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Gaita F, Ferraris F, Anselmino M, Calò L. Atrial fibrillation fundamentals: from physiopathology to transcatheter ablation. Eur Heart J Suppl 2023; 25:C7-C11. [PMID: 37125271 PMCID: PMC10132612 DOI: 10.1093/eurheartjsupp/suad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Atrial fibrillation (AF) is a common and harmful arrhythmia. Its complex pathogenesis can be outlined using Coumel's Triangle, that considers at the base of AF three different factors: substrate, trigger, and catalyst factor. The triangle can serve as a guide to understand the mechanism of action of the different possible treatments. Anti-arrhythmic drug therapies have a modest efficacy and no proven benefit on prognosis. Interventional therapy is more effective, especially if employed in the first stages of the disease, and can reduce mortality in selected populations. Ablative schemes must be different depending on the type of AF (paroxysmal, persistent) and the presence or absence of atrial dilation.
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Affiliation(s)
- Fiorenzo Gaita
- Corresponding author. Tel: +39 011 633 6767, Fax: +39 011 633 6769,
| | - Federico Ferraris
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Roma, Italy
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2
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Kowlgi GN, Kapa S. Advances in Atrial Fibrillation Ablation: Energy Sources Here to Stay. Card Electrophysiol Clin 2021; 12:167-174. [PMID: 32451101 DOI: 10.1016/j.ccep.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Energy sources used for catheter ablation of atrial fibrillation (AF) ablation have undergone an exceptional journey over the past 50 years. Traditional energy sources, such as radiofrequency and cryoablation, have been the mainstay of AF ablation. Novel investigations have led to inclusion of other techniques, such as laser, high-frequency ultrasound, and microwave energy, in the armamentarium of electrophysiologists. Despite these modalities, AF has remained one of the most challenging arrhythmias. Advances in the understanding of electroporation promise to overcome the shortcomings of conventional energy sources. A thorough understanding of the biophysics and practical implications of the existing energy sources is paramount.
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Affiliation(s)
- Gurukripa N Kowlgi
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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3
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Ismail AS, Baghdady Y, Salem MA, Wahab AA. The use of MRI in quantification of the atrial fibrosis in patients with rheumatic mitral disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common type of arrhythmia with higher incidence in countries with increased prevalence of rheumatic heart disease (RHD), where AF contributes to significant morbidity and mortality in young population. Atrial fibrosis is a common feature of AF. Delayed enhancement MRI (DE-MRI) is a well-established method for characterizing fibrosis in ventricles. The use of DE-MRI to detect left atrial fibrosis helps to evaluate the extent of atrial structural remodeling non-invasively. The aim of this study is to evaluate the atrial fibrosis in patients with mitral valve disease, using the DE MRI, regarding its amount, distribution, and relation to AF.
Results
Patients with AF were older and have longer duration of symptoms, smaller valve area, larger LA size, and more fibrosis at the left atrium (with the posterior wall most frequently involved) in comparison to those with sinus rhythm. Patients with atrial fibrosis were older and have longer duration of symptoms, smaller valve area, and larger LA, and most of them had AF compared to those without fibrosis. The comparison between types of AF showed a significant difference in the amount of atrial fibrosis that increases across the spectrum of AF.
Conclusion
In patients with rheumatic mitral valve diseases, AF is associated with more atrial fibrosis as assessed by DE-MRI. Atrial fibrosis is the best independent predictor of AF.
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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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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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6
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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: 681] [Impact Index Per Article: 113.5] [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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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: 1293] [Impact Index Per Article: 184.7] [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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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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Li X, Salinet JL, Almeida TP, Vanheusden FJ, Chu GS, Ng GA, Schlindwein FS. An interactive platform to guide catheter ablation in human persistent atrial fibrillation using dominant frequency, organization and phase mapping. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 141:83-92. [PMID: 28241971 DOI: 10.1016/j.cmpb.2017.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Optimal targets for persistent atrial fibrillation (persAF) ablation are still debated. Atrial regions hosting high dominant frequency (HDF) are believed to participate in the initiation and maintenance of persAF and hence are potential targets for ablation, while rotor ablation has shown promising initial results. Currently, no commercially available system offers the capability to automatically identify both these phenomena. This paper describes an integrated 3D software platform combining the mapping of both frequency spectrum and phase from atrial electrograms (AEGs) to help guide persAF ablation in clinical cardiac electrophysiological studies. METHODS 30s of 2048 non-contact AEGs (EnSite Array, St. Jude Medical) were collected and analyzed per patient. After QRST removal, the AEGs were divided into 4s windows with a 50% overlap. Fast Fourier transform was used for DF identification. HDF areas were identified as the maximum DF to 0.25Hz below that, and their centers of gravity (CGs) were used to track their spatiotemporal movement. Spectral organization measurements were estimated. Hilbert transform was used to calculate instantaneous phase. RESULTS The system was successfully used to guide catheter ablation for 10 persAF patients. The mean processing time was 10.4 ± 1.5min, which is adequate comparing to the normal electrophysiological (EP) procedure time (120∼180min). CONCLUSIONS A customized software platform capable of measuring different forms of spatiotemporal AEG analysis was implemented and used in clinical environment to guide persAF ablation. The modular nature of the platform will help electrophysiological studies in understanding of the underlying AF mechanisms.
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Affiliation(s)
- Xin Li
- Department of Engineering, University of Leicester, UK; Department of Cardiovascular Science, University of Leicester, UK
| | - João L Salinet
- Biomedical Engineering, Center for Engineering, Modelling and Applied Social Sciences, Universidade Federal do ABC, Brazil; Bioengineering Division, Heart Institute (InCor), Brasil
| | - Tiago P Almeida
- Department of Engineering, University of Leicester, UK; Biomedical Engineering, Center for Engineering, Modelling and Applied Social Sciences, Universidade Federal do ABC, Brazil
| | | | - Gavin S Chu
- Department of Cardiovascular Science, University of Leicester, UK; University Hospitals of Leicester NHS Trust, UK
| | - G André Ng
- Department of Cardiovascular Science, University of Leicester, UK; University Hospitals of Leicester NHS Trust, UK; National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK
| | - Fernando S Schlindwein
- Department of Engineering, University of Leicester, UK; National Institute for Health Research Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, UK.
