Safety and efficacy of catheter ablation of atrial fibrillation in patients with diabetes mellitus—single center experience Efficacy and safety of rivaroxaban in patients with diabetes and nonvalvular atrial fibrillation: the Rivaroxaban Once-daily, Oral, Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF Trial). Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study). Atrial fibrillation in patients with heart failure: Role of catheter ablation therapies. Long-term single procedure efficacy of catheter ablation of atrial fibrillation Rationale and Design of FIRE AND ICE: A multicenter randomized trial comparing efficacy and safety of pulmonary vein isolation using a cryoballoon versus radiofrequency ablation with 3D-reconstruction. One‐Year Outcome of Patients With Atrial Fibrillation Undergoing Coronary Artery Stenting: An Analysis of the AFCAS Registry Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation Natural History and Long-Term Outcomes of Ablated Atrial Fibrillation Long-term efficacy and safety of two different rhythm control strategies in elderly patients with symptomatic persistent atrial fibrillation. Comparison of catheter ablation and surgical ablation in patients with long-standing persistent atrial fibrillation and rheumatic heart disease: a four-year follow-up study. Long-Term Improvement in Left Ventricular Strain After Successful Catheter Ablation for Atrial Fibrillation in Patients With Preserved Left Ventricular Systolic Function Usefulness of serum uric acid level to predict atrial fibrillation recurrence after cryoballoon-based catheter ablation. Repeated catheter ablation of atrial fibrillation: how to predict outcome? Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. Mesh ablator vs. cryoballoon pulmonary vein ablation of symptomatic paroxysmal atrial fibrillation: results of the MACPAF study. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation Efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation in women. Catheter ablation of atrial fibrillation in patients with atrial septal defect: long-term follow-up results The atrial fibrillation ablation pilot study: a European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. The usefulness of global left atrial strain for predicting atrial fibrillation recurrence after catheter ablation in patients with persistent and paroxysmal atrial fibrillation. Perception of Atrial Fibrillation Before and After Radiofrequency Catheter Ablation: Relevance of Asymptomatic Arrhythmia Recurrence Assessment of clinical factors associated with a successful catheter ablation outcome in younger patients with atrial fibrillation.
Background and objective Little is known about the outcome of  catheter ablation of  atrial fibrillation ( AF )  in patients with diabetes mellitus ( DM ) . We investigated the safety and efficacy of catheter ablation of AF  in patients with DM . Material s and methods Thirty one patients with DM from a group of 263 consecutive patients undergoing a first-time catheter ablation of AF procedure  were enrolled in a prospect i ve study . The ablation protocol ( guided by CARTO system ) consisted in two continuous circular lesions around ipsilateral pulmonary veins . Results The following clinical characteristics differed between DM and no-DM patients : age ( 62.0 ± 10.8 vs. 56.1 ± 10.6 years , P = 0.004 ) , longer AF history ( 9.6 ± 9.3 vs. 6.7 ± 6.3 years , P = 0.024 ) , significantly larger left atrium size ( 41.1 ± 7.8 vs. 38.3 ± 5.8 mm , P = 0.021 ) , hypertension ( 58.1 vs. 35.8 % , P = 0.018 ) and structural heart disease ( 67.7 vs. 43.5 % , P = 0.011 ) . Despite a similar AF recurrence rate in DM and no-DM patients ( 32.3 vs. 22.4 % , P = 0.240 ) , the ablation procedure was complicated in 28 patients ( 11 hematomas , three cardiac tamponades and three strokes ) and the incidence of complications was significantly higher in DM than in no-DM patients ( 29.0 vs. 8.2 % , respectively , P = 0.002 ) . Multivariate analysis showed that DM was an independent risk factor for complications occurrence ( odd ratio 5.936 , 95 % confidence interval 2.059 to 17.112 , P = 0.001 ) . Conclusions First catheter ablation of AF procedure in DM patients was equally efficacious than in no-DM patients . However , DM patients had a higher incidence of complications , mostly thrombotic or hemorrhagic BACKGROUND The prevalence of both atrial fibrillation ( AF ) and diabetes mellitus ( DM ) are rising , and these conditions often occur together . Also , DM is an independent risk factor for stroke in patients with AF . We aim ed to examine the safety and efficacy of rivaroxaban vs warfarin in patients with nonvalvular AF and DM in a prespecified secondary analysis of the ROCKET AF trial . METHODS We stratified the ROCKET AF population by DM status , assessed associations with risk of outcomes by DM status and r and omized treatment using Cox proportional hazards models , and tested for interactions between r and omized treatments . For efficacy , primary outcomes were stroke ( ischemic or hemorrhagic ) or non- central nervous system embolism . For safety , the primary outcome was major or nonmajor clinical ly relevant bleeding . RESULTS The 5,695 patients with DM ( 40 % ) in ROCKET AF were younger , were more obese , and had more persistent AF  , but fewer had previous stroke  ( the CHADS2 score includes DM and stroke ) . The relative efficacy of  rivaroxaban and  warfarin for prevention of stroke and systemic embolism was similar in patients with ( 1.74 vs 2.14/100 patient-years , hazard ratio [ HR ] 0.82 ) and without ( 2.12 vs 2.32/100 patient-years , HR 0.92 ) DM ( interaction P = .53 ) . The safety of rivaroxaban vs warfarin regarding major bleeding ( HRs 1.00 and 1.12 for patients with and without DM , respectively ; interaction P = .43 ) , major or nonmajor clinical ly relevant bleeding ( HRs 0.98 and 1.09 ; interaction P = .17 ) , and intracerebral hemorrhage ( HRs 0.62 and 0.72 ; interaction P = .67 ) was independent of DM status . Adjusted exploratory analyses suggested 1.3- , 1.5- , and 1.9-fold higher 2-year rates of stroke , vascular mortality , and myocardial infa rct ion in DM patients . CONCLUSIONS AND RELEVANCE The relative efficacy and safety of rivaroxaban vs warfarin was similar in patients with and without DM , supporting use of rivaroxaban as an alternative to warfarin in diabetic patients with AF Atrial  fibrillation ( AF )  is prevalent in patients with type 2 diabetes mellitus ( DM ) and is associated with markers of poor glycemic control ; however , the impact of glycemic control on incident AF and outcomes is unknown . The aims of this study were to prospect ively evaluate if intensive glycemic control in patients with DM affects incident AF and to evaluate morbidity and mortality in patients with DM and incident AF . A total of 10,082 patients with DM from the Action to Control Cardiovascular Risk in Diabetes ( ACCORD ) cohort were studied in a r and omized , double-blind fashion . Participants were r and omized to an intensive therapeutic strategy targeting a glycated hemoglobin level of < 6.0 % or a st and ard strategy targeting a glycated hemoglobin level of 7.0 % to 7.9 % . Incident AF occurred in 159 patients ( 1.58 % ) over the follow-up period , at a rate of 5.9 per 1,000 patient-years in the intensive-therapy group and a rate of 6.37 per 1,000 patient-years in the st and ard-therapy group ( p = 0.52 ) . In a multivariate model , predictors of incident AF were age , weight , diastolic blood pressure , heart rate , and heart failure history .  Patients with DM and new-onset AF  had a hazard ratio of 2.65 for all-cause mortality ( 95 % confidence interval 1.8 to 3.86 , p < 0.0001 ) , a hazard ratio of 2.1 for myocardial infa rct ion ( 95 % confidence interval 1.33 to 3.31 , p = 0.0015 ) , and a hazard ratio of 3.80 for the development of heart failure ( 95 % confidence interval 2.48 to 5.84 , p < 0.0001 ) . In conclusion , intensive glycemic control did not affect the rate of new-onset AF .  Patients with DM and incident AF had an increased risk for morbidity and mortality compared with those without AF Atrial fibrillation ( AF ) represents the most common sustained cardiac arrhythmia in patients with heart failure ( HF ) . AF in HF patients is associated with worsening of symptoms and also results in a substantial increase in mortality . Although HF patients in sinus rhythm have a better outcome than patients with AF , several r and omized studies investigating pharmacological rhythm control versus rate control have shown no advantage of one strategy over the other in terms of patient outcomes . Catheter-based ablation therapy is a newer therapeutic option with a rapidly evolving and changing role in the management of this arrhythmia . In the present review , the authors discuss the epidemiology , pathophysiology and prognostic significance of AF in patients with HF . Exclusively addressed are studies investigating catheter-based ablation for rhythm-control and rate-control therapies in the management of AF in HF patients Background Two important limitations of the data regarding the outcomes of catheter ablation of atrial fibrillation ( AF ) are the short-term follow-up used in most published studies and the lack of single-procedure outcomes . Objective The objective was to report the long-term single-procedure outcomes at our center . Material s and methods The patient population was comprised of 200 consecutive patients who underwent ablation ( 133 men ; age 56 ± 11 years ) . Atrial fibrillation was paroxysmal in 92 ( 46 % ) . Success was defined as absence of symptomatic AF , off antiarrhythmic drug ( AAD ) after a single procedure . Results After a follow-up of 26 ± 11 months , the single-procedure long-term success rate was 28 % with an additional 7 % of patients demonstrating improvement . After including repeat procedures in 64 patients , the overall long-term success rate was 41 % with 11 % demonstrating improvement . Further subgroup analysis of 48 paroxysmal AF patients considered to be optimal c and i date s for the procedure , revealed a long-term success rate of 69 % with an additional 4 % demonstrating improvement . A major complication occurred in 7.9 % of patients . Conclusion The results reveal that the long-term single-procedure success rate  of catheter ablation of AF in a cohort of patients with predominantly non-paroxysmal AF is less than 40 % . The inclusion of redo procedures result ed in an improvement in outcomes . A much higher success rate of 69 % was achieved in patients with paroxysmal AF considered to be optimal c and i date s for this procedure . These results make it clear that further advances in the technique of catheter ablation of AF are needed to improve the safety and efficacy of this procedure . In order to be able to compare outcomes of various techniques in differing patient population s , we urge investigators to report long-term single procedure outcomes BACKGROUND Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia imposing substantial morbidity and mortality . Catheter-based pulmonary vein isolation ( PVI ) using radiofrequency current ( RFC ) has become a st and ard treatment for drug-resistant and symptomatic paroxysmal AF ( PAF ) . In recent years , the cryoballoon-based technique is increasingly used as a promising alternative with a short learning curve . METHODS The FIRE AND ICE trial is a prospect i ve , r and omized , controlled , open , blinded outcome assessment , noninferiority trial comparing cryoballoon- , and RFC-based PVI .  