Advertisement

Click here for more guidelines.
2012 ACCF/ AATS/ SCAI/ STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
ACCF/ SCAI/ STS/ AATS/ AHA/ ASNC/ HFSA/ SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
2012 ACCF/ AHA/ ACR/ SCAI/ SIR/ STS/ SVM/ SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

 
About JACC CME
Policy on Privacy and Confidentiality
Disclosures
Important Information
 

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME
 
 

Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions
 
 

About the Journal
Editorial Board & Staff
 
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2008; 51:843-849, doi:10.1016/j.jacc.2007.10.044
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View Current Clinical Collection-Atrial Fibrillation
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (50)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nademanee, K.
Right arrow Articles by Ngarmukos, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nademanee, K.
Right arrow Articles by Ngarmukos, T.
Related Collections
Right arrowRelated Article

FOCUS ISSUE: ATRIAL FIBRILLATION: CLINICAL RESEARCH: ABLATION THERAPY OF ATRIAL FIBRILLATION

Clinical Outcomes of Catheter Substrate Ablation for High-Risk Patients With Atrial Fibrillation

Koonlawee Nademanee, MD, FACC1,*, Mark C. Schwab, MD, Erol M. Kosar, MD, FACC, Margaret Karwecki, NP, Michael D. Moran, MD, FACC, Nithi Visessook, MD, Anthony Don Michael, MD, FACC and Tachapong Ngarmukos, MD

Pacific Rim Electrophysiology Research Institution, Inglewood, California.

Manuscript received August 22, 2007; revised manuscript received October 10, 2007, accepted October 29, 2007.

* Reprint requests and correspondence: Dr. Koonlawee Nademanee, Pacific Rim Electrophysiology Research Institution, 575 E. Hardy Street, #201, Inglewood, California 90301. (Email: wee{at}pacificrimep.com).

Objectives: The purpose of this study was to determine the long-term clinical outcomes of catheter ablation of atrial fibrillation (AF) substrate for high-risk patients with AF.

Background: The benefits of catheter ablation for high-risk AF patients with respect to mortality and stroke reductions remain unclear.

Methods: We performed AF substrate ablation guided by complex fractionated atrial electrogram (CFAE) mapping in 674 high-risk AF patients. The clinical end points were sinus rhythm (SR), death, stroke, or bleeding. Of these 674 patients, 635 were available for follow-up and made up the study cohort. The patients were relatively old (mean age 67 ± 12 years) and 129 had an ejection fraction (EF) <40%.

Results: After the mean follow-up period of 836 ± 605 days, 517 were in SR (81.4%). There were 15 deaths among the patients who stayed in SR compared with 14 deaths among those who remained in AF (5-year survival rate, 92% vs. 64%, respectively; p < 0.0001). SR was the most important independent favorable parameter for survival (hazard ratio 0.14, 95% confidence interval 0.06 to 0.36, p < 0.0001), whereas old age was unfavorable. Warfarin therapy was discontinued in 434 of the 517 patients in SR post-ablation (84%) whose annual stroke rate was only 0.4% compared with 2% in those with continuing warfarin treatment (p = 0.004).

Conclusions: CFAE-targeted ablation of AF is effective in maintaining SR in selected high-risk AF patients and might allow patients to stop warfarin therapy. SR after AF ablation is a marker of relatively low mortality and stroke risk. Our findings support conducting further randomized studies to determine whether AF ablation is associated with mortality and/or stroke reduction.

