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Solimene F, Giannotti Santoro M, Stabile G, et al. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. Pacing Clin Electrophysiol. 2021;44(12):2031-2040doi: 10.1111/pace.14374.
Solimene, F., Giannotti Santoro, M., Stabile, G., Malacrida, M., De Simone, A., Pandozi, C., Pelargonio, G., Rossi, P., Battaglia, A., Pecora, D., Bongiorni, M. G., Zucchelli, G., Stocco, C., Arestia, A., Iuliano, S., Russo, M., Narducci, M. L., & Segreti, L. (2021). Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. Pacing and clinical electrophysiology : PACE, 44(12), 2031-2040. https://doi.org/10.1111/pace.14374
Solimene, Francesco, et al. "Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry." Pacing and clinical electrophysiology : PACE vol. 44,12 (2021): 2031-2040. doi: https://doi.org/10.1111/pace.14374
Solimene F, Giannotti Santoro M, Stabile G, Malacrida M, De Simone A, Pandozi C, Pelargonio G, Rossi P, Battaglia A, Pecora D, Bongiorni MG, Zucchelli G, Stocco C, Arestia A, Iuliano S, Russo M, Narducci ML, Segreti L. Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry. Pacing Clin Electrophysiol. 2021 Dec;44(12):2031-2040. doi: 10.1111/pace.14374. Epub 2021 Oct 21. PMID: 34606098.
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Pacing Clin Electrophysiol. 2021 Dec;44(12):2031-2040. doi: 10.1111/pace.14374. Epub 2021 Oct 21.

Early rhythm-control ablation therapy to prevent atrial fibrillation recurrences: Insights from the CHARISMA Registry.

Pacing and clinical electrophysiology : PACE

Francesco Solimene, Mario Giannotti Santoro, Giuseppe Stabile, Maurizio Malacrida, Antonio De Simone, Claudio Pandozi, Gemma Pelargonio, Pietro Rossi, Alberto Battaglia, Domenico Pecora, Maria Grazia Bongiorni, Giulio Zucchelli, Camilla Stocco, Alberto Arestia, Sara Iuliano, Maurizio Russo, Maria Lucia Narducci, Luca Segreti

Affiliations

  1. Clinica Montevergine, Mercogliano, Avellino, Italy.
  2. Second Division of Cardiology, Cardiac, Thoracic, Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
  3. Anthea Hospital, Bari, Italy.
  4. Boston Scientific, Milan, Italy.
  5. Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy.
  6. Division of Cardiology, San Filippo Neri Hospital, Rome, Italy.
  7. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  8. Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.
  9. Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebefratelli, Isola Tiberina, Rome, Italy.
  10. Cardinal Massaia Hospital, Asti, Italy.
  11. Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy.

PMID: 34606098 DOI: 10.1111/pace.14374

Abstract

BACKGROUND: An early, comprehensive rhythm-control therapy is needed in order to treat atrial fibrillation (AF) effectively and to improve ablation outcomes.

METHODS: A total of 153 consecutive patients from the CHARISMA registry undergoing AF ablation at eight centers were included. Patients with de novo PVI were classified as having undergone early treatment (ET) if the procedure was performed within 6 months after the first AF episode, and as having undergone delayed treatment (DT) if ablation was performed over 6 months after the first AF episode.

RESULTS: One-hundred fifty-three patients were enrolled (69.9% male, 59 ± 10 years, 61.4% paroxysmal AF, 38.6% persistent AF). The time from the first AF episode to the ablation procedure was 1034 ± 1483 days. The ET group comprised 36 patients (25.3%), the DT group 60 (39.2%) and Redo cases were 57 (37.3%). During a mean follow-up of 366 ± 130 days, 18 patients (11.8%) suffered an AF/AT recurrence. More DT patients than ET patients suffered recurrences (15.7% vs. 2.2%, p = 0.0452) and the time to AT/AF recurrence was shorter in the group of patients who received an ablation treatment after 6 months (HR = 6.19, 95% CI: 1.7 to 21.9; p = 0.0474). On multivariate Cox analysis, only hypertension (HR = 4.86, 95% CI: 1.6 to 14.98, p = 0.0062) was independently associated with recurrences. Beyond the hypertension risk factor, ET was associated with a low risk of recurrence; recurrence rate ranged from 0% (ET patients without hypertension) to 25.0% (DT patients with hypertension).

CONCLUSIONS: An early rhythm-control ablation therapy in the absence of common risk factors was associated with the lowest rate of recurrences.

© 2021 Wiley Periodicals LLC.

