Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes

Naiara Calvo, Lluís Mont, David Tamborero, Antonio Berruezo, Graziana Viola, Eduard Guasch, Mercè Nadal, David Andreu, Barbara Vidal, Marta Sitges, Josep Brugada, Naiara Calvo, Lluís Mont, David Tamborero, Antonio Berruezo, Graziana Viola, Eduard Guasch, Mercè Nadal, David Andreu, Barbara Vidal, Marta Sitges, Josep Brugada

Abstract

Aims: Long-term endurance sport practice has been increasingly recognized as a risk factor for lone atrial fibrillation (AF). However, data on the outcome of circumferential pulmonary vein ablation (CPVA) in endurance athletes are scarce. The aim of the study was to evaluate the efficacy of CPVA in AF secondary to endurance sport practice.

Methods and results: Patients submitted to CPVA answered a questionnaire about lifetime history of endurance sport practice. Endurance athletes were defined as those who engaged in >3 h per week of high-intensity exercise for at least the 10 years immediately preceding their AF diagnosis. A series of 182 consecutive patients was included (51 +/- 11 years, 65% with paroxysmal AF, 81% men, 42 +/- 6 mm mean left atrial diameter); 107 (59%) patients had lone AF, and 42 of them (23% of the study population) were classified as endurance athletes (lone AF sport group). Freedom from arrhythmia after a single CPVA was similar in the lone AF sport group compared with the remaining patients (P = 0.446). Left atrial size and long-standing AF were the only independent predictors for arrhythmia recurrence after ablation.

Conclusion: Circumferential pulmonary vein ablation was as effective in AF secondary to endurance sport practice as in other aetiologies of AF.

Figures

Figure 1
Figure 1
Kaplan–Meier curves for long-term freedom from recurrent arrhythmias after a single ablation procedure in the lone AF sport group (dashed line) and the control group (solid line).
Figure 2
Figure 2
Kaplan–Meier curves for long-term freedom from recurrent arrhythmias after a single ablation procedure in the lone AF sport group (dashed line) and patients with lone AF and no history of exercise activity (solid line).
Figure 3
Figure 3
Kaplan–Meier curves for long-term freedom from recurrent arrhythmias after repeated ablation procedures in the lone AF sport group (dashed line) and the control group (solid line).

