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Haissaguerre M. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. Heart Rhythm 2024; 21:713-714. [PMID: 38816145 DOI: 10.1016/j.hrthm.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Michel Haissaguerre
- Department of Cardiac Electrophysiology and Stimulation, LIRYC Institute, CHU Bordeaux, University of Bordeaux, Inserm U1045, Bordeaux, France.
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2
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Mills EW, Antman EM, Javaheri S. Breathless nights and heart flutters: Understanding the relationship between obstructive sleep apnea and atrial fibrillation. Heart Rhythm 2023; 20:1267-1273. [PMID: 37127146 DOI: 10.1016/j.hrthm.2023.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Abstract
There is an extraordinary and increasing global burden of atrial fibrillation (AF) and obstructive sleep apnea (OSA), two conditions that frequently accompany one another and that share underlying risk factors. Whether a causal pathophysiologic relationship connects OSA to the development and/or progression of AF, or whether shared risk factors promote both conditions, is unproven. With increasing recognition of the importance of controlling AF-related risk factors, numerous observational studies now highlight the potential benefits of OSA treatment in AF-related outcomes. Physicians are regularly faced with caring for this important and increasing population of patients despite a paucity of clinical guidance on the topic. Here, we review the clinical epidemiology and pathophysiology of AF and OSA with a focus on key clinical studies and major outstanding questions that should be addressed in future studies.
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Affiliation(s)
- Eric W Mills
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Elliott M Antman
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sogol Javaheri
- Division of Sleep Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Tang S, Hu X, Bao W, Li F, Ge L, Wei H, Zhang Q, Zhang B, Zhang C, Wang Z, Li C. Development and Validation of a Nomogram Model Affecting the ACT Targeting Rate During Radiofrequency Ablation of Atrial Fibrillation in China. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07450-3. [PMID: 37160503 DOI: 10.1007/s10557-023-07450-3] [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] [Accepted: 03/19/2023] [Indexed: 05/11/2023]
Abstract
CONTEXT A nomogram model affecting the activated clotting time (ACT) targeting rate during radiofrequency ablation of atrial fibrillation (RFCA) in China. PURPOSE The aim of this study is to develop and validate a nomogram model for predicting the activated clotting time targeting rate after the initial bolus heparin dosages during the radiofrequency catheter ablation of atrial fibrillation in China. METHODS AND RESULTS A retrospective observational study was conducted on the data of 465 patients with atrial fibrillation who underwent radiofrequency catheter ablation (RFCA) from October 2019 to June 2022. All patients were randomized into a training cohort (70%; n = 325) and a validation cohort (30%; n = 140). Independent risk factors were identified using univariate and multifactorial logistic regression analysis. The predictive nomogram model was established using R software. The nomogram was developed and evaluated based on differentiation, calibration, and clinical efficacy using concordance statistic (C-statistic), calibration plots, and decision curve analysis (DCA), respectively. The nomogram was established using three variables, including sex (OR 1.01, 95% CI 0.29-1.76, P = 0.007), heparin dose (OR 0.04; 95%CI 0.02-0.05, P < 0.001), and the baseline ACT (OR 0.03; 95%CI 0.02-0.04, P < 0.001). The C-statistic of the nomogram was 0.736 (95%CI 0.675-0.732) in the training cohort and 0.700 (95%CI 0.622-0.721) in the validation cohort. The calibration plots showed good agreement between the predictions and observations in the training and validation cohorts. The clinical decision curve also proves that the map is useful in clinical settings. CONCLUSION The nomogram model has good discrimination and accuracy, which can screen attainment groups intuitively and individually, and has a certain predictive value for the probability of ACT reaching the target after the adequate dosage of initial heparin in Chinese patients with atrial fibrillation.
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Affiliation(s)
- Shiyun Tang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Xiaoqin Hu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Wei Bao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Fei Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Liqi Ge
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Hui Wei
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Quan Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Baixiang Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Chaoqun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zhirong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
| | - Chengzong Li
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.
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Haïssaguerre M. Toward radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm 2021; 18:2219-2220. [PMID: 34838242 DOI: 10.1016/j.hrthm.2021.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université of Bordeaux, CRCTB, INSERM U1045, Pessac, France.
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Efficacy and safety of novel temperature-controlled radiofrequency ablation system during pulmonary vein isolation in patients with paroxysmal atrial fibrillation: TRAC-AF study. J Interv Card Electrophysiol 2021; 64:375-381. [PMID: 34089431 DOI: 10.1007/s10840-021-00986-0] [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: 09/25/2020] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Saline-irrigated radiofrequency ablation (RFA) for atrial fibrillation (AF) is limited by the absence of reliable thermal feedback limiting the utility of temperature monitoring for power titration. The DiamondTemp (DT) ablation catheter was designed to allow efficient temperature-controlled irrigated ablation. We sought to assess the 1-year clinical safety and efficacy of the DT catheter in treating drug-refractory paroxysmal AF. METHODS The TRAC-AF trial (NCT02821351) is a prospective, multi-center (n = 4), single-arm study which enrolled patients with symptomatic, drug-refractory, paroxysmal AF. Using the DT catheter, point-by-point ablation was performed around all pulmonary veins (PVs) to achieve PV isolation (PVI). Ablation was performed in a temperature-controlled mode (60 °C, max 50 W). Acute and chronic efficacy and safety was evaluated. RESULTS Seventy-one patients (age 69.9 ± 11.0 years; 60.6% male) were ablated using the DT catheter. The mean fluoroscopy and RF ablation times were 9.3 ± 6.1 min and 20.6 ± 8.9 min, respectively. Acute isolation of all PVs was achieved in 100% of patients, and freedom from AF after 1 year was 70.6%. There were no steam pops, char, or coagulum on the catheter tip after ablation. There were few serious procedure/device-related adverse events including a single case of cardiac tamponade (1.4%) and transient ischemic attack (1.4). CONCLUSION This first in man series demonstrates that temperature-controlled irrigated RFA with the DT catheter is efficient, safe, and effective in the treatment of paroxysmal AF. Randomized controlled trials are ongoing and will evaluate better the role of this catheter in relation to standard RFA. TRIAL REGISTRATION Registered on the site ClinicalTrials.gov January 2016 with identifier: NCT02821351.
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Salinet J, Molero R, Schlindwein FS, Karel J, Rodrigo M, Rojo-Álvarez JL, Berenfeld O, Climent AM, Zenger B, Vanheusden F, Paredes JGS, MacLeod R, Atienza F, Guillem MS, Cluitmans M, Bonizzi P. Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value. Front Physiol 2021; 12:653013. [PMID: 33995122 PMCID: PMC8120164 DOI: 10.3389/fphys.2021.653013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 01/16/2023] Open
Abstract
Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.