Keywords: DirectSense; ablation timing; atrial fibrillation; catheter ablation; guidelines; risk factors

References

  1. Cosedis Nielsen J, Johannessen A, Raatikainen P, et al. Radiofrequency ablation as initial therapy in paroxysmal atrial fibrillation. N Engl J Med. 2012;367:1587-1595. - PubMed
  2. Jaïs P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: the A4 study. Circulation. 2008;118:2498-2505. - PubMed
  3. D'Ascenzo F, Corleto A, Biondi-Zoccai G, et al. Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis. Int J Cardiol. 2013;167:1984-1989. - PubMed
  4. Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by delayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study. JAMA. 2014;311:498-506. - PubMed
  5. Kuck KH, Lebedev DS, Mikhaylov EN, et al. Catheter ablation or medical therapy to delay progression of atrial fibrillation: the randomized controlled atrial fibrillation progression trial (ATTEST). EP Europace. 2021;23(3):362-369. - PubMed
  6. Lycke M, Kyriakopoulou M, El Haddad M, et al. Predictors of recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation. EP Europace. 2021;23(6):861-867. - PubMed
  7. Kirchhof P, Camm AJ, Goette A, et al. EAST-AFNET 4 trial investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383:1305-1316. - PubMed
  8. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. - PubMed
  9. Gunawardene M, Münkler P, Eickholt C, et al. A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements. Europace. 2019;21:i34-i42. - PubMed
  10. Segreti L, De Simone A, Schillaci V, et al. A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: preliminary experience across different ablation sites from the CHARISMA pilot study. J Cardiovasc Electrophysiol. 2020;31(9):2319-2327. - PubMed
  11. Martin CA, Martin R, Gajendragadkar PR, et al. First clinical use of novel ablation catheter incorporating local impedance data. J Cardiovasc Electrophysiol. 2018;29:1197-1206. - PubMed
  12. Chew DS, Black-Maier E, Loring Z, et al. Diagnosis-to-ablation time and recurrence of atrial fibrillation following catheter ablation: a systematic review and meta-analysis of observational studies. Circ Arrhythm Electrophysiol. 2020;13:e008128. - PubMed
  13. Hussein AA, Saliba WI, Barakat A, et al. Radiofrequency ablation of persistent atrial fibrillation diagnosis-to-ablation time, markers of pathways of atrial remodeling, and outcomes. Circ Arrhythm Electrophysiol. 2016;9:e003669. - PubMed
  14. Strisciuglio T, El Haddad M, Debonnaire P, et al. Paroxysmal atrial fibrillation with high vs. low arrhythmia burden: atrial remodelling and ablation outcome. Europace. 2020;22:1189-1196. - PubMed
  15. Kuppahally SS, Akoum N, Badger TJ, et al. Echocardiographic left atrial reverse remodeling after catheter ablation of atrial fibrillation is predicted by preablation delayed enhancement of left atrium by magnetic resonance imaging. Am Heart J. 2010;160:877-884. - PubMed
  16. Nieuwlaat R, Prins MH, Le Heuzey JY, et al. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J. 2008;29:1181-1189. - PubMed
  17. Healey JS, Oldgren J, Ezekowitz M, et al. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. Lancet. 2016;388:1161-1169. - PubMed
  18. Wazni OM, Dandamudi G, Sood N, et al. Cryoballoon ablation as initial therapy for atrial fibrillation. N Engl J Med. 2021;384(4):316-324. - PubMed
  19. Andrade JG, Wells GA, Deyell MW, et al. Cryoablation or drug therapy for initial treatment of atrial fibrillation. N Engl J Med. 2021;384:305-315. - PubMed
  20. De With RR, Marcos EG, Dudink EAMP, et al. Atrial fibrillation progression risk factors and associated cardiovascular outcome in well-phenotyped patients: data from the AF-RISK study. EP Europace. 2020;22:352-360. - PubMed
  21. Dzeshka MS, Shantsila A, Shantsila E, Lip GYH. Atrial fibrillation and hypertension. Hypertension. 2017;70:854-861. - PubMed
  22. Gaita F, Scaglione M, Battaglia A, et al. Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow up? Europace. 2018;20:443-450. - PubMed
  23. Musat DL, Milstein NS, Bhatt A, et al. Incidence and predictors of very late recurrence of atrial fibrillation following cryoballoon pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2020;13:e008646. - PubMed
  24. Chelu MG, King JB, Kholmovski EG, et al. Atrial fibrosis by late gadolinium enhancement magnetic resonance imaging and catheter ablation of atrial fibrillation: 5-year follow-up data. J Am Heart Assoc. 2018;7:e006313. - PubMed
  25. Yin X, Zhao Y, Xi Y, et al. The early stage of the atrial electroanatomic remodeling as substrates for atrial fibrillation in hypertensive patients. J Am Heart Assoc. 2014;3:e001033. - PubMed
  26. Pathak RK, Middeldorp ME, Lau DH, et al. Aggressive risk factor reduction study for atrial fibrillation and implications for the outcome of ablation: the ARREST-AF cohort study. J Am Coll Cardiol. 2014;64:2222-2231. - PubMed
  27. Solimene F, Maddaluno F, Malacrida M, Stabile G. How to leverage local impedance to guide effective ablation strategy: a case series. HeartRhythm Case Reports. 2021;7:P65-68. - PubMed

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