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Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation

Journal of Geriatric Cardiology 2019年第9期16卷 671-675页

作者： George Bazoukis Konstantinos P Letsas Konstantinos Vlachos Athanasios Saplaouras Dimitrios Asvestas Konstantinos Tyrovolas Aikaterini Rokiza Eirini Pagkalidou Gary Tse Stavros Stavrakis Antonios Sideris michael efremidis Department of Cardiology Electrophysiology Laboratory Evangelismos General Hospital of Athens Athens Greece Department of Hygiene and Epidemiology School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece Department of Medicine and Therapeutics Faculty of Medicine Chinese University of Hong Kong Hong Kong China Li Ka Shing Institute of Health Sciences Faculty of Medicine Chinese University of Hong Kong Hong Kong SAR China Department of Medicine Cardiovascular Section Heart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA

Backgound Red cell distribution width(RDW) and neutrophil-to-lymphocyte ratio(NLR) are simple hematologic indices that have been used to predict adverse outcomes in different clinical settings. The aim of our study is to determine whether RDW and NLR can predict atrial fibrillation(AF) recurrence in patients undergoing AF ablation. Methods Consecutive patients, without known hematological disorders, who underwent AF catheter ablation between January 2014 and April 2017 were enrolled into this study. Blood samples were taken one day before and five hours after the ablation procedure. Results A total of 346 patients(224 males(65%), mean age: 59 ± 11 years old) were included. After a mean follow up of 26.2 ± 12.1 months, 80(23.1%) patients experienced late AF recurrence(defined as any recurrence after the blanking period of three months), while 97(28%) patients experienced early AF recurrence during the blanking period. Univariate analysis showed that early arrhythmia recurrence, type of AF and NLR after the procedure were significantly associated with late AF recurrence, while early arrhythmia recurrence and NLR remained significant in multivariate analysis. RDW was not associated with late AF recurrence. None of the parameters above predicted early arrhythmia recurrence. Conclusions Simple and inexpensive hematological indices such as NLR should be evaluated for their ability to predict AF recurrence in patients undergoing catheter ablation in larger prospective studies.

关键词： Atrial fibrillation Neutrophils Radiofrequency ablation

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A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation

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Journal of Geriatric Cardiology 2015年第5期12卷 547-554页

作者： Konstantinos Vlachos Konstantinos P Letsas Panagiotis Korantzopoulos Tong Liu michael efremidis Antonios Sideris Laboratory of Invasive Cardiac Electrophysiology 'Evangelismos' General Hospital of Athens Athens Greece Department of Cardiology University Hospital of Ioannina Ioannina Greece Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of Cardiology Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin China

Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities, especially in the elderly or those with severe comorbidities. Compared with pharmacological therapy alone, the so-called ＂ablate and pace＂ approach offers the potential for more robust control ofven- tricular rate. Atrioventricular junction ablation and pacing strategy is associated with improvement in symptoms, quality of life, and exercise capacity. Given the close relationship between atrial fibrillation and heart failure, there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systolic fimction. There is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction ablation. The present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial fibrillation. The technique, the optimal implanta- tion time, and the proper device selection after atrioventricular junction ablation are also discussed.

关键词： Ablation Atrial fibrillation Atrioventricular junction Pacemaker

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Efficacy and safety of novel anticoagulants in the elderly

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Journal of Geriatric Cardiology 2016年第8期13卷 718-723页

作者： Nikolaos Karamichalakis Stamatis Georgopoulos Konstantinos Vlachos Ioarmis Liatakis michael efremidis Antonios Sideris Konstantinos P Letsas Laboratory of Cardiac Electrophysiology 'Evangelismos' General Hospital of Athens Greece

Atrial fibrillation and venous thromboembolism （VTE） are common disorders associated with maleficent thrombotic events, particularly in the elderly patients. Polypharmacy, co-morbidities, and altered pharmacokinetics, often present in these patients, render the use of antico-agulants quite challenging. Novel oral anticoagulants （NOACs） have recently emerged as alternatives to Vitamin K Antagonists （VKAs） and are gradually increasing their popularity mainly because of their fewer drug and food interactions and ease of use. Their effectiveness and safety has been weU-established in the general population but the balance between benefit and harm in the elderly is still unclear. Routine use in these patients is uncommon. Accumulating data have shown that the benefit of NOACs is consistent among all age groups, featuring equal or greater efficacy in preventing thrombotic events. Excess bleedings were lower with NOACs in comparison to VKAs, but bleeding patterns were disparate among them and head to head comparison is not available. The present review highlights on the efficacy and safety of novel anticoagulants in the elderly population.

关键词： Atrial fibrillation Efficacy Novel oral anticoagulants Safety Venous thromboembolism

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Catheter ablation of atrial fibrillation in the elderly

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Journal of Geriatric Cardiology 2014年第4期11卷 291-295页

作者： Louiza Lioni Konstantinos P. Letsas michael efremidis Konstantinos Vlachos Georgios Giannopoulos Vasileios Kareliotis Spyridon Deftereos Antonios Sideris Second Department of Cardiology Laboratory of Cardiac Electrophysiology Evangelismos General Hospital of Athens Athens 10676 Greece Department of Cardiology 'G. Gennimatas ' General Hospital of Athens Greece

Background Atrial fibrillation （AF） catheter ablation has emerged as a promising treatment strategy for AF, but has not been widely adopted in the elderly population. The present study aimed to determine the safety and efficacy of AF catheter ablation in the elderly popula-tion. Methods and Results The study population consisted of 316 patients with paroxysmal AF who underwent left atrial ablation. Ninety-five patients were≥65 years （48 males, mean age 68.9 ± 3.0 years old） and 221 patients were〈65 years old （130 males, mean age 52.5 ± 10.4 years old）. After a mean follow-up period of 34.0 ± 15.1 months, 55 （57.9%） patients in the elderly group were free from ar-rhythmia recurrence compared with 149 （67.4%） patients in the younger group （P=0.169）. Procedural complications were uncommon in both study groups. In logistic regression analysis, left atrial diameter （P=0.003）, hypertension （P=0.001）, dyslipidemia （P=0.039）, and coronary artery disease （P=0.018） were independent predictors of AF recurrence in the elderly population. Conclusions Catheter ablation of AF is safe and effective in older patients. Invasive strategies should be considered as an alternative choice in symptomatic elderly patients with AF.

关键词： Ablation Atrial fibrillation The elderly

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Catheter ablation of persistent atrial fibrillation:The importance of substrate modification

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World Journal of Cardiology 2015年第3期7卷 111-118页

作者： Konstantinos P Letsas michael efremidis Nikolaos P Sgouros Konstantinos Vlachos Dimitrios Asvestas Antonios Sideris Second Department of Cardiology Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of Athens

Accumulating data have shown that elimination of atrial fibrillation(AF) sources should be the goal in persistent AF ablation. Pulmonary vein isolation, linear lesions and complex fractionated atrial electrograms(CFAEs) ablation have shown limited efficacy in patients with persistent AF. A combined approach using voltage, CFAEs and dominant frequency(DF) mapping may be helpful for the identification of AF sources and subsequent focal substrate modification. The fibrillatory activity is maintained by intramural reentry centered on fibrotic patches. Voltage mapping may assist in the identification of fibrotic areas. Stable rotors display the higher DF and possibly drive AF. Furthermore, the single rotor is usually consistent with organized AF electrograms without fractionation. It is therefore quite possible that rotors are located at relatively "healthy islands" within the patchy fibrosis. This is supported by the fact that high DF sites have been negatively correlated to the amount of fibrosis. CFAEs are located in areas adjacent to high DF. In conclusion, patchy fibrotic areas displaying the maximum DF along with high organization index and the lower fractionation index are potential targets of ablation. Prospective studies are required to validate the efficacy of substrate modification in left atrial ablation outcomes.

关键词： Ablation Atrial fibrillation Persistent Substrate Dominant frequency

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Prediction of atrial fibrillation development and progression:current perspectives

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World Journal of Cardiology 2016年第3期8卷 267-276页

作者： Konstantinos Vlachos Konstantinos P Letsas Panagiotis Korantzopoulos Tong Liu Stamatis Georgopoulos Athanasios Bakalakos Nikolaos Karamichalakis Sotirios Xydonas michael efremidis Antonios Sideris Second Department of Cardiology Laboratory of Cardiac Electrophysiology"Evangelismos" General Hospital of Athens First Department of Cardiology University Hospital of Ioannina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical University

Atrial fibrillation(AF) is the most common arrhythmia in clinical practice. Several conventional and novel predictors of AF development and progression(from paroxysmal to persistent and permanent types) have been reported. The most important predictor of AF progression is possibly the arrhythmia itself. The electrical, mechanical and structural remodeling determines the perpetuation of AF and the progression from paroxysmal to persistent and permanent forms. Common clinical scores such as the hypertension, age ≥ 75 years, transient ischemic attack or stroke, chronic obstructive pulmonary disease, and heart failure and the congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category scores as well as biomarkers related to inflammation may also add important information on this topic. There is now increasing evidence that even in patients with so-called lone or idiopathic AF, the arrhythmia is the manifestation of a structural atrial disease which has recently been defined and described as fibrotic atrial cardiomyopathy. Fibrosis results from a broad range of factors related to AF inducing pathologies such as cell stretch, neurohumoral activation, and oxidative stress. The extent of fibrosis as detected either by late gadolinium enhancement-magnetic resonance imaging or electroanatomic voltage mapping may guide the therapeutic approach based on the arrhythmia substrate. The knowledge of these risk factors may not only delay arrhythmia progression, but also reduce the arrhythmia burden in patients with first detected AF. The present review highlights on the conventional and novel risk factors of development and progression of AF.

关键词： Atrial fibrillation Development Progression Risk factors inflammation Fibrosis

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A review on atrioventricular junction ablation and pacing for heart rate control of atrial fibrillation

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Journal of Geriatric Cardiology 2015年第05期 547-554页

作者： Konstantinos Vlachos Konstantinos P Letsas Panagiotis Korantzopoulos Tong Liu michael efremidis Antonios Sideris Laboratory of Invasive Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Department of Cardiology University Hospital of Ioannina Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical University

Atrioventricular junction ablation with permanent pacemaker implantation is a highly effective treatment approach in patients with atrial fibrillation and high ventricular rates resistant to other treatment modalities,especially in the elderly or those with severe *** with pharmacological therapy alone,the so-called "ablate and pace" approach offers the potential for more robust control of ventricular *** junction ablation and pacing strategy is associated with improvement in symptoms,quality of life,and exercise *** the close relationship between atrial fibrillation and heart failure,there is a particular benefit of such a rate control in patients with atrial fibrillation and reduced systohc *** is increasing evidence that cardiac resynchronization therapy devices may be beneficial in selected populations after atrioventricular junction *** present review article focuses on the current recommendations for atrioventricular junction ablation and pacing for heart rate control in patients with atrial *** technique,the optimal implantation time,and the proper device selection after atrioventricular junction ablation are also discussed.

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