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Belhassen B, Michowitz Y. Unmasking right atrial fibrillation: A new indication of adenosine triphosphate test? Heart Rhythm 2015; 13:364-5. [PMID: 26476150 DOI: 10.1016/j.hrthm.2015.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Bernard Belhassen
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yoav Michowitz
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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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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Burnett LA, Kocheril AG. Putative Role of Right Atrial Ablation in Atrial Fibrillation. J Atr Fibrillation 2014; 6:1085. [PMID: 27957069 DOI: 10.4022/jafib.1085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Lindsey A Burnett
- College of Medicine, University of Illinois at Urbana Champaign, Urbana, IL
| | - Abraham G Kocheril
- College of Medicine, University of Illinois at Urbana Champaign, Urbana, IL; Christie Clinic, Champaign, IL; Presence Covenant Medical Center, Urbana, IL
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13
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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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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1130] [Impact Index Per Article: 94.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1284] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Anselmino M, D’Ascenzo F, Amoroso G, Ferraris F, Gaita F. History of transcatheter atrial fibrillation ablation. J Cardiovasc Med (Hagerstown) 2012; 13:1-8. [PMID: 22130041 DOI: 10.2459/jcm.0b013e32834ead59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jurkko R, Mäntynen V, Lehto M, Tapanainen JM, Montonen J, Parikka H, Toivonen L. Interatrial conduction in patients with paroxysmal atrial fibrillation and in healthy subjects. Int J Cardiol 2010; 145:455-60. [DOI: 10.1016/j.ijcard.2009.05.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 04/19/2009] [Accepted: 05/30/2009] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW The optimal treatments for atrial fibrillation have long been sought among rhythm control and rate control strategies. Unfortunately, rhythm control strategies with antiarrhythmic drugs have proven to be a disappointment. Catheter ablation techniques, however, have been rapidly advancing and have the potential to offer a permanent cure. Rhythm control with catheter ablation may in fact be a superior treatment modality for atrial fibrillation. The purpose of this review is to examine the evidence in favor of this argument. RECENT FINDINGS The dissatisfaction with poorly performing antiarrhythmic drug therapies for the treatment of atrial fibrillation has fueled the development of alternative therapies for rhythm control. Catheter ablation has emerged as a viable, efficacious, and safe alternative. In fact, in head to head comparisons with antiarrhythmic drugs, catheter ablation continues to come out on top with often markedly superior performances. In addition to efficacy and safety, catheter ablation also seems to be a fiscally viable alternative. SUMMARY On the basis of the outstanding performance of catheter ablation compared with antiarrhythmic drug therapy, it is not surprising to see its widespread adoption and ever expanding indications.
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Jurkko R, Mäntynen V, Tapanainen JM, Montonen J, Väänänen H, Parikka H, Toivonen L. Non-invasive detection of conduction pathways to left atrium using magnetocardiography: validation by intra-cardiac electroanatomic mapping. Europace 2008; 11:169-77. [PMID: 19074785 DOI: 10.1093/europace/eun335] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Alteration in conduction from right to left atrium (LA) is linked to susceptibility to atrial fibrillation (AF). We examined whether different inter-atrial conduction pathways can be identified non-invasively by magnetocardiographic mapping (MCG). METHODS AND RESULTS In 27 patients undergoing catheter ablation of paroxysmal AF, LA activation sequence was determined during sinus rhythm using invasive electroanatomic mapping. Before this, 99-channel magnetocardiography was recorded over anterior chest. The orientation of the magnetic fields during the early (40-70 ms from P onset) and later part (last 50%) of LA depolarization was determined using pseudocurrent conversion. Breakthrough of electrical activation to LA occurred through Bachmann bundle (BB) in 14, margin of fossa ovalis (FO) in 3, coronary sinus ostial region (CS) in 2, and their combinations in 10 cases by invasive reference in total of 29 different P-waves. Based on the combination of pseudocurrent angles over early and late parts of LA activation, the MCG maps were divided to three types. These types correctly identified the LA breakthrough sites to BB, CS, FO, or their combinations in 27 of 29 (93%) cases. CONCLUSION Magnetocardiographic mapping seems capable of distinguishing inter-atrial conduction pathways. Recognizing the inter-atrial conduction pattern may assist in understanding the pathogenesis of AF and identifying the subgroups for patient-tailored therapy.
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Affiliation(s)
- Raija Jurkko
- Department of Cardiology Helsinki University Central Hospital, Helsinki, Finland.