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Affiliation(s)
- João Salinet
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rubén Molero
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Fernando S. Schlindwein
- School of Engineering, University of Leicester, United Kingdom and National Institute for Health Research, Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Joël Karel
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
| | - Miguel Rodrigo
- Electronic Engineering Department, Universitat de València, València, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematic Systems and Computation, University Rey Juan Carlos, Madrid, Spain
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI, United States
| | - Andreu M. Climent
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Brian Zenger
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Frederique Vanheusden
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Jimena Gabriela Siles Paredes
- Biomedical Engineering, Centre for Engineering, Modelling and Applied Social Sciences (CECS), Federal University of ABC, São Bernardo do Campo, Brazil
| | - Rob MacLeod
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - María S. Guillem
- ITACA Institute, Universitat Politècnica de València, València, Spain
| | - Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Pietro Bonizzi
- Department of Data Science and Knowledge Engineering, Maastricht University, Maastricht, Netherlands
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Nattel S, Sager PT, Hüser J, Heijman J, Dobrev D. Why translation from basic discoveries to clinical applications is so difficult for atrial fibrillation and possible approaches to improving it. Cardiovasc Res 2021; 117:1616-1631. [PMID: 33769493 DOI: 10.1093/cvr/cvab093] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained clinical arrhythmia, with a lifetime incidence of up to 37%, and is a major contributor to population morbidity and mortality. Important components of AF management include control of cardiac rhythm, rate, and thromboembolic risk. In this narrative review article, we focus on rhythm-control therapy. The available therapies for cardiac rhythm control include antiarrhythmic drugs and catheter-based ablation procedures; both of these are presently neither optimally effective nor safe. In order to develop improved treatment options, it is necessary to use preclinical models, both to identify novel mechanism-based therapeutic targets and to test the effects of putative therapies before initiating clinical trials. Extensive research over the past 30 years has provided many insights into AF mechanisms that can be used to design new rhythm-maintenance approaches. However, it has proven very difficult to translate these mechanistic discoveries into clinically applicable safe and effective new therapies. The aim of this article is to explore the challenges that underlie this phenomenon. We begin by considering the basic problem of AF, including its clinical importance, the current therapeutic landscape, the drug development pipeline, and the notion of upstream therapy. We then discuss the currently available preclinical models of AF and their limitations, and move on to regulatory hurdles and considerations and then review industry concerns and strategies. Finally, we evaluate potential paths forward, attempting to derive insights from the developmental history of currently used approaches and suggesting possible paths for the future. While the introduction of successful conceptually innovative new treatments for AF control is proving extremely difficult, one significant breakthrough is likely to revolutionize both AF management and the therapeutic development landscape.
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Affiliation(s)
- Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada.,IHU LIYRC Institute, Bordeaux, France.,Faculty of Medicine, Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany
| | - Philip T Sager
- Department of Medicine, Cardiovascuar Research Institute, Stanford University, Palo Alto, CA, USA
| | - Jörg Hüser
- Research and Development, Preclinical Research, Cardiovascular Diseases, Bayer AG, Wuppertal, Germany
| | - Jordi Heijman
- Faculty of Medicine, Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Dobromir Dobrev
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Canada.,Faculty of Medicine, Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany.,Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, USA
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Natesan H, Tian L, A Rogers J, Bischof J. A Microthermal Sensor for Cryoablation Balloons. J Biomech Eng 2020; 142:1083626. [PMID: 32391553 DOI: 10.1115/1.4047134] [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: 01/27/2019] [Indexed: 11/08/2022]
Abstract
Treatment of atrial fibrillation by cryoablation of the pulmonary vein (PV) suffers from an inability to assess probe contact, tissue thickness, and freeze completion through the wall. Unfortunately, clinical imaging cannot be used for this purpose as these techniques have resolutions similar in scale (∼1 to 2 mm) to PV thickness and therefore are unable to resolve changes within the PV during treatment. Here, a microthermal sensor based on the "3ω" technique which has been used for thin biological systems is proposed as a potential solution and tested for a cryoablation scenario. First, the sensor was modified from a linear format to a serpentine format for integration onto a flexible balloon. Next, using numerical analyses, the ability of the modified sensor on a flat substrate was studied to differentiate measurements in limiting cases of ice, water, and fat. These numerical results were then complemented by experimentation by micropatterning the serpentine sensor onto a flat substrate and onto a flexible balloon. In both formats (flat and balloon), the serpentine sensor was experimentally shown to: (1) identify tissue contact versus fluid, (2) distinguish tissue thickness in the 0.5 to 2 mm range, and (3) measure the initiation and completion of freezing as previously reported for a linear sensor. This study demonstrates proof of principle that a serpentine 3ω sensor on a balloon can monitor tissue contact, thickness, and phase change which is relevant to cryo and other focal thermal treatments of PV to treat atrial fibrillation.
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Affiliation(s)
- Harishankar Natesan
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455
| | - Limei Tian
- Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843
| | - John A Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208
| | - John Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455
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Mascia G, Giaccardi M. A New Era in Zero X-ray Ablation. Arrhythm Electrophysiol Rev 2020; 9:121-127. [PMID: 33240507 PMCID: PMC7675142 DOI: 10.15420/aer.2020.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
In this article, the authors focus on the importance of the zero X-ray ablation approach in electrophysiology. Radiation exposure related to conventional transcatheter ablation carries small but non-negligible stochastic and deterministic effects on health. Non-fluoroscopic mapping systems can significantly reduce, or even completely avoid, radiological exposure. The zero X-ray approach determines potential clinical benefits in terms of reduction of ionising radiation exposure, as well as safe technical advantages. The use of this method can result in similar outcomes when compared to the conventional fluoroscopic technique. These results are achieved without altering the duration, or compromising the effectiveness and safety, of the procedure. The zero X-ray ablation approach is a feasible and safe alternative to fluoroscopy, which is often only used in selected cases for troubleshooting. The non-fluoroscopic approach is considered a milestone for cancer prevention in ablation procedures.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marzia Giaccardi
- Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
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10
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Atrial fibrillation ablation strategies and technologies: past, present, and future. Clin Res Cardiol 2020; 110:775-788. [DOI: 10.1007/s00392-020-01751-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/30/2020] [Indexed: 12/31/2022]
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Adenosine and the Cardiovascular System: The Good and the Bad. J Clin Med 2020; 9:jcm9051366. [PMID: 32384746 PMCID: PMC7290927 DOI: 10.3390/jcm9051366] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022] Open
Abstract
Adenosine is a nucleoside that impacts the cardiovascular system via the activation of its membrane receptors, named A1R, A2AR, A2BR and A3R. Adenosine is released during hypoxia, ischemia, beta-adrenergic stimulation or inflammation and impacts heart rhythm and produces strong vasodilation in the systemic, coronary or pulmonary vascular system. This review summarizes the main role of adenosine on the cardiovascular system in several diseases and conditions. Adenosine release participates directly in the pathophysiology of atrial fibrillation and neurohumoral syncope. Adenosine has a key role in the adaptive response in pulmonary hypertension and heart failure, with the most relevant effects being slowing of heart rhythm, coronary vasodilation and decreasing blood pressure. In other conditions, such as altitude or apnea-induced hypoxia, obstructive sleep apnea, or systemic hypertension, the adenosinergic system activation appears in a context of an adaptive response. Due to its short half-life, adenosine allows very rapid adaptation of the cardiovascular system. Finally, the effects of adenosine on the cardiovascular system are sometimes beneficial and other times harmful. Future research should aim to develop modulating agents of adenosine receptors to slow down or conversely amplify the adenosinergic response according to the occurrence of different pathologic conditions.
