DOI: 10.25881/20728255_2021_16_3_68

Authors

Kozhenov A.T., Azizov S.N., Khuziakhmetov R.D, Musaev O.G., Arutyunyan V.B.

Federal Center for Cardiovascular Surgery S.G. Sukhanov, Perm’

Abstract

Atrial fibrillation is by far the most common cardiac arrhythmia. The prevalence of this disease in the general population is about 1–2% and is likely to increase over the next 50 years. Atrial fibrillation is accompanied by an increase in the incidence of stroke and other thromboembolic complications, the development of heart failure, the rate of hospitalization, a deterioration in the quality of life, and decreased exercise tolerance. The low efficiency of treatment of persistent atrial fibrillation, frequent relapses after interventional treatment determine the search for the optimal treatment option. The article discusses the main options for radiofrequency catheter ablation for persistent atrial fibrillation, as well as ways to prevent early recurrence of atrial fibrillation after catheter ablation. The effect of antiarrhythmic therapy on the prevention of early recurrence of atrial fibrillation after catheter ablation. Possibility of evaluating the effectiveness of antiarrhythmic therapy depending on the effective refractory period of the left atrium.

Keywords: persistent atrial fibrillation, catheter ablation, early recurrence.

References

1. Stewart S, Hart CL, Hole DJ, et al. Population prevalence, incidence, and predictors of atrial fibrillation in the Renfrew. Paisley study. Heart. 2001; 86: 516-521. doi: 10.1136/heart.86.5.516.

2. Le Heuzy JY, Paziaud О, Piot О, et al. Cost of care distribution in atrial fibrillation patients: The COCAF study. Am Heart J. 2004; 147: 121-126. doi: 10.1016/s0002-8703(03)00524-6.

3. Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. N Engl J Med. 2002; 347: 1825-33. doi: 10.1056/NEJMoa021328.

4. Packer DL, Mark DB, Robb RA, et al. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019; 321(13): 1261-1274. doi: 10.1001/jama.2019.0693.

5. Mark DB, Anstrom KJ, Sheng S, et al. Effect of catheter ablation vs medical therapy on quality of life among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019; 321(13): 1275-1285. doi: 10.1001/jama.2019.0692.

6. Pappone C, Augello G, Sala S, et al. A randomized trial of circumferential pulmonary vein ablation versus antiarrhythmic drug therapy in paroxysmal atrial fibrillation: the APAF Study. J Am CollCardiol. 2006; 48(11): 2340-2347. doi: 10.1016/j.jacc.2006.08.037.

7. Pappone C, Oreto G, Lamberti F, et al. Catheter ablation of paroxysmal atrial fibrillation using a 3D mapping system. Circulation. 1999; 100(11): 1203-1208. doi: 10.1161/01.cir.100.11.1203.

8. Pappone C, Oreto G, Rosanio S, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation. 2001; 104(21): 2539-2544. doi: 10.1161/hc4601.098517.

9. Ganesan AN, Shipp NJ, Brooks AG, et al. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc. 2013; Vol. 2(2): e004549. doi: 10.1161/JAHA.112.004549.

10. Revishvili ASh, Nardaya ShG, Rzaev FG, et al. Electrophysiological and clinical predictors of effectiveness of radiofrequency ablation in the pulmonary veins and left atrium in patients with persistent form of atrial fibrillation. Annals of arrhythmology. 2014; 11(1): 46-53. (In Russ). doi:10.15275/annaritmol.2014.1.6.

11. Haissaguerre M, Hocini M, Denis A, et al. Driver domains in persistent atrial fibrillation. Circulation. 2014; 130(7): 530-538. doi: 10.1161/ CIRCULATIONAHA.113.005421.

12. Mohanty S, Mohanty P, Trivedi Ch, et al. Long-term outcome of pulmonary vein isolation with and without focal impulse and rotor modulation mapping insights from a meta-analysis. Circ Arrhythm Electrophysiol. 2018; 11(3): e005789. doi: 10.1161/CIRCEP.117.005789.

13. Nademanee K, McKenzie J, Kosar E, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004; 43(11): 2044-2053. doi: 10.1016/j.jacc.2003. 12.054.

14. Providência R, Lambiase PD, Srinivasan N, et al. Is there still a role for complex fractionated atrial electrogram ablation in addition to pulmonary vein isolation in patients with paroxysmal and persistent atrial fibrillation? Meta-analysis of 1415 patients. Circ Arrhythm Electrophysiol. 2015; 8(5): 1017-1029. doi: 10.1161/CIRCEP.115.003019.

