المؤلفون: Barakat AF; Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA., Wazni OM; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Saliba WI; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Yzeiraj E; Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA., Amuthan R; Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA., Abdur Rehman K; Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA., Tarakji KG; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Bassiouny M; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Baranowski B; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Tchou P; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Bhargava M; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Dresing T; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Callahan T; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Cantillon D; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Kanj M; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Chung M; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Lindsay BD; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA., Hussein AA; Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

المصدر: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2018 Apr; Vol. 29 (4), pp. 551-558. Date of Electronic Publication: 2018 Mar 01.

نوع المنشور: Comparative Study; Journal Article; Observational Study

بيانات الدورية: Publisher: Blackwell Country of Publication: United States NLM ID: 9010756 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8167 (Electronic) Linking ISSN: 10453873 NLM ISO Abbreviation: J Cardiovasc Electrophysiol Subsets: MEDLINE

مواضيع طبية MeSH: Catheter Ablation*/adverse effects , Reoperation*/adverse effects, Anti-Arrhythmia Agents/*therapeutic use , Atrial Fibrillation/*surgery, Action Potentials ; Aged ; Anti-Arrhythmia Agents/adverse effects ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/physiopathology ; Combined Modality Therapy ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Progression-Free Survival ; Recurrence ; Registries ; Risk Assessment ; Risk Factors ; Time Factors

مستخلص: Introduction: Management of persistent atrial fibrillation (PersAF) remains challenging, and many patients are left on medical therapy after a failed first ablation. In patients with recurrent symptomatic arrhythmias after PersAF ablation, we aimed to compare outcomes of repeat ablation and medical therapy versus medical therapy alone.
Methods and Results: All 682 consecutive patients with recurrent symptomatic arrhythmia after a first ablation for PersAF at our institution (2005-2012) were included. Repeat ablation with continuation of medical therapy was performed in 364 patients (Group 1) and 318 were only medically managed (Group 2). The outcome of interest was freedom from arrhythmia recurrence beyond a 3-month blanking period. Separate analyses were performed to assess this endpoint totally off antiarrhythmics (primary endpoint) or alternatively with/without use of antiarrhythmics (secondary endpoint). Over a median follow-up of 26 months, 41.5% of Group 1 patients met the primary endpoint and remained free from arrhythmia recurrence off antiarrhythmics (vs. 14.5% in Group 2, P < 0.0001). At last follow-up, antiarrhythmics continued to be required for rhythm control in 40.1% and 46.2% of patients in Groups 1 and 2, respectively (P < 0.0001). The secondary endpoint was met in 60.2% versus 32.1% of patients in Groups 1 and 2, respectively (P < 0.0001). In multivariable Cox analyses, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to medical therapy alone (HR 0.48, 95% CI 0.35-0.65, P < 0.0001).
Conclusion: In patients with recurrent symptomatic arrhythmia after ablation of PersAF, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to routine medical therapy alone.
(© 2018 Wiley Periodicals, Inc.)

المؤلفون: Bassiouny M; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Lindsay BD; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Lever H; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Saliba W; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Klein A; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Banna M; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Abraham J; Minneapolis Heart Institute, Minneapolis, Minnesota., Shao M; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Rickard J; Johns Hopkins, Baltimore, Maryland., Kanj M; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Tchou P; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Dresing T; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Baranowski B; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Bhargava M; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Callahan T; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Tarakji K; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Cantillon D; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Hussein A; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Marc Gillinov A; Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio., Smedira NG; Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio., Wazni O; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: waznio@ccf.org.

المصدر: Heart rhythm [Heart Rhythm] 2015 Jul; Vol. 12 (7), pp. 1438-47. Date of Electronic Publication: 2015 Mar 23.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE

مواضيع طبية MeSH: Atrial Fibrillation*/diagnosis , Atrial Fibrillation*/etiology , Atrial Fibrillation*/physiopathology , Atrial Fibrillation*/surgery , Catheter Ablation*/adverse effects , Catheter Ablation*/methods , Postoperative Complications*/diagnosis , Postoperative Complications*/surgery , Reoperation*/methods , Reoperation*/statistics & numerical data, Cardiomyopathy, Hypertrophic/*complications, Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Outcome Assessment, Health Care ; Prognosis ; Pulmonary Veins/surgery ; Recurrence ; Risk Factors ; Stroke Volume ; United States

مستخلص: Background: Limited data exist regarding the outcome of atrial fibrillation (AF) surgery and catheter ablation in patients with hypertrophic cardiomyopathy (HCM).
Objective: The purpose of this study was to evaluate the safety and efficacy of nonpharmacologic treatment of AF in HCM.
Methods: One hundred forty-seven patients (46 female, age 55 ± 11 years, ejection fraction [EF] 58% ± 8%) with symptomatic paroxysmal (58%), persistent (31%), and long-standing persistent AF (11%) refractory to antiarrhythmic drugs who presented for their first catheter ablation (n = 79) or AF surgery (n = 68) were included.
Results: After follow-up of 35 months (interquartile range 13, 60), 29% of patients who underwent catheter ablation and 51% of those who had undergone AF surgery had no documented recurrent atrial arrhythmia after a single procedure. Repeat ablation was performed in 55% of patients with recurrent arrhythmia in the catheter group and 24% in the surgery group, increasing the success rate to 39% and 53%, respectively, after 1 or more procedures. Predictors of success after the first procedure in a multivariable setting included higher baseline EF and male gender. Persistent or long-standing AF and log of AF duration were associated with lower success. Major complications occurred in 6% of the catheter ablation group and 18% of the AF surgery group. During follow-up, 16 patients died (9 in catheter group, 7 in surgery group) and 1 underwent heart replacement. Lower baseline EF and older age were independently associated with death.
Conclusion: Catheter ablation and AF surgery are associated with symptomatic improvement in HCM patients. However, long-term success is lower and complications are higher than previously reported.
(Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)