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CALÒ LEONARDO, DE RUVO ERMENEGILDO, SCIARRA LUIGI, GRICIA ROBERTO, NAVONE GIOVANNA, DE LUCA LUCIA, NUCCIO FRANCESCA, SETTE ANTONELLA, PRISTIPINO CRISTIAN, DULIO ALESSANDRO, GAITA FIORENZO, LIOY ERNESTO. Diagnostic Accuracy of a New Software for Complex Fractionated Electrograms Identification in Patients with Persistent and Permanent Atrial Fibrillation. J Cardiovasc Electrophysiol 2008; 19:1024-30. [DOI: 10.1111/j.1540-8167.2008.01219.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Melby SJ, Lee AM, Zierer A, Kaiser SP, Livhits MJ, Boineau JP, Schuessler RB, Damiano RJ. Atrial fibrillation propagates through gaps in ablation lines: implications for ablative treatment of atrial fibrillation. Heart Rhythm 2008; 5:1296-301. [PMID: 18774106 DOI: 10.1016/j.hrthm.2008.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 06/07/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND It has been hypothesized that atrial lesions must be transmural to successfully cure atrial fibrillation (AF). However, ablation lines often do not extend completely across the atrial wall. OBJECTIVE The purpose of this study was to determine the effect of residual gaps on conduction properties of atrial tissue. METHODS Canine right atria (n = 13) were isolated, perfused, and mounted on a 250-lead electrode plaque. The atria were divided with a bipolar radiofrequency ablation clamp, leaving a gap that was progressively narrowed. Conduction velocities at varying pacing rates and AF frequencies were measured before and after ablations. AF was induced with an extra stimulus and acetylcholine. RESULTS Gap widths from 11.2 to 1.1 mm were examined. Conduction velocities through gaps were dependent cycle length (P = .002) and gap size (P <.001). Overall, 253 (97%) of a total of 260 gaps allowed paced propagation; 51 (91%) of 56 gaps 1-3 mm in width permitted paced propagation, as did 202 (99%) of 204 gaps >or=3.0 mm. Similarly, 253 (97%) of a total of 260 gaps allowed propagation of AF. For AF, 51 (93%) of 55 gaps 1-3 mm allowed AF to pass through, as did 202 (99%) of 205 gaps >or=3.0 mm. Gaps as small as 1.1 mm conducted paced and AF impulses. CONCLUSIONS Conduction velocities were slowed through residual gaps. However, propagation of wave fronts during pacing and AF occurred through the majority of residual gaps, down to sizes as small as 1.1 mm. Leaving viable tissue in ablation lines for the treatment of AF could account for failures.
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Affiliation(s)
- Spencer J Melby
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis School of Medicine and Barnes Jewish Hospital, St. Louis, Missouri 63110, USA
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Mainardi L, Sörnmo L, Cerutti S. Understanding Atrial Fibrillation: The Signal Processing Contribution, Part II. ACTA ACUST UNITED AC 2008. [DOI: 10.2200/s00153ed1v01y200809bme025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pedrinazzi C, Durin O, Agricola P, Romagnoli P, Inama G. Efficacy and safety of radiofrequency catheter ablation in the elderly. J Interv Card Electrophysiol 2007; 19:179-85. [PMID: 17823861 DOI: 10.1007/s10840-007-9153-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 07/24/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Radiofrequency (RF) catheter ablation has not been widely undertaken in elderly patients. The aim of our study was to compare the success rate of radiofrequency ablation and the incidence of severe procedural complications in young-adult and elderly patients. METHODS We enrolled all patients undergoing radiofrequency catheter ablation procedures for supraventricular and ventricular arrhythmias at our Cardiology Department from January 2000 to December 2005. The patients were divided into two groups according to age: patients aged <70 years (group A) and those aged >or=70 years (group B). Group B was then divided into two subgroups: B1 (age 70-79 years) and B2 (age >or=80 years). We recorded the incidence of procedural complications and the long-term efficacy (mean follow-up 46 +/- 20 months). RESULTS We studied 605 patients, 69% in group A and 31% in group B (24% in subgroup B1 and 7% in B2). The prevalence of structural heart disease was higher in elderly patients than in young adults (83 vs 37%, p < 0.01). The rate of procedural complications was 1.3%; no differences emerged between groups A and B (1.2 vs 1.5%, p = NS) or among groups A, B1 and B2 (1.2 vs 1.4 vs 2%, p = NS). The success rate of catheter ablation was 91%, with no differences between the age-groups (92 vs 88%, p = NS) or among groups A, B1 and B2 (92 vs 88 vs 88%, p = NS). CONCLUSION Catheter ablation in elderly and very elderly patients is as effective and safe as in young-adult subjects, at least in cases which do not require left heart catheterization.
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Affiliation(s)
- Claudio Pedrinazzi
- Department of Cardiology, Ospedale Maggiore, l.go U. Dossena, 2, 26013, Crema, Italy
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Comas GM, Imren Y, Williams MR. An overview of energy sources in clinical use for the ablation of atrial fibrillation. Semin Thorac Cardiovasc Surg 2007; 19:16-24. [PMID: 17403453 DOI: 10.1053/j.semtcvs.2007.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2007] [Indexed: 12/15/2022]
Abstract
Recent years have seen many developments in the field of alternative energy sources for arrhythmia surgery. The impetus behind these advances is to replace the traditional, "cut-and-sew" Cox maze III procedure with lesion sets that are simpler, shorter, and safer but just as effective. There is demand for technology to make continuous, linear, transmural ablations reliably with a versatile energy source via an epicardial approach. This would make minimally invasive endoscopic surgical ablation of atrial fibrillation (AF) without cardiopulmonary bypass and with a closed chest feasible. These advances would shorten cardio-pulmonary bypass and improve outcomes in patients having surgical ablation and concomitant cardiac surgery. This review summarizes the technology behind alternative energy sources used to treat AF. Alternative energy sources include hypothermic sources (cryoablation) and hyperthermic sources (radiofrequency, microwave, laser, ultrasound). For each source, the biophysical background, mode of tissue injury, factors affecting lesion size, and advantages and complications are discussed.
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Affiliation(s)
- George M Comas
- Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Hornero F, Rodriguez I, Estevez V, Gil O, Canovas S, Garcia R, Leon JM. Analysis of the postoperative epicardial auriculogram after surgical ablation of atrial fibrillation: risk stratification of late recurrences. J Thorac Cardiovasc Surg 2007; 133:1493-8. [PMID: 17532946 DOI: 10.1016/j.jtcvs.2007.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 01/23/2007] [Accepted: 01/29/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Late recurrence of atrial fibrillation frequently occurs after atrial ablation. Risk stratification for success and recurrence of the antiarrhythmic surgical procedure has not yet been established. We studied postoperative epicardial unipolar auriculograms to distinguish between high- and low-risk patients with late recurrence of atrial fibrillation. METHODS Epicardial atrial fibrillatory activity was registered in 70 patients with surgical ablation of permanent atrial fibrillation and postoperative recurrence through the temporary wires. The atrial activation pattern was characterized in 3 groups (type I, II, and III) using Wells's criteria. The groups were homogeneous in the main clinical preoperative and surgical variables. RESULTS Mean atrial frequency of postoperative atrial fibrillation recurrence showed differences between groups: 225 +/- 53 ms in type I, 177 +/- 21 ms in type II, and 150 +/- 19 ms in type III (P < .01). At the end of the study, sinus rhythm was achieved in 80% of the subjects with type I, 87.5% with type II, and 23.8% with type III (P < .001). During follow-up, late atrial fibrillation recurred in 21.7% of patients with type I, 17.4% with type II, and 64.2% with auriculogram type III. In multivariate regression analysis, the postoperative auriculogram type III was the only predictor of late atrial fibrillation recurrence (odds ratio 15.6; 95% confidence interval, 3.2-74.7; P < .001). CONCLUSIONS The unipolar epicardial auriculogram was able to characterize the complexity of the postoperative fibrillatory process and also to identify patients with a high risk of late recurrence. Auriculogram type III had a low success rate for the intraoperative ablation procedure. The lines of the ablation procedure facilitated organization of the auriculograms.
