1
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2024; 21:e31-e149. [PMID: 38597857 DOI: 10.1016/j.hrthm.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society.
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece.
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil; Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France; Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain; Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA; Case Western Reserve University, Cleveland, OH, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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2
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Espersen C, Modin D, Johansen ND, Janstrup KH, Johannessen A, Hansen J, Eskesen K, Iversen AZ, Worck RH, Ruwald MH, Hansen ML, Gislason GH, San José Estépar R, Marcus GM, Biering-Sørensen T. Prognostic importance of ischemic heart disease for patients with atrial fibrillation undergoing catheter ablation. Heart Rhythm 2024:S1547-5271(24)03141-2. [PMID: 39147302 DOI: 10.1016/j.hrthm.2024.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Ischemic heart disease (IHD) has been linked to an increased risk of atrial fibrillation (AF). However, data are sparse regarding the role of IHD in AF recurrence after catheter ablation. OBJECTIVE We sought to investigate whether preexisting or new-onset IHD is associated with a greater risk of AF recurrence after ablation. METHODS With use of Danish nationwide registries, all patients undergoing first-time AF ablation in Denmark from 2010 to 2020 were identified. The primary outcome was AF recurrence defined by AF-related hospital admission or antiarrhythmic drug use within 1 year after ablation excluding a 3-month blanking period. IHD was defined as an International Classification of Diseases, Tenth Revision diagnosis of IHD or prior coronary revascularization. RESULTS Of 12,162 patients undergoing first-time ablation for AF (mean age, 62 years; 30% female), 20% had preexisting IHD. Preexisting IHD was associated with an increased risk of AF recurrence in univariable log-binomial logistic regression (relative risk, 1.09; 95% CI, 1.04-1.14; P < .001). However, after multivariable adjustment including procedural year, preexisting IHD was no longer associated with an increased risk of AF recurrence (relative risk, 1.02; 95% CI, 0.97-1.06; P = .42). In a nested case-control study of those without preexisting IHD before ablation (n = 9778), newly diagnosed IHD after ablation was associated with an increased risk of AF recurrence in multivariable analysis (hazard ratio, 3.03; 95% CI, 1.84-4.99; P < .001). CONCLUSION The presence of IHD does not appear to reduce the effectiveness of AF ablation procedures. However, the emergence of IHD after AF ablation may serve as a trigger for AF that is insufficiently suppressed by prior ablation.
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Affiliation(s)
- Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Daniel Modin
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kira Hyldekær Janstrup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Kristian Eskesen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Allan Zeeberg Iversen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - René H Worck
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory M Marcus
- Department of Cardiology, University of California, San Francisco, California
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital-Herlev & Gentofte Hospital, Hellerup, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Steno Diabetes Center, Copenhagen, Denmark
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3
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Tzeis S, Gerstenfeld EP, Kalman J, Saad E, Shamloo AS, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O'Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Interv Card Electrophysiol 2024; 67:921-1072. [PMID: 38609733 DOI: 10.1007/s10840-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society (HRS), the Asia Pacific HRS, and the Latin American HRS.
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Affiliation(s)
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Gerhard Hindricks
- Department of Cardiac Electrophysiology, Charité University Berlin, Berlin, Germany
| | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | - Gregory F Michaud
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología 'Ignacio Chávez', Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O'Neill
- Cardiovascular Directorate, St. Thomas' Hospital and King's College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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4
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Tzeis S, Gerstenfeld EP, Kalman J, Saad EB, Sepehri Shamloo A, Andrade JG, Barbhaiya CR, Baykaner T, Boveda S, Calkins H, Chan NY, Chen M, Chen SA, Dagres N, Damiano RJ, De Potter T, Deisenhofer I, Derval N, Di Biase L, Duytschaever M, Dyrda K, Hindricks G, Hocini M, Kim YH, la Meir M, Merino JL, Michaud GF, Natale A, Nault I, Nava S, Nitta T, O’Neill M, Pak HN, Piccini JP, Pürerfellner H, Reichlin T, Saenz LC, Sanders P, Schilling R, Schmidt B, Supple GE, Thomas KL, Tondo C, Verma A, Wan EY. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2024; 26:euae043. [PMID: 38587017 PMCID: PMC11000153 DOI: 10.1093/europace/euae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 04/09/2024] Open
Abstract
In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .
