recurrences (log-rank test, p = 0.003). Among patients in group I who underwent additional non-PV trigger ablation, freedom from AF/atrial tachycardia was 69.8%, which was similar to groups II and III procedural success (log-rank p = 0.7). After adjusting for confounders, uncontrolled hypertension (group I) (hazard ratio [HR]: 1.52, p = 0.045), non-PV triggers (HR: 1.85, p < 0.001), and nonparoxysmal AF (HR: 1.64, p = 0.002) demonstrated significant association with arrhythmia recurrence. CONCLUSIONS: Controlled hypertension does not affect the AF ablation outcome when compared with patients without hypertension. By contrast, uncontrolled hypertension confers higher AF recurrence risk and requires more extensive ablation.
OBJECTIVES: The goal of this study was to evaluate the impact of hypertension on the outcome of atrial fibrillation (AF) ablation. BACKGROUND:Hypertension is a well-known independent risk factor for incident AF. METHODS: A total of 531 consecutive patients undergoing AF ablation were enrolled in this study and divided into 3 groups: patients with uncontrolled hypertension despite medical treatment (group I, n = 160), patients with controlled hypertension (group II, n = 192), and patients without hypertension (group III, n = 179). Pulmonary vein (PV) antrum and posterior wall isolation was always performed, and non-PV triggers were identified during isoproterenol infusion. All patients underwent extensive follow-up. RESULTS: Three groups differed in terms of left atrial (LA) size, non-PV triggers, and moderate/severe LA scar. Non-PV triggers were present in 94 (58.8%), 64 (33.3%), and 50 (27.9%) patients in groups I, II, and III, respectively (p < 0.001). After 19 ± 7.7 months of follow-up, 65 (40.6%), 54 (28.1%), and 46 (25.7%) patients in groups I, II, and III had recurrences (log-rank test, p = 0.003). Among patients in group I who underwent additional non-PV trigger ablation, freedom from AF/atrial tachycardia was 69.8%, which was similar to groups II and III procedural success (log-rank p = 0.7). After adjusting for confounders, uncontrolled hypertension (group I) (hazard ratio [HR]: 1.52, p = 0.045), non-PV triggers (HR: 1.85, p < 0.001), and nonparoxysmal AF (HR: 1.64, p = 0.002) demonstrated significant association with arrhythmia recurrence. CONCLUSIONS: Controlled hypertension does not affect the AF ablation outcome when compared with patients without hypertension. By contrast, uncontrolled hypertension confers higher AF recurrence risk and requires more extensive ablation.
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Humberto Rodríguez-Reyes; César I Laguna-Muñoz; Carlos F Gallegos-de Luna; Manuel O de-Los-Ríos-Ibarra; José L Salas-Pacheco; José L Leyva-Pons; Luz M Muñoz-Gutiérrez; Arturo Vargas-Hernandez; Karla M Rodríguez-Muñoz; Jaime Barragán-Luna; Marco A Alcocer-Gamba; Jorge Cortez-Lawrenz; Julio Farjat-Ruiz Journal: Arch Cardiol Mex Date: 2022-07-01
Authors: Maura M Zylla; Matthias Hochadel; Dietrich Andresen; Johannes Brachmann; Lars Eckardt; Ellen Hoffmann; Karl-Heinz Kuck; Thorsten Lewalter; Burghard Schumacher; Stefan G Spitzer; Stephan Willems; Jochen Senges; Hugo A Katus; Dierk Thomas Journal: J Clin Med Date: 2020-07-27 Impact factor: 4.241
Authors: Abdulaziz A Alodhayani; Abdullah Alkhushail; Mashhor Alhantoushi; Saad M Alsaad; Turky H Almigbal; Khalid Alotaibi; Mohammed A Batais; Abdulrahman Altheaby; Sultan Al Dalbhi; Yasser Alghamdi Journal: Int J Health Sci (Qassim) Date: 2019 Nov-Dec