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Obeidat O, Ismail MF, Abughazaleh S, Al-Ani H, Tarawneh M, Alhuneafat L, Obeidat A, Obeidat A, Alqudah Q, Daise MA, Alzghoul H, Al-Hammouri M, Althunibat W, Tong A, Alimohamed M. Decoding the evidence: A synopsis of indications and evidence for catheter ablation in atrial fibrillation (Review). MEDICINE INTERNATIONAL 2025; 5:1. [PMID: 39563946 PMCID: PMC11571048 DOI: 10.3892/mi.2024.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 10/24/2024] [Indexed: 11/21/2024]
Abstract
The present study reviews the role of catheter ablation (CA) in the management of atrial fibrillation (AF), a widespread arrhythmia associated with increased morbidity and mortality. The present review explores current indications and recent evidence supporting CA, assessing patient outcomes and identifying common complications associated with the procedure. Emphasis is placed on optimizing risk factors prior to ablation, including weight control and hypertension management, as these measures can significantly enhance post-procedural outcomes. The present review also discusses the use of antiarrhythmic and anticoagulant therapies following CA to minimize recurrence and reduce stroke risk. Additionally, the cost-effectiveness of CA is discussed, comparing its long-term economic impact with that of medical therapy alone. The present comprehensive review provides insight into best practices for AF management, supporting CA as a promising approach when integrated with targeted lifestyle modifications and pharmacological support for improved, patient-centered outcomes.
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Affiliation(s)
- Omar Obeidat
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohamed F Ismail
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Saeed Abughazaleh
- St. Elizabeth's Medical Center, Boston University Teaching Hospital, Brighton, MA 02135, USA
| | - Hashim Al-Ani
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohammad Tarawneh
- St. Elizabeth's Medical Center, Boston University Teaching Hospital, Brighton, MA 02135, USA
| | - Laith Alhuneafat
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ali Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Abedallah Obeidat
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Qusai Alqudah
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Moh'd Alamin Daise
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Hamza Alzghoul
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida North Florida Hospital, Gainesville, FL 32605, USA
| | - Mohammad Al-Hammouri
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ward Althunibat
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Internal Medicine Residency Program, HCA Florida Ocala Hospital, Ocala, FL 34471, USA
| | - Ann Tong
- Graduate Medical Education Program, College of Medicine, University of Central Florida, Orlando, FL 32827, USA
- Department of Cardiology, The Cardiac and Vascular Institute, Gainesville, FL 32605, USA
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Al-Ahmad O, Ourak M, Vlekken J, Lindner E, Vander Poorten E. Three-dimensional catheter tip force sensing using multi-core fiber Bragg gratings. Front Robot AI 2023; 10:1154494. [PMID: 36968129 PMCID: PMC10031093 DOI: 10.3389/frobt.2023.1154494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
Awareness of catheter tip interaction forces is a crucial aspect during cardiac ablation procedures. The most important contact forces are the ones that originate between the catheter tip and the beating cardiac tissue. Clinical studies have shown that effective ablation occurs when contact forces are in the proximity of 0.2 N. Lower contact forces lead to ineffective ablation, while higher contact forces may result in complications such as cardiac perforation. Accurate and high resolution force sensing is therefore indispensable in such critical situations. Accordingly, this work presents the development of a unique and novel catheter tip force sensor utilizing a multi-core fiber with inscribed fiber Bragg gratings. A customizable helical compression spring is designed to serve as the flexural component relaying external forces to the multi-core fiber. The limited number of components, simple construction, and compact nature of the sensor makes it an appealing solution towards clinical translation. An elaborated approach is proposed for the design and dimensioning of the necessary sensor components. The approach also presents a unique method to decouple longitudinal and lateral force measurements. A force sensor prototype and a dedicated calibration setup are developed to experimentally validate the theoretical performance. Results show that the proposed force sensor exhibits 7.4 mN longitudinal resolution, 0.8 mN lateral resolution, 0.72 mN mean longitudinal error, 0.96 mN mean lateral error, a high repeatability, and excellent decoupling between longitudinal and lateral forces.