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Affiliation(s)
- Fernando Hornero
- Department of Cardiac Surgery of Consorcio Hospital General Universitario de Valencia, Valencia University, Valencia, Spain.
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Ulphani JS, Arora R, Cain JH, Villuendas R, Shen S, Gordon D, Inderyas F, Harvey LA, Morris A, Goldberger JJ, Kadish AH. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Heart Circ Physiol 2007; 293:H1629-35. [PMID: 17545480 DOI: 10.1152/ajpheart.00139.2007] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the study was to investigate the morphology, distribution, and electrophysiological profile of the autonomic fibers that innervate the ligament of Marshall (LOM). Gross anatomical dissections were performed in 10 dogs. Sections of the left vagus nerve, left stellate ganglion, and the LOM were immunostained to identify adrenergic and cholinergic nerves. Hearts were also stained for acetylcholinesterase to identify epicardial cholinergic nerves. In vivo electrophysiological studies were performed in another 10 dogs before and after LOM ablation. The anatomical examination revealed that the LOM is innervated by a branch of the left vagus. Immunohistochemistry confirmed that these nerve bundles are predominantly cholinergic (cholinergic-to-adrenergic ratio of 12.6 +/- 3.9:1). Cholinergic nerves originating in the LOM were found to innervate surrounding left atrial structures, including the pulmonary veins, left atrial appendage, coronary sinus, and posterior left atrial fat pad. Ablation of the LOM significantly attenuated effective refractory period shortening at distant sites, such as pulmonary veins and left atrial appendage, in response to vagal stimulation (vagal-induced ERP decrease in the left atrium: baseline vs. postablation = 17 vs. 4%; P = 0.0056). In conclusion, the LOM contains a predominance of cholinergic nerve fibers. Cholinergic fibers arising from the LOM innervate surrounding structures and contribute to the electrophysiological profile of the left atrium. These findings may provide a basis for the role of the LOM in the genesis and maintenance of atrial fibrillation.
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Affiliation(s)
- Joseph S Ulphani
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Himel HD, Dumas JH, Kiser AC, Knisley SB. Translesion stimulus-excitation delay indicates quality of linear lesions produced by radiofrequency ablation in rabbit hearts. Physiol Meas 2007; 28:611-23. [PMID: 17664616 DOI: 10.1088/0967-3334/28/6/001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Failure of cardiac antiarrhythmic ablation to block action potential conduction produces poor outcomes which lead to repeat procedures. To overcome this, an intraoperative index of the quality of an ablation lesion is needed. We hypothesized that a rise in the translesion stimulus-excitation delay (TED) can indicate a continuous, transmural, linear lesion, and that the TED is related to the path length in the viable tissue around the lesion. Rabbit hearts were isolated, perfused with a warm physiological solution and stained with transmembrane potential-sensitive fluorescent dye. Radiofrequency (RF) ablation was performed on ventricular epicardium with a vacuum-assisted coagulation device to produce either a complete or incomplete lesion. Complete lesions were both transmural and continuous. Incomplete lesions were noncontinuous or nontransmural. The TED was determined with bipolar stimulation at one side of the lesion and either a bipolar electrogram at the other side or optical mapping on both sides. Hearts were then stained with tetrazolium chloride and examined histologically to estimate minimum path lengths of viable tissue from the stimulation site to the recording site. Complete lesions increased the TED by factors of 2.6-3.1 (p < 0.05), whereas incomplete lesions did not significantly increase the TED. Larger minimum path lengths were found for cases that had an increased TED. The TED was quantitatively predictable based on a conduction velocity of 0.38-0.49 m s(-1), which is typical of rabbit hearts. The TED significantly increases when a linear lesion is complete, suggesting that an intraoperative measurement of the TED may help to improve ablation lesions and outcomes. Predictability of the TED based on the viable tissue path suggests that quantitative TEDs for clinical lesions may be anticipated provided that the conduction velocity is considered.
