Search

Purpose: Multiple lead and generator replacement and related complications often complicate the decision of pacemaker implantation in non-elderly patients with symptomatic bradycardia. This study sought to investigate the efficacy and safety of atrial autonomic denervation for treating the symptomatic long-standing sinus bradycardia (SB) in non-elderly patients., Methods and Results: Eleven non-elderly patients (mean age, 45.9 ± 10.9 years; eight men) with a long history of SB (106.2 ± 43.7 months; range, 60-189) were enrolled. Five atrial ganglionated plexies (GPs), identified by anatomic distribution and high-frequency stimulation, were targeted and ablated. The end point was elimination of the vagal response at ablation sites. The symptoms of SB and Holter were followed up at 3 days, 6, and 12 months and, thereafter, over a period of 18 months. Six patients were under 50 years old (group I) and 5 patients were between 50 and 60 years old (group II). There were 3.1 ± 0.7 GPs with positive vagal response and 11.3 ± 2.7 ablation sites in each patient. During the 18.4 ± 6.2 (range, 12-25) months of follow-up, all patients reported significant symptom improvement with a significant decrease of the SB-related symptoms score. The total heartbeats, mean, and minimum heart rate significantly increased that persisted for 12 months. Compared with patients in group II, those in group I had more increases in total heartbeats and mean heart rate (HR)., Conclusion: Atrial autonomic denervation increases sinus rate and improves symptoms in non-elderly patients with symptomatic long-standing SB, thus, potentially serving as an alternative to pacemaker implantation.

Objective: The long-term outcomes, efficacy and safety of catheter ablation in atrial fibrillation (AF) patients with dilated cardiomyopathy (DCM) have not been reported previously., Methods and Results: Forty nine patients with AF (59% longstanding persistent AF, LSP-AF) and DCM were enrolled. Circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs, persistent and LSP-AF) were the endpoints of the index and repeat procedures. Cumulative success rate reached 49% (mean, 1.4 procedures) during the first year, and dropped to 38% at median follow-up of 45 months (range, 36-64 months) for multiple procedures (mean, 1.9 ± 0.8 [1-4]). Incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, LSP-AF (OR, 7.40 [95% CI, 1.42-38.34]; P = 0.017) and larger left ventricular end-diastolic diameter (OR, 1.24 [95% CI, 1.01-1.52]; P = 0.034) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa). Compared with patients with ATa recurrence, those free from ATa had better New York Heart Association functional class, 6-minute walk distance and left ventricular ejection fraction during long-term follow-up compared with pre-ablation, but this improvement was not sustained beyond 3 years., Conclusion: In patients with DCM, current commonly used ablation strategies including CPVA, linear ablation and CFAE ablation are not associated with long-term AF treatment success up to five years. Freedom from ATa is associated with improved heart failure during but not beyond 3 years post ablation., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Aims: The role of valvular regurgitation (VR) in outcomes of patients obtaining current ablation endpoints with long-standing persistent atrial fibrillation (LS-AF) was evaluated., Methods and Results: In all, 216 consecutive patients obtaining current ablation endpoints with LS-AF were studied. A standard two-dimensional and Doppler transthoracic echocardiography (TTE) was performed in every patient before the procedure. The presentation and the grade of mitral regurgitation (MR), tricuspid regurgitation, and aortic regurgitation were evaluated. The clinical characteristics, TTE, and procedural characteristics were compared between the sinus rhythm group and the recurrent atrial tachyarrhythmia (ATa) group. After a follow-up of 18.9 ± 2.7 months, there were 48 patients in the ATa group. The patients in the ATa group had greater MR, longer AF duration, and larger left atrium (LA). In multivariate analyses, MR, LA size, and AF duration were independent predictors of recurrent ATa. The grades of MR severity were correlated with the rate of recurrent ATa, and more severe grade of MR indicated more recurrent ATa. Compared with the patients with organic MR, the patients with functional MR had a lower rate of recurrent ATa and lesser degrees of MR., Conclusion: In the three types of VR, MR was associated with recurrent ATa after AF ablation. Patients with ATa recurrence had more severe MR and greater organic MR., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.)