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Andrade JG, Macle L. Atrial Fibrillation after Atrial Flutter Ablation: An existential journey to escape an inevitable fate. Can J Cardiol 2024:S0828-282X(24)00276-9. [PMID: 38522620 DOI: 10.1016/j.cjca.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- Jason G Andrade
- Vancouver General Hospital, Vancouver, Canada; Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Canada.
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Jin G, Li S, Wang Y, Pu J. Case report: Cardiac arrest after radiofrequency ablation in a 76-year-old male. Medicine (Baltimore) 2024; 103:e37191. [PMID: 38394505 DOI: 10.1097/md.0000000000037191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
RATIONALE Previous studies have found that the main treatment of sinus arrest is pacemaker treatment. It is rare to have 12 s of sinus arrest after radiofrequency ablation, and whether a permanent pacemaker is implanted immediately in this case is not described in the guidelines. PATIENT CONCERNS A 76-year-old male patient with persistent atrial fibrillation (AF) developed sinus arrest lasting 12 s in the early morning of the fourth day after using radiofrequency ablation for pulmonary vein isolation. DIAGNOSIS The patient was diagnosed with AF and sinus arrest. INTERVENTIONS The patient received cardiopulmonary resuscitation, intravenous injection of atropine 1 mg, and intravenous infusion of isoproterenol 1mg and immediately recovered consciousness thereafter. Approximately, 1.5 h later, the patient underwent surgery to install a temporary pacemaker in the right femoral vein. OUTCOMES The patient had repeated episodes of sinus arrest after the implantation of a temporary pacemaker. After 3 weeks, the patient stabilized and was discharged. The patient was followed up for 1 year and did not experience any recurrence of sinus arrest or AF. LESSONS We consider the potential for postoperative myocardial edema, injury to the sinoatrial node during the procedure, propafenone poisoning, and autonomic dysfunction as contributors to the occurrence of sinus arrest after radiofrequency ablation. When sinus arrest occurs after radiofrequency ablation, we can choose the appropriate treatment according to the patient's condition.
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Affiliation(s)
- Geya Jin
- North China University of Science and Technology, Tangshan, China
| | - Shuyu Li
- Tangshan Workers' Hospital, Tangshan, China
| | - Yafeng Wang
- North China University of Science and Technology, Tangshan, China
| | - Jianyi Pu
- Affiliated Hospital of North China University of Science and Technology, Tangshan, China
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Jilek C, Gleirscher L, Strzelczyk E, Sepela D, Tiemann K, Lewalter T. [Isthmus-dependent right atrial flutter : Clinical course after isthmus ablation]. Herzschrittmacherther Elektrophysiol 2023; 34:291-297. [PMID: 37847416 DOI: 10.1007/s00399-023-00966-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
Ablation of the cavotricuspid isthmus (CTI) to create bidirectional isthmus blockade is the most effective way to achieve rhythm control in typical atrial flutter. Compared with drug therapy, ablation reduces cardiovascular mortality, all-cause mortality, stroke risk, and the risk of cardiac decompensation. Concomitant arrhythmia of atrial flutter is atrial fibrillation (AF); therefore the duration of oral anticoagulation should be adapted according to the risk of stroke and bleeding. A combined procedure of CTI ablation and pulmonary vein isolation (PVI) in patients with typical atrial flutter but without evidence of AF should be evaluated individually especially in patients aged > 54 years depending on (cardiac) comorbidities. The comprehensive diagnostic view should keep in mind not only arrhythmias but also possibly underlying coronary artery disease.
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Affiliation(s)
- Clemens Jilek
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland.
| | - Lukas Gleirscher
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Elmar Strzelczyk
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Dominik Sepela
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Klaus Tiemann
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
| | - Thorsten Lewalter
- Peter-Osypka Herzzentrum München, Internistisches Klinikum München Süd, Am Isarkanal 36, 81379, München, Deutschland
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de Leon A, Hanson M, Alhammad N, Bakker D, Chacko S, Simpson C, Abdollah H, Baranchuk A, Redfearn D, Glover B, Enriquez A, Neira V. Half-Normal Saline vs Normal Saline for Cavotricuspid Isthmus-Dependent Atrial Flutter Ablation. CJC Open 2023; 5:965-970. [PMID: 38204850 PMCID: PMC10774089 DOI: 10.1016/j.cjco.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024] Open
Abstract
Background Cavotricuspid isthmus (CTI) ablation requires permanent bidirectional block to prevent recurrence of typical atrial flutter (AFL). Catheter irrigation with half-normal saline (HNS) produces larger and deeper lesions in experimental models compared with normal saline (NS). This study was performed to compare the clinical efficacy and safety of HNS vs NS irrigation for typical AFL ablation. Methods Sixty patients undergoing catheter ablation of typical AFL were randomized 1:1 to NS or HNS irrigation. Endpoints included time to CTI block, acute reconnection, incidence of steam pops, and recurrence of AFL during follow-up. Results Baseline characteristics were comparable between both arms. The mean age of the patients was 68.5 ± 8.2 years, 20% were female, and 32% had atrial fibrillation before being enrolled. Bidirectional CTI block was obtained in all patients with no difference in time to CTI block between groups (6.4 ± 4.4 minutes vs 7.6 ± 4.5 minutes, respectively; P = 0.15). There was a trend to less acute reconnection in the HNS group compared with NS (13.3% vs 26.6%; P = 0.46). Steam pops occurred in 4 patients using HNS vs none in the NS group, but no major complications were observed. During the follow-up, rate of AFL recurrence was similar between groups (6.7% with HNS vs 10% with NS; P = 0.5). There was no difference in time to recurrence (7.6 ± 6.9 vs 4.9 ± 4.5 months; P = 0.6). Conclusions In this small pilot randomized controlled trial, there was no significant difference between HNS and NS for CTI ablation; however, HNS may increase the incidence of steam pops.
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Affiliation(s)
- Ana de Leon
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Matthew Hanson
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Nasser Alhammad
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - David Bakker
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | | | - Hoshiar Abdollah
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Damian Redfearn
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Benedict Glover
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
| | - Victor Neira
- Division of Cardiology, Queen’s University, Kingston, Ontario, Canada
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Abuelazm M, Mohamed I, Seri AR, Almaadawy O, Abdelazeem B, Brašić JR. Contact Force-Guided versus Contact Force-Blinded Cavo-Tricuspid Isthmus Ablation for Atrial Flutter: A Systematic Review and Meta-Analysis. Diseases 2023; 11:98. [PMID: 37489450 PMCID: PMC10366732 DOI: 10.3390/diseases11030098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023] Open
Abstract
Contact force (CF) is a novel approach developed to increase the safety and efficacy of catheter ablation. However, the value of CF-sensing technology for atrial flutter (AFL) cavo-tricuspid isthmus ablation (CTIA) is inconclusive. To generate a comprehensive assessment of optimal extant data on CF for AFL, we synthesized randomized controlled trials (RCTs) and observational studies from Web of Science, SCOPUS, EMBASE, PubMed, and Cochrane until 29 November 2022, using the odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with a corresponding 95% confidence interval (CI). Two RCTs and three observational studies with a total of 376 patients were included in our analysis. CF-guided ablation was associated with (A) a higher rate of AFL recurrence (OR: 2.26 with 95% CI [1.05, 4.87]) and total CF (MD: 2.71 with 95% CI [1.28, 4.13]); (B) no effect on total procedure duration (MD: -2.88 with 95% CI [-7.48, 1.72]), fluoroscopy duration (MD: -0.96 with 95% CI [-2.24, 0.31]), and bidirectional isthmus block (BDIB) (OR: 1.50 with 95% CI [0.72, 3.11]); and (C) decreased radiofrequency (RF) duration (MD: -1.40 with 95% CI [-2.39, -0.41]). We conclude that although CF-guided CTIA was associated with increased AFL recurrence and total CF and reduced RF duration, it did not affect total procedure duration, fluoroscopy duration, or BDIB. Thus, CF-guided CTIA may not be the optimal intervention for AFL. These findings indicate the need for (A) providers to balance the benefits and risks of CF when utilizing precision medicine to develop treatment plans for individuals with AFL and (B) clinical trials investigating CF-guided catheter ablation for AFL to provide definitive evidence of optimal CF-sensing technology.