Patients with drug-resistant PAF will be r and omized in a 1:1 matrix in multiple European centers . The primary hypothesis is that cryoballoon ablation is not inferior to RFC ablation using 3-dimensional mapping with respect to clinical efficacy . The primary endpoint is defined as the time to first documented clinical failure , including : ( 1 ) recurrence of AF ; ( 2 ) atrial flutter or atrial tachycardia ; ( 3 ) prescription of class I or III antiarrhythmic drugs ; or ( 4 ) re-ablation , whichever comes first , following a blanking period of 3 months after the index ablation procedure . The primary safety endpoint is a composite of death , stroke/transient ischemic attack , cardiac arrhythmias ( apart from AF recurrence ) causally related to the therapeutic intervention , and procedure-related serious adverse events . CONCLUSION The FIRE AND ICE trial compares 2 different technologies to perform catheter ablation of PAF with respect to efficacy and safety . It aims at providing objective data to guide selection and usage of ablation catheters in the treatment of AF Most evidence regarding the efficacy and safety of the antithrombotic regimens for patients with atrial fibrillation ( AF ) undergoing percutaneous coronary intervention with stent ( PCI‐S )  derives from small , single‐center , retrospective data sets . To obtain further data on this issue , we carried out the prospect i ve , multicenter , observational Management of patients with Atrial Fibrillation undergoing Coronary Artery Stenting ( AFCAS ) registry ( Clinical trials.gov identifier NCT00596570 ) A prospect i ve registry was made of all patients hospitalized with atrial fibrillation ( AF ) in the State of Qatar from 1991 to 2010 .  Clinical characteristics , management , and outcomes were compared according to ethnicity ( Middle Eastern Arab vs South Asian ) . During this 20-year period , 2857 Arabs and 548 Asians were hospitalized for AF . Arabs were 9 years older and more likely to have hypertension , diabetes mellitus ( DM ) , chronic renal impairment , and dyslipidemia than the Asians . Valvular heart disease and acute coronary syndromes were more common among Asians , while congestive heart failure was more common in Arabs . The overall inhospital mortality was lower in Asians than that of Arabs , while stroke rates were comparable . There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period , but there was no change in mortality trends . Our findings underscore the need to study AF according to ethnicity Background —Atrial  fibrillation ( AF ) ablation  is increasingly used in clinical practice . We aim ed to study the natural history and long-term outcomes of ablated AF . Methods and Results —We followed 831 patients after pulmonary vein isolation ( PVI ) performed in 2005 . We documented clinical outcomes using our prospect i ve AF registry with most recent up date on this group of patients in October 2009 . In the first year after ablation , 23.8 % had early recurrence . Over long-term follow-up ( 55 months ) , only 8.9 % had late arrhythmia recurrence defined as occurring beyond the first year after ablation . Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6 % . At last follow-up , clinical improvement was 89.9 % ( 79.4 % arrhythmia-free off antiarrhythmic drugs and 10.5 % with AF controlled with antiarrhythmic drugs ) . Only 4.6 % continued to have drug-resistant AF . It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation ( CHADS score ⩽2 , stroke incidence of 0.06 % per year ) . The procedure-related complication rate was very low . Conclusions —Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF . It obviates the need for antiarrhythmic drugs , negative dromotropic agents , and anticoagulants in a substantial proportion of patients BACKGROUND We prospect ively compared the efficacy , safety , and quality of life ( QoL ) impact of catheter ablation versus antiarrhythmic drugs ( AAD ) in elderly patients with persistent atrial fibrillation ( AF ) . METHODS AND RESULTS Four hundred and twelve consecutive patients , aged ≥ 70 years , underwent ablation ( Group A , 153 patients ) or AAD ( Group B , 259 patients ) . Study endpoints : treatment failure ( any AF/AT lasting > 30 seconds ) and treatment-related adverse events ( acute when ≤1 month of procedure and long term when > 1 month ) . At a follow-up of 60 ± 17 months , 43 % and 46 % patients in Group B versus 58 % and 76 % in Group A were in sinus rhythm ( SR ) , respectively , after one ( P = 0.003 ) and 2 procedures ( P < 0.001 ) . Fifteen acute adverse events occurred ( 6.7 % in Group A vs 1 % in Group B , P < 0.001 ) , mainly periprocedural cerebral thromboembolism ( 3.3 % in Group A vs 0.7 % in Group B , P = 0.058 ) . Previous TIA/stroke result ed the only independent predictor of periprocedural cerebrovascular accidents ( OR 1.2 , 95%IC 1.1 - 1.3 ) . At follow-up , 74 long-term adverse events occurred ( 7.7 % in Group A vs 23.9 % in Group B , P < 0.001 ) with Group B patients more often experiencing  AAD-related  adverse events ( 12.7 % vs 2.6 % , P < 0.001 ) . Group A and absence of AF/AT recurrences significantly improved QoL scores ( P < 0.001 ) . CONCLUSIONS In elderly persistent AF patients  , catheter ablation is more effective in maintaining SR and in improving QoL  than AAD but is affected by a higher risk of embolic complications , particularly in patients with previous TIA/stroke . Over time , Group A patients more likely discontinued AAD with a reduction of long-term adverse events BACKGROUND In our previous prospect i ve and r and omized study , we have demonstrated that the concomitant surgical ablation using saline-irrigated cooled tip radiofrequency ablation ( SICTRA ) system is more effective than