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Affiliation(s)
- Omar Al-Ahmad
- Robot-Assisted Surgery (RAS) group, Department of Mechanical Engineering, KU Leuven University, Leuven, Belgium
- FBGS International NV, Geel, Belgium
- *Correspondence: Omar Al-Ahmad ,
| | - Mouloud Ourak
- Robot-Assisted Surgery (RAS) group, Department of Mechanical Engineering, KU Leuven University, Leuven, Belgium
| | | | | | - Emmanuel Vander Poorten
- Robot-Assisted Surgery (RAS) group, Department of Mechanical Engineering, KU Leuven University, Leuven, Belgium
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Muacevic A, Adler JR, Alfandi HA, AlDahan HA, Almadan HM, AlSaif HH, Menezes RG. Iatrogenic Causes of Cardiac Tamponade Resulting From Surgical Procedures: An Overview. Cureus 2023; 15:e33773. [PMID: 36655159 PMCID: PMC9840527 DOI: 10.7759/cureus.33773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Cardiac tamponade is one of the most severely life-threatening emergencies encountered, mainly because of its significant impact on the pumping capacity of the heart by compressing the cardiac chambers due to the rapid accumulation of blood, fluid, pus, or clots in the pericardial sac. These accumulations may be collected following traumas, malignancies, uremia, and many other medical conditions as well as surgical procedures. Numerous errors and medicolegal aspects have been identified in diagnosing and treating cardiac tamponade associated with cardiac-related procedures such as valve replacement surgeries, cardiac pacemaker implantation, pericardiocentesis, and other non-cardiac related procedures such as peri-hiatal surgeries. Patients taking anticoagulants or anticancer medications are especially susceptible to developing cardiac tamponade when undergoing surgical procedures, raising the question of preoperative screening to avoid errors. Misdiagnosis, treatment delay or failure to deliver the utmost quality of treatment, lack of complication screening and follow-ups for those at risk, surgeons rushing to complete cases, burnout, and other human factors are predispositions to the development of cardiac tamponade. Fortunately, most of these errors occurring within healthcare settings are avoidable and must be prevented for eliminating any risks to reduce the incidence and mortality of cardiac tamponade cases resulting from iatrogenic etiology. It is an intricate condition where precision and caution are crucial.
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Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias. J Clin Med 2022; 11:jcm11226766. [PMID: 36431243 PMCID: PMC9696936 DOI: 10.3390/jcm11226766] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. Methods: The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Results: Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95% CI 0.283−1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95% CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95% CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95% CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95% CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95% CI 0.000, 0.466). Conclusion: UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.
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Avula UMR, Noonavath M, Wan E. Gender Differences in Atrial Fibrillation. GENDER AND THE GENOME 2017. [DOI: 10.1089/gg.2016.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Uma Mahesh R. Avula
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Meghana Noonavath
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
| | - Elaine Wan
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York
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Avula U, Noonavath M, Wan E. Review Article: Gender Differences in Atrial Fibrillation. GENDER AND THE GENOME 2017. [DOI: 10.1177/247028971700100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Okishige K, Nakamura T, Aoyagi H, Kawaguchi N, Yamashita M, Kurabayashi M, Suzuki H, Asano M, Shimura T, Yamauchi Y, Sasano T, Hirao K. Comparative study of hemorrhagic and ischemic complications among anticoagulants in patients undergoing cryoballoon ablation for atrial fibrillation. J Cardiol 2017; 69:11-15. [DOI: 10.1016/j.jjcc.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/31/2016] [Accepted: 04/09/2016] [Indexed: 11/15/2022]
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Comparison of a Radiofrequency Powered Flexible Needle with a Classic Rigid Brockenbrough Needle for Transseptal Punctures in Terms of Safety and Efficacy. Heart Lung Circ 2015; 24:173-8. [DOI: 10.1016/j.hlc.2014.07.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/29/2014] [Accepted: 07/28/2014] [Indexed: 12/26/2022]
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Oliveira MM. How To Follow Atrial Fibrillation Ablation Patients? J Atr Fibrillation 2014; 7:1087. [PMID: 27957113 DOI: 10.4022/jafib.1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 08/25/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Abstract
Catheter ablation is an established treatment option for symptomatic atrial fibrillation (AF), with circumferential pulmonary vein isolation being considered the cornerstone of the procedure. However, this is a complex intervention with potential major complications and with common arrhythmia recurrences. There is consensus among experts that all patients should be seen in follow-up regularly after AF ablation. To date there are limited data regarding the best methodology for routine clinical follow-up of this population. This review summarizes a contemporary insight into management of late complications following AF ablation, post-procedural anticoagulation and arrhythmia monitoring strategies, in order to prevent thromboembolic events, detect and treat arrhythmia recurrences, and discuss the use of upstream therapies after AF ablation.