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Affiliation(s)
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri, Kansas City, MO 64108, USA
| | - Amith Reddy Seri
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - Omar Almaadawy
- Department of Internal Medicine, MedStar Health, Baltimore Internal Medicine Residency Program, Baltimore, MD 21218, USA
| | - Basel Abdelazeem
- Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48823, USA
| | - James Robert Brašić
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
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6
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Tondo C. The endless fascination of right atrial flutter: Can we predict its occurrence? J Cardiovasc Electrophysiol 2023; 34:1384-1385. [PMID: 37272696 DOI: 10.1111/jce.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Claudio Tondo
- Department of Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Ryckman N, Crinion D, Enriquez A, Bakker D, Chacko S, Abdollah H, Baranchuk A, Simpson C, Redfearn DP. Right atrial collision time (RACT): A novel marker of propensity for typical atrial flutter. J Cardiovasc Electrophysiol 2023; 34:1377-1383. [PMID: 37222182 DOI: 10.1111/jce.15935] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The risk of typical atrial flutter (AFL) is increased proportionately to right atrial (RA) size or right atrial scarring that results in reduced conduction velocity. These characteristics result in propagation of a flutter wave by ensuring the macro re-entrant wave front does not meet its refractory tail. The time taken to traverse the circuit would take account of both of these characteristics and may provide a novel marker of propensity to develop AFL. Our goal was to investigate right atrial collision time (RACT) as a marker of existing typical AFL. METHODS This single-centre, prospective study recruited consecutive typical AFL ablation patients that were in sinus rhythm. Controls were consecutive electrophysiology study patients >18 years of age. While pacing the coronary sinus (CS) ostium at 600 ms, a local activation time map was created to locate the latest collision point on the anterolateral right atrial wall. This RACT is a measure of conduction velocity and distance from CS to a collision point on the lateral right atrial wall. RESULTS Ninety-eight patients were included in the analysis, 41 with atrial flutter and 57 controls. Patients with atrial flutter were older, 64.7 ± 9.7 versus 52.4 ± 16.8 years (<.001), and more often male (34/41 vs. 31/57 [.003]). The AFL group mean RACT (132.6 ± 17.3 ms) was significantly longer than that of controls (99.1 ± 11.6 ms) (p < .001). A RACT cut-off of 115.5 ms had a sensitivity and specificity of 92.7% and 93.0%, respectively for diagnosis of atrial flutter. A ROC curve indicated an AUC of 0.96 (95% CI: 0.93-1.0, p < .01). CONCLUSION RACT is a novel and promising marker of propensity for typical AFL. This data will inform larger prospective studies.
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Affiliation(s)
- Nick Ryckman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Derek Crinion
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Andres Enriquez
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - David Bakker
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Sanoj Chacko
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Hoshiar Abdollah
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Christopher Simpson
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Damian P Redfearn
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
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Long-term results of two-stage ablation approach in coexistent atrial fibrillation and typical atrial flutter: prospective randomized study. КЛИНИЧЕСКАЯ ПРАКТИКА 2023. [DOI: 10.17816/clinpract114930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background
One of the most arrhythmias associated with atrial fibrillation (AF) is typical atrial flutter (AFL). The main methods of surgical treatment of these arrhythmias is catheter ablation. The problem of catheter ablation strategy for these coexistentarrhythmias is not solved.
Purpose:
To assess the effectiveness of long-term maintenance of sinus rhythm in a two-stage approach to the interventional treatment of atrial fibrillation associated with typical atrial flutter.
Methods:
The study included 34 patients aged 41-82 years with AF and coexistent typical AFL. Female 11 (32,35%), male 23 (67,35%). Randomization 1:1. Group 1 (n=17) has been performed radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) with radiofrequency catheter isolation of the PV. Group 2 (n=17) has been performed only RFA of CTI. AF and AFL recurrences rate has been evaluated in both groups. Follow-up period 12 months.
Results:
Procedure duration and fluoroscopy time were less in group 2 that those in group 1. Extended intervention in group 1 was accompanied with complications in two cases. There were no significant differences in AF recurrence rate in both groups (p=0,43183). AFL recurrences has not been found in both groups.
Conclusion:
One stage ablation approach in AF patients with coexistent AFLassociated with increaseprocedure duration and fluoroscopy time. The frequency of AF recurrence in patients who underwent extended intervention (catheter isolation of the PV and RFA CTI) and in patients who underwent only the elimination of typical atrial flutter, was not statistically significantly different (p = 0.43183). In the presence of AF and typical atrial flutter, a two-stage approach to interventional treatment should be regarded as appropriate.
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Lesion size index-guided cavotricuspid isthmus linear ablation. J Interv Card Electrophysiol 2023; 66:485-492. [PMID: 36074285 DOI: 10.1007/s10840-022-01360-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The lesion size index (LSI) predicts radiofrequency (RF) ablation lesion size and is an established parameter for pulmonary vein isolation. However, the effectiveness and safety of LSI for cavotricuspid isthmus (CTI) linear ablation remain unclear. METHODS This single-center retrospective study included 50 of patients (67 ± 10 years, 68% male) who underwent de novo CTI linear ablation between July 2020 and December 2020. The LSI target was set at 5.0 and 4.0 for the anterior 2/3 and posterior 1/3 segments, respectively. Acute procedural parameters of ablation were evaluated. RESULTS Acute bidirectional CTI block was achieved in all patients with an RF application time of 4.0 min (3.1-5.0 min), RF application number of 15 ± 7, and length of CTI of 36.9 ± 9.3 mm. First-pass bidirectional conduction block of the CTI was achieved in 39/50 (78%) patients. No major complications were observed. The contact force (CF) per application was significantly lower in the gap tag group than in the non-gap tag group (7 g [7-8 g] vs. 10 g [7-12 g], P = 0.0284). CONCLUSIONS LSI-guided CTI linear ablation is an effective and safe treatment approach. CF affects gap formation, even when the target LSI is the same.
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Sumi H, Hoshiyama T, Morihisa K, Noda K, Kaneko S, Kanazawa H, Ishii M, Fujisue K, Sueta D, Takashio S, Usuku H, Matsushita K, Tsujita K. Effect of contact vector direction on achieving cavotricuspid isthmus block. Sci Rep 2023; 13:2579. [PMID: 36781935 PMCID: PMC9925428 DOI: 10.1038/s41598-023-29738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
Cavotricuspid isthmus (CTI) ablation is an important treatment strategy for CTI-dependent atrial flutter (AFL). The location of the catheter contact area is confirmed by the contact vector direction (CVD) through three-dimensional mapping during the procedure. However, the relationship between CVD during radiofrequency ablation and its efficacy in achieving CTI block has not been clarified. This study aimed to investigate the relationship between CVD and efficacy in achieving CTI block. CVDs during radiofrequency ablation were divided into proximal vectors against the distal tip (P-vector) and other vectors (normal-vector). In 39 patients who underwent CTI linear ablation, the CTIs were divided into two segments: the tricuspid valve area (anterior) and inferior vena cava area (posterior). The frequency of the residual conduction gap was compared between segments in which the P- and normal-vectors were observed. P-vectors were observed in 13 of the 78 segments. The median ablation index was not significantly different between segments in which the P-vector and normal-vector were observed (398.2 [384.2-402.2] vs. 393.3 [378.3-400.1], p = 0.15). However, residual conduction gaps were significantly more frequently observed in the segment in which the P-vector was observed than those in which only the normal-vector was observed (6/13, 46.2% vs. 3/65, 4.6%; p < 0.01). During a 6-month follow-up, two patients required a second session of ablation due to AFL recurrence. A residual conduction gap was observed in one patient at the site where the P-vector was observed in the first session. Avoiding the P-vector might be an important factor in improving CTI block and reducing AFL recurrence.
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Affiliation(s)
- Hitoshi Sumi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Kenji Morihisa
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Katsuo Noda
- Kumamoto Chuo Hospital, 1-5-1, Tainoshima Minami-Ku, Kumamoto, 862-0965, Japan
| | - Shozo Kaneko
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo Chuo-Ku, Kumamoto, 860-8556, Japan
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Park CS, Choi EK, Lee SR, Ahn HJ, Kwon S, Kim S, Sohn SH, Choi JW, Hwang HY, Oh S. Catheter ablation and thoracoscopic ablation in long persistent atrial fibrillation with large left atrium. Front Cardiovasc Med 2022; 9:881831. [PMID: 36211574 PMCID: PMC9537550 DOI: 10.3389/fcvm.2022.881831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pulmonary vein antrum isolation (PVAI) is the cornerstone of atrial fibrillation (AF) ablation, but the clinical outcomes of PVAI are unsatisfactory in patients with persistent AF and a large left atrium (LA). Objectives We investigated the clinical outcomes following radiofrequency ablation (RFCA), cryoballoon ablation (CBA), and thoracoscopic maze in patients with persistent AF and a large LA. Methods We included patients with consecutive persistent AF who had a large LA (LA diameter >50 mm) and underwent RFCA, CBA, or thoracoscopic maze surgery. In the RFCA group, additional linear ablation was performed at the physician’s discretion. The endpoint was 12 months without recurrence of an atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia, following a 90-day blanking period. Results We recruited 89 persistent AF patients with a large LA who underwent RFCA (n = 32), CBA (n = 38), or the thoracoscopic maze procedure (n = 19). During the 12-month follow-up, 48 (53.9%) cases of AF recurrence were observed. There was no prognostic difference between groups (50.0% in RFCA vs. 52.6% in CBA vs. 63.2% in thoracoscopic maze, all P > 0.05). Early recurrence during the blanking period was a significant predictor of late recurrence for RFCA and CBA, but not for the thoracoscopic maze. Conclusion In persistent AF patients with a large LA, we did not find a prognostic difference RFCA, CBA, or a thoracoscopic maze procedure in recurrence of atrial arrhythmia. Early recurrence predicted late recurrence in catheter ablation, but not in thoracoscopic maze.