15. Haissaguerre M, Sanders P, Hocini P, et al. Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination. J Cardiovasc Electrophysiol. 2005; 16(11): 1125-1137. doi: 10.1111/ j. 1540-8167.2005.00307.x.

16. Vogler J, Willems S, Sultan A, et al. Pulmonary vein isolation versus defragmentation: the CHASE-AF clinical trial. J Am Coll Cardiol. 2015; 66(24): 2743-2752. doi: 10.1016/j.jacc.2015.09.088.

17. Martin CA, Curtain JP, Gajendragadkar PR, et al. Ablation of complex fractionated electrograms improves outcome in persistent atrial fibrillation of over 2 year’s duration. J Atr Fibrillation. 2018; 10(5): 1607. doi: 10.4022/ jafib.1607.

18. Wong KC, Paisey R, Sopher M, et al. No benefit of complex fractionated atrial electrogram ablation in addition to circumferential pulmonary vein ablation and linear ablation: Benefit of Complex Ablation study. Circ Arrhythm Electrophysiol. 2015; 8(6): 1316-1324. doi: 10.1161/CIRCEP.114.002504.

19. Mahnkopf Ch, Badger TJ, Burgon NS, et al. 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. 2010; 7(10): 1475-1481. doi: 10.1016/j.hrthm.2010.06.030.

20. Jadidi AS, Lehrmann H, Keyl C, et al. Ablation of persistent atrial fibrillation targeting low-voltage areas with selective activation characteristics. Circ Arrhythm Electrophysiol. 2016; 9(3): e002962. doi: 10.1161/CIRCEP. 115.002962.

21. Bisbal F, Benito E, Teis A, et al. Magnetic resonance imaging-guided fibrosis ablation for the treatment of atrial fibrillation: the ALICIA trial. Circ Arrhythm Electrophysiol. 2020; 13(11): e008707. doi: 10.1161/CIRCEP.120.008707.

22. Yang B, Jiang Ch, Lin Y, et al. STABLE-SR (electrophysiological substrate ablation in the left atrium during sinus rhythm) for the treatment of nonparoxysmal atrial fibrillation: a prospective, multicenter randomized clinical trial. Circ Arrhythm Electrophysiol. 2017; 10(11): e005405. doi: 10.1161/CIRCEP.117.005405.

23. Lin H, Chen YH, Hou JW, et al. Role of contact force guided radiofrequency catheter ablation for treatment of atrial fibrillation : a systematic review and meta-analysis. J Cardiovasc Electrophysiol. 2017; 28 (9): 994-1005. doi: 10.1111/jce.13264.

24. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace. 2018; 20(1): 157-208. doi: 10.1093/europace/eux275.

25. Themistoclakis S, China P. Early Recurrences of Atrial Tachyarrhythmias After Ablation of Atrial Fibrillation: How Long Do We Have to Be Blind? JACC Clin Electrophysiol. 2017; 3(6): 577-579. doi: 10.1016/j.jacep.2017.03.012.

26. Andrade JG, Khairy P, Verma A, et al. Early recurrence of atrial tachyarrhythmias following radiofrequency catheter ablation of atrial fibrillation. Pacing Clin Electrophysiol. 2012; 35(1): 106-116. doi: 10.1111/j.1540-8159.2011.03256.x.

27. Alipour P, Azizi Z, Pirbaglou M, et al. Defining Blanking Period Post-Pulmonary Vein Antrum Isolation. JACC Clin Electrophysiol. 2017; 3(6): 568-576. doi: 10.1016/j.jacep.2017.01.006.

28. Themistoclakis S, Schweikert RA, Saliba WI, et al. Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation. Heart Rhythm. 2008; 5(5): 679-85. doi: 10.1016/ j.hrthm.2008.01.031.

29. Bertaglia E, Stabile G, Senatore G, et al. Predictive value of early atrial tachyarrhythmias recurrence after circumferential anatomical pulmonary vein ablation. Pacing Clin Electrophysiol. 2005; 28(5): 366-71. doi: 10.1111/j.1540-8159.2005.09516.x.

30. Andrade JG, Macle L, Khairy P, et al. Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy. J Cardiovasc Electrophysiol. 2012; 23(12): 1295-301. doi: 10.1111/j.1540-8167.2012.02399.x.