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Affiliation(s)
- Stylianos Tzeis
- Department of Cardiology, Mitera Hospital, 6, Erythrou Stavrou Str., Marousi, Athens, PC 151 23, Greece
| | - Edward P Gerstenfeld
- Section of Cardiac Electrophysiology, University of California, San Francisco, CA, USA
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne and Baker Research Institute, Melbourne, Australia
| | - Eduardo B Saad
- Electrophysiology and Pacing, Hospital Samaritano Botafogo, Rio de Janeiro, Brazil
- Cardiac Arrhythmia Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jason G Andrade
- Department of Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Tina Baykaner
- Division of Cardiology and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Universiteit Brussel (VUB), Brussels, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ngai-Yin Chan
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shih-Ann Chen
- Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM) School of Medicine and Health, Munich, Germany
| | - Nicolas Derval
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Katia Dyrda
- Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Meleze Hocini
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Cardiac Electrophysiology and Stimulation Department, Fondation Bordeaux Université and Bordeaux University Hospital (CHU), Pessac-Bordeaux, France
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine and Korea University Medical Center, Seoul, Republic of Korea
| | - Mark la Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jose Luis Merino
- La Paz University Hospital, Idipaz, Universidad Autonoma, Madrid, Spain
- Hospital Viamed Santa Elena, Madrid, Spain
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
- Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy
| | - Isabelle Nault
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec (IUCPQ), Quebec, Canada
| | - Santiago Nava
- Departamento de Electrocardiología, Instituto Nacional de Cardiología ‘Ignacio Chávez’, Ciudad de México, México
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Mark O’Neill
- Cardiovascular Directorate, St. Thomas’ Hospital and King’s College, London, UK
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Tobias Reichlin
- Department of Cardiology, Inselspital Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luis Carlos Saenz
- International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | - Gregory E Supple
- Cardiac Electrophysiology Section, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Atul Verma
- McGill University Health Centre, McGill University, Montreal, Canada
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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5
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Taghji P, Deharo JC, Amraoui S, Bun SS. CLOSE-Guided Pulmonary Vein Isolation to Treat Persistent Atrial Fibrillation: 1-Year Outcome. J Clin Med 2023; 12:4698. [PMID: 37510813 PMCID: PMC10380439 DOI: 10.3390/jcm12144698] [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: 05/27/2023] [Revised: 06/23/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND CLOSE-guided pulmonary vein isolation (PVI) is based on contiguous and optimized (Ablation Index-guided) radiofrequency lesions. The efficacy of CLOSE-guided PVI in persistent atrial fibrillation (AF) treatment has been poorly evaluated. METHODS In two centers, 50 patients eligible for persistent AF ablation underwent CLOSE-guided PVI (Ablation Index ≥ 450 at the anterior wall, ≥300 at posterior wall, intertag distance ≤ 6 mm). If PVI failed to restore sinus rhythm (SR), electrical cardioversion (ECV) was performed. Atrial substrate modification (ASM) was performed only if PVI and ECV failed to restore SR. Recurrence was defined as any recorded episode of AF, atrial tachycardia (AT) or atrial flutter (AFL) > 30 s on Holter electrocardiographs at 3, 6 and 12 months. RESULTS From the 50 patients (64 ± 10 years, 14% long-standing persistent AF), SR was restored by ECV in 34 patients (68%) 56 ± 38 days prior to ablation. On the day of ablation, 42 patients (84%) were on class I-III anti-arrhythmic drug therapy (ADT) and the rhythm was AF in 23/50 patients. PVI was achieved in all patients; after PVI, ECV was required in 21 patients and ASM in 1 patient. The mean procedure time, radiofrequency time and fluoroscopy time were 141 ± 33 min, 23 ± 7 min and 7 ± 6 min, respectively. At 12 months, single-procedure freedom from AF/AT/AFL was 80%, with 19 patients (38%) receiving class I-III ADT. CONCLUSIONS In a population of patients with persistent AF monitored with intermittent cardiac rhythm recordings, CLOSE-guided PVI resulted in high single-procedure arrhythmia-free survival at 1 year. Future large-scale studies involving continuous cardiac monitoring are necessary.