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Affiliation(s)
- Chan Soon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Eue-Keun Choi,
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sunhwa Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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12
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Bagliani G, De Ponti R, Leonelli FM, Casella M, Gaggiotti G, Volpato G, Compagnucci P, Russo AD. The History of Atrial Flutter Electrophysiology, from Entrainment to Ablation: A 100-Year Experience in the Precision Electrocardiology. Card Electrophysiol Clin 2022; 14:357-373. [PMID: 36153119 DOI: 10.1016/j.ccep.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Atrial flutter (AFL) is a regular supraventricular reentrant tachycardia generating a continuous fluttering of the baseline electrocardiography (ECG) at a rate of 250 to 300 beats per minute. AFL is classified based on the involvement of the cavo-tricuspid isthmus in the circuit. The "isthmic" (or type 1) AFL develops entirely in the right atrium; this circuit is commonly activated in a counter-clockwise direction, generating the common sawtooth ECG morphology in the inferior leads (slow descendent-fast ascendent). AFL can be nonisthmus dependent (type 2), often presenting with faster atrial rate and most commonly a left atrial location.
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Affiliation(s)
- Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy.
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA; University of South Florida, FL 4202 East Fowler Avenue, Tampa, FL 33620, USA
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Gemma Gaggiotti
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona 60126, Italy; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Conca 71, Ancona 60126, Italy
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Marazzato J, Marazzi R, Doni LA, Blasi F, Angeli F, Bagliani G, Leonelli FM, De Ponti R. Pathophysiology of Atypical Atrial Flutters. Card Electrophysiol Clin 2022; 14:411-420. [PMID: 36153123 DOI: 10.1016/j.ccep.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atypical atrial flutters are complex supraventricular arrhythmias that share different pathophysiological aspects in common. In most cases, the arrhythmogenic substrate is essentially embodied by slow-conducting areas eliciting re-entrant circuits. Although atrial scarring seems to promote slow conduction, these arrhythmias may occur even in the absence of structural heart disease. To set out the ablation strategy in this setting, three-dimensional mapping systems have proved invaluable over the last decades, helping the cardiac electrophysiologist understand the electrophysiological complexity of these circuits and easily identify critical areas amenable to effective catheter ablation.
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Affiliation(s)
- Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Lorenzo Adriano Doni
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy
| | - Federico Blasi
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncaccio, 16, Tradate, Varese 21049, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
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Marazzato J, Marazzi R, Doni LA, Angeli F, Bagliani G, Leonelli FM, De Ponti R. Mapping and Ablation of Atypical Atrial Flutters. Card Electrophysiol Clin 2022; 14:471-481. [PMID: 36153127 DOI: 10.1016/j.ccep.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical atrial flutters are complex, hard-to-manage atrial arrhythmias. Catheter ablation has progressively emerged as a successful treatment option with a remarkable role played by irrigated-tip catheters and 3D electroanatomic mapping systems. However, despite the improvement of these technologies, the ablation results may be still suboptimal due to the progressive atrial substrate modification occurring in diseased hearts. Hence, a patient-tailored approach is required to improve the long-term success rate in this scenario, aiming at achieving specific procedure end points and detecting any potential arrhythmogenic substrate in each patient.
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Affiliation(s)
- Jacopo Marazzato
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Lorenzo A Doni
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy; Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS, Via Crotto Roncacci, 16, Tradate, Varese 21049, Italy
| | - Giuseppe Bagliani
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Via Conca 71, Ancona 60126, Italy
| | - Fabio M Leonelli
- Cardiology Department, James A. Haley Veterans' Hospital, University of South Florida, 13000 Bruce B Down Boulevard, Tampa, FL 33612, USA
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo - University of Insubria, Viale Borri, 57, Varese 21100, Italy; Department of Medicine and Surgery, University of Insubria, Viale Guicciardini, 9, Varese 21100, Italy.
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Rosemann A. [Atrial Fibrillation]. PRAXIS 2022; 111:640-652. [PMID: 35975417 DOI: 10.1024/1661-8157/a003916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Andrea Rosemann
- Verein mediX schweiz, Zürich/Institut für Hausarztmedizin, Universitätsspital Zürich, Zürich, Schweiz
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Saraf K, Black N, Garratt CJ, Muhyaldeen SA, Morris GM. Local impedance-guided ablation and ultra-high density mapping versus conventional or contact force-guided ablation with mapping for treatment of cavotricuspid isthmus dependent atrial flutter. Indian Pacing Electrophysiol J 2022; 22:188-194. [PMID: 35427782 PMCID: PMC9263660 DOI: 10.1016/j.ipej.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION - Local impedance (LI) guided ablation as a method of judging lesion effectiveness for cavotricuspid isthmus dependent atrial flutter (CTI-AFL), and ultra-high density (UHD) mapping when breakthrough occurred across an ablation line has not previously been assessed. METHODS This retrospective observational study evaluated patients undergoing CTI-AFL ablation using conventional, contact force (CF) and LI guided strategies. Ablation metrics were collected, and in the LI cohort, the use of UHD mapping for breakthrough evaluated. RESULTS 30 patients were included, 10 per group. Mean total ablation time was significantly shorter with LI (3.2 ± 1.3min) vs conventional (5.6 ± 2.7min) and CF (5.7 ± 2.0min, p = 0.0042). Time from start of ablation to CTI block was numerically shorter with LI (14.2 ± 8.0min) vs conventional and CF (19.7 ± 14.1 and 22.5 ± 19.1min, p = 0.4408). Mean lesion duration was significantly shorter with LI, but there were no differences in the number of lesions required to achieve block, procedural success, complication rates or recurrence. 15/30 patients did not achieve block following first-pass ablation. UHD mapping rapidly identified breakthrough in the five LI patients, including epicardial-endocardial breakthrough (EEB). CONCLUSION - The use of LI during ablation for real-time lesion assessment was as efficacious as the conventional and CF methods. UHD mapping rapidly identified breakthrough, including EEB.
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Affiliation(s)
- Karan Saraf
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Nicholas Black
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH, UK
| | - Clifford J Garratt
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Sahrkaw A Muhyaldeen
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK
| | - Gwilym M Morris
- Division of Cardiovascular Sciences, The University of Manchester, Oxford Road, Manchester, M139PL, UK; Manchester Heart Centre, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M139WL, UK.
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De Ponti R, Marazzi R, Vilotta M, Angeli F, Marazzato J. Procedural Feasibility and Long-Term Efficacy of Catheter Ablation of Atypical Atrial Flutters in a Wide Spectrum of Heart Diseases: An Updated Clinical Overview. J Clin Med 2022; 11:jcm11123323. [PMID: 35743394 PMCID: PMC9224569 DOI: 10.3390/jcm11123323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Atypical atrial flutters (AAFL) are difficult-to-manage atrial arrhythmias, yet potentially amenable to effective radiofrequency catheter ablation (CA). However, data on CA feasibility are only sparingly reported in the literature in different clinical settings, such as AAFL related to surgical correction of congenital heart disease. The aim of this review was to provide an overview of the clinical settings in which AAFL may occur to help the cardiac electrophysiologist in the prediction of the tachycardia circuit location before CA. Moreover, the role and proper implementation of cutting-edge technologies in this setting were investigated as well as which procedural and clinical factors are associated with long-term failure to maintain sinus rhythm (SR) to find out which patients may, or may not, benefit from this procedure. Not only different surgical and non-surgical scenarios are associated with peculiar anatomical location of AAFL, but we also found that CA of AAFL is generally feasible. The success rate may be as low as 50% in surgically corrected congenital heart disease (CHD) patients but up to about 90% on average after pulmonary vein isolation (PVI) or in patients without structural heart disease. Over the years, the progressive implementation of three-dimensional mapping systems and high-density mapping tools has also proved helpful for ablation of these macro-reentrant circuits. However, the long-term maintenance of SR may still be suboptimal due to the progressive electroanatomic atrial remodeling occurring after cardiac surgery or other interventional procedures, thus limiting the likelihood of successful ablation in specific clinical settings.
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Affiliation(s)
- Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
- Correspondence:
| | - Raffaella Marazzi
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Manola Vilotta
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
| | - Fabio Angeli
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, 21049 Tradate, Italy;
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy;
- Department of Heart and Vessels, Ospedale di Circolo, 21100 Varese, Italy; (R.M.); (M.V.)
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18
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Ablation index-guided cavotricuspid isthmus ablation with contiguous lesions using fluoroscopy integrated 3D mapping in atrial flutter. J Interv Card Electrophysiol 2022; 64:217-222. [PMID: 35294705 PMCID: PMC9236984 DOI: 10.1007/s10840-022-01182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/10/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The feasibility and safety of cavotricuspid isthmus (CTI) ablation with contiguous lesions using ablation index (AI) under the guidance of fluoroscopy integrated 3D mapping (CARTO UNIVU/CU) in typical atrial flutter (AFL) remains uncertain. This study aimed to determine the efficacy of AI-guided CTI ablation with contiguous lesions in patients with AFL. METHODS In this single-center, prospective, non-randomized, single-arm, observational study, procedural outcomes were determined in 151 patients undergoing AI-guided CTI ablation (AI group) with a target AI value of 450 and an interlesion distance of ≤ 4 mm under CU guidance. These outcomes were compared with those of 30 patients undergoing non-AI-guided ablation (non-AI group). RESULTS Among 151 patients, first-pass conduction block was achieved in 120 (80%) patients in the AI group (67% in the non-AI group, P = 0.152) with a shorter fluoroscopy time of 0.2 ± 0.4 min (1.7 ± 2.0 min in the non-AI group, P < 0.001). Conduction gaps were located at the atrial aspects near the inferior vena cava in 24 of 31 (78%) patients without first-pass conduction block. The AI group received 11 ± 5 (12 ± 4 in the non-AI group, P = 0.098) radiofrequency (RF) applications, and the RF time was 4.2 ± 2.4 (5.1 ± 2.5 min in the non-AI group, P = 0.011). Despite the occurrence of steam pop in 3 (2%) patients, none of them developed cardiac tamponade. No patients had recurrence within 6 months of follow-up. CONCLUSIONS AI-guided CTI ablation in combination with CU was feasible and effective in reducing radiation exposure in patients with AFL.
