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Ma S, Wen B, Zhang X. A review regarding the article 'Multidisciplinary management strategies for atrial fibrillation.'. Curr Probl Cardiol 2024; 49:102613. [PMID: 38692446 DOI: 10.1016/j.cpcardiol.2024.102613] [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: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/03/2024]
Abstract
Catheter ablation has become an accepted first line therapy for paroxysmal atrial fibrillation (PAF), with pulmonary vein isolation (PVI) being the key element of ablation strategies. Catheter ablation of AF has been proven to be superior to antiarrhythmic drug (AAD) therapy regarding efficacy and improvement of survival in patients with heart failure. PVI has become a routine treatment procedure in recent decades especially for patients with symptomatic PAF. Recent research investigations have shown that AF recurrence still occurs in a significant number of patients after ablation. AF recurrence leads to a decrease in patients' quality of life and is related to an increased risk of cardiovascular events and mortality. As most arrhythmia recurrences take place within the first 3 months after the initial procedure, this time period is seen as a so-called "blanking period", in which ablation is not recommended, since up to 50 % of patients can become arrhythmia free in the long run. Ablation therapy, however, is less successful in patients suffering from long standing persistent AF, with a 20.3 % success rate after a single procedure and a 45 % success rate after multiple RFA procedures. Several scores have been established and validated to predict cardiac rhythm outcomes after catheter ablation. However, due to the lack of external validation of most of the scores, their efficacy in predicting recurrence of atrial fibrillation needs to be further evaluated in independent external studies.
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Affiliation(s)
- Shanshan Ma
- Department of Cardiology, West China Hospital of Sichuan University, West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bi Wen
- Department of Cardiology, West China Hospital of Sichuan University, West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital of Sichuan University, West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, China.
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Bates A, Naseer M, Taylor M, Denham N, Yue A, Das M, Morris GM, Ullah W. A U.K. Multicenter Retrospective Study of the Learning Curve and Relative Impact on Success Rates and Procedural Metrics of the RHYTHMIA HDx™ Mapping System. J Innov Card Rhythm Manag 2023; 14:5442-5450. [PMID: 37216082 PMCID: PMC10193869 DOI: 10.19102/icrm.2023.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/23/2023] [Indexed: 05/24/2023] Open
Abstract
The learning curve for the novel RHYTHMIA HDx™ 3-dimensional electroanatomic system is unknown. Retrospective data collection was carried out at 3 U.K. centers from the introduction of RHYTHMIA HDx™ (Boston Scientific, Marlborough, MA, USA) and associated mapping and ablation catheters. Patients were matched with controls using the CARTO® 3 mapping system (Biosense Webster Inc., Diamond Bar, CA, USA). Fluoroscopy, radiofrequency ablation, and procedure times; acute and long-term success; and complications were assessed. A total of 253 study patients along with 253 controls were included. Significant correlations existed between procedural efficiency metrics and center experience for de novo atrial fibrillation (AF) ablation (procedure time, Spearman's ρ = -0.624; ablation time, ρ = -0.795; both P < .0005) and de novo atrial flutter (AFL) ablation (ablation time, ρ = -0.566; fluoroscopy time, ρ = -0.520; both P = .001). No correlations existed for other assessed atrial arrhythmias. For de novo AF and AFL, metrics significantly improved after 10 procedures in each center (procedure time [AF only, P = .001], ablation time [AF, P < .0005; AFL, P < .0005], and fluoroscopy time [AFL only, P = .0022]) and became comparable to those of controls. Acute success and long-term success did not experience significant improvements with experience, but they were comparable to the control group throughout. Complications with RHYTHMIA HDx™ were comparable to those associated with CARTO® 3. In conclusion, a short learning curve exists with the use of RHYTHMIA HDx™ for standardized procedures (de novo AF/AFL). Procedural performance improved and became comparable to that seen with CARTO® 3 following 10 cases at each center. Clinical outcomes at 6 and 12 months and complications were no different from those observed in controls.
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Affiliation(s)
- Alexander Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohammad Naseer
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Taylor
- Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nathan Denham
- Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Arthur Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Moloy Das
- Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gwilym M. Morris
- Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Department of Cardiology, Manchester University Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Waqas Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Raman J, Saxena P, Lim H. Atrial Fibrillation Ablation: We Are Not There Yet! Heart Lung Circ 2021; 30:1274-1276. [PMID: 34246561 DOI: 10.1016/j.hlc.2021.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jaishankar Raman
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Pankaj Saxena
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia
| | - Han Lim
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia
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Mapping strategies and ablation of premature atrial complexes. Herzschrittmacherther Elektrophysiol 2021; 32:9-13. [PMID: 33533993 DOI: 10.1007/s00399-021-00744-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
Premature atrial complexes (PACs) are a common finding in patients with structural heart disease, as well as in healthy subjects. In addition to the clinical spectrum ranging from asymptomatic patients to irritating palpitations, PACs are suggested to be associated with an increased risk of atrial fibrillation and stroke. Medical treatment leads to a significant reduction in PACs with clear symptom relief in a large proportion of patients, but is limited in cases of PACs that are refractory to antiarrhythmic drug (AAD) treatment. Furthermore, proarrhythmic effects of AAD or the patient's refusal of AAD treatment due to side effects need to be considered. Ablation of PACs is a good alternative to medical therapy with a comparable safety profile and at least comparable efficacy. In recent years, ultra-high-density (UHD) mapping with multiple improvements for successful ablation has been evolving. Before the introduction of UHD mapping, ablation strategies included activation mapping with single-tip catheters or conventional mapping aiming for the earliest activation of the PAC locally, with the earliest activation suspected to be the origin of the PAC and targeted by radiofrequency (RF) ablation. Using UHD mapping, a three-dimensional local activation map of the atrium can be acquired, identifying the point of earliest activation within the high-resolution map. PAC ablation has therefore developed into a true alternative for the treatment of symptomatic PACs.
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Alken FA, Chen S, Masjedi M, Pürerfellner H, Maury P, Martin CA, Sacher F, Jais P, Meyer C. Basket catheter-guided ultra-high-density mapping of cardiac arrhythmias: a systematic review and meta-analysis. Future Cardiol 2020; 16:735-751. [PMID: 32608246 DOI: 10.2217/fca-2020-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: Ultra-high-density mapping (HDM) is increasingly used for guidance of catheter ablation in cardiac arrhythmias. While initial results are promising, a systematic evaluation of long-term outcome has not been performed so far. Methods: A systematic review and meta-analysis was conducted on studies investigating long-term outcome after Rhythmia HDM-guided atrial fibrillation (AF) or atrial tachycardia catheter ablation. Results: Beyond multiple studies providing novel insights into arrhythmia mechanisms, follow-up data from 17 studies analyzing Rhythmia HDM-guided ablation (1768 patients, 49% with previous ablation) were investigated. Cumulative acute success was 100/90.2%, while 12 months long-term pooled success displayed at 71.6/71.2% (AF/atrial tachycardia). Prospective data are limited, showing similar outcome between HDM-guided and conventional AF ablation. Conclusion: Acute results of HDM-guided catheter ablation are promising, while long-term success is challenged by complex arrhythmogenic substrates. Prospective randomized trials investigating different HDM-guided ablation strategies are warranted and underway.
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Affiliation(s)
- Fares-Alexander Alken
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB) Frankfurt am Main, Frankfurt Academy For Arrhythmias (FAFA), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Wilhelm-Epstein Straße 4, Frankfurt am Main 60431, Germany
| | - Mustafa Masjedi
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Helmut Pürerfellner
- Department of Electrophysiology, Academic Teaching Hospital, Ordensklinikum Linz Elisabethinen, Linz, Austria
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse Cedex 09, France
| | - Claire A Martin
- Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, UK
| | - Frederic Sacher
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Jais
- Department of Cardiac Electrophysiology, LIRYC institute, INSERM 1045, Bordeaux University Hospital, Bordeaux, France
| | - Christian Meyer
- Department of Cardiology, cNEP, Cardiac Neuro- & Electrophysiology Research Group, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiology, Evangelical Hospital Düsseldorf, Kirchfeldstrasse 40, 40217 Düsseldorf, Germany.,Heinrich-Heine-University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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Siebermair J, Kochhäuser S, Kupusovic J, Köhler MI, Pesch E, Vonderlin N, Kaya E, Janosi RA, Rassaf T, Wakili R. Impact of previous left atrial ablation procedures on the mechanism of left atrial flutter: A single‐centre experience. J Cardiovasc Electrophysiol 2020; 31:1631-1639. [PMID: 32314838 DOI: 10.1111/jce.14505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/10/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Johannes Siebermair
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Simon Kochhäuser
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Jana Kupusovic
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Miriam I. Köhler
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elena Pesch
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Nadine Vonderlin
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Elif Kaya
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Rolf A. Janosi
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, West‐German Heart and Vascular Center Essen, University of Essen Medical School University Duisburg‐Essen Essen Germany
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