Abbreviations and Acronyms
  AF = atrial fibrillation
  CFAE = complex fractionated atrial electrogram
  CI = confidence interval
  CVA = cerebrovascular accident
  EF = ejection fraction
  HR = hazard ratio
  INR = international normalized ratio
  RF = radiofrequency
  SR = sinus rhythm
  TIA = transient ischemic attack


Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 51: A23-A24. [Full Text] [PDF]



This article has been cited by other articles:


Home page
 HeartHome page
R. J. Hunter, J. McCready, I. Diab, S. P. Page, M. Finlay, L. Richmond, A. French, M. J. Earley, S. Sporton, M. Jones, et al.
Maintenance of sinus rhythm with an ablation strategy in patients with atrial fibrillation is associated with a lower risk of stroke and death
Heart, January 1, 2012; 98(1): 48 - 53.
[Abstract] [Full Text] [PDF]

Home page
 Interact CardioVasc Thorac SurgHome page
R. Michael Gray, M. Nagendran, and M. Maruthappu
Is it safe to stop anticoagulants after successful surgery for atrial fibrillation?
Interact CardioVasc Thorac Surg, December 1, 2011; 13(6): 642 - 649.
[Abstract] [Full Text] [PDF]

Home page
 Circ Arrhythm ElectrophysiolHome page
S. Miyazaki, A. J. Shah, X. Liu, A. S. Jadidi, I. Nault, M. Wright, A. Forclaz, N. Linton, O. Xhaet, L. Rivard, et al.
Preprocedural Clinical Parameters Determining Perimitral Conduction Time During Mitral Isthmus Line Ablation
Circ Arrhythm Electrophysiol, June 1, 2011; 4(3): 287 - 294.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
R. Lemery
Catheter ablation of paroxysmal atrial fibrillation: long-term follow-up and the inevitability to fibrillate
Europace, March 1, 2011; 13(3): 301 - 303.
[Full Text] [PDF]

Home page
 EuropaceHome page
M. H. Kong, J. P. Piccini, and T. D. Bahnson
Efficacy of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation for the treatment of atrial fibrillation: a meta-analysis of randomized controlled trials
Europace, February 1, 2011; 13(2): 193 - 204.
[Abstract] [Full Text] [PDF]

Home page
 Physiol. Rev.Home page
U. Schotten, S. Verheule, P. Kirchhof, and A. Goette
Pathophysiological Mechanisms of Atrial Fibrillation: A Translational Appraisal
Physiol Rev, January 1, 2011; 91(1): 265 - 325.
[Abstract] [Full Text] [PDF]

Home page
 J CARDIOVASC PHARMACOL THERHome page
M. Govindan, I. Savelieva, A. Catanchin, and A. J. Camm
Atrial Fibrillation-The Final Frontier
Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2010; 15(4_suppl): 36S - 50S.
[Abstract] [PDF]

Home page
 StrokeHome page
C. Medi, G. J. Hankey, and S. B. Freedman
Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation
Stroke, November 1, 2010; 41(11): 2705 - 2713.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
R. J. Hunter, T. J. Berriman, I. Diab, V. Baker, M. Finlay, L. Richmond, E. Duncan, R. Kamdar, G. Thomas, D. Abrams, et al.
Long-term efficacy of catheter ablation for atrial fibrillation: impact of additional targeting of fractionated electrograms
Heart, September 1, 2010; 96(17): 1372 - 1378.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
R. J. Hunter and R. J. Schilling
Long-term outcome after catheter ablation for atrial fibrillation: safety, efficacy and impact on prognosis
Heart, August 1, 2010; 96(16): 1259 - 1263.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
A. Verma, R. Mantovan, L. Macle, G. De Martino, J. Chen, C. A. Morillo, P. Novak, V. Calzolari, P. G. Guerra, G. Nair, et al.
Substrate and Trigger Ablation for Reduction of Atrial Fibrillation (STAR AF): a randomized, multicentre, international trial
Eur. Heart J., June 1, 2010; 31(11): 1344 - 1356.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. Katritsis, F. M. Merchant, T. Mela, J. P. Singh, E. K. Heist, and A. A. Armoundas
Catheter Ablation of Atrial Fibrillation: The Search for Substrate-Driven End Points
J. Am. Coll. Cardiol., May 25, 2010; 55(21): 2293 - 2298.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
I. Nault, S. Miyazaki, A. Forclaz, M. Wright, A. Jadidi, P. Jais, M. Hocini, and M. Haissaguerre
Drugs vs. ablation for the treatment of atrial fibrillation: the evidence supporting catheter ablation
Eur. Heart J., May 1, 2010; 31(9): 1046 - 1054.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Themistoclakis, A. Corrado, F. E. Marchlinski, P. Jais, E. Zado, A. Rossillo, L. Di Biase, R. A. Schweikert, W. I. Saliba, R. Horton, et al.
The Risk of Thromboembolism and Need for Oral Anticoagulation After Successful Atrial Fibrillation Ablation
J. Am. Coll. Cardiol., February 23, 2010; 55(8): 735 - 743.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. L. Hall, A. Barac, and E. J. Benjamin
Genetic Mutations as Risk Predictors of Atrial Fibrillation Recurrence After Catheter Ablation?
J. Am. Coll. Cardiol., February 23, 2010; 55(8): 754 - 757.
[Full Text] [PDF]

