ABSTRACT
Objectives: We aimed to investigate the outcomes of pulmonary vein isolation in athletes. Methods: We retrospectively identified endurance athletes who underwent catheter ablation at our institution (2004-2018). Endurance athletes were defined as participating in competitive athletics for at least 1500 lifetime hours in sports at the IB or IIA Bethesda classification or higher. Primary endpoints were freedom from atrial arrhythmias at 12, 24, and 36 months after the procedure. Secondary endpoints were defined as qualitative improvement in symptoms allowing athletes to return to their previous level of activity. Athletes were compared with a control group of nonathletes in a 3-to-1 matched analysis by age and sex. Results: A total of 39 endurance athletes who underwent catheter ablation were identified during the study period. At 12 months, there was no difference in treatment outcomes for athletes versus nonathletes (relative risk [RR], 1.06; 95% CI, 0.92-1.22; p = .40). Freedom from atrial arrhythmias was 35% less likely in athletes than nonathletes at 24 months (RR, 0.65; 95% CI, 0.50-0.83; p < .001) and 42% less likely at 36 months (RR, 0.58; 95% CI, 0.41-0.79; p < .001). Overall, 77% of the athletes were able to return to their previous level of activity following catheter ablation. Conclusion: Endurance athletes with atrial fibrillation appear to have higher rates of atrial arrhythmia recurrence than nonathletes after catheter ablation, with higher rates of atypical flutter. The majority of athletes were able to return to their previous level of activity after ablation.
ABSTRACT
Magnetic resonance imaging (MRI) is a valuable imaging modality for the assessment of both cardiac and non-cardiac structures. With a growing population of patients with cardiovascular implantable electronic devices (CIEDs), 50%-75% of these patients will need an MRI. MRI-conditional CIEDs have demonstrated safety of MRI scanning with such devices, yet non-conditional devices such as hybrid CIEDs which have generator and lead brand mismatch may pose a safety risk. In this retrospective study, we examined the outcomes of patients with hybrid CIEDs undergoing MRI compared to those patients with non-hybrid CIEDs. A total of 349 patients were included, of which 24 patients (7%) had hybrid CIEDs. The primary endpoint was the safety of MRI for patients with hybrid CIEDs as compared to those with non-hybrid devices, measured by the rate of adverse events, including death, lead or generator failure needing immediate replacement, loss of capture, new onset arrhythmia, or power-on reset. Secondary endpoints consisted of pre- and post-MRI changes of decreased P-wave or R-wave sensing by ≥50%, changes in pacing lead impedance by ≥50 ohms, increase in pacing thresholds by ≥ 0.5 V at 0.4 ms, and decreasing battery voltage of ≥ 0.04 V. The primary endpoint of any adverse reaction was present in 1 (4.2%) patient with a hybrid device, and consistent of atrial tachyarrhythmia, and in 10 (3.1%) patients with a non-hybrid device, and consisted of self-limited atrial and non-sustained ventricular arrhythmias; this was not statistically significant. No significant differences were found in the secondary endpoints. This study demonstrates that MRI in patients with hybrid CIEDs does not result in increased patient risk or significant device changes when compared to those patients who underwent MRI with non-hybrid CIEDs.