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Affiliation(s)
- Herman D Himel
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7575, USA
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29
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Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJG, Damiano RJ, Davies DW, Haines DE, Haissaguerre M, Iesaka Y, Jackman W, Jais P, Kottkamp H, Kuck KH, Lindsay BD, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Natale A, Pappone C, Prystowsky E, Raviele A, Ruskin JN, Shemin RJ. HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4:816-61. [PMID: 17556213 DOI: 10.1016/j.hrthm.2007.04.005] [Citation(s) in RCA: 886] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Stulak JM, Dearani JA, Sundt TM, Daly RC, McGregor CGA, Zehr KJ, Schaff HV. Superiority of cut-and-sew technique for the Cox maze procedure: comparison with radiofrequency ablation. J Thorac Cardiovasc Surg 2007; 133:1022-7. [PMID: 17382646 DOI: 10.1016/j.jtcvs.2006.09.115] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 08/21/2006] [Accepted: 09/08/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although radiofrequency ablation is increasingly used to create the atrial lesions of the Cox maze procedure, its effectiveness in ablating atrial fibrillation compared with the standard cut-and-sew method is not known. We compare the freedom from atrial fibrillation in patients undergoing both methods with identical lesion sets. METHODS Radiofrequency ablation was used to create full Cox maze lesions in 56 patients between January 2002 and February 2005; these patients were matched with those who underwent the standard cut-and-sew method. Matched variables were gender (33 male, 23 female, both), age (67.5 vs 67.2 years), New York Heart Association class (mean 2.28 vs 1.96), atrial fibrillation type (37 paroxysmal, 19 continuous, both), and concomitant mitral valve surgery (37 in both). Hypertension, preoperative left atrial size, and preoperative duration of atrial fibrillation were similar between groups. RESULTS When compared with matched controls, fewer patients undergoing radiofrequency ablation were free from atrial fibrillation at dismissal (63% vs 88%; P = .0039) and at last follow-up (62% vs 92%; P = .016). According to logistic regression for matched pairs, patients undergoing radiofrequency ablation were 4.5 times more likely to be in atrial fibrillation at dismissal (95% confidence intervals [CI], 1.8, 10.9) and 5 times more likely to be in atrial fibrillation at follow-up (95% CI, 1.4, 17.3). No other covariate was associated with atrial fibrillation status at hospital dismissal or follow-up. CONCLUSION Creating Cox maze lesions with radiofrequency ablation is associated with less freedom from atrial fibrillation both early and late postoperatively. Because transmurality can be assured, the standard cut-and-sew Cox maze procedure remains the gold standard for the surgical treatment of atrial fibrillation.
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Affiliation(s)
- John M Stulak
- Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minn 55905, USA
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Bertaglia E, Stabile G, Senatore G, Colella A, Del Greco M, Goessinger H, Lamberti F, Lowe M, Mantovan R, Peters N, Pratola C, Raatikainen P, Turco P, Verlato R. A clinical and health-economic evaluation of pulmonary vein encircling ablation compared with antiarrhythmic drug treatment in patients with persistent atrial fibrillation (Catheter Ablation for the Cure of Atrial Fibrillation-2 study). ACTA ACUST UNITED AC 2007; 9:182-5. [PMID: 17303627 DOI: 10.1093/europace/eum004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Catheter Ablation for the Cure of Atrial Fibrillation 2 study is a prospective, randomized trial aimed to demonstrate the efficacy of catheter ablation with combined lesions in the right and left atria, in preventing atrial fibrillation (AF) recurrences among patients with recurrent persistent AF refractory to one antiarrhythmic drug, in comparison with the best pharmacological therapy. METHODS AND RESULTS Enrolment is limited to patients aged between 18 and 70 years who have experienced at least one documented relapse of persistent AF during antiarrhythmic drug therapy. One hundred and twenty-six patients will be randomized to ablation or antiarrhythmic drug therapy in a 2 : 1 manner. In the ablation group, the patients will undergo right and left atrial linear ablation. Control group patients will be treated with the best antiarrhythmic drug. After an initial blanking period of 2 months patients will be followed for 24 months. Primary endpoint of the study is the absence of documented persistent atrial tachyarrhythmias relapse during the first 24 months after the blanking period. Enrolment is scheduled in 14 centres in Italy, UK, Austria, and Finland. Seventy-two patients have currently been enrolled. CONCLUSION This study will provide important data about the efficacy of catheter ablation in comparison with antiarrhythmic drugs for the treatment of persistent AF.
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Bakir I, Casselman FP, Brugada P, Geelen P, Wellens F, Degrieck I, Van Praet F, Vermeulen Y, De Geest R, Vanermen H. Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy. Ann Thorac Surg 2007; 83:331-40. [PMID: 17184704 DOI: 10.1016/j.athoracsur.2006.07.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 07/15/2006] [Accepted: 07/18/2006] [Indexed: 10/23/2022]
Abstract
Atrial fibrillation is the most common rhythm disturbance in clinical practice. It is a major source of stroke and morbidity. Although the Cox maze procedure effectively eliminates atrial fibrillation in most patients, the procedure has not found widespread application. As a consequence, new operations that use alternative sources of energy, such as radiofrequency, microwave, cryothermy, laser, and ultrasound have emerged to surgically create lesion sets to treat atrial fibrillation. This article reviews the fundamentals and current strategies in the surgical treatment of atrial fibrillation.
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Affiliation(s)
- Ihsan Bakir
- Cardiovascular and Thoracic Surgery Department, Onze Lieve Vrouw Clinic, Aalst, Belgium
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Shimizu A, Ueyama T, Yoshiga M, Sawa A, Suzuki S, Sugi N, Matsuzaki M. Spectral Analysis of Atrial Fibrillation Cycle Lengths Comparison Between Fast Fourier Transform Analysis and Autocorrelation Function Analysis Using Multipurpose Physio-Informatic Analysis Software. Circ J 2007; 71:242-51. [PMID: 17251675 DOI: 10.1253/circj.71.242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fast Fourier transform (FFT) analysis is a popular method of spectral analysis of atrial fibrillation cycle lengths (AFCL). Autocorrelation function (ACF) analysis is also available, so the aim of this study was to elucidate the relationship between FFT and ACF analyses in the spectral analysis of AFCLs. METHODS AND RESULTS A total of 75 atrial fibrillation (AF) data from 39 patients were subjected to analysis. The dominant frequencies (DFs) from 4 different spectral resolutions of the FFT and peak AFCL from the ACF analysis were compared. In the FFT analysis using rectified signals, the DF was influenced by spectral resolution, no matter how the signals were tapered by the Hanning or Hamming window or filtered with the low-pass filter. There was a significant relationship between the DF from each spectral resolution and the peak AFCL. The DF from the 4,096-point FFT analysis had the strongest relationship to the peak AFCL with the smallest difference, when using 30-s AF data. In a study of the different lengths of the atrial fibrillation data, the DF also had a strong correlation to the peak AFCL with a small difference. CONCLUSIONS The peak AFCL obtained from ACF analysis was not of the same quality as that from FFT analysis, but had the same value as the DF from FFT analysis.