Home page
 Circ Arrhythm ElectrophysiolHome page
R. Cappato, H. Calkins, S.-A. Chen, W. Davies, Y. Iesaka, J. Kalman, Y.-H. Kim, G. Klein, A. Natale, D. Packer, et al.
Updated Worldwide Survey on the Methods, Efficacy, and Safety of Catheter Ablation for Human Atrial Fibrillation
Circ Arrhythm Electrophysiol, February 1, 2010; 3(1): 32 - 38.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. J. Wilber, C. Pappone, P. Neuzil, A. De Paola, F. Marchlinski, A. Natale, L. Macle, E. G. Daoud, H. Calkins, B. Hall, et al.
Comparison of Antiarrhythmic Drug Therapy and Radiofrequency Catheter Ablation in Patients With Paroxysmal Atrial Fibrillation: A Randomized Controlled Trial
JAMA, January 27, 2010; 303(4): 333 - 340.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
S. K. Kim, H.-N. Pak, J. H. Park, K. J. Ko, J. S. Lee, J. I. Choi, D. H. Choi, and Y.-H. Kim
Clinical and serological predictors for the recurrence of atrial fibrillation after electrical cardioversion
Europace, December 1, 2009; 11(12): 1632 - 1638.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. J. Wilber
Pursuing Sinus Rhythm in Patients With Persistent Atrial Fibrillation: When Is It Too Late?
J. Am. Coll. Cardiol., August 25, 2009; 54(9): 796 - 798.
[Full Text] [PDF]

Home page
 EuropaceHome page
P. Kirchhof, J. Bax, C. Blomstrom-Lundquist, H. Calkins, A. J. Camm, R. Cappato, F. Cosio, H. Crijns, H.-C. Diener, A. Goette, et al.
Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'
Europace, July 1, 2009; 11(7): 860 - 885.
[Full Text] [PDF]

Home page
 EuropaceHome page
R. F. Berntsen, A. Cheng, H. Calkins, and R. D. Berger
Evaluation of spatiotemporal organization of persistent atrial fibrillation with time- and frequency-domain measures in humans
Europace, March 1, 2009; 11(3): 316 - 323.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
M. Duytschaever and R. Tavernier
What is needed for a good 'Decaf'?
Europace, March 1, 2009; 11(3): 278 - 279.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst
CHAPTER 29 Atrial Fibrillation
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
H. Niinuma, R. T. George, A. Arbab-Zadeh, J. A.C. Lima, and C. A. Henrikson
Imaging of pulmonary veins during catheter ablation for atrial fibrillation: the role of multi-slice computed tomography
Europace, November 1, 2008; 10(suppl_3): iii14 - iii21.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
D. Steven and S. Willems
How to assess the efficacy of catheter ablation of atrial fibrillation: reply
Eur. Heart J., September 1, 2008; 29(17): 2184 - 2185.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
E. Aliot and J. N. Ruskin
Controversies in ablation of atrial fibrillation
Eur. Heart J. Suppl., September 1, 2008; 10(suppl_H): H32 - H54.
[Abstract] [Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement