Advertisement

Heart and Vessels

, Volume 34, Issue 5, pp 842–850 | Cite as

Clinical significance of the timing of early recurrence of atrial arrhythmia after pulmonary vein isolation: a two-institution clinical study

  • Yosuke Murase
  • Yasuya IndenEmail author
  • Hajime Imai
  • Seifuku Kyo
  • Satoshi Yanagisawa
  • Aya Fujii
  • Yusuke Sakamoto
  • Toshiro Tomomatsu
  • Toyoaki Murohara
Original Article
  • 64 Downloads

Abstract

Early recurrence of atrial arrhythmia (ERAA) after ablation frequently occurs, but there is limited evidence about ERAA-timing. This study aimed to investigate the association between ERAA-timing and late recurrence. We retrospectively investigated 332 patients who underwent PVI for paroxysmal atrial fibrillation at Nagoya University Hospital and Komaki City Hospital. Seventy-six patients (23%) had ERAA. The cutoff value of the first ERAA for late recurrence was set as 3 days, with a specificity of 77% and sensitivity of 43%. On multivariate analysis, first ERAA beyond 3 days (hazard ratio, 2.477; 95% confidence interval, 1.168–5.25; p = 0.018) and large left atrial diameter (LAD) (hazard ratio, 1.101; 95% confidence interval, 1.024–1.184; p = 0.009) were independent predictors for late recurrence. Patients who had first ERAA within 3 days and no ERAA beyond 3 days showed a significantly higher recurrence–free rate than those who had first ERAA beyond 3 days and those who had ERAA both within 3 days and beyond 3 days (89% versus 39%, 44%; p  < 0.001). Moreover, the patients with ERAA within 3 days and LAD ≤ 37.7 mm showed a significantly higher recurrence–free rate than those with ERAA beyond 3 days and LAD > 37.7 mm, and as compared with the other patients (100% versus 26% and 60%, respectively; p < 0.001). ERAA beyond 3 days after ablation was a predictor for late recurrence. Among patients with ERAA, those with ERAA within 3 days and smaller LAD showed favorable prognosis after ablation.

