BACKGROUND: Few studies evaluated the impact of catheter ablation (CA) on atrial tachyarrhythmia (ATA) burden in paroxysmal atrial fibrillation (AF). OBJECTIVE: In the prospective, patient-controlled CLOSE to CURE study, we determined the longer-term impact of optimized CA on ATA burden by using an insertable cardiac monitor (ICM). METHODS: A total of 105 patients with paroxysmal AF were implanted with an ICM 65 (interquartile range [IQR] 61-78) days before CA. CA consisted of contact force-guided pulmonary vein isolation targeting an intertag distance of ≤6 mm and a region-specific ablation index. The primary end point was reduction in ICM-detected ATA burden; secondary end points were single-procedure freedom from ATA, quality of life, and adverse events. RESULTS: The mean age was 62 ± 8 years; the median CHA2DS2-VASc score was 1 (IQR 1-2); and the median left atrial diameter was 43 (IQR 39-43) mm. After pulmonary vein isolation (1.13 ± 0.39 procedures per patient), median ATA burden decreased from 2.68% (IQR 0.09%-15.02%) at baseline to 0% (IQR 0%-0%) during the first year and to 0% (IQR 0%-0%) during the second year (reduction in ATA burden 100% [IQR 100%-100%]; P < .001). Single-procedure freedom from any ATA was 87% at 1 year and 78% at 2 years. Quality of life improved significantly across all scores. Adverse events occurred in 5 patients (4.8%). CONCLUSION: CA has become an effective procedure in paroxysmal AF, with a major impact on ICM-detected ATA burden. Whereas conventional survival analysis suggests a progressive decline in efficacy, we observed that burden reduction is maintained at longer follow-up. These data imply that ATA burden is a more optimal end point for assessing ablation efficacy.
BACKGROUND: Few studies evaluated the impact of catheter ablation (CA) on atrial tachyarrhythmia (ATA) burden in paroxysmal atrial fibrillation (AF). OBJECTIVE: In the prospective, patient-controlled CLOSE to CURE study, we determined the longer-term impact of optimized CA on ATA burden by using an insertable cardiac monitor (ICM). METHODS: A total of 105 patients with paroxysmal AF were implanted with an ICM 65 (interquartile range [IQR] 61-78) days before CA. CA consisted of contact force-guided pulmonary vein isolation targeting an intertag distance of ≤6 mm and a region-specific ablation index. The primary end point was reduction in ICM-detected ATA burden; secondary end points were single-procedure freedom from ATA, quality of life, and adverse events. RESULTS: The mean age was 62 ± 8 years; the median CHA2DS2-VASc score was 1 (IQR 1-2); and the median left atrial diameter was 43 (IQR 39-43) mm. After pulmonary vein isolation (1.13 ± 0.39 procedures per patient), median ATA burden decreased from 2.68% (IQR 0.09%-15.02%) at baseline to 0% (IQR 0%-0%) during the first year and to 0% (IQR 0%-0%) during the second year (reduction in ATA burden 100% [IQR 100%-100%]; P < .001). Single-procedure freedom from any ATA was 87% at 1 year and 78% at 2 years. Quality of life improved significantly across all scores. Adverse events occurred in 5 patients (4.8%). CONCLUSION: CA has become an effective procedure in paroxysmal AF, with a major impact on ICM-detected ATA burden. Whereas conventional survival analysis suggests a progressive decline in efficacy, we observed that burden reduction is maintained at longer follow-up. These data imply that ATA burden is a more optimal end point for assessing ablation efficacy.
Authors: Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; K R Julian Chun; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Andreas Metzner; Tilman Maurer; Nils-Christian Ewertsen; Henning Jansen; Andreas Rillig; Victoria Johnson; Till Althoff Journal: Herzschrittmacherther Elektrophysiol Date: 2021-07-26
Authors: René Worck; Samuel K Sørensen; Arne Johannessen; Martin Ruwald; Martin Haugdal; Jim Hansen Journal: J Cardiovasc Electrophysiol Date: 2022-05-31 Impact factor: 2.942
Authors: Dhiraj Gupta; Johan Vijgen; Tom De Potter; Daniel Scherr; Hugo Van Herendael; Sebastien Knecht; Richard Kobza; Benjamin Berte; Niels Sandgaard; Jean-Paul Albenque; Gábor Széplaki; Yorick Stevenhagen; Philippe Taghji; Matt Wright; Mattias Duytschaever Journal: Heart Date: 2021-05-05 Impact factor: 5.994