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Carberry T, Tsao S, Chaouki AS. Patient-activated Anti-tachycardia pacing in adult congenital heart disease. Pacing Clin Electrophysiol 2022; 45:711-716. [PMID: 35266171 PMCID: PMC9314925 DOI: 10.1111/pace.14475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
Introduction In adults with congenital heart disease, intra‐atrial reentrant tachycardia (IART) is a common arrhythmia that causes significant morbidity and mortality. One treatment option for IART is antitachycardia pacing. Atrial antitachycardia pacing algorithms deliver therapy for IART with ≥2:1 conduction, but most algorithms will not recognize IART with 1:1 conduction. Temporary Patient Activated Rx (TPARx) is Medtronic software that can be installed in antitachycardia pacemakers allowing patients to deliver therapies on demand for IART with 1:1 conduction. Methods Retrospective chart review at a single institution of all patients who had TPARx installed into their pacemaker. Results Four adults with single ventricle congenital heart disease and IART underwent Fontan conversion, arrhythmia surgery, and placement of an epicardial dual‐chamber antitachycardia pacemaker. They had recurrent IART with a long cycle length and 1:1 conduction that failed to trigger antitachycardia pacing therapies. TPARx software was programmed into their pacemakers to allow recognition and treatment of IART with 1:1 conduction. Mean follow‐up duration after TPARx programming was 4.9 years. Each patient received at least one successful antitachycardia pacing therapy via TPARx – range 0.4–26 treated IART episodes per year. There were no atrial or ventricular arrhythmias induced with antitachycardia pacing. Two patients were able to discontinue anticoagulation after TPARx installation. Conclusion This series demonstrates the use of TPARx software as part of a long‐term IART management strategy in select patients with IART who have failed more conventional therapies.
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Affiliation(s)
- Thomas Carberry
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
| | - Sabrina Tsao
- Division of Cardiology, Hong Kong Children's Hospital, The University of Hong Kong, Shing Cheong Rd, Ngau Tau Kok, Hong Kong
| | - Ahmad Sami Chaouki
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL, USA
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Ramak R, Lipartiti F, Mojica J, Monaco C, Bisignani A, Eltsov I, Sorgente A, Capulzini L, Paparella G, Deruyter B, Iacopino S, Motoc AI, Luchian ML, Osorio TG, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Jordaens L, Brugada P, de Asmundis C, Chierchia GB. Comparison between the novel diamond temp and the classical 8-mm tip ablation catheters in the setting of typical atrial flutter. J Interv Card Electrophysiol 2022; 64:751-757. [PMID: 35239069 DOI: 10.1007/s10840-022-01152-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Radiofrequency (RF) catheter ablation is widely accepted as a first-line therapy for cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). The novel DiamondTemp (DT) catheter with temperature feedback during RF ablation has been released recently on the market. The purpose of this study was to evaluate the impact of DiamondTemp (DT) technology on ablation efficiency during AFL. METHODS In this single-center study, 30 consecutive patients with typical AFL indicated to ablation of CTI were included. The first 15 patients underwent CTI ablation using 8-mm tip catheter, and the following 15 patients underwent temperature-controlled RF ablation using DT catheter. The endpoints were number and mean total duration of RF applications, mean temperature reached in the setting of CTI, procedural times, and fluoroscopy times. RESULTS There were no significant differences between the two groups concerning baseline characteristics. Mean duration of the each application (71.5 s ± 30.6 vs 12.4 s ± 13.2, p value < 0.001), mean total duration of RF applications (517,73 s ± 377,96 vs 112,8 s ± 43,58; p value < 0.001), procedural times (51.6 min ± 24.2 vs 38.6 ± 8.2; p = 0.03), and fluoroscopy times (16.2 min ± 10.2 vs 8 min ± 4.24; p = 0.005) were longer in the 8-mm ablation catheter group. Mean temperature measurements (51.9 °C ± 3.59 vs 56.7 °C ± 3.34, p value < 0.003) were as well lower in the 8-mm ablation catheter group. CONCLUSIONS Catheter ablation of CTI-dependent AFL by means of DT resulted in a significant reduction of total and single application RF delivery time, procedure, and fluoroscopy times.
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Affiliation(s)
- Robbert Ramak
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Felicia Lipartiti
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ivan Eltsov
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Lucio Capulzini
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bernard Deruyter
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Andreea Iulia Motoc
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maria Luiza Luchian
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thiago Guimaraes Osorio
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Luc Jordaens
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
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22
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Yamaji H, Higashiya S, Murakami T, Kawamura H, Murakami M, Kamikawa S, Kusachi S. Rates of atrial flutter occurrence and cavotricuspid isthmus reconduction after prophylactic isthmus ablation performed during atrial fibrillation ablation: a clinical study, review, and comparison with previous findings. J Interv Card Electrophysiol 2021; 64:67-76. [PMID: 34755243 DOI: 10.1007/s10840-021-01087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Based on the high rate of coexisting atrial fibrillation (AF) and atrial flutter (AFL), prophylactic cavotricuspid isthmus ablation (CTIA) adjunctive to AF ablation has recently been attempted in patients with AF and without AFL. The present study aimed to determine the rates of AFL occurrence and CTI reconduction after performing CTI ablation adjunctive to AF ablation. METHODS We analyzed the data of 3833 consecutive patients with AF, who underwent prophylactic CTIA with AF ablation between 2009 and 2020. RESULTS In all patients, CTIA and AF ablations were successful. Clinical AFL occurred in seven patients (0.18%, 7/3,833), and the observed rate was lower than those reported for cases of AF ablation without CTIA and for those of CTIA for pure AFL. A second ablation was needed in 745 patients at a median of 253 days (25 and 75 percentiles, 116 and 775 days) after the first ablation. In 12.1% (90/745) of the patients, CTI reconduction was observed. The reconduction rate was lower than that previously reported for CTIA for pure AFL. CONCLUSIONS The present retrospective study found acceptably low rates of clinical AFL occurrence and CTI reconduction following prophylactic CTIA performed with AF ablation, which was supported by the findings obtained after performing a comparison of the rates with those of other ablations (AF ablation only and CTIA for pure AFL). Considering the high correlation between AF and AFL, the present study provided information regarding the efficacy of adjunctive CTIA.
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Affiliation(s)
- Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan.
| | - Shunichi Higashiya
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takashi Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Hiroshi Kawamura
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Masaaki Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shigeshi Kamikawa
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shozo Kusachi
- Department of Medical Technology, Okayama University Graduate School of Health Okayama, Japan Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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23
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Chou CY, Chung FP, Chang HY, Lin YJ, Lo LW, Hu YF, Chao TF, Liao JN, Tuan TC, Lin CY, Chang TY, Liu CM, Wu CI, Huang SH, Chen CC, Cheng WH, Liu SH, Lugtu IC, Jain A, Feng AN, Chang SL, Chen SA. Prediction of Recurrent Atrial Tachyarrhythmia After Receiving Atrial Flutter Ablation in Patients With Prior Cardiac Surgery for Valvular Heart Disease. Front Cardiovasc Med 2021; 8:741377. [PMID: 34631838 PMCID: PMC8495322 DOI: 10.3389/fcvm.2021.741377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical scars cause an intra-atrial conduction delay and anatomical obstacles that facilitate the perpetuation of atrial flutter (AFL). This study aimed to investigate the outcome and predictor of recurrent atrial tachyarrhythmia after catheter ablation in patients with prior cardiac surgery for valvular heart disease (VHD) who presented with AFL. Methods: Seventy-two patients with prior cardiac surgery for VHD who underwent AFL ablation were included. The patients were categorized into a typical AFL group (n = 45) and an atypical AFL group (n = 27). The endpoint was the recurrence of atrial tachyarrhythmia during follow-up. A multivariate analysis was performed to determine the predictor of recurrence. Results: No significant difference was found in the recurrence rate of atrial tachyarrhythmia between the two groups. Patients with concomitant atrial fibrillation (AF) had a higher recurrence of typical AFL compared with those without AF (13 vs. 0%, P = 0.012). In subgroup analysis, typical AFL patients with concomitant AF had a higher incidence of recurrent atrial tachyarrhythmia than those without it (53 vs. 14%, P = 0.006). Regarding patients without AF, the typical AFL group had a lower recurrence rate of atrial tachyarrhythmia than the atypical AFL group (14 vs. 40%, P = 0.043). Multivariate analysis showed that chronic kidney disease (CKD) and left atrial diameter (LAD) were independent predictors of recurrence. Conclusions: In our study cohort, concomitant AF was associated with recurrence of atrial tachyarrhythmia. CKD and LAD independently predicted recurrence after AFL ablation in patients who have undergone cardiac surgery for VHD.
