Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation

Jung Ok Kim, Jaemin Shim, Seung Hyun Lee, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jongil Choi, Jae Young Choi, Moon Hyung Lee, Young Hoon Kim, Byung Chul Chang, Hui Nam Pak

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Abstract

Background: Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. Methods: We compared 77 patients with VAF (46.8% male, 52.7 ± 8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. Results: The left atrial (LA) diameter was greater (p < 0.001), LA voltage lower (p < 0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p = 0.004) for VAF than NVAF. During 70.2 ± 1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p = 0.399), even after excluding patients with maze procedures (log rank p = 0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p = 0.244), or between patients with prior maze procedures and those without (log rank p = 0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. Conclusions: Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusPublished - 2019 Jan 1

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Catheter Ablation
Atrial Fibrillation
Atrial Remodeling
Sick Sinus Syndrome
Recurrence
Cicatrix
Hemodynamics

Keywords

  • Catheter ablation
  • Maze operation
  • Valvular atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation. / Kim, Jung Ok; Shim, Jaemin; Lee, Seung Hyun; Yu, Hee Tae; Kim, Tae Hoon; Uhm, Jae Sun; Choi, Jongil; Choi, Jae Young; Lee, Moon Hyung; Kim, Young Hoon; Chang, Byung Chul; Pak, Hui Nam.

In: Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Kim, Jung Ok ; Shim, Jaemin ; Lee, Seung Hyun ; Yu, Hee Tae ; Kim, Tae Hoon ; Uhm, Jae Sun ; Choi, Jongil ; Choi, Jae Young ; Lee, Moon Hyung ; Kim, Young Hoon ; Chang, Byung Chul ; Pak, Hui Nam. / Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation. In: Journal of Cardiology. 2019.
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abstract = "Background: Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. Methods: We compared 77 patients with VAF (46.8{\%} male, 52.7 ± 8.8 years old, 46.8{\%} paroxysmal AF, 24.7{\%} with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1{\%}) had mechanical valve AF (MV-AF) and 33 (42.9{\%}) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. Results: The left atrial (LA) diameter was greater (p < 0.001), LA voltage lower (p < 0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p = 0.004) for VAF than NVAF. During 70.2 ± 1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p = 0.399), even after excluding patients with maze procedures (log rank p = 0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p = 0.244), or between patients with prior maze procedures and those without (log rank p = 0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2{\%}) and cavotricuspid isthmus (84.2{\%}) areas, and recurrence mechanisms were macroreentry (63.2{\%}) and focal/microreentry (26.3{\%}) at scar border zones. Conclusions: Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.",
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T1 - Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation

AU - Kim, Jung Ok

AU - Shim, Jaemin

AU - Lee, Seung Hyun

AU - Yu, Hee Tae

AU - Kim, Tae Hoon

AU - Uhm, Jae Sun

AU - Choi, Jongil

AU - Choi, Jae Young

AU - Lee, Moon Hyung

AU - Kim, Young Hoon

AU - Chang, Byung Chul

AU - Pak, Hui Nam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. Methods: We compared 77 patients with VAF (46.8% male, 52.7 ± 8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. Results: The left atrial (LA) diameter was greater (p < 0.001), LA voltage lower (p < 0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p = 0.004) for VAF than NVAF. During 70.2 ± 1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p = 0.399), even after excluding patients with maze procedures (log rank p = 0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p = 0.244), or between patients with prior maze procedures and those without (log rank p = 0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. Conclusions: Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.

AB - Background: Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. Methods: We compared 77 patients with VAF (46.8% male, 52.7 ± 8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. Results: The left atrial (LA) diameter was greater (p < 0.001), LA voltage lower (p < 0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p = 0.004) for VAF than NVAF. During 70.2 ± 1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p = 0.399), even after excluding patients with maze procedures (log rank p = 0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p = 0.244), or between patients with prior maze procedures and those without (log rank p = 0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. Conclusions: Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.

KW - Catheter ablation

KW - Maze operation

KW - Valvular atrial fibrillation

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