A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation

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A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation. / Wesselink, Robin; Vroomen, Mindy; Overeinder, Ingrid et al.

In: Revista española de cardiología (English ed.), 22.09.2022.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{491b703fd4df4cd1b5cf53273e2fdbdc,

title = "A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation",

abstract = "INTRODUCTION AND OBJECTIVES: Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation.METHODS: We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution.RESULTS: A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation na{\"i}ve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m2, P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation na{\"i}ve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers.CONCLUSIONS: Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation na{\"i}ve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.",

author = "Robin Wesselink and Mindy Vroomen and Ingrid Overeinder and Jolien Neefs and {van den Berg}, {Nicoline W E} and Meulendijks, {Eva R} and Piersma, {Femke R} and Al-Shama, {Rushd F M} and {de Vries}, {Tim A C} and Verstraelen, {Tom E} and Justin Luermans and Bart Maesen and {de Asmundis}, Carlo and Gian-Battista Chierchia and {La Meir}, Mark and Laurent Pison and {van Boven}, {Wim Jan P} and Driessen, {Antoine H G} and {de Groot}, {Joris R}",

year = "2022",

month = sep,

day = "22",

doi = "10.1016/j.rec.2022.09.006",

language = "English",

journal = "Revista espa{\~n}ola de cardiolog{\'i}a (English ed.)",

issn = "1885-5857",

publisher = "Elsevier Doyma",

}

RIS

TY - JOUR

T1 - A failed catheter ablation of atrial fibrillation is associated with more advanced remodeling and reduced efficacy of further thoracoscopic ablation

AU - Wesselink, Robin

AU - Vroomen, Mindy

AU - Overeinder, Ingrid

AU - Neefs, Jolien

AU - van den Berg, Nicoline W E

AU - Meulendijks, Eva R

AU - Piersma, Femke R

AU - Al-Shama, Rushd F M

AU - de Vries, Tim A C

AU - Verstraelen, Tom E

AU - Luermans, Justin

AU - Maesen, Bart

AU - de Asmundis, Carlo

AU - Chierchia, Gian-Battista

AU - La Meir, Mark

AU - Pison, Laurent

AU - van Boven, Wim Jan P

AU - Driessen, Antoine H G

AU - de Groot, Joris R

PY - 2022/9/22

Y1 - 2022/9/22

N2 - INTRODUCTION AND OBJECTIVES: Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation.METHODS: We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution.RESULTS: A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m2, P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers.CONCLUSIONS: Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.

AB - INTRODUCTION AND OBJECTIVES: Recent observations suggest that patients with a previous failed catheter ablation have an increased risk of atrial fibrillation (AF) recurrence after subsequent thoracoscopic AF ablation. We assessed the risk of AF recurrence in patients with a previous failed catheter ablation undergoing thoracoscopic ablation.METHODS: We included patients from 3 medical centers. To correct for potential heterogeneity, we performed propensity matching to compare AF freedom (freedom from any atrial tachyarrhythmia> 30 s during 1-year follow-up). Left atrial appendage tissue was analyzed for collagen distribution.RESULTS: A total of 705 patients were included, and 183 had a previous failed catheter ablation. These patients had fewer risk factors for AF recurrence than ablation naïve controls: smaller indexed left atrial volume (40.9± 12.5 vs 43.0±12.5 mL/m2, P=.048), less congestive heart failure (1.5% vs 8.9%, P=.001), and less persistent AF (52.2% vs 60.3%, P=.067). However, AF history duration was longer in patients with a previous failed catheter ablation (6.5 [4-10.5] vs 4 [2-8] years; P<.001). In propensity matched analysis, patients with a failed catheter ablation were at a 68% higher AF recurrence risk (OR, 1.68; 95%CI, 1.20-2.15; P=.034). AF freedom was 61.1% in patients with a previous failed catheter ablation vs 72.5% in ablation naïve matched controls. On histology of the left atrial appendage (n=198), patients with a failed catheter ablation had a higher density of collagen fibers.CONCLUSIONS: Patients with a prior failed catheter ablation had fewer risk factors for AF recurrence but more frequently had AF recurrence after thoracoscopic AF ablation than ablation naïve patients. This may in part be explained by more progressed, subclinical, atrial fibrosis formation.

U2 - 10.1016/j.rec.2022.09.006

DO - 10.1016/j.rec.2022.09.006

M3 - Article

C2 - 36155846

JO - Revista española de cardiología (English ed.)

JF - Revista española de cardiología (English ed.)

SN - 1885-5857

ER -

ID: 28223118

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