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Ota T, Degani A, Zubiate B, Wolf A, Choset H, Schwartzman D, Zenati MA. Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 1:335-340. [PMID: 17895961 PMCID: PMC1993852 DOI: 10.1097/imi.0b013e31802f43b1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. Methods In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. Results Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. Conclusions We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype.
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Affiliation(s)
- Takeyoshi Ota
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amir Degani
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Brett Zubiate
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Alon Wolf
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Howie Choset
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - David Schwartzman
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marco A. Zenati
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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FEM-based elasticity reconstruction using ultrasound for imaging tissue ablation. Int J Comput Assist Radiol Surg 2018; 13:885-894. [PMID: 29666974 DOI: 10.1007/s11548-018-1714-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Success of ablation treatment depends on the accurate placement of the target ablation focus and the complete destruction of the pathological tissue. Thus, monitoring the formation, location, and size of the ablated lesion is essential. As ablated tissue gets stiffer, an option for ablation monitoring is ultrasound elastography, for imaging the tissue mechanical properties. Reconstruction of elasticity distribution can be achieved by solving an inverse problem from observed displacements, based on a deformable tissue model, commonly discretized by the finite element method (FEM). However, available reconstruction techniques are prone to noise and may achieve suboptimal accuracy. METHODS We propose a novel inverse problem formulation and elasticity reconstruction method, in which both the elasticity parameters and the model displacements are estimated as independent parameters of an unconstrained optimization problem. Total variation regularization of spatial elasticity distribution is introduced in this formulation, providing robustness to noise. RESULTS Our approach was compared to state of the art direct and iterative harmonic elastography techniques. We employed numerical simulation studies using various noise and inclusion contrasts, given multiple excitation frequencies. Compared to alternatives, our method leads to a decrease in RMSE of up to 50% and an increase in CNR of up to 11 dB in numerical simulations. The methods were also compared on an ex vivo bovine liver sample that was locally subjected to ablation, for which improved lesion delineation was obtained with our proposed method. Our method takes [Formula: see text] for [Formula: see text] reconstruction grid. CONCLUSIONS We present a novel FEM problem formulation that improves reconstruction accuracy and inclusion delineation compared to currently available techniques.
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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, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, 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. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 694] [Impact Index Per Article: 115.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and 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
| | - 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, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and 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 and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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Melby DP. Catheter Ablation of Atrial Fibrillation: A Review of the Current Status and Future Directions. J Innov Card Rhythm Manag 2017; 8:2907-2917. [PMID: 32477760 PMCID: PMC7252758 DOI: 10.19102/icrm.2017.081101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/19/2017] [Indexed: 11/20/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias encountered in clinical practice today. Over the last 20 years, the frequency of use of catheter ablation to treat AF has grown, commensurate with the rise in arrhythmia burden and via a number of technical advancements. These developments can be divided into new techniques for myocardial ablation, improvements in the understanding of AF trigger mechanisms, and advancements in atrial mapping. Progress in these fields has led to a fundamental change in daily practice, and has contributed to a rise, for ablation, from a procedure performed infrequently at select centers to one that is commonplace worldwide. In this article, the data and methods leading to this fundamental change will be presented and discussed.
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Affiliation(s)
- Daniel P Melby
- Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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17
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Carrizo AG, Morillo CA. Catheter Ablation as First-Line Therapy for Atrial Fibrillation: Ready for Prime-Time? Curr Cardiol Rep 2017; 18:71. [PMID: 27300744 DOI: 10.1007/s11886-016-0747-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Current guidelines include atrial fibrillation (AF) catheter ablation as part of the management strategy in patients that have failed at least one oral antiarrhythmic drug treatment course. However, growing evidence derived from both randomized and non-randomized studies demonstrate lower rates of AF recurrence and AF burden in patients with paroxysmal AF that are naïve to antiarrhythmic drug treatment. Furthermore, progression from paroxysmal AF to persistent AF appears to be delayed by early catheter ablation of AF. The current review addresses the question of the best timing for ablation in patients with paroxysmal AF and provides the rationale for offering AF ablation as first-line therapy based on the most updated evidence available.
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Affiliation(s)
- Aldo G Carrizo
- Arrhythmia & Pacing Service, Hamilton Health Science, McMaster University, 237 Barton St East. David Braley CVSRI, Room 3C-120, Hamilton, ON, Canada, L8L 2X2
| | - Carlos A Morillo
- Department of Medicine, Arrhythmia & Pacing Service, Hamilton Health Science, McMaster University, Hamilton, ON, Canada, L8L 2X2. .,Population Health Research Institute, David Braley CVSRI, Room 3C-120, Hamilton, ON, Canada, L8L 2X2.
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18
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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, Davies DW, Day JD, d’Avila A, de Groot N(N, 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. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1347] [Impact Index Per Article: 192.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and 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
| | - 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, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and 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 and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
The prevalence of atrial fibrillation (AF) has risen significantly over the past two decades. Catheter ablation is an increasingly utilized treatment strategy and has evolved significantly over the same time period. Successful ablation improves patient symptoms, reduces stroke risk, and can preserve or improve cardiac function. Recurrences following ablation can occur, particularly in patients with persistent AF. Procedural efficacy can best be improved through continued advancements in ablation technology and strategy, better understanding of the mechanisms of AF initiation and perpetuation, and rigorous integration of ablation into a multidisciplinary AF management approach.
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Affiliation(s)
| | - Fred Morady
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109; ,
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21
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Abstract
Background Over the past decade, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has evolved into a frequently performed procedure. The aim of this study was to monitor changes in patient characteristics, procedural characteristics, outcomes and complications over the past 10 years. Methods All consecutive patients who underwent primary RFCA treatment of AF in the University Medical Center Utrecht from 2005–2015 were included. In all patients, the primary ablation strategy was pulmonary vein (PV) antrum isolation without additional substrate modification. Baseline patient and procedure characteristics, and 1‑year follow-up data of 975 patients were prospectively collected. Results In 2005, 73.4% of patients suffered from paroxysmal AF, which decreased to 45.3% in 2014. Mean age increased from 54 ± 9 to 61 ± 10 years and CHA2DS2-VASc score ≥2 from 18 to 40.6%. History of AF decreased significantly from 7 to 4 years. Mean procedure duration was 237 ± 53 min in 2005 and 163 ± 41 min in 2014. Fluoroscopy time significantly decreased from 41 ± 17 to 19 ± 8 min and total radiation exposure from 465 (263–687) to 210 (118–376) mGy. One-year success remained similar (2005: 55.6%, 2014: 54.8%), as did the amount of PV reconnection observed during redo procedures. Due to a marked reduction in vascular complications and moderate PV stenosis, the total complication rate decreased significantly. Conclusion Over the past decade, AF ablation has increasingly been performed in older patients with persistent AF and more comorbidity. Moreover, it has been performed earlier after AF diagnosis. Although several performance parameters, such as procedure duration and complication rate, improved, 1‑year single procedure success remained unchanged.
