- Email: [email protected]
PROGRESSION OF PAROXYSMAL TO PERSISTENT AF IN PATIENTS AWAITING AF ABLATION
S222
Canadian Cardiovascular Society (CCS) Oral ATRIAL FIBRILLATION ABLATION Monday, October 26, 2015 422 PROGRESSION OF PAROXYSMAL TO PERSISTENT AF IN PATIENTS AWAITING AF ABLATION S Kochhaeuser, DG Dechering, K Trough, P Hache, T Haig-Carter, Y Khaykin, Z Wulffhart, A Pantano, B Tsang, L Eckardt, A Verma Newmarket, Ontario
Atrial fibrillation (AF) is a progressive disease for which ablation has become an important treatment option. Success rates have been shown to be significantly higher while AF has not yet progressed to persistent. In a general AF-population the HATCH-score has been proposed to predict the risk of progression to persistent AF. However, little is known about predictors of progression in patients awaiting AF ablation. METHODS/RESULTS: We performed a retrospective, single centre investigation of patients with paroxysmal AF at the time they were placed onto our AF ablation waiting list and evaluated possible risk factors for the progression of AF until the time of the actual ablation of 564 patients (median age 60.4 (15.1) years, 194 (34.4%) female) 60 (11%) progressed from paroxysmal to persistent AF during a median waiting time of 291 (244.3) days. In patients that progressed to persistent AF, ablation took significantly longer (18099 min vs. 15785min; p 0.009), had a tendency to require longer RFenergy delivery (68.940 min vs. 61.844 min; p 0.052) and was associated with a higher rate of recurrence (53.3% vs. 39.1%; p<0.001). Patients that did progress to persistent AF had tied significantly more antiarrhythmic drugs (1 (2) vs. 1(1); p 0,048) and more frequently had a history of amiodaron treatment (21.7% vs. 11.9%; p 0.03). The previously proposed HATCH-score was only a poor predictor of AF progression (AUC 0.54). Furthermore, none of the individual HATCH-score parameters was a significantly predicted the progression of AF in our population. However, a left atrial (LA) diameter of more than 45mm (OR 3.46, p< 0.001) and heart failure (OR 3.11, p 0.036) were strong and independent predictors of AF progression in multivariable analysis. CONCLUSION: Patients with an increased LA-diameter or heart failure have a significantly increased risk to progress to persistent AF. If ablation is considered in such a patient it should be conducted as soon as possible to prevent progression to persistent AF. OBJECTIVE:
Canadian Journal of Cardiology Volume 31 2015 BACKGROUND: Catheter-tissue contact is essential for effective lesion formation hence there is a growing usage of contact force (CF) technology in atrial fibrillation (AF) ablation. Data regarding the efficacy and safety of CF for catheter ablation of AF are limited. We conducted a metaanalysis to assess the impact of CF on clinical outcomes and procedural parameters in comparison to conventional catheter (CC) for AF ablation. METHODS: An electronic search was performed using Cochrane central database, PubMed, Embase, and Web of Knowledge. References were searched manually. Outcomes of interest were: recurrence rate, major complications (including major bleeding, ischemic stroke, embolism or transient ischemic attack), total procedure, and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. RESULTS: Eleven studies (2 randomized controlled studies and 9 cohorts) involving 1428 adult patients (855 patients (60%) with paroxysmal AF) were identified. CF was deployed in 552 patients. The range of CF used was between 2 and 60 grams-force (Mean CF 175 g). Follow up period ranged between 10- 53 weeks. In comparison between CF and CC groups, a lower recurrence rate was noted with CF (35% vs. 46%, OR 0.62 (95% confidence interval [CI] 0.45; 0.86), P¼0.004). No significant heterogeneity was noted for the comparison (I2¼23%, P¼0.23). Shorter procedure and fluoroscopic times were achieved with CF (156 vs. 173 mins, SDM -0.85 (95% CI -1.48; -0.21), P¼0.009; 28 vs. 36 mins, SDM -0.94 (95% CI.66; -0.21), P¼0.01, respectively). Major complication rate was higher numerically in the CC group but this did not reach statistical significance (1.33% vs. 1.94%, OR 0.71 (95% CI 0.29; 1.73), P¼ 0.45). CONCLUSION: The use of CF technology results in a significant reduction of AF recurrence rate after AF ablation in comparison to CC group. CF technology is able to significantly reduce procedure and fluoroscopic times without compromising complication rate.
424 CONTACT FORCE-GUIDED VERSUS CONTACT FORCE-BLINDED CATHETER ABLATION OF TYPICAL ATRIAL FLUTTER: A PROSPECTIVE STUDY S Venier, J Andrade, M Dubuc, K Dyrda, P Guerra, P Khairy, B Mondésert, L Rivard, D Roy, M Talajic, B Thibault, N Malliet, S Gomes, R Tadros, L Macle Montréal, Québec
423 IMPACT OF CONTACT FORCE TECHNOLOGY ON ATRIAL FIBRILLATION ABLATION: A META-ANALYSIS M Shurrab, L Di Biase, D Briceno, A Kaoutskaia, D Newman, I Lashevsky, H Nakagawa, E Crystal Nablus, Palestine
BACKGROUND:
Whether contact force (CF) sensing ablation technology is useful for CavoTricuspid Isthmus (CTI) ablation is unknown. We prospectively evaluated procedural parameters and outcomes of CF-Guided versus CFBlinded CTI ablation for atrial flutter in our academic institution.