References

    1. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285:2370–5.
    1. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) Am J Cardiol. 1994;74:236–41.
    1. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98:946–52.
    1. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation—Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) J Am Coll Cardiol. 2006;48:854–906.
    1. Planas F, Romero-Menor C, Gabriel Vázquez-Oliva JS, Poblet T, Navarro-López F on behalf of the FAP Study researchers. Perfil clínico de la fibrilación auricular paroxística primaria (registro FAP) Rev Esp Cardiol. 2001;54:838–44.
    1. Lévy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL, et al. Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists. Circulation. 1999;99:3028–35.
    1. Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: case–control study. BMJ. 1998;316:1784–5.
    1. Mont L, Sambola A, Brugada J, Vacca M, Marrugat J, Elosua R, et al. Long lasting sport practice and atrial fibrillation. Eur Heart J. 2002;23:477–82.
    1. Hoogsteen J, Schepb G, van Hemelc NM, van der Walld EE. Paroxysmal atrial fibrillation in male endurance athletes. A 9-year follow up. Europace. 2004;6:222e–8e.
    1. Elosua R, Arquer A, Mont L, Sambola A, Molina L, Garcia-Moran E, et al. Sport practice and the risk of lone atrial fibrillation: a case–control study. Int J Cardiol. 2006;108:332–7.
    1. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, et al. Sinus node disease and arrhythmias in the long term follow-up of former professional cyclists. Eur Heart J. 2008;29:71–8.
    1. Mont L, Tamborero D, Elosua R, Molina I, Coll-Vinent B, Sitges M, et al. on behalf of the GIRAFA (Grup Integrat de Recerca en Fibril-lacio Auricular) Investigators. Physical activity, height and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace. 2008;10:15–20.
    1. Molina L, Mont L, Marrugat J, Berruezo A, Brugada J, Bruguera J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008;10:618–23.
    1. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103:1572–7.
    1. Haïssaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.
    1. Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, et al. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary vein ablation: efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation. 2001;104:2539–44.
    1. Oral H, Knight BP, Tada H, Ozaydin M, Chugh A, Hassan S, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002;105:1077–81.
    1. Pappone C, Rosanio S, Augello G, Gallus G, Vicedomini G, Mazzone P, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled non-randomized long-term study. J Am Coll Cardiol. 2003;42:185–97.
    1. Oral H, Scharf C, Chugh A, Hall B, Cheung P, Good E, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation. 2003;108:2355–60.
    1. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation. 2005;111:1100–5.
    1. Khan MN, Jais P, Cummings J, Di Biase L, Sanders P, Martin DO, et al. Pulmonary-vein isolation for atrial fibrillation in patients with heart failure. N Engl J Med. 2008;359:1778–85.
    1. Furlanello F, Lupo P, Pittalis M, Foresti S, Vitali-Serdoz L, Francia P, et al. Radiofrequency catheter ablation of atrial fibrillation in athletes referred for disabling symptoms preventing usual training schedule and sport competition. J Cardiovasc Electrophysiol. 2008;19:457–62.
    1. Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS) Europace. 2007;9:335–79.
    1. Oral H, Chugh A, Scharf C, Hall B, Cheung P, Veerareddy S, et al. Pulmonary vein isolation for vagotonic, adrenergic, and random episodes of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2004;15:402–6.
    1. Berruezo A, Tamborero D, Mont L, Benito B, Tolosana JM, Sitges M, et al. Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J. 2007;28:836–41.
    1. Natale A, Raviele A, Arentz T, Calkins H, Chen SA, Haïssaguerre M, et al. Venice Chart international consensus document on atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2007;18:560–80.
    1. Heidbüchel H, Anne W, Willems R, Adriaenssens B, Van de Werf F, Ector H. Endurance sport is a risk factor for atrial fibrillation after ablation for atrial flutter. Int J Cardiol. 2006;107:67–72.
    1. Pelliccia A, Maron BJ, Di Paolo FM, Biffi A, Quattrini FM, Pisicchio C, et al. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol. 2005;46:690–6.
    1. Bettoni M, Zimmermann M. Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation. 2002;105:2753–9.
    1. Hoff HE, Geddes LA. Cholinergic factor in atrial fibrillation. J Appl Physiol. 1955;8:177–92.
    1. Alessie R, Nusynowitz M, Abildskow J, Moe GK. Non-uniform distribution of vagal effects on the atrial refractory period. Am J Physiol. 1958;194:406–10.
    1. Masiá R, Pena A, Marrugat J, Sala J, Vila J, Pavesi M, et al. High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGICOR Investigators. J Epidemiol Community Health. 1998;52:707–15.
    1. Chugh A, Oral H, Lemola K, Hall B, Cheung P, Good E, et al. Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm. 2005;2:464–71.
    1. Wazni O, Marrouche NF, Martin DO, Gillinov AM, Saliba W, Saad E, et al. Randomized study comparing combined pulmonary vein–left atrial junction disconnection and cavotricuspid isthmus ablation versus pulmonary vein–left atrial junction disconnection alone in patients presenting with typical atrial flutter and atrial fibrillation. Circulation. 2003;108:2479–83.
    1. Vassamreddy CR, Lickfett L, Jayam VK, Nasir K, Bradley D, Eldadah Z, et al. Predictors of recurrence following catheter ablation of atrial fibrillation using an irrigated-tip ablation catheter. J Cardiovasc Electrophysiol. 2004;15:692–7.
    1. Lee S-H, Tai C-T, Hsieh M-H, Tsai C-F, Lin Y-K, Tsao H-M, et al. Predictors of early and late recurrence of atrial fibrillation after catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2004;10:221–6.
    1. Dagres N, Kottkamp H, Piorkowski C, Weis S, Arya A, Sommer P, et al. Influence of the duration of Holter monitoring on the detection of arrhythmia recurrences after catheter ablation of atrial fibrillation: implications for patient follow-up. Int J Cardiol. Advance access publication 4 November 2008, doi: 10.1016/j.ijcard.2008.10.004.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj