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Microsoft Word LVTS ENG FINAL docx MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES BY VIEN HOANG LONG MD CLINICAL, PARACLINICAL CHA[.]
MINISTRY MINISTRY OF EDUCATION AND TRAINING OF DEFENCE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES BY VIEN HOANG LONG MD CLINICAL, PARACLINICAL CHARACTERISTICS, ELECTROPHYSIOLOGICAL FEATURES AND RESULT OF PERSISTENT ATRIAL FIBRILLATION ABLATION WITH RADIOFREQUENCY ENERGY A Dissertation for the Degree of Medical Doctor of Cardiology HA NOI - 2023 MINISTRY MINISTRY OF EDUCATION AND TRAINING OF DEFENCE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES BY VIEN HOANG LONG MD CLINICAL, PARACLINICAL CHARACTERISTICS, ELECTROPHYSIOLOGICAL FEATURES AND RESULT OF PERSISTENT ATRIAL FIBRILLATION ABLATION WITH RADIOFREQUENCY ENERGY A Dissertation for the Degree of Medical Doctor of Cardiology Speciality: Internal Medicine/Internal Cardiology Code: 9720107 HA NOI - 2023 ACKNOWLEDGMENTS For the completion of this dissertation, my deepest appreciations go to: - 108 Institute of clinical medical and pharmaceutical sciences - Department of Post graduates of 108 Central Military Hospital - Department of Internal Cardiological Medicine - Board of Director of Vietnam National Heart Institute - Bach Mai Hospital - C7 Department, Cardiac catheterization laboratory Department, Outpatients service Department, Electrography and Electrophysiology Department of Vietnam National Heart Institute - Bach Mai Hospital Special thanks to: - My dearest teachers: Associate Professor Pham Quoc Khanh and Associate Professor Pham Nguyen Son - Pham Tran Linh, PhD - Phan Dinh Phong, PhD - Dr Le Vo Kien, Dr Tran Tuan Viet, Dr Nguyen Thi Le Thuy, Dr Nguyen Duy Linh, Dr Nguyen Duy Tuan I am personally indebted to: - My past grandparents Vien Van Doan, Nguyen Thi Bi, my beloved parents Vien Van Doan, Nguyen Thi Kim Hoang for giving my birth, my wife Le Thanh Ha, my kids Hoang Bach and Nhat Quang for their love to me - My patients, my staff without them this work would never be completed PROTESTATION I hereby declare that this is my own research, under the guidance of Assoc Prof Pham Quoc Khanh and Assoc Prof Pham Nguyen Son All data in this dissertation were collected by myself, and the results presented are honest and have not been published in any other research work in Vietnam I ensure the honesty of the data and the results obtained from data processing in this study Hanoi, 26th June 2023 Author of the dissertation Vien Hoang Long LIST OF ABBREVIATIONS 2D 2-dimensional ACC American College of Cardiology AFL Atrial flutter AH Atrial - his AHRE Atrial high-rate episode APHRS Asia Pacific Heart Rhythm Society AT Atrial tachycardia AVN Atrioventricular node BMI Body mass index BP Blood pressure bpm beats per minute CHA2DS2-VASc Stroke risk score CHA2DS2-VASc DBP Diastolic blood pressure ECAS European Cardiac Arrhythmia Society ECG Electrocardiogram EHRA European Heart Rhythm Association ERP Effective refractory period ESC European Society of Cardiology FU Follow-up GMR Grade of mitral valve regurgitation GTR Grade of tricuspid valve regurgitation HASBLED Bleeding risk score HASBLED HCM Hypertrophic cardiomyopathy HRS Heart Rhythm Society HV His - ventricular interval LA Left atrial LIPV Left inferior pulmonary vein LSPV Left superior pulmonary vein LVZ Low voltage zone PA P - atrial interval PAC Premature atrial complex PV Pulmonary vein PVC Premature ventricular complex PVI Pulmonary vein isolation RIPV Right inferior pulmonary vein RSPV Right superior pulmonary vein SBP Systolic blood pressure SNRT Sinus node recovery time SNRTc Corrected sinus node recovery time SOLAECE Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología TABLE OF CONTENTS INTRODUCTION CHAPTER LITERATURE OVERVIEW 1.1 Diagnosis of atrial fibrillation 1.1.1 Definition of atrial fibrillation 1.1.2 Diagnostic criteria for atrial fibrillation 1.1.3 Classification of AF 1.2 Atrial fibrillation management 1.2.1 ACB pathway: 1.2.2 Indications for atrial fibrillation catheter ablation 1.3 Recent studies about atrial fibrillation catheter ablation 1.3.1 Overview of study about atrial fibrillation in Vietnam 1.3.2 Overview of studies about persistent atrial fibrillation ablation CHAPTER SUBJECTS AND METHODS 12 2.1 Subjects 12 2.1.1 Inclusion criteria 12 2.1.2 Exclusion criteria 13 2.1.3 Diagnostic criteria used in the study 13 2.2 Methods 15 2.2.1 Design and sample size 15 2.2.2 Data collection 15 2.3 Study data analysis 28 2.4 Study ethics 28 CHAPTER RESULTS 30 3.1 General characteristics of the study group 30 3.1.1 Baseline characteristics 30 3.1.2 Age and sex distribution 30 3.2 Clinical, paraclinical characteristics and electrophysiological features 32 3.2.1 Clinical characteristics 32 3.2.2 Paraclinical characteristics 34 3.2.3 Electrophysiological features of persistent atrial fibrillation patients 37 3.3 Results of catheter ablation for persistent atrial fibrillation 42 3.3.1 Technique index in catheter ablation for persistent atrial fibrillation 42 3.3.2 Result within 24 hours after catheter ablation 44 3.3.3 Results at month follow-up 45 3.3.4 Results after months follow-up 47 3.3.5 Results after 6-month follow-up 50 3.3.6 The proportion of maintaining sinus rhythm and clinical and paraclinical changes after intervention 51 3.3.7 Evaluation of some factors related to the success rate of maintaining sinus rhythm after persistent atrial fibrillation ablation 55 3.3.8 Complications of persistent atrial fibrillation catheter ablation 60 CHAPTER DISCUSSIONS 61 4.1 General characteristics of patients in the study 61 4.2 Clinical and paraclinical characteristics of patients in the study 62 4.2.1 Clinical characteristics 62 4.2.2 Paraclinical characteristics 63 4.2.3 Electrophysiological features of patients in study 65 4.3 Results of persistent atrial fibrillation catheter ablation 69 4.3.1 Strategy and technique of persistent atrial fibrillation catheter ablation 69 4.3.2 AF-free rate after catheter ablation for persistent AF 76 4.3.3 Some factors affecting the success rate after catheter ablation for persistent AF 81 4.3.4 Safety of persistent atrial fibrillation catheter ablation 83 4.4 Limitations 84 CONCLUSIONS 85 RECOMMENDATIONS 87 LIST OF PUBLISHED PAPERS OF THE DISSERTATION REFERENCES SAMPLES OF MEDICAL RECORD FOR THE STUDY LIST OF TABLES Table 1.1: Definition of AF according to ESC AF guideline 2020 Table 1.2: Classification of AF Table 1.3: HRS/EHRA/ECAS/APHRS/SOLAECE indications for catheter ablation Table 2.1: European Heart Rhythm Association (EHRA) symptom scale 12 Table 3.1 Baseline characteristics 30 Table 3.2 Sex and age subgroups distribution 31 Table 3.3 Risk factors and cardiovascular diseases history 32 Table 3.4 Physical examination data 34 Table 3.5 Blood test index of patients 34 Table 3.6 Transthoracic cardiac echo index of patients 35 Table 3.7 Left atrial volume and pulmonary veins' diameter on MSCT 36 Table 3.8 The proportion of electrical connection between the pulmonary veins and the left atrium 37 Table 3.9 Acute success rate of PVI 37 Table 3.10 Some other atrial arrhythmias and substrates besides AF 38 Table 3.11 Basic intervals after sinus rhythm recovered 39 Table 3.12 Sinus node recovery time 40 Table 3.13 SNRT by age and sex 40 Table 3.14 ERP of atrial, ventricular, atrial - ventricular node 41 Table 3.15 Ablation time, number of lesions, procedure's time and number of cardioversions 43 Table 3.16 24-hour Holter ECG within 24 hours after catheter ablation 44 Table 3.17 Transthoracic cardiac echo after catheter ablation 44 Table 3.18 Proportion of sinus rhythm maintain within 24 hour of catheter ablation on Holter ECG 45