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Affiliation(s)
- Philippe Taghji
- Electrophysiology Unit, Cardiology Department, La Timone University Hospital, 13005 Marseille, France
| | - Jean-Claude Deharo
- Electrophysiology Unit, Cardiology Department, La Timone University Hospital, 13005 Marseille, France
| | - Sana Amraoui
- Electrophysiology Unit, Cardiology Department, American Hospital of Paris, 92200 Neuilly-sur-Seine, France
| | - Sok-Sithikun Bun
- Electrophysiology Unit, Cardiology Department, Pasteur University Hospital, 06000 Nice, France
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6
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Fujisawa T, Kawakami H, Nagai T, Miyazaki S, Akazawa Y, Miyoshi T, Higaki A, Seike F, Higashi H, Nishimura K, Inoue K, Ikeda S, Yamaguchi O. Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation. Pacing Clin Electrophysiol 2023; 46:152-160. [PMID: 36524673 DOI: 10.1111/pace.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although premature atrial contractions (PACs) just after catheter ablation (CA) for atrial fibrillation (AF) are common, their clinical significance is uncertain. This study aimed to evaluate whether the PAC burden after an initial CA for AF was associated with late recurrence. METHODS We enrolled 346 patients with AF (median age, 65 years; 30% female; 57% with paroxysmal AF) who underwent an initial radiofrequency CA and a 24-h Holter monitoring the day after the procedure. PAC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with a previous RR interval, and the number of PAC/24 h during post-procedural Holter monitoring was analyzed. RESULTS AF recurred in 106 patients (31%) during a median follow-up of 19 months. These patients had significantly more PAC/24 h than those without (median [interquartile range], 891 [316-4351] beats vs. 409 [162-1,303] beats; p < 0.01). The number of PACs was independently associated with AF recurrence after adjustment for clinical parameters and left atrial (LA) enlargement. Receiver operating characteristic (ROC) curve analysis revealed that 1431 PAC/24 h was the optimal cut-off value for predicting AF recurrence. Adding the PAC/24 h to the prediction model with LA diameter appeared to correctly reclassify patients who were thought to be at high risk for AF recurrence into the low-risk group and vice versa. CONCLUSIONS The number of PACs was an independent risk factor for AF recurrence. A 24-h Holter recording the day after an initial CA is a simple and beneficial tool for the risk stratification of AF recurrence.
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Affiliation(s)
- Tomoki Fujisawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroshi Kawakami
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takayuki Nagai
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shigehiro Miyazaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yusuke Akazawa
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Toru Miyoshi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Akinori Higaki
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Fumiyasu Seike
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Haruhiko Higashi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazuhisa Nishimura
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Katsuji Inoue
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shuntaro Ikeda
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Osamu Yamaguchi
- Division of Cardiology, Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime, Japan
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Gottlieb LA, Coronel R, Dekker LRC. Reduction in atrial and pulmonary vein stretch as a therapeutic target for prevention of atrial fibrillation. Heart Rhythm 2023; 20:291-298. [PMID: 36265692 DOI: 10.1016/j.hrthm.2022.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased mortality. Heart failure, hypertension, valvular disease, and obstructive sleep apnea are risk factors for incident AF. A common characteristic of these diseases is that they increase atrial wall stretch. Multiple experimental studies confirm a proarrhythmic effect of atrial stretch. Conversely, a reduction in stretch is antiarrhythmic. A therapeutic target for AF, therefore, lies in local reduction of atrial stretch. This review focuses on atrial stretch and its clinical associations in patients with AF and its downstream effects on electrophysiology. We discuss the possible application of targeted atrial stretch reduction in AF prevention. We conclude that a reduction in local atrial stretch should be considered an essential element in rhythm control.
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Affiliation(s)
- Lisa A Gottlieb
- Department of Cardiology, University Hospital Copenhagen - Bispebjerg, Copenhagen, Denmark; AUMC, location Academic Medical Centre, Department of Experimental Cardiology, Amsterdam, The Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France
| | - Ruben Coronel
- AUMC, location Academic Medical Centre, Department of Experimental Cardiology, Amsterdam, The Netherlands; IHU Liryc, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux, France.
| | - Lukas R C Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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8
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Minami K, Kazawa M, Kakuta T, Fukushima S, Fujita T, Kabata D, Ohnishi Y. Early Atrial Tachyarrhythmia Recurrence Predicts Late Atrial Tachyarrhythmia Recurrence After the Cryo-Maze Procedure - An Observational Study. Circ J 2022; 87:76-83. [PMID: 35965068 DOI: 10.1253/circj.cj-22-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is unknown whether early atrial tachyarrhythmia (ATA) recurrence occurring within 3 months after the Maze procedure predicts late ATA recurrence. METHODS AND RESULTS This study involved 610 patients who underwent the modified Cryo-Maze procedure in conjunction with other cardiac surgery. The primary outcomes were late ATA recurrence, defined as occurring ≥3 months after surgery. The effects of early ATA recurrence on late ATA recurrence were analyzed using a Cox proportional hazards model. The following 11 covariates were considered explanatory variables: early ATA recurrence, age, sex, body surface area, preoperative duration of atrial fibrillation, preoperative left atrial diameter, and concomitant surgery (mitral valve replacement, mitral valve repair, aortic valve replacement, tricuspid annuloplasty, and left atrial appendage closure). Statistical analyses were performed with a 2-sided 5% significance level. Early ATA recurrence occurred in 174 patients (28.5%). Late ATA recurrence occurred in 167 patients (27.5%), with 595 events identified in these patients. The Cox proportional hazards model showed that early ATA recurrence was an independent predictor of late ATA recurrence (hazard ratio, 4.14; 95% confidence interval, 3.00-5.70; P<0.001). CONCLUSIONS Early ATA recurrence was an independent predictor of late ATA recurrence among patients undergoing the modified Cryo-Maze procedure. The blanking period might not be applied to patients undergoing the modified Cryo-Maze procedure.
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Affiliation(s)
- Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center
| | - Masahiro Kazawa
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
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9
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Njeru DK, Athawale TM, France JJ, Johnson CR. Quantifying and Visualizing Uncertainty for Source Localization in Electrocardiographic Imaging. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. IMAGING & VISUALIZATION 2022; 11:812-822. [PMID: 37284179 PMCID: PMC10241371 DOI: 10.1080/21681163.2022.2113824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/12/2022] [Indexed: 06/08/2023]
Abstract
Electrocardiographic imaging (ECGI) presents a clinical opportunity to noninvasively understand the sources of arrhythmias for individual patients. To help increase the effectiveness of ECGI, we provide new ways to visualize associated measurement and modeling errors. In this paper, we study source localization uncertainty in two steps: First, we perform Monte Carlo simulations of a simple inverse ECGI source localization model with error sampling to understand the variations in ECGI solutions. Second, we present multiple visualization techniques, including confidence maps, level-sets, and topology-based visualizations, to better understand uncertainty in source localization. Our approach offers a new way to study uncertainty in the ECGI pipeline.