subsequent circumferential pulmonary vein isolation ( CPVI ) combined with substrate modification in treating patients with long-st and ing persistent atrial fibrillation ( LS-AF ) and rheumatic heart disease ( RHD ) undergoing cardiac surgery during middle-term follow-up . Whether this strategy also decreases longer-term arrhythmia recurrence is unknown . This study describes the 4-year efficacy of SICTRA for these patients . Furthermore , we seek to compare the electrophysiological characteristics for recurrent atrial tachyarrhythmia ( ATa ) at the session of catheter ablation between two groups . METHODS Long-term follow-up was performed in 95 patients who underwent the catheter ablation strategy ( n=47 , Group A ) or SICTRA ( n=48 , Group B ) combined with valvular surgery for symptomatic LS-AF patients with RHD . RESULTS After one procedure , Group B had a significantly higher freedom from ATa compared with Group A ( 29/48 vs 15/47 , P=0.005 ) after a mean follow-up of 54 months ( range 48 to 63 months ) . Catheter-based mapping and ablation of recurrent ATa showed larger amounts of macro-reentrant atrial tachycardias ( ATs ) in Group B and higher incidence of pulmonary vein ( PV ) recovery in Group A. After multiple catheter ablations for recurrent ATa , sinus rhythm ( SR ) could be maintained equally between two groups . CONCLUSIONS Single procedure success seems to be higher with SICTRA but repeated catheter ablation potentially results in comparable outcomes in treating patients with LS-AF and RHD during long-term follow-up . More macro-reentrant ATs and more PV recoveries are identified to be responsible for ATa in SICTRA and catheter ablation group , respectively Background —The effect of successful catheter ablation on left ventricular ( LV ) strain in patients with preserved LV systolic function is unknown . The aim of the present study was to assess the long-term effects of catheter ablation for atrial fibrillation ( AF )  on LV strain and strain rate in patients with preserved LV ejection fraction . Methods and Results —In 78 patients undergoing catheter ablation for AF  , speckle tracking strain imaging was performed to assess LV strain in 3 directions ( radial , circumferential , and longitudinal ) at baseline and after 12-month follow-up . The study population was divided into 2 groups , according to the maintenance of sinus rhythm ( SR ) during follow-up . After 13.8±4.7 months of follow-up , 54 patients ( 69 % ) were in SR ( SR group ) , whereas 24 patients ( 31 % ) had recurrence of AF ( AF group ) . No significant changes in LV ejection fraction from baseline to follow-up were noted ( 60±7 % versus 59±7 % , P = NS ) . Circumferential strain improved significantly in the SR group ( −18.3±3.2 % versus −20.4±3.8 % , P<0.001 ) , whereas it remained unchanged in the AF group ( −18.9±3.5 % versus −17.9±3.1 % , P = NS ) . In the SR group , significant improvements in LV longitudinal strain and strain rate were noted , whereas in the AF group , LV longitudinal strain and strain rate deteriorated significantly at long-term follow-up . Conclusions —After successful catheter ablation , LV circumferential and longitudinal strain and strain rate improve significantly in patients who maintain SR . In contrast , a decrease in LV longitudinal strain and strain rate is observed in patients with recurrence of AF AIMS Catheter-based atrial fibrillation ( AF ) ablation has become an important therapeutic option in AF patients . Although there has been significant improvent in procedural success , post-procedural AF recurrences are continuing to be a major clinical problem . To the best of our knowledge , the impact of pre-procedural serum uric acid ( SUA ) level , as a pro-oxidant and pro-inflammatory marker , on AF recurrence following cryoballoon-based AF ablation has never been studied before . The objective of this study was to establish whether there is a relationship between levels of SUA and recurrence of paroxysmal AF after catheter ablation . METHODS AND RESULTS A total of 363 patients ( mean age 53.5 ± 11.2 years , 52.6 % male ) with symptomatic paroxysmal AF underwent initial cryoablation procedure .  Patients were categorized into quartiles on the basis of their pre-procedural SUA assays and follow-up , and the Kaplan-Meier estimation with a log-rank test was used for the analysis of the influence of SUA on the recurrence of AF . Post-ablation blanking period was observed for 3 months . At a mean follow-up of 19.2 ± 6.1 months , 68 patients ( 18.7 % ) had developed AF recurrence . Atrial fibrillation recurrence rates from the lowest to the highest SUA quartiles were 2.9 , 7.4 , 11.8 , and 77.9 % , respectively ( P < 0.001 ) . On multivariate Cox regression analysis , pre-ablation SUA level ( HR : 1.96 , 95 % CI : 1.49 - 2.59 , P < 0.001 ) , left atrial diameter ( HR : 1.11 , 95 % CI : 1.04 - 1.19 , P = 0.002 ) and early AF recurrence ( HR : 4.34 , 95 % CI : 1.9 - 9.95 , P = 0.001 ) were independent predictors of AF recurrence after cryoablation . Using a cut-off level of 6.37 , the pre-ablation SUA level predicted AF recurrence during follow-up with a sensitivity of 85.7 % and a specificity of 83.7 % . CONCLUSION In this prospect i ve study of patients with paroxysmal AF undergoing cryoablation , increased pre-ablation SUA levels were associated with a higher rate of AF recurrence . Our results support the role of a pre-ablation pro-inflammatory and pro-oxidant environment in the development of AF recurrence after ablation therapy but suggest that other factors are also important BACKGROUND Pre-procedural predictors ( PP ) of  atrial fibrillation ( AF ) recurrence ( AFR ) after repeated catheter ablation of AF ( RCAF )  are unknown . The aim of this study was identification of PP of outcome after RCAF . METHODS AND RESULTS In 213 patients ( 73 % male ) with drug-refractory AF ( 47 % paroxysmal AF ; PAF ) RCAF was performed . CHADS2 , CHA2DS2-VASc and ALARMEc ( AF type , Left Atrium size , Renal insufficiency , MEtabolic syndrome , cardiomyopathy ) scores were calculated for each patient . Complete success was defined as no AFR . After RCAF , 125 patients ( 59 % ) were free of atrial flutter or atrial tachycardia ( AFLAT ) on long-term follow-up ( FU ) . The univariate predictors of AFR were : type of AF ( non-PAF vs. PAF , P=0.001 ) , normalized left atrium area ( NLA ≥10.25 vs. NLA < 10.25 , P=0.012 ) and estimated glomerular filtration rate ( < 68ml/min vs. ≥68ml/min , P=0.048 ) . The independent predictors of AFLAT-free survival after RCAF were non-PAF ( P=0.002 ) and NLA ≥10.25 ( P=0.018 ) . Among combined predictors , only ALARMEc score , and neither CHADS2 or CHA2DS2-VASc , predicted outcome after RCAF ( P<0.0001 ) . CONCLUSIONS RCAF results in a moderate success rate on very long-term FU . Lower success was observed in patients with non-PAF and enlarged LA . ALARMEc score allows for clear description of expected outcome after RCAF INTRODUCTION Atrial fibrillation ( AF ) and diabetes mellitus type 2 ( DM2 ) often coexist ; however , a small number of patients with DM2 undergoing catheter ablation ( CA ) of AF  have been included in previous studies . The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF . METHODS AND RESULTS From January 2005 to September 2006 , 70 patients with a diagnosis of DM2 and paroxysmal ( n = 29 ) or persistent ( n = 41 ) AF were r and omized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment ( ADT ) with a 1-year follow-up . The primary endpoint was the time to first AF recurrence . By Kaplan-Meier analysis , at the end of follow-up , 42.9 % of patients in the ADT group and 80 % of patients who received a single ablation procedure and were without medications were free of AF ( P = 0.001 ) . In the ablation group , a significant improvement in quality -of-life ( QoL ) scores as compared with ADT group was observed . Six patients in the ADT group ( 17.1 % ) developed significant adverse drug effects . Hospitalization rate during follow-up was higher in the ADT group ( P = 0.01 ) . The only complication attributable to ablation was one significant access-site hematoma . CONCLUSION In patients with DM2 , CA of AF provides significant clinical benefits over the ADT and appears to be a reasonable approach regarding feasibility , effectiveness , and low procedural risk AIMS Catheter ablation of the pulmonary veins ( PVs ) is a promising therapeutic approach for symptomatic atrial fibrillation ( AF ) . The prospect i ve r and omized single-centre study ' Mesh Ablator versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation ' ( MACPAF ; clinical trials.gov NCT01061931 ) compared the efficacy and safety of two balloon-based PV ablation systems . METHODS AND RESULTS Thirty-two patients underwent PV ablation for symptomatic paroxysmal AF using the A rct ic Front ® or the HD Mesh Ablator ® catheter  according to study protocol . The primary endpoint was complete PV isolation ( PVI ) at the end of the ablation procedure , determined by exit block after achieving entrance block . Long-term follow-up data are not included in this publication . Patients ' mean age was 61.7 ± 8.9 years , 43.2 % were female , and median CHA₂DS₂-VASc score was 2.0 . In the intention-to-treat analysis , the rate of the primary endpoint was 56.5 % in patients r and omized to the A rct ic Front ® and 9.5 % in patients r and omized to the HD Mesh Ablator ® catheter ( P = 0.001 ) . In the per- protocol analysis , complete PVI was achieved in 13 ( 76.5 % ) of 17 A rct ic Front ® patients but in none of the 15 HD Mesh Ablator ® patients ( P < 0.0001 ) . There were one major and two minor complications in each study arm but no clinical ly evident stroke . Post-procedural AF recurrence was detected within hospital stay in two ( 11.8 % ) A rct ic Front ® patients and in seven ( 46.7 % ) HD Mesh Ablator ® patients ( P = 0.049 ) . CONCLUSION The MACPAF study revealed a superiority of the A rct ic Front ® catheter concerning complete PVI . Owing to the insufficient efficacy of the HD Mesh Ablator ® catheter , the safety board decided to stop MACPAF prematurely During the past three decades , catheter and surgical ablation of  atrial fibrillation ( AF ) have evolved from investigational procedures to their current role as effective treatment options for patients with AF .  Surgical ablation of AF , using either st and ard , minimally invasive , or hybrid techniques , is available in most major hospitals throughout the world . Catheter ablation of AF is even more widely available , and is now the most commonly performed catheter ablation procedure . In 2007 , an initial Consensus Statement on Catheter and Surgical AF Ablation was developed as a joint effort of the Heart Rhythm Society ( HRS ) , the European Heart Rhythm Association ( EHRA ) , and the European Cardiac Arrhythmia Society (ECAS).1 The 2007 document was also developed in collaboration with the Society of Thoracic Surgeons ( STS ) and the American College of Cardiology ( ACC ) . This Consensus Statement on Catheter and Surgical AF Ablation was rewritten in 2012 to reflect the many advances in AF ablation that had occurred in the interim.2 The rate of advancement in the tools , techniques , and outcomes of AF ablation continue to increase as enormous research efforts are focused on the mechanisms , outcomes , and treatment of AF . For this reason , the HRS initiated an effort to rewrite and up date this Consensus Statement . Reflecting both the worldwide importance of AF , as well as the worldwide performance of AF