Canadian Cardiovascular Society (CCS) Oral ATRIAL FIBRILLATION ABLATION Monday, October 26, 2015 422 PROGRESSION OF PAROXYSMAL TO PERSISTENT AF IN PATIENTS AWAITING AF ABLATION S Kochhaeuser, DG Dechering, K Trough, P Hache, T Haig-Carter, Y Khaykin, Z Wulffhart, A Pantano, B Tsang, L Eckardt, A Verma Newmarket, Ontario
Atrial fibrillation (AF) is a progressive disease for which ablation has become an important treatment option. Success rates have been shown to be significantly higher while AF has not yet progressed to persistent. In a general AF-population the HATCH-score has been proposed to predict the risk of progression to persistent AF. However, little is known about predictors of progression in patients awaiting AF ablation. METHODS/RESULTS: We performed a retrospective, single centre investigation of patients with paroxysmal AF at the time they were placed onto our AF ablation waiting list and evaluated possible risk factors for the progression of AF until the time of the actual ablation of 564 patients (median age 60.4 (15.1) years, 194 (34.4%) female) 60 (11%) progressed from paroxysmal to persistent AF during a median waiting time of 291 (244.3) days. In patients that progressed to persistent AF, ablation took significantly longer (18099 min vs. 15785min; p 0.009), had a tendency to require longer RFenergy delivery (68.940 min vs. 61.844 min; p 0.052) and was associated with a higher rate of recurrence (53.3% vs. 39.1%; p<0.001). Patients that did progress to persistent AF had tied significantly more antiarrhythmic drugs (1 (2) vs. 1(1); p 0,048) and more frequently had a history of amiodaron treatment (21.7% vs. 11.9%; p 0.03). The previously proposed HATCH-score was only a poor predictor of AF progression (AUC 0.54). Furthermore, none of the individual HATCH-score parameters was a significantly predicted the progression of AF in our population. However, a left atrial (LA) diameter of more than 45mm (OR 3.46, p< 0.001) and heart failure (OR 3.11, p 0.036) were strong and independent predictors of AF progression in multivariable analysis. CONCLUSION: Patients with an increased LA-diameter or heart failure have a significantly increased risk to progress to persistent AF. If ablation is considered in such a patient it should be conducted as soon as possible to prevent progression to persistent AF. OBJECTIVE:
Canadian Journal of Cardiology Volume 31 2015 BACKGROUND: Catheter-tissue contact is essential for effective lesion formation hence there is a growing usage of contact force (CF) technology in atrial fibrillation (AF) ablation. Data regarding the efficacy and safety of CF for catheter ablation of AF are limited. We conducted a metaanalysis to assess the impact of CF on clinical outcomes and procedural parameters in comparison to conventional catheter (CC) for AF ablation. METHODS: An electronic search was performed using Cochrane central database, PubMed, Embase, and Web of Knowledge. References were searched manually. Outcomes of interest were: recurrence rate, major complications (including major bleeding, ischemic stroke, embolism or transient ischemic attack), total procedure, and fluoroscopic times. Continuous variables were reported as standardized difference in means (SDM); odds ratios (OR) were reported for dichotomous variables. RESULTS: Eleven studies (2 randomized controlled studies and 9 cohorts) involving 1428 adult patients (855 patients (60%) with paroxysmal AF) were identified. CF was deployed in 552 patients. The range of CF used was between 2 and 60 grams-force (Mean CF 175 g). Follow up period ranged between 10- 53 weeks. In comparison between CF and CC groups, a lower recurrence rate was noted with CF (35% vs. 46%, OR 0.62 (95% confidence interval [CI] 0.45; 0.86), P¼0.004). No significant heterogeneity was noted for the comparison (I2¼23%, P¼0.23). Shorter procedure and fluoroscopic times were achieved with CF (156 vs. 173 mins, SDM -0.85 (95% CI -1.48; -0.21), P¼0.009; 28 vs. 36 mins, SDM -0.94 (95% CI.66; -0.21), P¼0.01, respectively). Major complication rate was higher numerically in the CC group but this did not reach statistical significance (1.33% vs. 1.94%, OR 0.71 (95% CI 0.29; 1.73), P¼ 0.45). CONCLUSION: The use of CF technology results in a significant reduction of AF recurrence rate after AF ablation in comparison to CC group. CF technology is able to significantly reduce procedure and fluoroscopic times without compromising complication rate.
424 CONTACT FORCE-GUIDED VERSUS CONTACT FORCE-BLINDED CATHETER ABLATION OF TYPICAL ATRIAL FLUTTER: A PROSPECTIVE STUDY S Venier, J Andrade, M Dubuc, K Dyrda, P Guerra, P Khairy, B Mondésert, L Rivard, D Roy, M Talajic, B Thibault, N Malliet, S Gomes, R Tadros, L Macle Montréal, Québec
423 IMPACT OF CONTACT FORCE TECHNOLOGY ON ATRIAL FIBRILLATION ABLATION: A META-ANALYSIS M Shurrab, L Di Biase, D Briceno, A Kaoutskaia, D Newman, I Lashevsky, H Nakagawa, E Crystal Nablus, Palestine
BACKGROUND:
Whether contact force (CF) sensing ablation technology is useful for CavoTricuspid Isthmus (CTI) ablation is unknown. We prospectively evaluated procedural parameters and outcomes of CF-Guided versus CFBlinded CTI ablation for atrial flutter in our academic institution.