Persistent atrial fibrillation ablation in cardiac laminopathy: Electrophysiological findings and clinical outcomes.

Chauvel, Rémi; Derval, Nicolas; Duchateau, Josselin; Denis, Arnaud; Tixier, Romain; Welte, Nicolas; André, Clémentine; Ramirez, F Daniel; Nakashima, Takashi; Nakatani, Yosuke; Kamakura, Tsukasa; Takagi, Takamitsu; Krisai, Philipp; Cheniti, Ghassen; Vlachos, Konstantinos; Bourier, Félix; Takigawa, Masateru; Kitamura, Takeshi; Sacher, Frédéric; Hocini, Mélèze; Jaïs, Pierre; Haïssaguerre, Michel; Pambrun, Thomas

doi:10.1016/j.hrthm.2021.03.040

journal article

Title:: Persistent atrial fibrillation ablation in cardiac laminopathy: Electrophysiological findings and clinical outcomes.
Document type:: Journal Article; Research Support, Non-U.S. Gov't
Author(s):: Chauvel, Rémi; Derval, Nicolas; Duchateau, Josselin; Denis, Arnaud; Tixier, Romain; Welte, Nicolas; André, Clémentine; Ramirez, F Daniel; Nakashima, Takashi; Nakatani, Yosuke; Kamakura, Tsukasa; Takagi, Takamitsu; Krisai, Philipp; Cheniti, Ghassen; Vlachos, Konstantinos; Bourier, Félix; Takigawa, Masateru; Kitamura, Takeshi; Sacher, Frédéric; Hocini, Mélèze; Jaïs, Pierre; Haïssaguerre, Michel; Pambrun, Thomas
Abstract:: BACKGROUND: Little is known about persistent atrial fibrillation (AF) ablation in patients with cardiac laminopathy (CLMNA). OBJECTIVES: We aimed to characterize atrial electrophysiological properties and to assess the long-term outcomes of persistent AF ablation in patients with CLMNA. METHODS: All patients with CLMNA referred in our center for persistent AF ablation were retrospectively included. Left atrial (LA) volume, left atrial appendage (LAA) cycle length, interatrial conduction delay, and LA voltage amplitude were analyzed during the ablation procedure. Sinus rhythm maintenance and LA contractile function were assessed during long-term follow-up. RESULTS: From 2011 to 2020, 8 patients were included. The mean age was 47 ± 14 years, and 3 patients (38%) were women. The LA volume was 205.8 ± 43.7 mL; the LAA AF cycle length was 250.7 ± 85.6 ms; and the interatrial conduction delay was 296.5 ± 110.1 ms. Large low-voltage areas (>50% of the LA surface; <0.5 mV electrogram) were recorded in all 8 patients. Two patients had inadvertent LAA disconnection during ablation. All A waves recorded by pulsed Doppler in sinus rhythm were <30 cm/s before and after AF ablation. Early arrhythmia recurrence was recorded in 7 patients (87%) (time to recurrence 4 ± 4 months; 1.5 procedures per patient). After a mean follow-up of 4.4 ± 3.2 years, 4 patients underwent implantable cardioverter-defibrillator therapy for life-threatening ventricular arrhythmia and 3 patients finally underwent heart transplantation. CONCLUSION: Patients with persistent AF afflicted by CLMNA exhibit severe LA impairment because of large low-voltage areas, prolonged conduction velocity, and reduced contractile function. Ablation procedures have a limited effect with a high recurrence rate.
Journal title abbreviation:: Heart Rhythm
Year:: 2021
Journal volume:: 18
Journal issue:: 7
Pages contribution:: 1115-1121
Fulltext / DOI:: doi:10.1016/j.hrthm.2021.03.040
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33812085
Print-ISSN:: 1547-5271
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2021