ablation , this document is the result of a joint partnership between the HRS , EHRA , ECAS , the Asia Pacific Heart Rhythm Society ( APHRS ) , and the Latin American Society of Cardiac Stimulation and Electrophysiology ( Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia [ SOLAECE ] ) . The purpose of this 2017 Consensus Statement is to provide a state-of-the-art review of the field of catheter and surgical ablation of AF and to report the findings of a writing group , convened by these five international societies . The writing group is charged with defining the indications , techniques , and outcomes of AF ablation procedures . Included within this document are recommendations pertinent to the design of clinical trials in the field of AF ablation and the reporting of outcomes , including definitions relevant to this topic . The writing group is composed of 60 experts representing 11 organizations : HRS , EHRA , ECAS , APHRS , SOLAECE , STS , ACC , American Heart Association ( AHA ) , Canadian Heart Rhythm Society ( CHRS ) , Japanese Heart Rhythm Society ( JHRS ) , and Brazilian Society of Cardiac Arrhythmias ( Sociedade Brasileira de Arritmias Cardiacas [ SOBRAC ] ) . All the members of the writing group , as well as peer review ers of the document , have provided disclosure statements for all relationships that might be perceived as real or potential conflicts of interest . All author and peer review er disclosure information is provided in Appendix A and Appendix B. In writing a consensus document , it is recognized that consensus does not mean that there was complete agreement among all the writing group members . Surveys of the entire writing group were used to identify areas of consensus concerning performance of AF ablation procedures and to develop recommendations concerning the indications for catheter and surgical AF ablation . These recommendations were systematic ally balloted by the 60 writing group members and were approved by a minimum of 80 % of these members . The recommendations were also subject to a 1-month public comment period . Each partnering and collaborating organization then officially review ed , commented on , edited , and endorsed the final document and recommendations . The grading system for indication of class of evidence level was adapted based on that used by the ACC and the AHA.3,4 It is important to state , however , that this document is not a guideline . The indications for catheter and surgical ablation of AF , as well as recommendations for procedure performance , are presented with a Class and Level of Evidence ( LOE ) to be consistent with what the reader is familiar with seeing in guideline statements . A Class I recommendation means that the benefits of the AF ablation procedure markedly exceed the risks , and that AF ablation should be performed ; a Class IIa recommendation means that the benefits of an AF ablation procedure exceed the risks , and that it is reasonable to perform AF ablation ; a Class IIb recommendation means that the benefit of AF ablation is greater or equal to the risks , and that AF ablation may be considered ; and a Class III recommendation means that AF ablation is of no proven benefit and is not recommended . The writing group review ed and ranked evidence supporting current recommendations with the weight of evidence ranked as Level A if the data were derived from high- quality evidence from more than one r and omized clinical trial , meta-analyses of high- quality r and omized clinical trials , or one or more r and omized clinical trials corroborated by high- quality registry studies . The writing group ranked available evidence as Level B-R when there was moderate- quality evidence from one or more r and omized clinical trials , or meta-analyses of moderate- quality r and omized clinical trials . Level B-NR was used to denote moderate- quality evidence from one or more well- design ed , well-executed nonr and omized studies , observational studies , or registry studies . This design ation was also used to denote moderate- quality evidence from meta-analyses of such studies . Evidence was ranked as Level C-LD when the primary source of the recommendation was r and omized or nonr and omized observational or registry studies with limitations of design or execution , meta-analyses of such studies , or physiological or mechanistic studies of human subjects . Level C-EO was defined as expert opinion based on the clinical experience of the writing group . Despite a large number of authors , the participation of several societies and professional organizations , and the attempts of the group to reflect the current knowledge in the field adequately , this document is not intended as a guideline . Rather , the group would like to refer to the current guidelines on AF management for the purpose of guiding overall AF management strategies.5,6 This consensus document is specifically focused on catheter and surgical ablation of AF , and summarizes the opinion of the writing group members based on an extensive literature review as well as their own experience . It is directed to all health care professionals who are involved in the care of patients with AF , particularly those who are caring for patients who are undergoing , or are being considered for , catheter or surgical ablation procedures for AF , and those involved in research in the field of AF ablation . This statement is not intended to recommend or promote catheter or surgical ablation of AF . Rather , the ultimate judgment regarding care of a particular patient must be made by the health care provider and the patient in light of all the circumstances presented by that patient . The main objective of this document is to improve patient care by providing a foundation of