Clinical and anatomic predictors of need for repeat atrial fibrillation ablation

AIM To identify predictors of need for repeat procedures after initial atrial fibrillation(AF) ablation. METHODS We identified a cohort undergoing first time AF ablation at our institution from January 2004 to February 2014 who had cardiac magnetic resonance(CMR) imaging performed prior to ablation. Clinical variables and anatomic characteristics(determined from CMR) were assessed as predictors of need for repeat ablation. The decision regarding need for and timing of repeat ablation was at the discretion of the treating physician. RESULTS From a cohort of 331 patients, 142 patients(43%) underwent repeat ablation at a mean of 13.6 ± 18.4 mo afterthe index procedure. Both male gender(81% vs 71%, P = 0.05) and lower ejection fraction(57.4% ± 10.3% vs 59.8% ± 9.4%, P = 0.04) were associated with need for repeat ablation. On pre-ablation CMR, mean pulmonary vein(PV) diameters were significantly larger in all four PVs among patients requiring repeat procedures. In multivariate analysis, increased right superior PV diameter significantly predicted need for repeat ablation(odds ratio 1.08 per millimeter increase in diameter, 95%CI: 1.00-1.16, P = 0.05). There were also trends toward significance for increased left and right inferior PV sizes among those requiring repeat procedures.CONCLUSION Increased PV size predicts the need for repeat AF ablation, with each millimeter increase in PV diameter associated with an approximately 5%-10% increased risk of requiring repeat procedures.

Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange

BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.