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Affiliation(s)
- Akihiko Shimizu
- Division of Cardiology and Faculty of Health Sciences, Yamaguchi University Graduated School of Medicine, Japan.
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Benditt DG, Sakaguchi S, Lurie KG, Lu F. Sinus Node Dysfunction. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Benditt DG, Sakaguchi S. Syncope. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_100] [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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Hennig T, Maass P, Hayano J, Heinrichs S. Exponential distribution of long heart beat intervals during atrial fibrillation and their relevance for white noise behaviour in power spectrum. J Biol Phys 2006; 32:383-92. [PMID: 19669444 DOI: 10.1007/s10867-006-9022-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 07/30/2006] [Indexed: 10/23/2022] Open
Abstract
The statistical properties of heart beat intervals of 130 long-term surface electrocardiogram recordings during atrial fibrillation (AF) are investigated. We find that the distribution of interbeat intervals exhibits a characteristic exponential tail, which is absent during sinus rhythm, as tested in a corresponding control study with 72 healthy persons. The rate gamma of the exponential decay lies in the range 3-12 Hz and shows diurnal variations. It equals, up to statistical uncertainties, the level of the previously uncovered white noise part of the power spectrum, which is also characteristic for AF. The overall statistical features can be described by decomposing the intervals into two statistically independent times, where the first one is associated with a correlated process with 1/f noise characteristics, while the second one belongs to an uncorrelated process and is responsible for the exponential tail. It is suggested to use gamma as a further parameter for a better classification of AF and for the medical diagnosis. The relevance of the findings with respect to a general understanding of AF is discussed.
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Affiliation(s)
- Thomas Hennig
- Institut für Physik, Technische Universität Ilmenau, 98684 Ilmenau, Germany.
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Abstract
Following the advent of the surgical maze procedure, several catheter techniques have been developed to provide permanent prophylaxis against atrial fibrillation. These noninvasive techniques work by compartmentalizing the atria, by ablating the arrhythmogenic foci, or by isolating the atria from these foci. Although still at an early stage of development, preliminary results using focal ablation and circumferential ablation show extreme promise.
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Affiliation(s)
- Fu Siong Ng
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, U.K
| | - Ajohn Camm
- Department of Cardiological Sciences, St. George's Hospital Medical School, London, U.K
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Fernández-Lozano I, Toquero-Ramos J, Escudero-Vela C, Castedo-Mejuto E, Escudier-Villa JM, Alonso-Pulpón L. El período refractario de la aurícula izquierda posterior y de las venas pulmonares se relaciona con la inducibilidad de fibrilación auricular en cerdos. Rev Esp Cardiol 2006. [DOI: 10.1157/13091366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Calò L, Lamberti F, Loricchio ML, De Ruvo E, Colivicchi F, Bianconi L, Pandozi C, Santini M. Left Atrial Ablation Versus Biatrial Ablation for Persistent and Permanent Atrial Fibrillation. J Am Coll Cardiol 2006; 47:2504-12. [PMID: 16781381 DOI: 10.1016/j.jacc.2006.02.047] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 01/20/2006] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to compare--in patients with persistent and permanent atrial fibrillation (AF)--the efficacy and safety of left atrial ablation with that of a biatrial approach. BACKGROUND Left atrium-based catheter ablation of AF, although very effective in the paroxysmal form of the arrhythmia, has an insufficient efficacy in patients with persistent and permanent AF. METHODS Eighty highly symptomatic patients (age, 58.6 +/- 8.9 years) with persistent (n = 43) and permanent AF (n = 37), refractory to antiarrhythmic drugs, were randomized to two different ablation approaches guided by electroanatomical mapping. A procedure including circumferential pulmonary vein, mitral isthmus, and cavotricuspid isthmus ablation was performed in 41 cases (left atrial ablation group). In the remaining 39 patients (biatrial ablation group), the aforementioned approach was integrated by the following lesions in the right atrium: intercaval posterior line, intercaval septal line, and electrical disconnection of the superior vena cava. RESULTS During follow-up (mean duration 14 +/- 5 months), AF recurred in 39% of patients in the left atrial ablation group and in 15% of patients in the biatrial ablation group (p = 0.022). Multivariable Cox regression analysis showed that ablation technique was an independent predictor of AF recurrence during follow-up. CONCLUSIONS In patients with persistent and permanent AF, circumferential pulmonary vein ablation, combined with linear lesions in the right atrium, is feasible, safe, and has a significantly higher success rate than left atrial and cavotricuspid ablation alone.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, ASL RM B, Rome, Italy.
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Merino JL. Slow Conduction and Flutter Following Atrial Fibrillation Ablation: Proarrhythmia or Unmasking Effect of RadiofrequencyApplication? J Cardiovasc Electrophysiol 2006; 17:516-9. [PMID: 16684025 DOI: 10.1111/j.1540-8167.2006.00454.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asaumi Y, Watanabe G, Nagamine H, Tomita S. An Innovative Balloon-Type Surgical Device for Atrial Fibrillation. Heart Surg Forum 2006; 9:E480-5. [PMID: 16318931 DOI: 10.1532/hsf98.20041141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The maze procedure and its modifications are the surgical treatment for atrial fibrillation. In an attempt to achieve a less invasive operation, we developed a balloon-type device for electric pulmonary vein isolation and evaluated its effectiveness macroscopically and microscopically. METHODS We created a left heart system model from 20 pigs. Based on a mold, a balloon was made with silicone resin. When this balloon was inflated, all pulmonary vein orifices were pressed and ablated by probes using radiofrequency and cryotherm as energy sources. Macroscopic and microscopic evaluations were performed. RESULTS Complete circular ablation by radiofrequency was confirmed in 2 of 3 veins. The transmural denaturation was pathologically confirmed in all areas ablated at 80 degrees for 2 minutes. The complete circular ablation line and the transmural denaturation were macroscopically and microscopically confirmed after cryoablation at -100 degrees for 2 minutes using liquid nitrogen. CONCLUSIONS This study proved that the balloon is effective in simplifying pulmonary vein isolation and has potential to become an instrument that contributes to less invasive operations in the near future.