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Catheter ablation of persistent atrial fibrillation : Circumferential pulmonary vein ablation: beneficial effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Herzschrittmacherther Elektrophysiol 2017; 28:328-334. [PMID: 28695373 DOI: 10.1007/s00399-017-0519-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/11/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Circumferential pulmonary vein ablation is still the standard approach in patients with persistent atrial fibrillation. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. METHODS A total of 125 patients with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). The long-term follow-up data was compared to 125 patients with similar clinical characteristics who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). RESULTS The ablation procedure could be performed as planned in all 250 patients. Three years after catheter ablation, the success rate was 72.0% (no arrhythmia recurrence in 90 out of 125 patients) in group A and 63.2% in group B (no arrhythmia recurrence in 79 out of 125 patients; P = 0.04). There were no major complications. CONCLUSIONS Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable long-term results than circumferential pulmonary vein ablation alone.
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Kettering K, Gramley F, von Bardeleben S. Catheter ablation of atrial fibrillation facilitated by preprocedural three-dimensional transesophageal echocardiography: Long-term outcome. World J Cardiol 2017; 9:539-546. [PMID: 28706589 PMCID: PMC5491471 DOI: 10.4330/wjc.v9.i6.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/30/2016] [Accepted: 04/20/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the long-term outcome of catheter ablation of atrial fibrillation (AF) facilitated by preprocedural three-dimensional (3-D) transesophageal echocardiography.
METHODS In 50 patients, 3D transesophageal echocardiography (3D TEE) was performed immediately prior to an ablation procedure (paroxysmal AF: 30 patients, persistent AF: 20 patients). The images were available throughout the ablation procedure. Two different ablation strategies were used. In most of the patients with paroxysmal AF, the cryoablation technique was used (Arctic Front Balloon, CryoCath Technologies/Medtronic; group A2). In the other patients, a circumferential pulmonary vein ablation was performed using the CARTO system [Biosense Webster; group A1 (paroxysmal AF), group B (persistent AF)]. Success rates and complication rates were analysed at 4-year follow-up.
RESULTS A 3D TEE could be performed successfully in all patients prior to the ablation procedure and all four pulmonary vein ostia could be evaluated in 84% of patients. The image quality was excellent in the majority of patients and several variations of the pulmonary vein anatomy could be visualized precisely (e.g., common pulmonary vein ostia, accessory pulmonary veins, varying diameter of the left atrial appendage and its distance to the left superior pulmonary vein). All ablation procedures could be performed as planned and almost all pulmonary veins could be isolated successfully. At 48-mo follow-up, 68.0% of all patients were free from an arrhythmia recurrence (group A1: 72.7%, group A2: 73.7%, group B: 60.0%). There were no major complications.
CONCLUSION 3D TEE provides an excellent overview over the left atrial anatomy prior to AF ablation procedures and these procedures are associated with a favourable long-term outcome.
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Kettering K, Yim DH, Benz A, Gramley F. Catheter ablation of paroxysmal atrial fibrillation: circumferential pulmonary vein ablation: success rates with and without exclusion of areas adjacent to the esophagus. Clin Res Cardiol 2017; 106:743-751. [PMID: 28492985 DOI: 10.1007/s00392-017-1118-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 04/18/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory paroxysmal atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. The occurrence of an atrioesophageal fistula is a rare but life-threatening complication after such ablation procedures. This is due to the fact that the esophagus does frequently have a very close anatomical relationship to the left or right pulmonary vein ostia. The aim of our study was to evaluate whether the exclusion of areas adjacent to the esophagus does have a significant effect on the success rate after circumferential pulmonary vein ablation. METHODS Two hundred consecutive patients [121 men, 69 women; mean age 59.1 years (SD ± 11.3 years)] with symptomatic paroxysmal atrial fibrillation underwent a circumferential pulmonary vein ablation procedure (using the CARTO- or the NAVX-system). In 100 patients, a complete circumferential pulmonary vein ablation was attempted regardless of the anatomical relationship between the ablation sites and the esophagus (group A). In the remaining 100 patients, the esophagus was marked by a special EP catheter and areas adjacent to the esophagus were excluded from the ablation procedure. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 9, 12, 24 and 36 months after the ablation procedure. RESULTS The ablation procedure could be performed as planned in all 200 patients. In group A, all pulmonary veins could be isolated successfully in 88 out of 100 patients (88%). A mean number of 3.9 pulmonary veins (SD ± 0.37 PVs) were isolated per patient. The 12 cases of an incomplete pulmonary vein isolation were due to poorly accessible pulmonary vein ostia. In group B, all pulmonary veins could be isolated successfully in only 58 out of 100 patients (58%; P < 0.01). A mean number of 3.5 PVs (SD ± 0.6 PVs) were isolated per patient (P < 0.01). This was mostly due to a close anatomical relationship to the esophagus. The ablation strategy had to be modified in 46/100 patients in group B because of a close anatomical relationship between the right (n = 25) or left (n = 21) pulmonary vein ostia and the esophagus. One year after the ablation procedure, 87% of patients in group A (87/100) and 79% of patients in group B (79/100) were free from an arrhythmia recurrence (P = 0.19). Three years after catheter ablation, the success rate was 80% (no arrhythmia recurrence in 80 out of 100 patients) in group A and 66% in group B (no arrhythmia recurrence in 66 out of 100 patients; P = 0.04). There were no major complications during long-term follow-up. CONCLUSIONS The exclusion of areas adjacent to the esophagus results in a markedly higher percentage of incompletely isolated pulmonary veins after circumferential pulmonary vein ablation procedures. This results in a significantly higher arrhythmia recurrence rate during long-term follow-up.
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Affiliation(s)
- Klaus Kettering
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Dag-Hau Yim
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Alexander Benz
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Felix Gramley
- HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany
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Kettering K, Gramley F. Catheter ablation of persistent atrial fibrillation : Beneficial effect of a short-term adjunctive amiodarone therapy on the long-term outcome. Herzschrittmacherther Elektrophysiol 2017; 29:133-140. [PMID: 28447159 DOI: 10.1007/s00399-017-0498-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Catheter ablation has become the first line therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favorable (especially in patients with persistent atrial fibrillation). Therefore, more complex ablation strategies and the usefulness of (short-term) adjunctive antiarrhythmic drug therapy are a matter of discussion. The aim of this study was to analyze whether short-term amiodarone therapy after catheter ablation (3 months) has a positive effect on the success rates after circumferential pulmonary vein ablation in patients with persistent atrial fibrillation. METHODS A total of 230 consecutive patients with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure (using the NAVX or CARTO system). Catheter ablation of the right or left atrial isthmus and a linear lesion in the roof of the left atrium were only performed in selected patients with documented episodes of atrial fibrillation. In 115 patients, a short-term adjunctive antiarrhythmic drug therapy with amiodarone was initiated immediately prior to the ablation procedure (for the first 3 months group A). In the remaining 115 patients, no antiarrhythmic drug therapy was administered except for beta blockers (group B). RESULTS Out of 115 patients 19 (16.5%) in group A and 34 (29.6%) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring electrical cardioversion (P = 0.03; blanking period). One year after the ablation procedure 81.7% of patients in group A (94/115) and 73.0% of patients in group B (84/115) were free from further arrhythmia recurrences (P = 0.16). The success rate 2 years after catheter ablation was 76.5% (no arrhythmia recurrence in 88/115 patients) in group A and 63.5% in group B (no arrhythmia recurrence in 73/115 patients; P = 0.04). There were no major complications during long-term follow-up. CONCLUSION Adjunctive short-term amiodarone therapy improves the success rate after catheter ablation of persistent atrial fibrillation during long-term follow-up. This might be due to a decreased incidence of early arrhythmia recurrences after catheter ablation of atrial fibrillation and an improved reverse remodelling process.