Keywords

Paroxysmal atrial fibrillation Catheter ablation Early recurrence Atrial arrhythmia recurrence Left atrial diameter 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Haissaguerre M, Jais P, Shah DC, Garrigue S, Takahashi A, Lavergne T, Hocini M, Peng JT, Roudaut R, Clementy J (2000) Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation 101:1409–1417CrossRefGoogle Scholar
  2. 2.
    Nault I, Miyazaki S, Forclaz A, Wright M, Jadidi A, Jais P, Hocini M, Haissaguerre M (2010) Drugs vs. ablation for the treatment of atrial fibrillation: the evidence supporting catheter ablation. Eur Heart J 31:1046–1054CrossRefGoogle Scholar
  3. 3.
    Kumar P, Mounsey JP (2012) Early recurrences are not always benign after catheter ablation of atrial fibrillation:do we need to reassess the need for a blanking period? J Cardiovasc Electrophysiol 23:1302–1303CrossRefGoogle Scholar
  4. 4.
    Choi JI, Pak HN, Park JS, Kwak JJ, Nagamoto Y, Lim HE (2010) Clinical significance of early recurrences of atrial tachycardia after atrial fibrillation ablation. J Cardiovasc Electrophysiol 21:1331–1337CrossRefGoogle Scholar
  5. 5.
    Jiang H, Lu Z, Lei H, Zhao D, Yang B, Huang C (2006) Predictors of early recurrence and delayed cure after segmental pulmonary vein isolation for paroxysmal atrial fibrillation without structural heart disease. J Interv Card Electrophysiol 15:157–163CrossRefGoogle Scholar
  6. 6.
    Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D; Heart Rhythm Society Task Force on Catheter and Surgical Ablation of Atrial Fibrillation (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. Heart Rhythm 9:632–696CrossRefGoogle Scholar
  7. 7.
    Miyazaki S, Taniguchi H, Nakamura H, Takagi T, Iwasawa J, Hachiya H, Iesaka Y (2015) Clinical significance of early recurrence after pulmonary vein antrum isolation in paroxysmal atrial fibrillation—insight into the mechanism. Circ J 79:2353–2359CrossRefGoogle Scholar
  8. 8.
    Willems S, Khairy P, Andrade JG, Hoffmann BA, Levesque S, Verma A, Weerasooriya R, Novak P, Arentz T, Deisenhofer I, Rostock T, Steven D, Rivard L, Guerra PG, Dyrda K, Mondesert B, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S, Macle L, ADVICE Trial Investigators (2016) Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. Circ Rhythm Electrophysiol 9:003909Google Scholar
  9. 9.
    Lim HS, Schultz C, Dang J, Alasady M, Lau DH, Brooks AG, Wong CX, Roberts-Thomson KC, Young GD, Worthley MI, Sanders P, Willoughby SR (2014) Time course of inflammation, myocardial injury, and prothrombotic response after radiofrequency catheter ablation for atrial fibrillation. Circ Rhythm Electrophysiol 7:83–89CrossRefGoogle Scholar
  10. 10.
    Richter B, Gwechenberger M, Socas A, Marx M, Gossinger HD (2008) Frequency of recurrence of atrial fibrillation within 48 hours after ablation and its impact on long-term outcome. Am J Cardiol 101:843–847CrossRefGoogle Scholar
  11. 11.
    Wann LS, Curtis AB, January CT, Ellenbogen KA, Lowe JE, Estes NA 3rd, Page RL, Ezekowitz MD, Slotwiner DJ, Jackman WM, Stevenson WG, Tracy CM, 2006 Writing Committee Members, Fuster V, Ryden LE, Cannom DS, Le Heuzey JY, Crijns HJ, Lowe JE, Curtis AB, Olsson S, Ellenbogen KA, Prystowsky EN, Halperin JL, Tamargo JL, Kay GN, Wann LS, ACCF/AHA Task Force Members, Jacobs AK, Anderson JL, Albert N, Hochman JS, Buller CE, Kushner FG, Creager MA, Ohman EM, Ettinger SM, Stevenson WG, Guyton RA, Tarkington LG, Halperin JL, Yancy CW (2011) 2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (Updating the 2006 Guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Heart Rhythm 8:157–176Google Scholar
  12. 12.
    January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (2014) 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 64:e1–e76Google Scholar
  13. 13.
    Deftereos S, Giannopoulos G, Kossyvakis C, Efremidis M, Panagopoulou V, Kaoukis A, Raisakis K, Bouras G, Angelidis C, Theodorakis A, Driva M, Doudoumis K, Pyrgakis V, Stefanadis C (2012) Colchicine for prevention of early atrial fibrillation recurrence after pulmonary vein isolation: a randomized controlled study. J Am Coll Cardiol 60:1790–1796CrossRefGoogle Scholar
  14. 14.
    Koyama T, Sekiguchi Y, Tada H, Arimoto T, Yamasaki H, Kuroki K, MachinoT Tajiri K, Zhu XD, Kanemoto M, Sugiyasu A, Kuga K, Aonuma K (2009) Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation. Am J Cardiol 103:1249–1254CrossRefGoogle Scholar
  15. 15.
    Das M, Wynn GJ, Morgan M, Lodge B, Waktare JE, Todd DM, Hall MC, Snowdon RL, Modi S, Gupta D (2015) Recurrence of atrial tachyarrhythmia during the second month of the blanking period is associated with more extensive pulmonary vein reconnection at repeat electrophysiology study. Circ Arrhythm Electrophysiol 8:846–852CrossRefGoogle Scholar
  16. 16.
    Andrade JG, Macle L, Khairy P, Khaykin Y, Mantovan R, De Martino G, Chen J, Morillo CA, Novak P, Guerra PG, Nair G, Torrecilla EG, Verma A (2012) Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy. J Cardiovasc Electrophysiol 23:1295–1301CrossRefGoogle Scholar
  17. 17.
    Bertaglia E, Stabile G, Senatore G, Zoppo F, Turco P, Amellone C, De Simone A, Fazzari M, Pascotto P (2005) Predictive value of early atrial tachyarrhythmias recurrence after circumferential anatomical pulmonary vein ablation. Pacing Clin Electrophysiol 28:366–371CrossRefGoogle Scholar
  18. 18.
    Alipour P, Azizi Z, Pirbaglou M, Ritvo P, Pantano A, Verma A, Khaykin Y (2017) Defining blanking period post-pulmonary vein antrum isolation. JACC Clin Electrophysiol 3:568–576CrossRefGoogle Scholar
  19. 19.
    Cai L, Yin Y, Ling Z, Su L, Liu Z, Wu J, Du H, Lan X, Fan J, Chen W, Xu Y, Zhou P, Zhu J, Zrenner B (2013) Predictors of late recurrence of atrial fibrillation after catheter ablation. Int J Cardiol 164:82–87CrossRefGoogle Scholar
  20. 20.
    Kaitani K, Inoue K, Kobori A, Nakazawa Y, Ozawa T, Kurotobi T, Morishima I, Miura F, Watanabe T, Masuda M, Naito M, Fujimoto H, Nishida T, Furukawa Y, Shirayama T, Tanaka M, Okajima K, Yao T, Egami Y, Satomi K, Noda T, Miyamoto K, Haruna T, Kawaji T, Yoshizawa T, Toyota T, Yahata M, Nakai K, Sugiyama H, Higashi Y, Ito M, Horie M, Kusano KF, Shimizu W, Kamakura S, Morimoto T, Kimura T, Shizuta S, Trial Investigators EAST-AF (2016) Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial. Eur Heart J 37:610–618CrossRefGoogle Scholar
  21. 21.
    Baman TS, Gupta SK, Billakanty SR, Ilg KJ, Good E, Crawford T, Jongnarangsin K, Ebinger M, Pelosi F Jr, Bogun F, Chugh A, Morady F, Oral H (2009) Time to cardioversion of recurrent atrial arrhythmias after catheter ablation of atrial fibrillation and long-term clinical outcome. J Cardiovasc Electrophysiol 20:1321–1325CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yosuke Murase
    • 1
  • Yasuya Inden
    • 2
    Email author
  • Hajime Imai
    • 1
  • Seifuku Kyo
    • 1
  • Satoshi Yanagisawa
    • 2
  • Aya Fujii
    • 2
  • Yusuke Sakamoto
    • 2
  • Toshiro Tomomatsu
    • 2
  • Toyoaki Murohara
    • 2
  1. 1.Department of CardiologyKomaki City HospitalKomakiJapan
  2. 2.Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan

Personalised recommendations