TY - JOUR
T1 - Catheter ablation approach and outcome in HIV+ patients with recurrent atrial fibrillation
AU - La Fazia, Vincenzo Mirco
AU - Pierucci, Nicola
AU - Mohanty, Sanghamitra
AU - Gianni, Carola
AU - Della Rocca, Domenico Giovanni
AU - Compagnucci, Paolo
AU - MacDonald, Bryan
AU - Mayedo, Angel
AU - Torlapati, Prem Geeta
AU - Bassiouny, Mohamed
AU - Gallinghouse, Gerald Joseph
AU - Burkhardt, John D.
AU - Horton, Rodney
AU - Al-Ahmad, Amin
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2023 Wiley Periodicals LLC.
PY - 2023/12
Y1 - 2023/12
N2 - Introduction: Earlier studies have shown a clear association between severity of human immunodeficiency virus (HIV) infection and incident atrial fibrillation (AF). We present the long-term outcome of catheter ablation (CA) and electrophysiological characteristics in HIV+ AF patients. Methods: This study evaluated 1438 consecutive AF patients [31 (2.15%) with HIV and 1407 (97.8%) without HIV diagnosis] undergoing their first CA at our center. A total of 31 HIV patients and 31 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model. During first procedure, all received isolation of pulmonary vein (PV) + posterior wall and superior vena cava. Non-PV triggers, defined as ectopic triggers originating from sites other than PVs, were identified at the redo ablation with high-dose isoproterenol challenge. Results: Clinical characteristics were not different between the groups. When compared to the control, by the end of 5 years after the first procedure, recurrence was significantly greater in HIV group [100% vs. 54%, p <.001]. Among patients that underwent redo ablation non-PV triggers were higher in HIV group [93.5% vs. 54%, p <.001], and most frequently originated from the coronary sinus [67.7% vs. 45.2%, p <.001] and left atrial appendage [41.9% vs. 25.8%, p <.001]. After focal ablation of non-PV trigger, no difference in arrhythmia recurrence between two groups [80.6% vs. 87.1%, p =.753] at 1-year follow up was found. Conclusion: Our findings suggest that non-PV triggers are highly prevalent in HIV+ AF patients resulting in higher rate of the mid- and long-term arrhythmia recurrence.
AB - Introduction: Earlier studies have shown a clear association between severity of human immunodeficiency virus (HIV) infection and incident atrial fibrillation (AF). We present the long-term outcome of catheter ablation (CA) and electrophysiological characteristics in HIV+ AF patients. Methods: This study evaluated 1438 consecutive AF patients [31 (2.15%) with HIV and 1407 (97.8%) without HIV diagnosis] undergoing their first CA at our center. A total of 31 HIV patients and 31 controls were generated by propensity matching, based on calculated risk factor scores, using a logistic model. During first procedure, all received isolation of pulmonary vein (PV) + posterior wall and superior vena cava. Non-PV triggers, defined as ectopic triggers originating from sites other than PVs, were identified at the redo ablation with high-dose isoproterenol challenge. Results: Clinical characteristics were not different between the groups. When compared to the control, by the end of 5 years after the first procedure, recurrence was significantly greater in HIV group [100% vs. 54%, p <.001]. Among patients that underwent redo ablation non-PV triggers were higher in HIV group [93.5% vs. 54%, p <.001], and most frequently originated from the coronary sinus [67.7% vs. 45.2%, p <.001] and left atrial appendage [41.9% vs. 25.8%, p <.001]. After focal ablation of non-PV trigger, no difference in arrhythmia recurrence between two groups [80.6% vs. 87.1%, p =.753] at 1-year follow up was found. Conclusion: Our findings suggest that non-PV triggers are highly prevalent in HIV+ AF patients resulting in higher rate of the mid- and long-term arrhythmia recurrence.
KW - HIV
KW - atrial fibrillation
KW - catheter ablation
KW - non-pulmonary vein triggers
KW - outcomes
KW - pulmonary veins
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U2 - 10.1111/jce.16076
DO - 10.1111/jce.16076
M3 - Article
C2 - 37746923
AN - SCOPUS:85173045569
SN - 1045-3873
VL - 34
SP - 2527
EP - 2534
JO - Journal of cardiovascular electrophysiology
JF - Journal of cardiovascular electrophysiology
IS - 12
ER -