knowledge for those involved with catheter ablation of AF . A second major objective is to provide recommendations for design ing clinical trials and reporting outcomes of clinical trials of AF ablation . It is recognized that this field continues to evolve rapidly . As this document was being prepared , further clinical trials of catheter and surgical ablation of AF were under way OBJECTIVES It is uncertain whether gender affects the outcomes of catheter ablation ( CA ) for atrial fibrillation ( AF ) . The objective of the study is to evaluate the efficacy and safety of CA for long-st and ing persistent AF in women . METHODS Between January 2010 and May 2011 , 220 consecutive patients ( 73 females , 33.2 % ) , with long-st and ing persistent AF who underwent CA were prospect ively recruited . Gender-related differences in clinical presentation , periprocedural complications , and outcomes were compared . RESULTS Women were less likely to have lone AF than men ( 27.4 % vs 47.6 % ; P = 0.004 ) . The incidence of rheumatic heart disease was higher in women ( 19.2 % in women vs 1.4 % in men ; P < 0.001 ) . Women had a lower initial ablation success rate than men ( 35.6 % vs 57.1 % ; P = 0.003 ) . Hematomas occurred more often in women ( 6.8 % in women vs 0.7 % in men ; P = 0.027 ) . A Cox regression analysis demonstrated total duration of AF ( per month , hazard ratio [ HR ] 1.003 , confidence interval [ CI ] 1.001 - 1.006 ; P = 0.006 ) and gender ( HR 1.663 , CI 1.114 - 2.485 ; P = 0.013 ) as the independent predictors for recurrence after the first CA . CONCLUSIONS Women and long AF duration were closely related to the recurrence of AF after the first ablation in patients with long-st and ing persistent AF . Women also had a higher risk of vascular complications Introduction Atrial fibrillation ( AF ) is commonly found in patients with structural heart disease ( SHD ) , including atrial septal defect ( ASD ) . The feasibility and safety of ablation for AF in patients with unrepaired ASD is seldom reported . Objectives This study aims to evaluate and compare the long-term efficacy of  AF ablation  in patients with and without ASD . Methods From January 2008 to December 2012 , 18 consecutive patients were identified with medically refractory AF and an unrepaired ASD under catheter ablation .  For each ASD patient , four control subjects were matched from our data base . Results There were no significant differences between groups in terms of age , sex , type of AF , LA diameter , LVIDD , and EF . The mean procedural and fluoroscopy times were not different between the groups ( p = NS ) . After a median follow-up of 20 months , the patients in the ASD group had 44.4 % AF recurrence after a single procedure compared with 34.7 % in the control group ( p = 0.11 ) . The mean LA diameter in non-recurrent patients was smaller than in recurrent patients ( p = 0.03 ) . In univariate Cox proportional hazards analyses , the factor found to have a significant association with arrhythmia recurrences was left atrial diameter ( hazard ratio 1.059 , 95 % confidence interval 1.002 to 1.120 , p = 0.03 ) . Conclusions These results indicate that in patients with AF and an ASD amenable to percutaneous closure , a staged approach with radiofrequency ablation of AF preceding closure is a rational strategy AIMS The Atrial Fibrillation Ablation Pilot Study is a prospect i ve registry design ed to describe the clinical epidemiology of patients undergoing an atrial fibrillation ( AFib ) ablation  , and the diagnostic/therapeutic processes applied across Europe . The aims of the 1-year follow-up were to analyse how centres assess in routine clinical practice the success of the procedure and to evaluate the success rate and long-term safety/complications . METHODS AND RESULTS Seventy-two centres in 10 European countries were asked to enrol 20 consecutive patients undergoing a first AFib ablation procedure .  A web-based case report form captured information on pre-procedural , procedural , and 1-year follow-up data . Between October 2010 and May 2011 , 1410 patients were included and 1391 underwent an AFib ablation ( 98.7 % ) . A total of 1300 patients ( 93.5 % ) completed a follow-up control 367 ± 42 days after the procedure . Arrhythmia documentation was done by an  electrocardiogram  in 76 % ,  Holter-monitoring  in 52 % ,  transtelephonic monitoring in 8 % , and /or implanted systems in 4.5 % . Over 50 % became asymptomatic . Twenty-one per cent were re-admitted due to post-ablation arrhythmias . Success without antiarrhythmic drugs was achieved in 40.7 % of patients ( 43.7 % in paroxysmal AF ; 30.2 % in persistent AF ; 36.7 % in long-lasting persistent AF ) . A second ablation was required in 18 % of the cases and 43.4 % were under antiarrhythmic treatment . Thirty-three patients ( 2.5 % ) suffered an adverse event , 272 ( 21 % ) experienced a left atrial tachycardia , and 4 patients died ( 1 haemorrhagic stroke , 1 ventricular fibrillation in a patient with ischaemic heart disease , 1 cancer , and 1 of unknown cause ) . CONCLUSION The AFib Ablation Pilot Study provided crucial information on the epidemiology , management , and outcomes of catheter ablation of AFib in a real-world setting . The methods used to assess the success of the procedure appeared at least suboptimal . Even in this context , the 12-month success rate appears to be somewhat lower to the one reported clinical trials BACKGROUND Given the potential complications of atrial fibrillation ( AF ) recurrence after ablation , better predictors of the effectiveness of the procedure are necessary to guide patient selection . AIM This prospect i ve study was conducted to evaluate the clinical relevance of global left atrial longitudinal strain ( GLAS ) and AF