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Affiliation(s)
- Ching-Yao Chou
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Medical Center, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Yu Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sung-Hao Huang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chun-Chao Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Isaiah Carlos Lugtu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Ankit Jain
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - An-Ning Feng
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
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24
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Betz J, Vitali-Serdoz L, Buia V, Walaschek J, Rittger H, Bastian D. Minielectrode catheter technology for near zero-fluoroscopy substrate-guided ablation of typical atrial flutter. Heart Rhythm O2 2021; 2:262-270. [PMID: 34337577 PMCID: PMC8322787 DOI: 10.1016/j.hroo.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background MicroFidelity catheter technology may facilitate voltage-guided ablation by high-resolution electroanatomic mapping (HR-EAM) and precisely targeted energy application. Objective To evaluate the performance of minielectrode (ME) technology for zero-fluoroscopy substrate-guided cavotricuspid isthmus (CTI) ablation. Methods Eighty-two patients underwent near zero-fluoroscopy substrate-guided CTI ablation using a nonirrigated large-tip catheter with 3 MEs. The CTI was subdivided into 15 electroanatomic segments. Bipolar voltage maps were compared with ME signals. The outcome was compared with a historic cohort of 92 patients who underwent linear ablation. Results Compared with linear ablation, the substrate-guided approach was associated with an almost halved ablation duration (336 ± 228 vs 649 ± 409 seconds, P < .001), halved radiofrequency energy applied (14.2 ± 10.6 vs 28.6 ± 19.6 kJ, P < .001), and shorter procedure duration (60.8 ± 33.8 vs 76.3 ± 40.9 minutes, P = .008) limiting the extent of energy delivery to 22.7% of the CTI area. HR-EAM visualized 2.03 ± 0.88 conductive pathways with a diameter of 5.35 ± 1.98 mm. A higher number of ME-detected bundles and a larger channel diameter correlated with increased ablation requirements. In 97.6% of the voltage-guided and 88.0% of the linear procedures, fluoroscopy was not used. Conclusion HR-EAM-based substrate-guided CTI ablation may improve procedural outcome compared with the linear approach. Enhanced identification of discrete conductive pathways correlates with ablation efficacy. The electroanatomic subdivision of the CTI into 15 segments was feasible and may improve the understanding and comparability of anatomic variants and ablation results. Independent of the ablation strategy, modern EAM technology enables safe zero-fluoroscopy procedures in the majority of cases.
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Affiliation(s)
- Johanna Betz
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Erlangen, Germany
- Address reprint requests and correspondence: Ms Johanna Betz, Klinikum Fürth, Jacob-Henle-Str. 1, 90766 Fürth, Germany.
| | - Laura Vitali-Serdoz
- Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Veronica Buia
- Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Janusch Walaschek
- Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Harald Rittger
- Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Dirk Bastian
- Department for Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
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25
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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26
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Grubb CS, Melki L, Wang DY, Peacock J, Dizon J, Iyer V, Sorbera C, Biviano A, Rubin DA, Morrow JP, Saluja D, Tieu A, Nauleau P, Weber R, Chaudhary S, Khurram I, Waase M, Garan H, Konofagou EE, Wan EY. Noninvasive localization of cardiac arrhythmias using electromechanical wave imaging. Sci Transl Med 2021; 12:12/536/eaax6111. [PMID: 32213631 DOI: 10.1126/scitranslmed.aax6111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/21/2020] [Indexed: 12/13/2022]
Abstract
Cardiac arrhythmias are a major cause of morbidity and mortality worldwide. The 12-lead electrocardiogram (ECG) is the current noninvasive clinical tool used to diagnose and localize cardiac arrhythmias. However, it has limited accuracy and is subject to operator bias. Here, we present electromechanical wave imaging (EWI), a high-frame rate ultrasound technique that can noninvasively map with high accuracy the electromechanical activation of atrial and ventricular arrhythmias in adult patients. This study evaluates the accuracy of EWI for localization of various arrhythmias in all four chambers of the heart before catheter ablation. Fifty-five patients with an accessory pathway (AP) with Wolff-Parkinson-White (WPW) syndrome, premature ventricular complexes (PVCs), atrial tachycardia (AT), or atrial flutter (AFL) underwent transthoracic EWI and 12-lead ECG. Three-dimensional (3D) rendered EWI isochrones and 12-lead ECG predictions by six electrophysiologists were applied to a standardized segmented cardiac model and subsequently compared to the region of successful ablation on 3D electroanatomical maps generated by invasive catheter mapping. There was significant interobserver variability among 12-lead ECG reads by expert electrophysiologists. EWI correctly predicted 96% of arrhythmia locations as compared with 71% for 12-lead ECG analyses [unadjusted for arrhythmia type: odds ratio (OR), 11.8; 95% confidence interval (CI), 2.2 to 63.2; P = 0.004; adjusted for arrhythmia type: OR, 12.1; 95% CI, 2.3 to 63.2; P = 0.003]. This double-blinded clinical study demonstrates that EWI can localize atrial and ventricular arrhythmias including WPW, PVC, AT, and AFL. EWI when used with ECG may allow for improved treatment for patients with arrhythmias.
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Affiliation(s)
- Christopher S Grubb
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Lea Melki
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Daniel Y Wang
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - James Peacock
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jose Dizon
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Vivek Iyer
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Carmine Sorbera
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - David A Rubin
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - John P Morrow
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Andrew Tieu
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Pierre Nauleau
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Rachel Weber
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA
| | - Salma Chaudhary
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Irfan Khurram
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Marc Waase
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elisa E Konofagou
- Ultrasound Elasticity Imaging Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA. .,Department of Radiology, Columbia University Medical Center, New York, NY 10032, USA
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine and Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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27
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Zhou B, Zhu YJ, Zhai ZQ, Weng SX, Ma YZ, Yu FY, Qi YJ, Jiang YZ, Gao X, Xu XQ, Jiang X, Jing ZC, Tang M. Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Patients With Pulmonary Hypertension: Feasibility and Long-Term Outcome. Front Physiol 2021; 12:674909. [PMID: 34220537 PMCID: PMC8249814 DOI: 10.3389/fphys.2021.674909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background Supraventricular tachycardia (SVT) occurs commonly and is strongly correlated with clinical deterioration in patients with pulmonary hypertension (PH). This study aimed to investigate the feasibility and long-term outcome of radiofrequency catheter ablation (RFCA) in PH patients with SVT. Materials and Methods Consecutive PH patients with SVT who were scheduled to undergo electrophysiological study and RFCA between September 2010 and July 2019 were included. The acute results and long-term success of RFCA were assessed after the procedure. Results In total, 71 PH patients with 76 episodes of SVT were analyzed. Cavotricuspid isthmus-dependent atrial flutter (n = 33, 43.5%) was the most common SVT type, followed by atrioventricular nodal reentrant tachycardia (n = 16, 21.1%). Of the 71 patients, 60 (84.5%) underwent successful electrophysiological study and were subsequently treated by RFCA. Among them, acute sinus rhythm was restored in 54 (90.0%) patients, and procedure-related complications were observed in 4 (6.7%) patients. Univariate logistic regression analysis showed that cavotricuspid isthmus-independent atrial flutter [odds ratio (OR) 25.00, 95% confidence interval (CI) 3.45–180.98, p = 0.001] and wider pulmonary artery diameter (OR 1.19, 95% CI 1.03–1.38; p = 0.016) were associated with RFCA failure. During a median follow-up of 36 (range, 3–108) months, 7 patients with atrial flutter experienced recurrence, yielding a 78.3% 3-year success rate for RFCA treatment. Conclusion The findings suggest that RFCA of SVT in PH patients is feasible and has a good long-term success rate. Cavotricuspid isthmus-independent atrial flutter and a wider PAD could increase the risk for ablation failure.
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Affiliation(s)
- Bin Zhou
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Cardiology, Zhujiang Hospital, Laboratory of Heart Center, Southern Medical University, Guangzhou, China
| | - Yong-Jian Zhu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng-Qin Zhai
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Si-Xian Weng
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ya-Zhe Ma
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Yuan Yu
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying-Jie Qi
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Zhou Jiang
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Gao
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Jiang
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Cheng Jing
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Tang
- State Key Lab of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Ablation Therapy as Management of Typical Atrial Flutter in the Early Period After Cardiac Surgery. Cardiol Ther 2021; 10:569-575. [PMID: 34028729 PMCID: PMC8555042 DOI: 10.1007/s40119-021-00221-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Available data on management of atrial flutter in the early postoperative setting after cardiac surgery are scarce. We aimed to investigate the safety and efficacy (profile) of flutter ablation in the early postoperative phase (30 days after cardiac surgery) in a cohort of 47 consecutive patients. Methods Between 2007 and 2016, 47 patients who underwent ablation for postoperative typical atrial flutter were retrospectively identified and analyzed. Follow-up data were acquired from patients’ records in case of rehospitalization and via follow-up calls. Results The median age of patients was 69 years, 89% male and with a median LV-EF of 55%. CAD was present in 80.8% of patients. The predominant conduction of atrial flutter was 2:1 (76.6%); 85.1% of patients had either undergone CABG, SAVR, or a combination of these two. Acute procedural success could be achieved in 100% of patients with one vascular pseudoaneurysm that was managed conservatively. No other complications occurred. After a median follow-up of 5.7 years, follow-up information regarding heart rhythm was available in 87.2% of patients. One patient (2.1%) had undergone repeat ablation for typical flutter. Two patients (4.2%) had developed atrial fibrillation, while 87.2% of patients were in sinus rhythm. Conclusions In this small cohort, early postoperative ablation of typical flutter was associated with a favorable short- and long-term safety and efficacy profile and can be considered part of heart rhythm management options in this setting.
