Clinical outcomes of catheter ablation of paroxysmal atrial fibrillation in very young population compared to older population: a prospective study

Springer Science and Business Media LLC - Tập 71 - Trang 1-8 - 2019
Lamyaa Allam1, Rania Samir1, Ahmed Nabil Ali1
1Cardiology Department, Ain Shams University, Nasr City, Egypt

Tóm tắt

Data on procedural characteristics and clinical outcome of catheter ablation of atrial fibrillation (AF) in adults younger than 35 years has not been sufficiently addressed. The aim is to assess procedural characteristics and clinical outcome of catheter ablation of paroxysmal atrial fibrillation in young adults in comparison to older adults. Seventy-six consecutive patients with symptomatic paroxysmal AF underwent pulmonary vein isolation (PVI) at Ain Shams University Hospitals from 2013 till 2016. They were divided into the two groups, young population group (mean age 31.6 ± 4.2 years, 77% men) and older population group (mean age 49 ± 8.4 years, 74% men). Clinical data before and during the procedure were recorded. Follow-up was based on outpatient visits including 24 h Holter, ECG at 3, 6, and, 12 months post single ablation procedure. Recurrence was defined as any AF/atrial tachycardia episode > 30 s following a 3-month blanking period. Body mass index, CHA2DS2-VASc score, and left atrial volume were higher in the older population group [P values 0.019, < 0.001, and 0.001, respectively]. The presence of low-voltage areas was found only in 22% of the older population group and not in the younger group [P 0.02]. All patients were followed up for 1 year; 1-year arrhythmia-free survival after a single procedure was 83.3% (25/30) and 78.3% (36/46) in the older group [P 0.75]. No complications were recorded in both groups. Redo AF ablation were done for four patients in the old group and one patient in the young group. Catheter ablation of AF in very young adults is associated with higher 1-year success rates but comparable to success rates in older populations. AF ablation for PAF is effective in very young adults.

Tài liệu tham khảo

Ferrari R, Bertini B-LC, Dobrev D, Kirchhof P, Pappone C, Ravens U, Tamargo J, Tavazzi L, Vicedomini GG (2016) An update on atrial fibrillation in 2014: from pathophysiology to treatment. Int J Cardiol 203:22–29 Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, D'Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ (2004) Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 110(9):1042–1046 Abdel Latif A, Messinger-Rapport BJ (2004) Should nursing home residents with atrial fibrillation be anticoagulated? Cleve Clin J Med 71(1):40–44 Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P (2012) ESC Committee for Practice Guidelines (CPG). Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Europace. 14:1385–1413 Saguner AM, Maurer T, Wissner E, Santoro F, Lemes C, Mathew S, Sohns C, Heeger CH, Reißmann B, Riedl J, Fink T, Hayashi K, Wohlmuth P, Kuck KH, Ouyang F, Metzner A (2016) Catheter ablation of atrial fibrillation in very young adults: a 5-year follow-up study. Europace. 20(1):58–64 Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA et al (2012) 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace. 14:528–606 Hoffmann BA, Kuck KH, Andresen D, Spitzer SG, Hoffmann E, Schumacher B, Eckardt L, Brachmann J, Becker R, Steven D, Rostock T, Jünger C, Senges J, Willems S (2014) Impact of structural heart disease on the acute complication rate in atrial fibrillation ablation: results from the German ablation registry. J Cardiovasc Electrophysiol. 25:242–249 Kapa S, Desjardins B, Callans DJ, Marchlinski FE, Dixit S (2014) Contact Electroanatomic. Mapping derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology. 25(10):1044–1052 Lip GY, Halperin JL (2010) Improving stroke risk stratification in atrial fibrillation. Am J Med. 123(6):484–488 Kircher S, Arya A, Altmann D, Rolf S, Bollmann A, Sommer P, Dagres N, Richter S, Breithardt O, Dinov B, Husser D, Eitel C, Gaspar T, Piorkowski C, Hindricks G (2017) Individually tailored vs. standardized substrate modification during radiofrequency catheter ablation for atrial fibrillation: a randomized study. Europace. 0:1–10 Verma A, Wazni O, Marrouche N, Martin D, Kilicaslan F, Minor S, Schweikert R, Saliba W, Cummings J, Burkhardt J, Bhargava M, Belden W, Abdul-Karim A, Natale A (2017) Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation an independent predictor of procedural failure. JACC. 45(2):285–292 Mahnkopf C, Badger TJ, Burgon NS, Daccarett M, Haslam TS, Badger CT, McGann CJ, Akoum N, Kholmovski E, Macleod RS, Marrouche NF (2010) Evaluation of the left atrial substrate in patients with lone atrial fibrillation using delayed-enhanced MRI: implications for disease progression and response to catheter ablation. Heart Rhythm. 7:1475–1481 Marrouche NF, Wilber D, Hindricks G, Jais P, Akoum N, Marchlinski F, Kholmovski E, Burgon N, Hu N, Mont L, Deneke T, Duytschaever M, Neumann T, Mansour M, Mahnkopf C, Herweg B, Daoud E, Wissner E, Bansmann P, Brachmann J (2014) Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 311:498–506 Oakes RS, Badger TJ, Kholmovski EG, Akoum N, Burgon NS, Fish EN, Blauer JJ, Rao SN, DiBella EV, Segerson NM, Daccarett M, Windfelder J, McGann CJ, Parker D, MacLeod RS, Marrouche NF (2009) Detection and quantification of left atrial structural remodeling with delayed enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation. 119:1758–1767 Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, Neven K, Köktürk B, Konstantinidou M, Metzner A, Fuernkranz A, Kuck KH (2010) Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 122:2368–2377 Chun KR, Schmidt B, Kuck KH, Andresen D, Willems S, Spitzer SG, Hoffmann E, Schumacher B, Eckardt L, Seidl K, Jünger C, Horack M, Brachmann J, Senges J (2013) Catheter ablation of atrial fibrillation in the young: insights from the German ablation registry. Clin Res Cardiol. 102:459–468 Leong-Sit P, Zado E, Callans DJ, Garcia F, Lin D, Dixit S, Bala R, Riley MP, Hutchinson MD, Cooper J, Gerstenfeld EP, Marchlinski FE (2010) Efficacy and risk of atrial fibrillation ablation before 45 years of age. Circ Arrhythm Electrophysiol. 3:452–457