recurrence after catheter ablation . METHODS In 115 consecutive patients with AF ( persistent , n=62 ; paroxysmal , n=53 ) ,  transthoracic echocardiography was performed before catheter ablation to assess baseline left atrial mechanical function using speckle tracking echocardiography ( STE ) . RESULTS After 12 months of follow-up , 22 ( 35.5 % ) patients in the persistent AF group and 15 ( 28.3 % ) in the paroxysmal AF group exhibited AF recurrence . In both the paroxysmal and persistent AF population s , patients with recurrence presented with significantly impaired GLAS compared with patients without recurrence . Patients with recurrence also had a significantly higher pro-B-type natriuretic peptide concentration . A receiver operator curve analysis yielded area under the curve values of 0.94 and 0.86 for paroxysmal and persistent AF , respectively . In a multivariable Cox proportional-hazards analysis , GLAS was an independent predictor of AF recurrence after catheter ablation in both the paroxysmal AF group ( hazard ratio : 0.79 , 95 % confidence interval : 0.67 - 0.96 ; P=0.01 ) and the persistent AF group ( hazard ratio : 0.81 , 95 % confidence interval : 0.71 - 0.93 ; P=0.004 ) . CONCLUSIONS In both paroxysmal and persistent AF , decreased baseline left atrial deformation capabilities assessed by two-dimensional STE can help to identify patients at high risk of AF recurrence after catheter ablation . This variable may help to guide c and i date selection and improve therapeutic strategies Background —The objective of this study was to assess the incidence and impact of asymptomatic arrhythmia in patients with highly symptomatic atrial fibrillation ( AF ) who qualified for radiofrequency ( RF ) catheter ablation .  Methods and Results —In this prospect i ve study , 114 patients with at least 3 documented AF episodes together with corresponding symptoms and an ineffective trial of at least 1 antiarrhythmic drug were selected for  RF ablation .  With the use of CARTO , circumferential lesions around the pulmonary veins and linear lesions at the roof of the left atrium and along the left atrial isthmus were placed . A continuous , 7-day , Holter session was recorded before ablation , right after ablation , and after 3 , 6 , and 12 months of follow-up . During each 7-day Holter monitoring , the patients recorded quality and duration of any complaints by using a detailed symptom log . More than 70 000 hours of ECG recording were analyzed . In the 7-day Holter records before ablation , 92 of 114 patients ( 81 % ) had documented AF episodes . All episodes were symptomatic in 35 patients ( 38 % ) . In 52 patients ( 57 % ) , both symptomatic and asymptomatic episodes were recorded , whereas in 5 patients ( 5 % ) , all documented AF episodes were asymptomatic . After ablation , the percentage of patients with only asymptomatic AF recurrences increased to 37 % ( P<0.05 ) at the 6-month follow-up . An analysis of patient characteristics and arrhythmia patterns failed to identify a specific subset who were at high risk for the development of asymptomatic AF . Conclusions —Even in patients presenting with highly symptomatic AF , asymptomatic episodes may occur and significantly increase after catheter ablation . A symptom-only – based follow-up would substantially overestimate the success rate . Objective measures such as long-term Holter monitoring are needed to identify asymptomatic AF recurrences after ablation BACKGROUND Catheter ablation is now an alternative approach to antiarrhythmic drug therapy for patients with symptomatic atrial fibrillation ( AF ) . We focused on younger patients in whom the prevalence of AF is low , and we sought clinical factors associated with unsuccessful ablation outcomes . METHODS AND RESULTS Among 1983 consecutive symptomatic patients who underwent AF ablation procedures , 95 patients ( 4.8 % ) , age ≤ 40 years , were prospect ively included . Of them , 64 had paroxysmal AF , and the remaining 31 had persistent AF . All patients underwent pulmonary vein isolation and cavotricuspid isthmus ablation . When AF recurred , redo ablations were performed if the patients desired . The mean number of ablation procedures was 1.3 ± 0.6 times per patient . During the follow-up of 40 [ 27.8 - 49.6 ] months , sinus rhythm was maintained in 86 patients ( 90.5 % ) without any antiarrhythmic drugs , but not in the remaining 9 patients ( 9.5 % ) . Low body mass index ( BMI ) and persistent AF were associated with unsuccessful ablation procedures . In multivariate logistic regression analysis , a low BMI had the most significant value , with an odds ratio of 7.33 ( p=0.022 ) . The receiver operating characteristic curve demonstrated a BMI cut point of 22.1 kg/m(2 ) , with an area under the curve of 0.773 . CONCLUSION In symptomatic younger AF patients , a low BMI was an independent clinical factor for unsuccessful AF ablation outcomes
Catheter ablation of AF  safety and efficacy in DM patients is similar to general population , especially when performed in younger patients with satisfactory glycemic control .
Catheter ablation of AF reduces the amount of patients requiring AADs , an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments
AIMS Diabetes mellitus ( DM ) and atrial fibrillation ( AF ) share pathophysiological links , as supported by the high prevalence of AF within DM patients .
Catheter ablation of AF ( AFCA ) is an established therapeutic option for rhythm control in drug resistant symptomatic patients .
Its efficacy and safety among patients with DM is based on small population s , and long-term outcome is unknown .
The present systematic review and meta- analysis aims to assess safety and long-term outcome of AFCA in DM patients , focusing on predictors of recurrence .