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 493] [Impact Index Per Article: 164.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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31
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reißmann B, Rottner L, Rillig A, Metzner A. [Cardiac arrhythmia]. MMW Fortschr Med 2021; 163:62-71. [PMID: 33783803 DOI: 10.1007/s15006-021-9651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Bruno Reißmann
- Abteilung für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg--Eppendorf, Hamburg, Germany
| | - Laura Rottner
- Abteilung für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg--Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- Abteilung für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg--Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- ASKLEPIOS Klinik St. Georg, Hanseat. Herzzentrum Hamburg\/Abt. Kardiologie, Lohmühlenstraße 5, 20099, Hamburg, Germany
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Katritsis DG, Chokesuwattanaskul R, Zografos T, Jame S, Paxinos G, Morady F. A simplified differential pacing technique for the evaluation of bidirectional cavo-tricuspid isthmus block during ablation of typical atrial flutter. J Interv Card Electrophysiol 2021; 63:109-114. [PMID: 33550494 DOI: 10.1007/s10840-020-00935-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Bidirectional block of the cavo-tricuspid isthmus (CTI) is an established endpoint of CTI-dependent atrial flutter (AFl) ablation. Differential pacing has been used to evaluate the CTI block. The purpose of this study is to describe a modified differential pacing technique to evaluate the CTI block. METHODS Sixty-two patients underwent radiofrequency (RF) ablation of CTI-dependent AFl. The acute endpoints were non-inducibility of the AFl, and verification of the bidirectional CTI block by our methodology. Pacing was performed in the CS with an ablation catheter positioned immediately lateral to the CTI ablation line, and then 1-2 cm more laterally. The stimulus-to-ablation catheter atrial electrogram intervals were measured at these sites (StimCS-Abl1 and StimCS-Abl2, respectively). Pacing with the ablation catheter also was performed at these 2 sites, and the stimulus-to-CS electrogram intervals (StimABL1-CS and StimABL2-CS) were measured. The criteria for the bidirectional block were StimCS-Abl1 > StimCS-Abl2, and StimABL1-CS > StimABL2-CS. Clinical efficacy was defined as freedom from recurrent AFl during follow-up. RESULTS Following 12.2 ± 3.7 min of RF delivery across the CTI, intervals were StimCS-Abl1 = 181.2 ± 22.7 ms and StimABL1-CS = 181.0 ± 23.6 ms, and StimCS-Abl2 = 152.2 ± 26.5 ms and StimABL2-CS = 151.2 ± 22.7 (P < 0.001). Atrial flutter was rendered not inducible in all patients, and no procedural complications were encountered. During the next 15.9 ± 0.7 months, two patients were lost to follow-up, and among the 62 other patients, one (1.7%) had flutter recurrence. CONCLUSIONS The bidirectional CTI block can be assessed quickly and easily using only the ablation and CS catheters for differential pacing.
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Affiliation(s)
| | | | | | - Sina Jame
- University of Michigan Health System, Ann Arbor, MI, USA
| | - George Paxinos
- Hygeia Hospital, 4 Erythrou Stavrou Str, 15123, Athens, Greece
| | - Fred Morady
- University of Michigan Health System, Ann Arbor, MI, USA
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 4864] [Impact Index Per Article: 1621.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Jani C, Arora S, Zuzek Z, Jaswaney R, Thakkar S, Patel HP, Lahewala S, Arora N, Josephson R, Deshmukh A, Viles-Gonzalez J, Osman MN, Sahadevan J, Hoit BD, Mackall JA. Impact of catheter ablation in patients with atrial flutter and concurrent heart failure. Heart Rhythm O2 2020; 2:53-63. [PMID: 34113905 PMCID: PMC8183960 DOI: 10.1016/j.hroo.2020.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF). Objectives To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF. Methods This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016–17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios. Results Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61–0.85, P < .001). HF readmission (HR 0.73, 95% CI 0.61–0.89, P = .001), all-cause mortality (HR 0.62, 95% CI 0.46–0.85, P = .003), and AF readmission (HR 0.63, 95% CI 0.48–0.82, P = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63–1.01, P = .065). Conclusion In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.
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Affiliation(s)
- Chinmay Jani
- Mount Auburn Hospital-Harvard Medical School, Cambridge, Massachusetts
| | - Shilpkumar Arora
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Zachary Zuzek
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Rahul Jaswaney
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | - Richard Josephson
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | | | - Juan Viles-Gonzalez
- Miami Cardiac and Vascular Institute/ Baptist Health South Florida, Miami, Florida
| | - Mohammed Najeeb Osman
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Jayakumar Sahadevan
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Brian D Hoit
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
| | - Judith A Mackall
- Harrington Heart and Vascular Institute/University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio
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Andrade JG, Aguilar M, Atzema C, Bell A, Cairns JA, Cheung CC, Cox JL, Dorian P, Gladstone DJ, Healey JS, Khairy P, Leblanc K, McMurtry MS, Mitchell LB, Nair GM, Nattel S, Parkash R, Pilote L, Sandhu RK, Sarrazin JF, Sharma M, Skanes AC, Talajic M, Tsang TSM, Verma A, Verma S, Whitlock R, Wyse DG, Macle L. The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation. Can J Cardiol 2020; 36:1847-1948. [PMID: 33191198 DOI: 10.1016/j.cjca.2020.09.001] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/05/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published in 2010. Since then, periodic updates were published dealing with rapidly changing areas. However, since 2010 a large number of developments had accumulated in a wide range of areas, motivating the committee to complete a thorough guideline review. The 2020 iteration of the CCS AF guidelines represents a comprehensive renewal that integrates, updates, and replaces the past decade of guidelines, recommendations, and practical tips. It is intended to be used by practicing clinicians across all disciplines who care for patients with AF. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate recommendation strength and the quality of evidence. Areas of focus include: AF classification and definitions, epidemiology, pathophysiology, clinical evaluation, screening and opportunistic AF detection, detection and management of modifiable risk factors, integrated approach to AF management, stroke prevention, arrhythmia management, sex differences, and AF in special populations. Extensive use is made of tables and figures to synthesize important material and present key concepts. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada; Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
| | - Martin Aguilar
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Alan Bell
- University of Toronto, Toronto, Ontario, Canada
| | - John A Cairns
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Dorian
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Paul Khairy
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Girish M Nair
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Stanley Nattel
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | - Jean-François Sarrazin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Mukul Sharma
- McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Mario Talajic
- Montreal Heart Institute, University of Montreal, Montréal, Quebec, Canada
| | - Teresa S M Tsang
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
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Sebag FA, Simeon É, Moubarak G, Zhao A, Villejoubert O, Darondel JM, Vedrenne G, Lepillier A, Jorrot P, Mouhoub Y, Bouzeman A, Hamon D, Lellouche N, Mignot N. Definition of success criteria for ablation of typical right atrial flutter with a single-catheter approach: A pilot study. Arch Cardiovasc Dis 2020; 113:791-796. [PMID: 33051170 DOI: 10.1016/j.acvd.2020.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The success rate of cavotricuspid isthmus ablation to treat right common flutter is high (up to 95%), but needs bidirectional block confirmation, requiring two or three catheters. AIM To describe a new pacing technique using a single catheter to ablate and confirm cavotricuspid isthmus block with differential PR interval measurements. METHODS We included 61 patients from five centres, who were referred for cavotricuspid isthmus ablation. All patients had cavotricuspid isthmus ablation, and the cavotricuspid isthmus block was confirmed by differential pacing using two or three catheters. The new method consisted of measuring the PR interval on the surface electrocardiogram using pacing from the tip of the ablation catheter on the lateral side (lateral delay) and the septal side (coronary sinus ostium) of the cavotricuspid isthmus line (difference=delta PR interval), before and after cavotricuspid isthmus ablation. We analysed the value of the delta PR interval in predicting bidirectional cavotricuspid isthmus block as confirmed by standard methods. RESULTS Among our patient population (mean age 63±12 years), 39 patients were ablated during sinus rhythm, and 22 during common flutter. Cavotricuspid isthmus block was achieved in all patients but one. Lateral delay and delta PR interval increased significantly after validation of cavotricuspid isthmus block (257±42 vs. 318±50ms and 32±23 vs. 96±22ms, respectively; P<0.0001). A delta PR interval cut-off of ≥70ms had 100% sensitivity and specificity to predict bidirectional cavotricuspid isthmus block. CONCLUSIONS A single-catheter ablation approach to performing cavotricuspid isthmus line based on surface electrocardiogram PR interval measurement is feasible. After ablation, cavotricuspid isthmus block was systematically obtained when the delta PR interval was>70ms.