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Affiliation(s)
- Dennis K Njeru
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Tushar M Athawale
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Jessie J France
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Chris R Johnson
- Scientific Computing and Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
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Mhanna M, Beran A, Al‐Abdouh A, Sajdeya O, Barbarawi M, Alsaiqali M, Jabri A, Al‐Aaraj A, Alharbi A, Chacko P. Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta-analysis. J Arrhythm 2022; 38:570-579. [PMID: 35936032 PMCID: PMC9347204 DOI: 10.1002/joa3.12742] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Catheter placement and stability are well-known challenges in atrial fibrillation (AF) ablation. As a result, steerable sheaths (SS) were developed to improve catheter stabilization and maintain proper catheter-tissue contact. The purpose of this systematic review and meta-analysis is to see if employing a SS influences procedure outcome. Method We performed a comprehensive literature search for studies that evaluated the efficacy and safety of SS compared to nonsteerable sheaths (NSS) in AF ablation. The primary outcome was the rate of atrial arrhythmia (AA) freedom by the time of the last follow-up. The secondary outcomes were the procedure-related complications and procedural characteristics. Risk ratio (RR) or the mean difference (MD) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. Results A total of 10 studies, including 967 AF patients (mean age: 59.2 ± 11.1 years, 516 patients managed with SS vs. 454 with NSS), were included. SS group showed a higher rate of freedom of AA compared to NSS (RR: 1.19; 95% CI 1.09-1.29; p < .001). Both techniques had similar rate for procedural-related complication (RR: 1.09, 95% CI 0.50-2.39; p = .83). The SS strategy had a shorter procedure time (MD -10.6 [min], 95% CI -20.97, -0.20; p = .05) but comparable fluoroscopic and radiofrequency application times to the NSS group. Conclusions The SS for AF catheter ablation not only reduced the total procedure time but also significantly increased the rate of successful ablation while maintaining a similar safety profile when compared to the traditional NSS.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal MedicineUniversity of ToledoToledoOhioUSA
| | - Azizullah Beran
- Department of Internal MedicineUniversity of ToledoToledoOhioUSA
| | - Ahmad Al‐Abdouh
- Department of Internal MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - Omar Sajdeya
- Department of Internal MedicineUniversity of ToledoToledoOhioUSA
| | - Mahmoud Barbarawi
- Department of Cardiovascular MedicineUniversity of ConnecticutFarmingtonConnecticutUSA
| | - Mahmoud Alsaiqali
- Department of Internal MedicineState University of New York Downstate Medical CenterBrooklynNew YorkUSA
| | - Ahmad Jabri
- Department of CardiologyCase Western Reserve University/MetroHealth Medical CenterClevelandOhioUSA
| | - Ahmad Al‐Aaraj
- Department of CardiologyJames Cook University HospitalMiddlesbroughUK
| | | | - Paul Chacko
- Department of Cardiovascular MedicineUniversity of ToledoToledoOhioUSA
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11
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The characteristic of an abnormal p-wave axis in patients with atrial fibrillation. J Electrocardiol 2022; 73:1-7. [DOI: 10.1016/j.jelectrocard.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022]
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12
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Li Z, Wang S, Hidru TH, Sun Y, Gao L, Yang X, Xia Y. Long Atrial Fibrillation Duration and Early Recurrence Are Reliable Predictors of Late Recurrence After Radiofrequency Catheter Ablation. Front Cardiovasc Med 2022; 9:864417. [PMID: 35402564 PMCID: PMC8990906 DOI: 10.3389/fcvm.2022.864417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Recurrence after atrial fibrillation (AF) ablation is still common. Objective This study aimed to evaluate the predictive abilities of AF duration and early recurrence (ER) to discriminate high-risk patients for recurrence. Methods We enrolled 1,763 consecutive patients with AF who were scheduled to receive the index radiofrequency catheter ablation (RFCA) from January 2016 to August 2021 in Dalian, China. Long AF duration (LAFD) was considered if the course of AF lasted for ≥ 12 months. ER was defined as any atrial tachycardia (AT) or AF event longer than 30 s occurring within a 3-month post-RFCA. Results Late recurrence occurred in 643 (36.5%) of the 1,763 patients at a median of 35 months after RFCA. Multivariate analysis identified LAFD (hazard ratio (HR): 1.80, 95% confidence interval (CI): 1.38–2.35, p < 0.001) and ER (HR: 2.34, 95% CI: 1.82–3.01, p < 0.001) as strong independent predictors of late recurrence in non-paroxysmal AF. Similarly, LAFD (HR: 1.48, 95% CI: 1.20–1.84, p < 0.001) and ER (HR: 3.40, 95% CI: 2.68–4.30, p < 0.001) were significantly associated with late recurrence in paroxysmal AF. Receiver operating curve analyses revealed that the CAAP-AF (CAD, Atrial diameter, Age, Persistent or longstanding AF, Antiarrhythmic drugs failed, Female) had the highest predict power [area under ROC curve (AUC) 0.586]. The addition of ER and LAFD to the CAAP-AF score significantly improved risk discrimination for late recurrence after AF ablation from 0.586 to 0.686. Conclusion Long AF duration and ER were independently associated with late recurrence. The prediction performance of the CAAP-AF model for recurrence was improved by the addition of LAFD and ER.