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Affiliation(s)
- Yoshihide Asaumi
- Department of General and Cardiothoracic Surgery, Kanazawa University Graduate, School of Medicine, Ishikawa, Japan.
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Haïssaguerre M, Hocini M, Sanders P, Sacher F, Rotter M, Takahashi Y, Rostock T, Hsu LF, Bordachar P, Reuter S, Roudaut R, Clémenty J, Jaïs P. Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias. J Cardiovasc Electrophysiol 2006; 16:1138-47. [PMID: 16302893 DOI: 10.1111/j.1540-8167.2005.00308.x] [Citation(s) in RCA: 500] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation of atrial fibrillation (AF) is challenging in patients with long-standing persistent AF. The clinical outcome and subsequent arrhythmia recurrence after using an ablation method targeting multiple left atrial sites with the aim of achieving acute AF termination has not been characterized. METHODS Sixty patients (mean age: 53 +/- 9 years) with persistent AF (mean duration: 17 +/- 27 months) were prospectively followed after catheter ablation. Catheter ablation targeting the following sites was performed in a random sequence: (i) electrical isolation of all pulmonary veins (PV); (ii) disconnection of other thoracic veins; (iii) atrial ablation at sites possessing complex electrical activity, activation gradients, or short cycle lengths. Finally, linear ablation of the LA roof and mitral isthmus was performed if sinus rhythm was not restored following energy delivery to the above sites. At 1, 3, 6, and 12 months after ablation, patients underwent clinical review and 24-hour ambulatory ECG monitoring to identify asymptomatic arrhythmia. Repeat mapping and catheter ablation was performed in any patient experiencing recurrent atrial tachycardia (AT). Clinical success was defined as the absence of any sustained atrial arrhythmia. RESULTS AF terminated during ablation in 52 patients (87%). The fluoroscopy and procedural durations were 84 +/- 30 minutes and 264 +/- 77 minutes, respectively. Three months after ablation, sustained ATs were documented in 24 patients (associated with AF in 2). Mapping in 23 patients showed a single AT in 7 while multiple ATs were observed in 16. Macroreentry was confirmed to be due to gaps in the ablation lines, while focal ATs originated from discrete sites or isthmuses near the left atrial appendage, coronary sinus, pulmonary veins, or fossa ovalis; these sites were similar to those at which the greatest impact was observed on the fibrillatory process during the initial ablation procedure. After repeat ablation, at 11 +/- 6 months of follow-up, 57 patients (95%) were in sinus rhythm and 3 developed recurrent AF or AT. All patients in sinus rhythm demonstrated improved exercise capacity and all but 2 had evidence of atrial transport as assessed by Doppler echocardiography (mitral A wave velocity 34 +/- 17 cm/sec) by 6 months. CONCLUSION Catheter ablation of long-lasting persistent AF associated with acute AF termination achieves medium to long-term restoration and maintenance of sinus rhythm in 95% of patients. Arrhythmia recurrence in the majority of patients is AT.
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Abstract
Surgical ablation of atrial fibrillation (AF) is the most effective means of curing this arrhythmia, with the classic Maze procedure eliminating AF in more than 90% of patients. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. However, recent advances in the understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein ablation, create linear left atrial lesions, and remove the left atrial appendage rapidly and safely. Lesions are created under direct vision, minimizing the risk of damage to the pulmonary veins and adjacent mediastinal structures. Most surgical ablation procedures have been performed in conjunction with mitral valve surgery, the combination of mitral valve repair and cure of AF enabling patients to avoid lifelong anticoagulation. Recently developed surgical instrumentation now enables thoracoscopic and keyhole approaches, facilitating extension of epicardial AF ablation and excision of the left atrial appendage to patients with isolated AF and no other indication for cardiac surgery.
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Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Mickelsen S, Dudley B, Treat E, Barela J, Omdahl J, Kusumoto F. Survey of physician experience, trends and outcomes with atrial fibrillation ablation. J Interv Card Electrophysiol 2005; 12:213-20. [PMID: 15875112 DOI: 10.1007/s10840-005-0621-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Accepted: 02/22/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the prevalence, trends, outcomes and the general experience of physicians performing atrial fibrillation ablation (AF-ABL) in the United States (US). BACKGROUND AF-ABL is a non-pharmacological and potentially curative therapy for AF. Success rates for AF-ABL have been reported to be between 80 and 90%. Although there are numerous clinical trial addressing this therapy little is known about the general status of AF-ABL in clinical practice. METHODS We administered a mailed survey to the physician members of a professional arrhythmia society (Heart Rhythm Society, formerly known as the North American Society of Pacing and Electrophysiology) who practiced in the US (n = 1843). RESULTS There were 304 responses, 66% (n = 204) performed ABL and 30% (n = 92) performed AF-ABL. The study group performed a total of 5,592 AF-ABL from 2000 to 2003, out of 72,575 total ABL procedures during the same time period. There was a four-fold increase in the number of AF-ABL between 2000 and 2003 (2000: 628 vs. 2003: 2,575). In the same period, the self-reported short and long-term success rates of AF-ABL improved an average of 18 +/- 4% (p < or = 0.001). In 2003 the average self-reported one-month, one-year, and two-year success rates were: 71 +/- 4%, 66 +/- 5%, 63 +/- 6% respectively. The predicted five-year success was 60 +/- 4%. The average procedure took 4.5 +/- 0.4 hours. Physicians reported that approximately 29 +/- 4% of their patents were potential candidates for AF-ABL. CONCLUSIONS AF-ABL is becoming a much more common procedure in the US. Over the last four years the perceived short and long term success rates of AF-ABL have improved. Success rates in this survey are 10 to 20% lower than those reported in the recent clinical trials.
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Affiliation(s)
- Steven Mickelsen
- University of New Mexico School of Medicine, Albuquerque, 87111, USA.