31. Kim YG, Boo KY, Choi JI, et al. Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation Catheter Ablation: Atrial Arrhythmias/Atrial Fibrillation. J Am Coll Cardiol EP. 2021; 7(3): 343-351. doi: 10.1016/j.jacep.2020.09.029.

32. Das M, Wynn GJ, Morgan M, et al. 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. 2015; 8(4): 846-52. doi: 10.1161/CIRCEP. 115.003095.

33. Mujović N, Marinković M, Marković N, et al. The relationship of early recurrence of atrial fibrillation and the 3-month integrity of the ablation lesion set. Sci Rep. 2018; 8(1): 9875. doi: 10.1038/s41598-018-28072-y.

34. Roux JF, Zado E, Callans DJ, et al. Antiarrhythmics After Ablation of Atrial Fibrillation (5A Study). Circulation. 2009; 120(12): 1036-1040. doi: 10.1161/CIRCULATIONAHA.108.839639.

35. Darkner S, Chen Xu, Hansen J, et al. Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind, randomized, placebo-controlled study (AMIO-CAT trial). Eur Heart J. 2014; 35(47): 3356-64. doi: 10.1093/eurheartj/ehu354.

36. Kaitani K, Inoue K, Kobori A, et al. Efficacy of antiarrhythmic drugs short-term use after catheter ablation for atrial fibrillation (EAST-AF) trial. Eur Heart J 2016; 37(7): 610-618. doi: 10.1093/eurheartj/ehv501.

37. Goldenberg GR, Burd D, Lodzinski P, et al. Antiarrhythmic therapy as an adjuvant to promote post pulmonary vein isolation success-a meta-analysis. J Interv Card Electrophysiol. 2016; 47(2): 171-176. doi: 10.1007/ s10840-016-0157-y.

38. Chen W, Liu H, Ling Z, et al. Efficacy of Short-Term Antiarrhythmic Drugs Use after Catheter Ablation of Atrial Fibrillation-A Systematic Review with Meta-Analyses and Trial Sequential Analyses of Randomized Controlled Trials. PLoS One. 2016; 11(5): e0156121. doi: 10.1371/journal.pone. 0156121.

39. Xu X, Alida CT, Yu B. Administration of antiarrhythmic drugs to maintain sinus rhythm after catheter ablation for atrial fibrillation: a meta-analysis. Cardiovasc Ther. 2015; 33(4): 242-6. doi: 10.1111/1755-5922.12133.

40. Lei M, Gong M, Bazoukis G, et al. Steroids prevent early recurrence of atrial fibrillation following catheter ablation: a systematic review and meta-analysis. Biosci Rep. 2018; 38(5): BSR20180462. doi: 10.1042/BSR20180462.

41. Deftereos S, Giannopoulos G, Efremidis M, et al. Colchicine for prevention of atrial fibrillation recurrence after pulmonary vein isolation: mid-term efficacy and effect on quality of life. Heart Rhythm. 2014; 11(4): 620-8. doi: 10.1016/j.hrthm.2014.02.002.

42. Tarasov AV, Davtyan KV, Martsevich SYu. Comparison of effectiveness of antiarrhythmic therapies in postoperative period of pulmonary vein ostia catheter isolation for prevention of early recurrences of atrial tachyarrhythmias in the proof study. Rational Pharmacotherapy in Cardiology. 2017; 13(1): 18-24. (In Russ.) doi: 10.20996/1819-6446-2017-13-1-18-24.

43. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res 2002; 54(2): 230-246. doi: 10.1016/s0008-6363(02)00258-4.

44. Spach MS, Barr RC, Jewett PH. Spread of excitation from the atrium into thoracic veins in human beings and dogs. Am J Cardiol. 1972; 30(8): 844–854.

45. Bokeriya LA, Bazaev VA, Filatov AG, et al. Electrophysiological study in atrial fibrillation. Annals of Arrhythmology 2006; 6: 48-58.

For citation

Kozhenov A.T., Azizov S.N., Khuziakhmetov R.D, Musaev O.G., Arutyunyan V.B. Prevention of early recurrencies of atrial fibrillation in patients after ablation due to persistent form of atrial fibrillation. Bulletin of Pirogov National Medical & Surgical Center. 2021;16(3):68-72. (In Russ.) https://doi.org/10.25881/20728255_2021_16_3_68