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Affiliation(s)
- Klaus Kettering
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Felix Gramley
- Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany
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Kettering K, Yim DH, Albert C, Gramley F. Catheter ablation of persistent atrial fibrillation : Long-term results of circumferential pulmonary vein ablation in combination with a linear lesion at the roof of the left atrium. Herzschrittmacherther Elektrophysiol 2017; 28:403-408. [PMID: 28439660 DOI: 10.1007/s00399-017-0499-x] [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: 01/10/2017] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. However, catheter ablation of persistent atrial fibrillation is still a challenge. Various relatively complex ablation strategies exist and their results are not very favorable. Therefore, the aim of our study was to evaluate a well-defined reasonable approach to catheter ablation of persistent atrial fibrillation. The strategy consisted of a circumferential pulmonary vein ablation in combination with a linear lesion at the roof of the left atrium. METHODS A total of 150 patients with symptomatic persistent atrial fibrillation were enrolled in this study. All patients underwent catheter ablation of persistent atrial fibrillation using the abovementioned approach. RESULTS The ablation procedure could be performed as planned in all 150 patients. Five years after catheter ablation, the success rate was 71.3% (no arrhythmia recurrence in 107 out of 150 patients). There were no major complications during long-term follow-up. CONCLUSION Catheter ablation of persistent atrial fibrillation can be performed safely and effectively using this ablation strategy providing favorable long-term follow-up results.
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Affiliation(s)
- Klaus Kettering
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Dag-Hau Yim
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Caroline Albert
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Felix Gramley
- HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany
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Kettering K, Gramley F. Radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique : Long-term outcome. Herzschrittmacherther Elektrophysiol 2017; 28:225-231. [PMID: 28243805 DOI: 10.1007/s00399-017-0493-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). Cryoablation has been shown to be a safe and effective technique for pulmonary vein (PV) isolation. However, the arrhythmia recurrence rate is high after cryoablation procedures. Radiofrequency catheter ablation has been shown to be an effective strategy for redo procedures in these patients and to provide a favourable outcome during midterm follow-up. The aim of this study was to analyse whether the strategy also provides favourable results during long-term follow-up (5 years). METHODS In this study 30 patients (paroxysmal AF: 22 patients, persistent AF: 8 patients) underwent a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (Arctic Front Balloon, Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster, Diamond Bar, CA, USA) depending on the intraprocedural findings. RESULTS During the repeat procedure, a mean number of 2.9 reconnected PV (SD ± 1.0) were detected. In 20 patients, a segmental approach was sufficient to eliminate the residual PV conduction because only a few PV fibres were recovered (1-3 reconnected PV; group A). In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the pulmonary vein - left atrial (PV-LA) conduction (group B). All reconnected PV were isolated successfully again. A third or fourth ablation procedure had to be performed in 4 (3 and 1, respectively) patients (13.3%). At 5‑year follow-up, 66.7% of all patients were free from an arrhythmia recurrence (20 out of 30). There were no major complications during long-term follow-up. CONCLUSION In patients with an initial circumferential PV isolation using the cryoballoon technique, a repeat ablation procedure can be safely and effectively performed using radiofrequency catheter ablation providing good long-term follow-up results.
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Affiliation(s)
- Klaus Kettering
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Felix Gramley
- HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany
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Han X, Li J. Catheter Ablation of Atrial Fibrillation: Where Are We? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kirchhof P, Calkins H. Catheter ablation in patients with persistent atrial fibrillation. Eur Heart J 2017; 38:20-26. [PMID: 27389907 PMCID: PMC5353871 DOI: 10.1093/eurheartj/ehw260] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/29/2016] [Accepted: 06/01/2016] [Indexed: 12/29/2022] Open
Abstract
Catheter ablation is increasingly offered to patients who suffer from symptoms due to atrial fibrillation (AF), based on a growing body of evidence illustrating its efficacy compared with antiarrhythmic drug therapy. Approximately one-third of AF ablation procedures are currently performed in patients with persistent or long-standing persistent AF. Here, we review the available information to guide catheter ablation in these more chronic forms of AF. We identify the following principles: Our clinical ability to discriminate paroxysmal and persistent AF is limited. Pulmonary vein isolation is a reasonable and effective first approach for catheter ablation of persistent AF. Other ablation strategies are being developed and need to be properly evaluated in controlled, multicentre trials. Treatment of concomitant conditions promoting recurrent AF by life style interventions and medical therapy should be a routine adjunct to catheter ablation of persistent AF. Early rhythm control therapy has a biological rationale and trials evaluating its value are underway. There is a clear need to generate more evidence for the best approach to ablation of persistent AF beyond pulmonary vein isolation in the form of adequately powered controlled multi-centre trials.
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Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, IBR, Room # 136, Birmingham B15 2TT, UK
- SWBH and UHB NHS Trusts, Birmingham, UK
- Atrial Fibrillation NETwork (AFNET), Münster, Germany
- Department of Cardiovascular Medicine, Hospital of the University of Münster, Münster, Germany
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Starek Z, Lehar F, Jez J, Scurek M, Wolf J, Kulik T, Zbankova A, Novak M. Three-dimensional rotational angiography of the left atrium and the oesophagus: the short-term mobility of the oesophagus and the stability of the fused three-dimensional model of the left atrium and the oesophagus during catheter ablation for atrial fibrillation. Europace 2016; 19:1310-1316. [DOI: 10.1093/europace/euw187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/28/2016] [Indexed: 11/14/2022] Open
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Molina CE, Heijman J, Dobrev D. Differences in Left Versus Right Ventricular Electrophysiological Properties in Cardiac Dysfunction and Arrhythmogenesis. Arrhythm Electrophysiol Rev 2016; 5:14-9. [PMID: 27403288 DOI: 10.15420/aer.2016.8.2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A wide range of ion channels, transporters, signaling pathways and tissue structure at a microscopic and macroscopic scale regulate the electrophysiological activity of the heart. Each region of the heart has optimised these properties based on its specific role during the cardiac cycle, leading to well-established differences in electrophysiology, Ca(2+) handling and tissue structure between atria and ventricles and between different layers of the ventricular wall. Similarly, the right ventricle (RV) and left ventricle (LV) have different embryological, structural, metabolic and electrophysiological features, but whether interventricular differences promote differential remodeling leading to arrhythmias is not well understood. In this article, we will summarise the available data on intrinsic differences between LV and RV electrophysiology and indicate how these differences affect cardiac function. Furthermore, we will discuss the differential remodeling of both chambers in pathological conditions and its potential impact on arrhythmogenesis.