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Affiliation(s)
- Mário M Oliveira
- Pacing and Electrophysiology Department, Cardiology, Santa Marta HospitalLisbon, Portugal
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Feasibility and Safety of Uninterrupted Rivaroxaban for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation. J Am Coll Cardiol 2014; 63:982-8. [DOI: 10.1016/j.jacc.2013.11.039] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/12/2013] [Accepted: 11/19/2013] [Indexed: 11/17/2022]
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Philip I, Leblanc I, Berroëta C, Mouren S, Chterev V, Bourel P. Fibrillation atriale en anesthésie–réanimation : de la cardiologie médicale à la période périopératoire. ACTA ACUST UNITED AC 2012; 31:897-910. [DOI: 10.1016/j.annfar.2012.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 08/20/2012] [Indexed: 01/11/2023]
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Lakkireddy D, Reddy YM, Di Biase L, Vanga SR, Santangeli P, Swarup V, Pimentel R, Mansour MC, D'Avila A, Sanchez JE, Burkhardt JD, Chalhoub F, Mohanty P, Coffey J, Shaik N, Monir G, Reddy VY, Ruskin J, Natale A. Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation. J Am Coll Cardiol 2012; 59:1168-74. [PMID: 22305113 DOI: 10.1016/j.jacc.2011.12.014] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/29/2011] [Accepted: 12/15/2011] [Indexed: 11/20/2022]
Affiliation(s)
- Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital and Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7200, USA.
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Abstract
Care before, during, and after ablation is discussed in this article.
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Affiliation(s)
- Jody Zak
- University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
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Schmidt EJ, Mallozzi RP, Thiagalingam A, Holmvang G, d'Avila A, Guhde R, Darrow R, Slavin GS, Fung MM, Dando J, Foley L, Dumoulin CL, Reddy VY. Electroanatomic mapping and radiofrequency ablation of porcine left atria and atrioventricular nodes using magnetic resonance catheter tracking. Circ Arrhythm Electrophysiol 2010; 2:695-704. [PMID: 19841033 DOI: 10.1161/circep.109.882472] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The MRI-compatible electrophysiology system previously used for MR-guided left ventricular electroanatomic mapping was enhanced with improved MR tracking, an MR-compatible radiofrequency ablation system and higher-resolution imaging sequences to enable mapping, ablation, and ablation monitoring in smaller cardiac structures. MR-tracked navigation was performed to the left atrium (LA) and atrioventricular (AV) node, followed by LA electroanatomic mapping and radiofrequency ablation of the pulmonary veins (PVs) and AV node. METHODS AND RESULTS One ventricular ablation, 7 PV ablations, 3 LA mappings, and 3 AV node ablations were conducted. Three MRI-compatible devices (ablation/mapping catheter, torqueable sheath, stimulation/pacing catheter) were used, each with 4 to 5 tracking microcoils. Transseptal puncture was performed under x-ray, with all other procedural steps performed in the MRI. Preacquired MRI roadmaps served for real-time catheter navigation. Simultaneous tracking of 3 devices was performed at 13 frames per second. LA mapping and PV radiofrequency ablation were performed using tracked ablation catheters and sheaths. Ablation points were registered and verified after ablation using 3D myocardial delayed enhancement and postmortem gross tissue examination. Complete LA electroanatomic mapping was achieved in 3 of 3 pigs, Right inferior PV circumferential ablation was achieved in 3 of 7 pigs, with incomplete isolation caused by limited catheter deflection. During AV node ablation, ventricular pacing was performed, 3 devices were simultaneously tracked, and intracardiac ECGs were displayed. 3D myocardial delayed enhancement visualized node injury 2 minutes after ablation. AV node block succeeded in 2 of 3 pigs, with 1 temporary block. CONCLUSIONS LA mapping, PV radiofrequency ablation, and AV node ablation were demonstrated under MRI guidance. Intraprocedural 3D myocardial delayed enhancement assessed lesion positional accuracy and dimensions.
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Affiliation(s)
- Ehud J Schmidt
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Esophagus imaging for catheter ablation of atrial fibrillation: comparison of two methods with showing of esophageal movement. J Interv Card Electrophysiol 2009; 26:159-64. [DOI: 10.1007/s10840-009-9434-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
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Iatrogenic Pericardial Effusion and Tamponade in the Percutaneous Intracardiac Intervention Era. JACC Cardiovasc Interv 2009; 2:705-17. [DOI: 10.1016/j.jcin.2009.04.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 04/03/2009] [Indexed: 11/20/2022]
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