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Role of the burden of premature atrial contractions during the blanking period following second-generation cryoballoon ablation in predicting late recurrences of atrial arrhythmias

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Abstract

Purpose

Recent data suggests that high burden of premature atrial complexes after pulmonary vein isolation predicts recurrences of atrial arrhythmias. The present study sought to assess the role of premature atrial complexes burden in predicting atrial arrhythmias recurrences in patients with atrial fibrillation (AF) who have undergone second-generation cryoballoon ablation (CB-Adv).

Methods

Consecutive patients with drug-resistant paroxysmal atrial fibrillation who underwent pulmonary vein isolation using CB-Adv technology as the index procedure were retrospectively included. Twenty-four-hour Holter recordings were performed for every patient. Based on previously published data, a burden of more than 76 premature atrial complexes per day was considered as being high.

Results

One hundred and seven patients were included in the analysis. The recurrence rate among the group of patients with more than 76 premature atrial complexes per day was significantly higher compared with the group with a lower burden of premature atrial complexes (47.5 vs 11.9%, respectively; p < 0.001). In the multivariate analysis, the documentation of more than 76 premature atrial complexes per day registered at 1 month and at the end of the blanking period, predicted late recurrence of atrial arrhythmias.

Conclusions

Frequent premature atrial complexes in the early stages after CB-Adv ablation strongly predict late recurrences of atrial arrhythmias.

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References

  1. Irfan G, de Asmundis C, Mugnai G, Poelaert J, Verborgh C, Umbrain V, et al. One-year follow-up after second-generation cryoballoon ablation for atrial fibrillation in a large cohort of patients: a single-centre experience. Europace. 2016;18:987–93.

    Article  PubMed  Google Scholar 

  2. Chierchia GB, Di Giovanni G, Ciconte G, de Asmundis C, Conte G, Sieira-Moret J, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace. 2014;16:639–44.

    Article  PubMed  Google Scholar 

  3. Mugnai G, de Asmundis C, Hunuk B, Ströker E, Velagic V, Moran D, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences. Heart Rhythm. 2016;13:845–51.

    Article  PubMed  Google Scholar 

  4. Alhede C, Johannessen A, Dixen U, Jensen JS, Raatikainen P, Hindricks G et al. Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation. Europace. 2016.

  5. Gang UJ, Nalliah CJ, Lim TW, Thiagalingam A, Kovoor P, Ross DL, et al. Atrial ectopy predicts late recurrence of atrial fibrillation after pulmonary vein isolation. Circ Arrhythmia Electrophysiol. 2015;8:569–74.

    Article  Google Scholar 

  6. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–962.

    Article  PubMed  Google Scholar 

  7. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 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 a report of the heart rhythm society (HRS) task force on catheter and surgical ablation of atrial fibrillation. Developed in partnership with the European heart rhythm association (EHRA), a registered branch of the European society of cardiology (ESC) and the European cardiac arrhythmia society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific heart rhythm society (APHRS), and the society of thoracic surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European cardiac arrhythmia society, the European heart rhythm association, the society of thoracic surgeons, the Asia Pacific heart rhythm society, and the heart rhythm society. EP Europace. 2012;14:528–606.

    Article  Google Scholar 

  8. Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, et al. Prognostic significance of premature atrial complexes burden in prediction of long-term outcome. J Am Heart Assoc. 2015;4:e002192.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Binici Z, Intzilakis T, Nielsen OW, Kober L, Sajadieh A. Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke. Circulation. 2010;121:1904–11.

    Article  CAS  PubMed  Google Scholar 

  10. Chong BH, Pong V, Lam KF, Liu S, Zuo ML, Lau YF, et al. Frequent premature atrial complexes predict new occurrence of atrial fibrillation and adverse cardiovascular events. Europace. 2012;14:942–7.

    Article  PubMed  Google Scholar 

  11. Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2

  12. Lellouche N, Jais P, Nault I, Wright M, Bevilacqua M, Knecht S, et al. Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation. J Cardiovasc Electrophysiol. 2008;19:599–605.

    Article  PubMed  Google Scholar 

  13. Gerstenfeld EP, Callans DJ, Dixit S, Zado E, Marchlinski FE. Incidence and location of focal atrial fibrillation triggers in patients undergoing repeat pulmonary vein isolation: implications for ablation strategies. J Cardiovasc Electrophysiol. 2003;14:685–90.

    Article  PubMed  Google Scholar 

  14. Hayashi K, An Y, Nagashima M, Hiroshima K, Ohe M, Makihara Y, et al. Importance of nonpulmonary vein foci in catheter ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2015;12:1918–24.

    Article  PubMed  Google Scholar 

  15. Saito T, Waki K, Becker AE. Left atrial myocardial extension onto pulmonary veins in humans: anatomic observations relevant for atrial arrhythmias. J Cardiovasc Electrophysiol. 2000;11:888–94.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Hugo-Enrique Coutiño and Juan-Pablo Abugattas contributed equally to the article as first authors

Authors and Affiliations

  1. Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Hugo-Enrique Coutiño, Juan-Pablo Abugattas, Moisés Levinstein, Giacomo Mugnai, Darragh Moran, Valentina De Regibus, Erwin Ströker, Ken Takarada, Rajin Choudhury, Luis Marroquín, Francesca Salghetti, Ian-Emiray Lusoc, Juan Sieira, Carlo de Asmundis, Pedro Brugada & Gian-Battista Chierchia

  2. Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy

    Saverio Iacopino

Authors
  1. Hugo-Enrique Coutiño
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  2. Juan-Pablo Abugattas
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  3. Moisés Levinstein
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  4. Giacomo Mugnai
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  5. Darragh Moran
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  6. Valentina De Regibus
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  7. Erwin Ströker
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  8. Ken Takarada
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  9. Rajin Choudhury
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  10. Luis Marroquín
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  11. Francesca Salghetti
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  12. Ian-Emiray Lusoc
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  13. Saverio Iacopino
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  14. Juan Sieira
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  15. Carlo de Asmundis
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  16. Pedro Brugada
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  17. Gian-Battista Chierchia
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Corresponding author

Correspondence to Hugo-Enrique Coutiño.

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Conflict of interest

Dr. Chierchia and Dr. Asmundis have received compensation for teaching purposes and proctoring from AF Solutions and Medtronic. Dr. Brugada has received research grants on behalf of the center from Biotronik, Medtronic, St. Jude Medical, Sorin, and Boston Scientific and speaker’s fees from Biosense Webster, Biotronik, and Medtronic. Dr. Asmundis is a consultant for Daiichi Sankyo. Dr. Mugnai has received an educational grant for postgraduate in Cardiac Electrophysiology and Pacing academic course from Medtronic. Dr. Abugattas is currently receiving an educational grant for postgraduate in Cardiac Electrophysiology and Pacing academic course from St. Jude Medical.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Coutiño, HE., Abugattas, JP., Levinstein, M. et al. Role of the burden of premature atrial contractions during the blanking period following second-generation cryoballoon ablation in predicting late recurrences of atrial arrhythmias. J Interv Card Electrophysiol 49, 329–335 (2017). https://doi.org/10.1007/s10840-017-0270-6

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  • DOI: https://doi.org/10.1007/s10840-017-0270-6

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