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Gillinov AM. Surgical Ablation of Atrial Fibrillation. J Interv Card Electrophysiol 2005; 13:115-24. [PMID: 16133838 DOI: 10.1007/s10840-005-0302-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 05/10/2005] [Indexed: 11/29/2022]
Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Kocheril AG, Calkins H, Sharma AD, Cher D, Stubbs HA, Block JE. Hybrid Therapy with Right Atrial Catheter Ablation and Previously Ineffective Antiarrhythmic Drugs for the Management of Atrial Fibrillation. J Interv Card Electrophysiol 2005; 12:189-97. [PMID: 15875109 DOI: 10.1007/s10840-005-0620-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 02/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many patients with paroxysmal atrial fibrillation (AF) become refractory to antiarrhythmic drugs (AADs). Early studies suggested that linear catheter ablation in the right atrium may provide sufficient substrate modification to reestablish therapeutic efficacy of previously ineffective AADs. METHODS This prospective before-after multicenter trial evaluated the safety and effectiveness of hybrid therapy that included right atrial catheter ablation coupled with a regimen of previously ineffective AADs on AF episode frequency and symptoms in drug refractory patients with paroxysmal AF. A standard linear lesion set (lateral, septal, isthmus) was used in all subjects. AF episode frequency, clinical arrhythmia symptoms, condition-specific (AFSS) and global health-related quality of life (SF-36) were assessed prior to ablation and at 6 months. RESULTS Ninety-three subjects, refractory to an average 2.9 AADs at baseline, qualified for inclusion and underwent right atrial catheter ablation. Eighty-four subjects (90%) provided 6 month AF episode frequency data which demonstrated a significant decrease compared to baseline (3.4 vs. 9.5, p < 0.0001). Forty-nine subjects (58%) were considered a clinical success by virtue of achieving a pre-specified target level episode frequency reduction of 50% or greater. Substantial and statistically significant improvements were realized almost uniformly for all measured arrhythmia symptoms as well as for both quality of life measures. The incidence of major complications was 5.4%. CONCLUSIONS The addition of right atrial catheter ablation to a regimen of previously ineffective AADs is associated with a significant reduction in the frequency, duration and severity of AF episodes and symptoms.
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Affiliation(s)
- Abraham G Kocheril
- Section of Cardiac Electrophysiology, Carle Heart Center and University of Illinois, Urbana, 61801, USA.
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Shimizu A. Atrial Fibrillation and Atrial Fibrillation Intervals-Frequency Analysis and Interpretation-. J Arrhythm 2005. [DOI: 10.4020/jhrs.21.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Shimizu A. Atrial Fibrillation and Atrial Fibrillation Intervals—Frequency Analysis and Interpretation—. J Arrhythm 2005. [DOI: 10.1016/s1880-4276(05)80011-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Montenero AS, Quayyum A, Franciosa P, Mangiameli D, Antonelli A, Barbieri L, Bruno N, Zumbo F, Vimercati M. Implantable loop recorders: a novel method to judge patient perception of atrial fibrillation. Preliminary results from a pilot study. J Interv Card Electrophysiol 2004; 10:211-20. [PMID: 15133357 DOI: 10.1023/b:jice.0000026914.04770.9a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION At the present time, several techniques are used or are under investigation for atrial fibrillation (AF) therapy. Nowadays, no well-defined target for such therapies has been yet completely identified. Furthermore, AF is an arrhythmia with high rates of recurrences, both symptomatic and asymptotic. Thus the measure of therapy success rates not only based on symptom perception remains a goal to be reached. AIMS OF THE STUDY This study investigates the role of an implantable loop recorder (ILR) as an additional tool to identify initiating and perpetuating mechanisms of AF. The role of right atrial linear ablation (RALA) procedures is also investigated using the monitoring capabilities of the ILR. METHODS AND RESULTS Nine patients (mean age 63.8 +/- 5.9) with paroxysmal AF were referred to our institution as candidates for AF ablation. All patients (pts) had in their medical history several years of AF episodes. Therefore pts were aware of AF related symptoms. Six of them were implanted with an ILR before ablation and were monitored one month before and six months after the procedure. The ILRs stored 54 patient activated events (PAE) and 124 automatically activated events (AAE). 68% of PAEs and 67% of AAEs were classified as appropriate. Most common reasons for inappropriate detections were premature atrial or ventricular contractions among PAEs and undersensing among AAEs. The arrhythmia onset was properly identified in 4 pts (44%). The average AF recurrence rate was 10.8 +/- 3.5 ep/month before ablation and 5.0 +/- 1.8 ep/month after the procedure ( p = 0.042). CONCLUSION The ILR may be a helpful tool in monitoring pts undergoing ablation. Dedicated AF detection characteristics could give additional value to the device. RALA appears as a feasible, safe and relatively effective first approach in AF therapy.
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Affiliation(s)
- Annibale S Montenero
- Department of Cardiology and Arrhythmia Center, Policlinico MultiMedica, Sesto S. Giovanni (MI), Italy.
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Gillinov AM, Rice TW. Prandial Atrial Fibrillation: Off-Pump Pulmonary Vein Isolation With Hiatal Hernia Repair. Ann Thorac Surg 2004; 78:1836-8. [PMID: 15511491 DOI: 10.1016/s0003-4975(03)01434-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2003] [Indexed: 11/16/2022]
Abstract
Frequent palpitations with eating developed in a 62-year-old man with a history of typical gastroesophageal reflux successfully treated by Nissen fundoplication 5 years previously. A Holter monitor demonstrated paroxysmal atrial fibrillation associated with eating. Barium swallow showed a slipped Nissen fundoplication with herniation into the chest. Under a single anesthetic, the patient had median sternotomy and off-pump pulmonary vein isolation with a bipolar radiofrequency clamp and transabdominal redo-Nissen fundoplication. A 24-hour Holter monitor performed 6 weeks after operation demonstrated a normal sinus rhythm with no atrial fibrillation. Barium swallow demonstrated an intact infradiaphragmatic repair.
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Affiliation(s)
- A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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