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Affiliation(s)
- Frédéric A Sebag
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France.
| | - Édouard Simeon
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Ghassan Moubarak
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | - Alexandre Zhao
- Centre médico-chirurgicale Ambroise-Paré, 92200 Neuilly-sur-Seine, France
| | | | - Jean-Marc Darondel
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | | | | | - Pierre Jorrot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
| | - Yamina Mouhoub
- Service de cardiologie, hôpital Saint-Joseph, 75014 Paris, France
| | | | - David Hamon
- Service de cardiologie, hôpital Henri-Mondor, 94010 Créteil, France
| | | | - Nicolas Mignot
- Département de cardiologie, institut mutualiste Montsouris, 75014 Paris, France
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Yoneda ZT, Shoemaker MB, Richardson T, Crawford D, Kanagasundram A, Shen S, Estrada JC, Holmes B, Lugo R, McHugh J, Saavedra P, Crossley G, Ellis CR, Montgomery JA, Michaud GF. Conduction Recovery After Cavotricuspid Isthmus Ablation When Performed With or Without Concomitant Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2020; 6:989-996. [PMID: 32819535 DOI: 10.1016/j.jacep.2020.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/24/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to define the association between conduction recovery across the cavotricuspid isthmus (CTI) and typical atrial flutter (AFL) recurrence when CTI ablation is performed with pulmonary vein isolation (PVI) compared with a stand-alone procedure. BACKGROUND CTI ablation is commonly performed at the same time as PVI to treat AFL or as an empiric therapy. Conduction recovery is a recognized problem after linear ablation in the left atrium (e.g., mitral isthmus ablation) and is proarrhythmic. Less is known about conduction recovery after CTI ablation and possible differences in outcomes when performed at the time of PVI compared with at the time of a stand-alone procedure. METHODS Eligible participants who underwent stand-alone CTI ablation were compared with those who underwent a combined (CTI+PVI) procedure. CTI conduction recovery was assessed at the time of a second ablation. Conduction recovery across the CTI (primary outcome) and recurrence of typical AFL (secondary outcome) were studied using multivariable logistic regression. RESULTS Among 295 eligible participants (median age: 64 years [interquartile range: 55 to 69 years]; 33% women), recovery was assessed in 232 and was more common after combined versus stand-alone CTI ablation (52% [72 of 139] vs. 13% [12 of 93]; p < 0.001). In multivariable analysis, CTI ablation performed as a combined procedure increased odds of CTI conduction recovery 7.8-fold (odds ratio: 7.8; 95% confidence interval: 3.3 to 18.3; p < 0.001) and clinical AFL recurrence 4.1-fold (odds ratio: 4.1; 95% confidence interval: 1.0 to 16.9; p = 0.049). CONCLUSIONS CTI ablation performed at the time of atrial fibrillation ablation is associated with higher rates of conduction recovery and typical flutter recurrence.
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Affiliation(s)
- Zachary T Yoneda
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M Benjamin Shoemaker
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Travis Richardson
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane Crawford
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arvindh Kanagasundram
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon Shen
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Juan Carlos Estrada
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Holmes
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Lugo
- Department of Cardiology, Ascension Saint Thomas West, Nashville, Tennessee, USA
| | - Julia McHugh
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Pablo Saavedra
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - George Crossley
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher R Ellis
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jay A Montgomery
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory F Michaud
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Garcia R, Bouleti C, Li A, Frasca D, El Harrouchi S, Marechal J, Roumegou P, Corbi P, Christiaens L, Le Gal F, Degand B. Hypnosis Versus Placebo During Atrial Flutter Ablation: The PAINLESS Study: A Randomized Controlled Trial. JACC Clin Electrophysiol 2020; 6:1551-1560. [PMID: 33213815 DOI: 10.1016/j.jacep.2020.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the superiority of hypnosis versus placebo on pain perception and morphine consumption during typical atrial flutter (AFL) ablation. BACKGROUND AFL ablation commonly requires intravenous opioid for analgesia, which can be associated with adverse outcomes. Hypnosis is an alternative technique with rising interest, but robust data in electrophysiological procedures are lacking. METHODS This single center, randomized controlled trial compared hypnosis and placebo during AFl ablation. In addition to the randomized intervention, all patients were treated according to the institution's standard of care analgesia protocol (administration of 1 mg of intravenous morphine in case of self-reported pain ≥5 on an 11-point numeric rating scale or on demand). The primary endpoint was perceived pain quantified by patients using a visual analog scale. RESULTS Between October 2017 and September 2019, 113 patients (mean age 70 ± 12 years, 21% women) were randomized to hypnosis (n = 56) or placebo (n = 57). Mean pain score was 4.0 ± 2.2 in the hypnosis group versus 5.5 ± 1.8 in the placebo group (p < 0.001). Pain perception, assessed every 5 min during the whole procedure, was consistently lower in the hypnosis group. Patients' sedation scores were also better in the hypnosis group than in the placebo group (8.3 ± 2.2 vs. 5.4 ± 2.5; p < 0.001). Finally, morphine requirements were significantly lower in the hypnosis group (1.3 ± 1.3 mg) compared with the placebo group (3.6 ± 1.8 mg; p < 0.001). CONCLUSIONS In this first randomized trial, hypnosis during AFL ablation was superior to placebo for alleviating pain and reducing morphine consumption.
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Affiliation(s)
- Rodrigue Garcia
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.
| | - Claire Bouleti
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; INSERM CIC 1402, Poitiers, France
| | - Anthony Li
- Cardiology Clinical Academic Group, St. George's University of London, London, United Kingdom
| | - Denis Frasca
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; Centre Hopsitalier Universitaire (CHU) Poitiers, Anesthesia and Intensive Care, Poitiers, France
| | - Sophia El Harrouchi
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Julien Marechal
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Pierre Roumegou
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Pierre Corbi
- Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France; Centre Hospitalier Universitaire (CHU) Poitiers, Department of Thoracic and Cardiovascular Surgery, Poitiers, France
| | - Luc Christiaens
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France; Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France
| | - François Le Gal
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
| | - Bruno Degand
- Centre Hospitalier Universitaire (CHU) Poitiers, Cardiology Department, Poitiers, France
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, De Ponti R. Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2632-2641. [DOI: 10.1111/jce.14666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | | | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
- Department of Medicine and Cardiopulmonary Rehabilitation Maugeri Care and Research Institutes, IRCCS Tradate Varese Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
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Robaye B, Deceuninck O, Blommaert D, Godeaux V, Dormal F, Collet B, Ballant E, Huys F, Guedes A, Xhaët O. 3D navigation system allows remarkable reduction in fluoroscopy use during cavo-tricuspid isthmus ablation. J Interv Card Electrophysiol 2020; 61:333-338. [PMID: 32643105 DOI: 10.1007/s10840-020-00818-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Typical atrial flutter (AFL) is one of the most common supraventricular arrhythmias. Its treatment mainly relies on cavo-tricuspid isthmus (CTI) ablation, which can be performed either using conventional fluoroscopy, still mainly used, or 3D navigation system to track the position of the catheter. The aim of this study is to show that the use of a 3D navigation system allows a dramatic reduction of fluoroscopy use during CTI ablation, without any loss of efficacy, time, or safety. METHODS In this single-center study, we retrospectively compared 134 cases of CTI ablation performed for typical AFL without a 3D navigation system with 95 cases of CTI ablation performed with such a 3D system. We compared the rates of procedural success (defined as obtaining a bidirectional electrical conduction block), freedom from AFL recurrence at 1-year follow-up, procedural time and safety, and fluoroscopy use. RESULTS Compared to conventional fluoroscopy, the use of a 3D navigation system significantly decreased the duration of fluoroscopy use (2 min 13 s ± 2 min 16 s versus 14 min 41 s ± 10 min 39 s, p < 0.0001) and dose-area products (1567.9 ± 1329.5 mGy cm2 versus 8263.3 ± 8636.6 mGy cm2, p < 0.0001). Procedure success rates, duration, and safety were not different between groups. CONCLUSIONS The use of 3D navigation during CTI ablation substantially reduces fluoroscopy use duration, without reducing the success rates and safety or prolonging the procedure duration, as compared to conventional fluoroscopy. We therefore suggest the generalization of this navigation system.
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Affiliation(s)
- Benoit Robaye
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium.
| | - Olivier Deceuninck
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium.,Department of Cardiology, CHR Namur, 5000, Namur, Belgium
| | - Dominique Blommaert
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Véronique Godeaux
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Fabien Dormal
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Benoit Collet
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Elisabeth Ballant
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Florence Huys
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Antoine Guedes
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
| | - Olivier Xhaët
- Department of Cardiology, Université catholique de Louvain, CHU UCL Namur - Cliniques universitaire de Mont-Godinne, Av Dr G Therasse, 1, 5530, Yvoir, Belgium
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Guettler N, Bron D, Manen O, Gray G, Syburra T, Rienks R, d'Arcy J, Davenport ED, Nicol ED. Management of cardiac conduction abnormalities and arrhythmia in aircrew. Heart 2020; 105:s38-s49. [PMID: 30425085 PMCID: PMC6256301 DOI: 10.1136/heartjnl-2018-313057] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/03/2018] [Accepted: 06/11/2018] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular diseasesi are the most common cause of loss of flying licence globally, and cardiac arrhythmia is the main disqualifier in a substantial proportion of aircrew. Aircrewii often operate within a demanding physiological environment, that potentially includes exposure to sustained acceleration (usually resulting in a positive gravitational force, from head to feet (+Gz)) in high performance aircraft. Aeromedical assessment is complicated further when trying to discriminate between benign and potentially significant rhythm abnormalities in aircrew, many of whom are young and fit, have a resultant high vagal tone, and among whom underlying cardiac disease has a low prevalence. In cases where a significant underlying aetiology is plausible, extensive investigation is often required and where appropriate should include review by an electrophysiologist. The decision regarding restriction of flying activity will be dependent on several factors including the underlying arrhythmia, associated pathology, risk of incapacitation and/or distraction, the type of aircraft operated, and the specific flight or mission criticality of the role performed by the individual aircrew.
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Affiliation(s)
- Norbert Guettler
- German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Dennis Bron
- Aeromedical Centre, Swiss Air Force, Dubendorf, Switzerland
| | - Olivier Manen
- Aviation Medicine Department, AeMC, Percy Military Hospital, Clamart, France
| | - Gary Gray
- Canadian Forces Environmental Medical Establishment, Toronto, Ontario, Canada
| | - Thomas Syburra
- Cardiac Surgery Department, Luzerner Kantonsspital, Luzern, Switzerland
| | - Rienk Rienks
- Department of Cardiology, University Medical Center Utrecht and Central Military Hospital, Utrecht, The Netherlands
| | - Joanna d'Arcy
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
| | - Eddie D Davenport
- Aeromedical Consult Service, USAF School of Aerospace Medicine, Wright-Patterson AFB, Ohio, USA
| | - Edward D Nicol
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
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Bianco I, Silva GOD, Forno ARJD, Nascimento HG, Lewandowski A, Pereira E, d'Avila A. Risk of Atrial Fibrillation after Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter: Is Combined Ablation of Atrial Fibrillation Worthwhile? Arq Bras Cardiol 2020; 114:775-782. [PMID: 32236324 PMCID: PMC8386990 DOI: 10.36660/abc.20190238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF. OBJECTIVES To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF. METHODS Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation. RESULTS Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation. CONCLUSIONS Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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Affiliation(s)
| | | | | | | | | | - Elayne Pereira
- Universidade do Sul de Santa Catarina, Palhoça, SC - Brasil
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The role of amiodarone in contemporary management of complex cardiac arrhythmias. Pharmacol Res 2020; 151:104521. [PMID: 31756386 DOI: 10.1016/j.phrs.2019.104521] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/25/2019] [Accepted: 10/30/2019] [Indexed: 01/09/2023]
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Wyn Davies D, Day JD, d'Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: executive summary. J Interv Card Electrophysiol 2019; 50:1-55. [PMID: 28914401 PMCID: PMC5633646 DOI: 10.1007/s10840-017-0277-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | - Joseph G Akar
- Yale University School of Medicine, New Haven, CT, USA
| | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, UK
| | - Peng-Sheng Chen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, UK
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY, USA
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, UK
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA, USA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, USA
- The National Center for Cardiovascular Research Carlos III (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO, USA
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea Natale
- St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX, USA
| | - Stanley Nattel
- Montreal Heart Institute, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
- University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
- Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, ON, Canada
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Rhea IB, Lyon AR, Fradley MG. Anticoagulation of Cardiovascular Conditions in the Cancer Patient: Review of Old and New Therapies. Curr Oncol Rep 2019; 21:45. [DOI: 10.1007/s11912-019-0797-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Begg GA, O’Neill J, Sohaib A, McLean A, Pepper CB, Graham LN, Hogarth AJ, Page SP, Gillott RG, Hill N, Walshaw J, Schilling RJ, Kanagaratnam P, Tayebjee MH. Multicentre randomised trial comparing contact force with electrical coupling index in atrial flutter ablation (VERISMART trial). PLoS One 2019; 14:e0212903. [PMID: 30943196 PMCID: PMC6447159 DOI: 10.1371/journal.pone.0212903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/09/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Electrical coupling index (ECI) and contact force (CF) have been developed to aid lesion formation during catheter ablation. ECI measures tissue impedance and capacitance whilst CF measures direct contact. The aim was to determine whether the presence of catheter / tissue interaction information, such as ECI and CF, reduce time to achieve bidirectional cavotricuspid isthmus block during atrial flutter (AFL) ablation. Methods Patients with paroxysmal or persistent AFL were randomised to CF visible (range 5-40g), CF not visible, ECI visible (change of 12%) or ECI not visible. Follow-up occurred at 3 and 6 months and included a 7 day ECG recording. The primary endpoint was time to bidirectional cavotricuspid isthmus block. Results 114 patients were randomised, 16 were excluded. Time to bidirectional block was significantly shorter when ECI was visible (median 30.0 mins (IQR 31) to median 10.5mins (IQR 12) p 0.023) versus ECI not visible. There was a trend towards a shorter time to bidirectional block when CF was visible. Higher force was applied when CF was visible (median 9.03g (IQR 7.4) vs. 11.3g (5.5) p 0.017). There was no difference in the acute recurrence of conduction between groups. The complication rate was 2%, AFL recurrence was 1.1% and at 6 month follow-up, 12% had atrial fibrillation. Conclusion The use of tissue contact information during AFL ablation was associated with reduced time taken to achieve bidirectional block when ECI was visible. Contact force data improved contact when visible with a trend towards a reduction in the procedural endpoint. ClinicalTrials.gov trial identifier: NCT02490033.
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Affiliation(s)
- Gordon A. Begg
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - James O’Neill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Afzal Sohaib
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Ailsa McLean
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Chris B. Pepper
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Lee N. Graham
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Andrew J. Hogarth
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Stephen P. Page
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard G. Gillott
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Nicola Hill
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Jacqueline Walshaw
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
| | - Richard J. Schilling
- Department of Cardiology, Barts Health NHS Trust, St Bartholomew’s Hospital, London, United Kingdom
| | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Muzahir H. Tayebjee
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, United Kingdom
- * E-mail:
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, Zwar N. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2019; 27:1209-1266. [PMID: 30077228 DOI: 10.1016/j.hlc.2018.06.1043] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - John Amerena
- Geelong Cardiology Research Unit, University Hospital Geelong, Geelong, Australia
| | - John Attia
- University of Newcastle, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney & Department of Pharmacy, Royal North Shore Hospital, Australia
| | - Kim H Chan
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cia Connell
- The National Heart Foundation of Australia, Melbourne, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Caleb Ferguson
- Western Sydney University, Western Sydney Local Health District, Blacktown Clinical and Research School, Blacktown Hospital, Sydney, Australia
| | | | - Haris Haqqani
- University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Jeroen Hendriks
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia
| | - Jonathan M Kalman
- University of Melbourne, Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John Worthington
- RPA Comprehensive Stroke Service, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Nicholas Zwar
- Graduate Medicine, University of Wollongong, Wollongong, Australia
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49
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Van Steenkiste G, De Clercq D, Vera L, Decloedt A, Loon G. Sustained atrial tachycardia in horses and treatment by transvenous electrical cardioversion. Equine Vet J 2019; 51:634-640. [DOI: 10.1111/evj.13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/06/2019] [Indexed: 01/10/2023]
Affiliation(s)
- G. Van Steenkiste
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - D. De Clercq
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - L. Vera
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - A. Decloedt
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
| | - G. Loon
- Department of Large Animal Internal Medicine Ghent University Equine Cardioteam Ghent University Merelbeke Belgium
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50
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Radiofrequency Ablation Versus Antiarrhythmic Drug Therapy for Atrial Fibrillation: Meta-analysis of Safety and Efficacy. J Cardiovasc Pharmacol 2019; 73:241-247. [PMID: 30688797 DOI: 10.1097/fjc.0000000000000654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) and antiarrhythmic drugs (AADs) are the main treatments used for atrial fibrillation (AF). In recent years, a number of articles comparing the 2 treatments have begun to emerge. Though, the influence of follow-up time in the meta-analysis was not considered in these articles. However, more recently, large-scale clinical trial articles have included follow-up with the patients up to 5 years after treatment. Therefore, the aim of this study was to assess the impact of variable follow-up times on the recurrence of AF by observing both the short-term and long-term efficacy and safety of catheter ablation and AADs for the treatment of AF. METHODS AND RESULTS The primary investigators of eligible randomized controlled trials were invited to contribute standardized outcome data. Random effect summary estimates were calculated as standardized mean differences and odds ratios with 95% confidence intervals for continuous and binary outcomes. In this study, 9 randomized controlled trials (n = 1542 patients) were included. The rate of recurrence of AF with no limit on follow-up time, >12 months, >18 months, >24 months, >30 months, and approximately 36 months was compared. Furthermore, the gap between the RFA and AAD groups in the recurrence rate of AF was found to decrease inversely to follow-up time. When the follow-up time reached 24 months, the difference between RFA and AAD was relatively stable with an odds ratio of 0.45 (95% confidence interval: 0.32-0.62). Overall, RFA decreased adverse events in the remaining trials; however, AAD performed better in terms of safety and had fewer adverse events with RFA usually causing more serious complications. CONCLUSION RFA is more advantageous in terms of recurrence rate of AF than drug therapy. In addition, the analysis suggests that this effect persists during long-term follow-up; however, these benefits appear to decrease with longer follow-up time. Finally, AAD performed better in terms of safety and had fewer adverse events.
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