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Affiliation(s)
- Cristina E Molina
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Jordi Heijman
- Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
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Stárek Z, Lehar F, Jež J, Žbánková A, Kulík T, Wolf J, Novák M. Long-term mobility of the esophagus in patients undergoing catheter ablation of atrial fibrillation: data from computer tomography and 3D rotational angiography of the left atrium. J Interv Card Electrophysiol 2016; 46:81-7. [PMID: 26971333 DOI: 10.1007/s10840-016-0121-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Computed tomography (CT) and 3D rotational angiography (3DRA) of the left atrium (LA) are used to evaluate the esophagus prior to radiofrequency ablation for atrial fibrillation. The aim of this study was to compare preprocedural and periprocedural views of the esophagus and the left atrium. METHODS From September 2011 to August 2012, 3DRA and CT of the LA were performed on 56 patients before they underwent catheter ablation of atrial fibrillation. The 3DRA was performed periprocedurally, and the CT was performed an average of 20 days prior to the procedure. 3D models of the LA and the esophagus were then segmented on the EP Navigator V 3.1 workstation. Five positions of the esophagus, A-E, in order from left to right, were evaluated. RESULTS The most common position of the esophagus was behind the left part of the LA (CT, position B (n = 26)) and behind the central part of the LA (3DRA, position C (n = 21)). The maximum shift of the esophagus was three positions, and the average shift was 0.857 ± 0.766 of a position. There was a shift of one position in 44.6 % of the patients, two positions in 17.9 %, and three positions in 1.8 %. A statistically significant difference was found between the positions of the esophagus when the 3DRA and CT evaluations were compared. CONCLUSIONS The most common position of the esophagus was behind the middle and left part of the LA. The outpatient views of the esophagus obtained before ablation did not reflect the position of the esophagus at the beginning of the procedure.
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Affiliation(s)
- Zdeněk Stárek
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic. .,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic.
| | - František Lehar
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Jiří Jež
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Alena Žbánková
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Tomáš Kulík
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Jiří Wolf
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Miroslav Novák
- International Clinical Research Center, 1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
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Rosenheck S. Paroxysmal atrial fibrillation ablation: Where and what to ablate. Heart Rhythm 2015; 12:1925-6. [PMID: 26001506 DOI: 10.1016/j.hrthm.2015.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Indexed: 10/23/2022]
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Cappato R, Marchlinski FE, Hohnloser SH, Naccarelli GV, Xiang J, Wilber DJ, Ma CS, Hess S, Wells DS, Juang G, Vijgen J, Hügl BJ, Balasubramaniam R, De Chillou C, Davies DW, Fields LE, Natale A. Uninterrupted rivaroxaban vs. uninterrupted vitamin K antagonists for catheter ablation in non-valvular atrial fibrillation. Eur Heart J 2015; 36:1805-11. [PMID: 25975659 PMCID: PMC4508487 DOI: 10.1093/eurheartj/ehv177] [Citation(s) in RCA: 320] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/24/2015] [Indexed: 12/03/2022] Open
Abstract
Aims VENTURE-AF is the first prospective randomized trial of uninterrupted rivaroxaban and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) undergoing catheter ablation (CA). Methods and results Trial size was administratively set at 250, the protocol-specified target. Events were independently and blindly adjudicated. We randomly assigned 248 NVAF patients to uninterrupted rivaroxaban (20 mg once-daily) or to an uninterrupted VKA prior to CA and for 4 weeks afterwards. The primary endpoint was major bleeding events after CA. Secondary endpoints included thromboembolic events (composite of stroke, systemic embolism, myocardial infarction, and vascular death) and other bleeding or procedure-attributable events. Patients were 59.5 ± 10 years of age, 71% male, 74% paroxysmal AF, and had a CHA2DS2-VASc score of 1.6. The average total heparin dose used to manage activated clotting time (ACT) was slightly higher (13 871 vs. 10 964 units; P < 0.001) and the mean ACT level attained slightly lower (302 vs. 332 s; P < 0.001) in rivaroxaban and VKA arms, respectively. The incidence of major bleeding was low (0.4%; 1 major bleeding event). Similarly, thromboembolic events were low (0.8%; 1 ischemic stroke and 1 vascular death). All events occurred in the VKA arm and all after CA. The number of any adjudicated events (26 vs. 25), any bleeding events (21 vs. 18), and any other procedure-attributable events (5 vs. 5) were similar. Conclusion In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy. Name of the Trial Registry Clinicaltrials.gov trial registration number is NCT01729871.
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Affiliation(s)
- Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy Gavazzeni Hospital, Second Arrhythmia and EP Unit, Bergamo, Italy
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stefan H Hohnloser
- Department of Cardiology, Division of Clinical Electrophysiology, JW Goethe University, Frankfurt, Germany
| | - Gerald V Naccarelli
- Heart and Vascular Institute, Penn State University College of Medicine, Hershey, PA, USA
| | - Jim Xiang
- Biostatistics and Programming, Janssen Research & Development, LLC, Raritan, NJ, USA
| | - David J Wilber
- Department of Medicine, Cardiovascular Institute, Loyola University, Chicago, IL, USA
| | - Chang-Sheng Ma
- Cardiology Division, Beijing AnZhen Hospital, Capital Medical University (CMU), Beijing, China
| | - Susanne Hess
- Medical Affairs, Bayer Healthcare Pharmaceuticals, Berlin, Germany
| | - Darryl S Wells
- Cardiac Electrophysiology, Swedish Heart & Vascular Institute, Seattle, WA, USA
| | - George Juang
- Heart and Arrhythmia Care of New York, Manhasset, NY, USA
| | - Johan Vijgen
- Division of Cardiac Electrophysiology, Jessa Hospitals, Hasselt, Belgium
| | - Burkhard J Hügl
- Department of Cardiology and Rhythmology, Marienhaus Klinikum St. Elisabeth, Neuwied, Germany
| | | | | | - D Wyn Davies
- Waller Department of Cardiology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom
| | - L Eugene Fields
- Medical Affairs, Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX 78705, USA
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Starek Z, Lehar F, Jez J, Wolf J, Novák M. Hybrid therapy in the management of atrial fibrillation. Curr Cardiol Rev 2015; 11:167-79. [PMID: 25028165 PMCID: PMC4356725 DOI: 10.2174/1573403x10666140713172231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/02/2014] [Accepted: 07/11/2014] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation is the most common sustained arrhythmia. Because of the sub-optimal outcomes and associated risks of medical therapy as well as the recent advances in non-pharmacologic strategies, a multitude of combined (hybrid) algorithms have been introduced that improve efficacy of standalone therapies while maintaining a high safety profile. Antiarrhythmic administration enhances success rate of electrical cardioversion. Catheter ablation of antiarrhythmic drug-induced typical atrial flutter may prevent recurrent atrial fibrillation. Through simple ablation in the right atrium, suppression of atrial fibrillation may be achieved in patients with previously ineffective antiarrhythmic therapy. Efficacy of complex catheter ablation in the left atrium is improved with antiarrhythmic drugs. Catheter ablation followed by permanent pacemaker implantation is an effective and safe treatment option for selected patients. Additional strategies include pacing therapies such as atrial pacing with permanent pacemakers, preventive pacing algorithms, and/or implantable dual-chamber defibrillators are available. Modern hybrid strategies combining both epicardial and endocardial approaches in order to create a complex set of radiofrequency lesions in the left atrium have demonstrated a high rate of success and warrant further research. Hybrid therapy for atrial fibrillation reviews history of development of non-pharmacological treatment strategies and outlines avenues of ongoing research in this field.
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Affiliation(s)
| | | | | | | | - Miroslav Novák
- International Clinical Research Center, 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital Brno, Pekarska 53, 656 91 Brno, Czech Republic.
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Jiang Md CY, Jiang Ms RH. Improvements In AF Ablation Outcome Will Be Based More On Technological Advancement Versus Mechanistic Understanding. J Atr Fibrillation 2014; 7:1120. [PMID: 27957107 DOI: 10.4022/jafib.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is one of the most common cardiac arrhythmias. Catheter ablation has proven more effective than antiarrhythmic drugs in preventing clinical recurrence of AF, however long-term outcome remains unsatisfactory. Ablation strategies have evolved based on progress in mechanistic understanding, and technologies have advanced continuously. This article reviews current mechanistic concepts and technological advancements in AF treatment, and summarizes their impact on improvement of AF ablation outcome.
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Affiliation(s)
- Chen-Yang Jiang Md
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ru-Hong Jiang Ms
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Anselmino M, Ferraris F, Cerrato N, Barbero U, Scaglione M, Gaita F. Left persistent superior vena cava and paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2014; 15:647-52. [DOI: 10.2459/jcm.0000000000000144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Šedivá L, Petrů J, Škoda J, Janotka M, Chovanec M, Reddy V, Neužil P. Visually guided laser ablation: a single-centre long-term experience. Europace 2014; 16:1746-51. [PMID: 25031237 DOI: 10.1093/europace/euu168] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Durable isolation of the pulmonary veins (PVs) remains the cornerstone of treatment for paroxysmal atrial fibrillation (PAF) and is also used in the treatment of some patients with persistent atrial fibrillation. Visually guided laser ablation (VGLA) has been proven to be safe and effective as a treatment for atrial fibrillation (AF). It has shown high levels of durable PV isolation (PVI), even in the hands of less experienced users. This paper presents the long-term clinical outcomes of all patients treated with VGLA over the course of 4 years in the world's most experienced centre: from early product feasibility work treating only PAF patients to our work using the commercially available product, when we also treated persistent AF patients. METHODS AND RESULTS One hundred and ninety-four patients (63 females, mean age 61 years) with either a history of drug-refractory PAF (time since initial diagnosis: 60.73 months) or persistent AF (time since initial diagnosis: 62.75 months) were treated in our laboratory with VGLA between 7 January 2009 and 17 May 2013. Follow-up of all patients was consistent with our standard clinical practice with a 7-day Holter being performed at the first clinical visit between 4 and 6 months and, for most patients, again at 12 months post-procedure. Twelve lead electrocardiograms were performed at all clinical visits. Recurrence of AF is defined as any documented AF episode >30 s. Acute procedural results show that 692 veins were acutely isolated with a mean procedure and fluoroscopy time of 226 and 20.4 min, respectively. One hundred and seventy (158 PAF and 12 persistent AF) patients reached 1 year of follow-up, 130 (82.3%) patients remained free of AF in the PAF group, and 9 (75%) in the persistent group. Eighty-seven PAF patients have now reached 24 months follow-up and 66 (75.9%) remain free of AF. Fifty-four PAF patients have reached 36 months follow-up with 41 (75.9%) remaining free of AF. Thirty-two PAF patients have reached 48 months follow-up and 24 (75%) remain free of AF. The peri-procedural complications we encountered were phrenic nerve injury in four patients (2.06%), tamponade or pericardial effusion in one patient (0.51%), stroke or transient ischaemic attack in one patient (0.514%), and vascular injury in six patients (3.09%). We experienced no cases of PV stenosis or atrio-oesophageal fistula. CONCLUSION Our single-centre experience using VGLA over 4 years shows that it can be used safely and effectively in normal clinical practice and gives high levels of acute PVI accompanied by good clinical outcomes, even after long-term follow-up.
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Affiliation(s)
- Lucie Šedivá
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
| | - Jan Petrů
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
| | - Jan Škoda
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
| | - Marek Janotka
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
| | - Milan Chovanec
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
| | - Vivek Reddy
- Department of Cardiology, Mount Sinai Hospital, New York 150 00, USA
| | - Petr Neužil
- Department of Cardiology, Na Homolce Hospital, Roentgenova 2, Prague 5 150 30, Czech Republic
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Effects of the Selective KACh Channel Blocker NTC-801 on Atrial Fibrillation in a Canine Model of Atrial Tachypacing. J Cardiovasc Pharmacol 2014; 63:421-7. [DOI: 10.1097/fjc.0000000000000065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vandecasteele T, Vandevelde K, Doom M, Van Mulken E, Simoens P, Cornillie P. The Pulmonary Veins of the Pig as an Anatomical Model for the Development of a New Treatment for Atrial Fibrillation. Anat Histol Embryol 2013; 44:1-12. [DOI: 10.1111/ahe.12099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- T. Vandecasteele
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - M. Doom
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - E. Van Mulken
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Simoens
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Cornillie
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
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Spragg DD, Khurram I, Nazarian S. Role of Magnetic Resonance Imaging of Atrial Fibrosis in Atrial Fibrillation Ablation. Arrhythm Electrophysiol Rev 2013; 2:124-7. [PMID: 26835053 DOI: 10.15420/aer.2013.2.2.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 10/14/2013] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) likely involves a complex interplay between triggering activity, usually from pulmonary vein foci, and maintenance of the arrhythmia by an arrhythmogenic substrate. Both components of AF, triggers and substrate have been linked to atrial fibrosis and attendant changes in atrial electrophysiology. Recently, there has been a growing use of imaging modalities, particularly cardiac magnetic resonance (CMR), to quantify the burden of atrial fibrosis and scar in patients either undergoing AF ablation, or who have recently had the procedure. How to use the CMR derived data is still an open area of investigation. The aim of this article is to summarise what is known as atrial fibrosis, as assessed by traditional catheter-based techniques and newer imaging approaches, and to report on novel efforts from our group to advance the use of CMR in AF ablation patients.
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Affiliation(s)
- David D Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
| | - Irfan Khurram
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, US
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Corradi D, Callegari S, Gelsomino S, Lorusso R, Macchi E. Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation. Part I: Atrial structures (atrial myocardium and coronary sinus). Int J Cardiol 2013; 168:1758-68. [DOI: 10.1016/j.ijcard.2013.05.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/22/2013] [Accepted: 05/04/2013] [Indexed: 12/21/2022]
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Moyer CB, Helm PA, Clarke CJ, Budge LP, Kramer CM, Ferguson JD, Norton PT, Holmes JW. Wall-motion based analysis of global and regional left atrial mechanics. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1765-1776. [PMID: 23708788 PMCID: PMC4427253 DOI: 10.1109/tmi.2013.2264062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial fibrillation is an increasingly prevalent cardiovascular disease; changes in atrial structure and function induced by atrial fibrillation and its treatments are often spatially heterogeneous. However, spatial heterogeneity of function is difficult to assess with standard imaging techniques. This paper describes a method to assess global and regional mechanical function by combining cardiac magnetic resonance imaging and finite-element surface fitting. We used this fitted surface to derive measures of left atrial volume, regional motion, and spatial heterogeneity of motion in 23 subjects, including healthy volunteers and atrial fibrillation patients. We fit the surfaces using a Newton optimization scheme in under 1 min on a standard laptop, with a root mean square error of 2.3 ± 0.5 mm, less than 9% of the mean fitted radius, and an inter-operator variability of less than 10%. Fitted surfaces showed clear definition of the phases of left atrial motion (filling, passive emptying, active contraction) in both volume-time and regional radius-time curves. Averaged surfaces of healthy volunteers and atrial fibrillation patients provided evidence of substantial regional variation in both amount and timing of regional motion, indicating spatial heterogeneity of function, even in healthy adults.
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Dewire J, Calkins H. Update on atrial fibrillation catheter ablation technologies and techniques. Nat Rev Cardiol 2013; 10:599-612. [DOI: 10.1038/nrcardio.2013.121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kettering K, Gramley F. Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation. World J Cardiol 2013; 5:280-287. [PMID: 24009817 PMCID: PMC3761181 DOI: 10.4330/wjc.v5.i8.280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/20/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.
METHODS: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure.
RESULTS: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications.
CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.
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Roten L, Derval N, Pascale P, Scherr D, Komatsu Y, Shah A, Ramoul K, Denis A, Sacher F, Hocini M, Haïssaguerre M, Jaïs P. Current hot potatoes in atrial fibrillation ablation. Curr Cardiol Rev 2013; 8:327-46. [PMID: 22920482 PMCID: PMC3492816 DOI: 10.2174/157340312803760802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 05/11/2012] [Accepted: 05/11/2012] [Indexed: 12/30/2022] Open
Abstract
Atrial fibrillation (AF) ablation has evolved to the treatment of choice for patients with drug-resistant and symptomatic AF. Pulmonary vein isolation at the ostial or antral level usually is sufficient for treatment of true paroxysmal AF. For persistent AF ablation, drivers and perpetuators outside of the pulmonary veins are responsible for AF maintenance and have to be targeted to achieve satisfying arrhythmia-free success rate. Both complex fractionated atrial electrogram (CFAE) ablation and linear ablation are added to pulmonary vein isolation for persistent AF ablation. Nevertheless, ablation failure and necessity of repeat ablations are still frequent, especially after persistent AF ablation. Pulmonary vein reconduction is the main reason for arrhythmia recurrence after paroxysmal and to a lesser extent after persistent AF ablation. Failure of persistent AF ablation mostly is a consequence of inadequate trigger ablation, substrate modification or incompletely ablated or reconducting linear lesions. In this review we will discuss these points responsible for AF recurrence after ablation and review current possibilities on how to overcome these limitations.
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Affiliation(s)
- Laurent Roten
- Hôpital Cardiologique du Haut-Lévêque and the Université Victor Segalen Bordeaux II, Bordeaux, France.
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Mathew S, Metzner A, Ouyang F, Kuck KH, Tilz RR. [Catheter ablation of paroxysmal atrial fibrillation. Optimal approach and result]. Herzschrittmacherther Elektrophysiol 2013; 24:7-14. [PMID: 23588966 DOI: 10.1007/s00399-013-0244-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/29/2013] [Indexed: 11/28/2022]
Abstract
The gold standard in ablation of paroxysmal atrial fibrillation (PAF) is radiofrequency (RF) based point by point pulmonary vein isolation (PVI). In the majority of patients with PAF (80 %) PVI can restore stable SR even during long-term follow-up of up to 5 years. However multiple procedures are often required. Cryo-balloon based PVI is an established technique. Safety and efficacy are comparable to RF ablation. Due to the high success rates in patients with PAF and the progression rate to persistent atrial fibrillation (AF) an early intervention is recommended as implemented in the latest guidelines for AF treatment.
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Affiliation(s)
- Shibu Mathew
- II. Medizinische Klinik, Klinik für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, Hamburg, Germany.
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Spragg D. Left Atrial Fibrosis: Role in Atrial Fibrillation Pathophysiology and Treatment Outcomes. J Atr Fibrillation 2013; 5:810. [PMID: 28496835 DOI: 10.4022/jafib.810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 01/07/2023]
Abstract
The mechanisms of atrial fibrillation are complex, and have been the subject of intensive study for over fifty years. There is likely a complex interplay between triggers and substrate that mediates the initiation and maintenance of AF. Increasingly, atrial fibrosis has been recognized as a key component of that substrate, playing a critical role in conduction abnormalities in the left atrium that appear necessary to maintaining AF. In the last several years, our abilities to quantify left atrial fibrosis - both through catheter- and MRI-based techniques - has shed important light on the underlying mechanisms of AF, and on therapeutic strategies to treat AF. Whether our increased appreciation of the role of atrial fibrosis in AF translates into improved efficacy of catheter ablation or anti-arrhythmic therapy, though, remains to be seen. The aim of this review is to summarize clinical investigations of atrial fibrosis as a factor in the development and treatment of atrial fibrillation.
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Affiliation(s)
- David Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Zhao X, Zhang J, Hu J, Liao D, Zhu Y, Mei X, Sheng J, Yuan F, Gui Y, Lu W, Dai L, Guo X, Xu Y, Zhang Y, He B, Liu Z. Pulmonary Antrum Radial–Linear Ablation for Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:310-7. [PMID: 23434517 DOI: 10.1161/circep.113.000196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xue Zhao
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Jiayou Zhang
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Jianqiang Hu
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Dening Liao
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Yinxiang Zhu
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Xiang Mei
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Jun Sheng
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Fang Yuan
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Yanping Gui
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Wenliang Lu
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Li Dai
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Xingui Guo
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Yawei Xu
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Yanzhou Zhang
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Ben He
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
| | - Zhenguo Liu
- From the Division of Cardiac Electrophysiology, Translational Medicine Center, Changzheng Hospital, Second Military Medical University, Shanghai, China (X.Z., J.Z., J.H., D.L., Y. Zhu, X.M., J.S., F.Y., Y.G.); Department of Cardiology, Huadong Hospital, Fudan University, Shanghai, China (W.L., L.D., X.G.); Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China (Y.X.); Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China (Y
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Pagana G, Galleani L, Gross S, Roch MR, Pastore E, Poggio M, Quaranta G. Time-frequency analysis of the endocavitarian signal in paroxysmal atrial fibrillation. IEEE Trans Biomed Eng 2012; 59:2838-44. [PMID: 22875240 DOI: 10.1109/tbme.2012.2211596] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We apply the time-frequency analysis to the endocavitarian signal of patients suffering from paroxysmal atrial fibrillation. The time-frequency spectrum reveals the components of the endocavitarian signal. These components are located in the regions of the time-frequency domain that differ for in-rhythm and in-atrial fibrillation signals. By using experimental data, we perform a statistical study of these regions, and we obtain their average value. The difference in the shape of these regions is caused by the re-entry circuits that characterize atrial fibrillation. We propose a propagation model for atrial fibrillation based on the re-entry circuits, which explains the shape of the time-frequency spectrum.
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