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13
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Barrio-Lopez MT, Castellanos E, Betancur A, Zorita B, Medina J, Losada N, Del Valle MD, Sanchez C, Crespo R, Gonzalez V, Morales T, Urriza B, Ortiz M, Almendral J. The presence of a large patent foramen ovale reduces acute and chronic success in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 64:705-713. [PMID: 35142969 DOI: 10.1007/s10840-022-01134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE In this study, we analyzed PFO implications in atrial fibrillation (AF) ablation. METHODS Six hundred and twenty-five consecutive patients with AF undergoing PV isolation were included. We considered that a large and/or compliant PFO was present if the catheters advanced gently into the LA without puncturing the septum. Atrial tachyarrhythmias after the 3-month blanking period were classified as a recurrence. RESULTS Out of the 625 patients included, 36 (5.8%) were found to have PFO. No significant differences were observed in the clinical characteristics of patients with PFO compared with patients without PFO. Nevertheless, patients with PFO had lower acute success in PV isolation compared with patients without PFO (98.2% vs. 88.5%; p = 0.006) even after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (odds ratio: 0.1; 95% confidence interval (CI): 0.02-0.9; p = 0.039). In 546 patients followed more than 6 months, the recurrence rate of any atrial tachyarrhythmia after 18.6 ± 11.9 months was significantly higher in patients with PFO compared with patients without PFO (41.9 vs. 70%; p = 0.012). This difference remained significant after adjusting for age, sex, type of AF, LA area, cardiomyopathy, time from AF diagnosis to the ablation, and ablation technique (hazard ratio: 1.9; 95% CI: 1.1-3.3; p = 0.015). CONCLUSIONS The presence of a large and/or compliant PFO is an independent factor for PV isolation failure and arrhythmia recurrence rate after the ablation.
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Affiliation(s)
- Maria Teresa Barrio-Lopez
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain.
| | - Eduardo Castellanos
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Andres Betancur
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Blanca Zorita
- Department of Cardiology, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
| | - Juan Medina
- Department of Cardiology, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, Madrid, Spain
| | - Nieves Losada
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Maria Diaz Del Valle
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Cristina Sanchez
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Rosa Crespo
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Victor Gonzalez
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Tamara Morales
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Belen Urriza
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Mercedes Ortiz
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
| | - Jesús Almendral
- Electrophysiology Laboratory and Arrhythmia Unit, Centro Integral de Enfermedades Cardiovasculares (HM CIEC), Unidad de Electrofisiología, Hospital Universitario HM Monteprincipe, HM Hospitales, Avda Monteprincipe, 25, 28660, Boadilla del Monte, Madrid, Spain
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14
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Prevention and Management of Perioperative Dysrhythmias. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms. JACC Clin Electrophysiol 2021; 7:416-430. [PMID: 33736761 DOI: 10.1016/j.jacep.2021.01.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.
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Affiliation(s)
- Lisa A Gottlieb
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands; Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands.
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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Gopesh T, Wen JH, Santiago-Dieppa D, Yan B, Scott Pannell J, Khalessi A, Norbash A, Friend J. Soft robotic steerable microcatheter for the endovascular treatment of cerebral disorders. Sci Robot 2021; 6:6/57/eabf0601. [PMID: 34408094 PMCID: PMC9809155 DOI: 10.1126/scirobotics.abf0601] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 07/26/2021] [Indexed: 01/05/2023]
Abstract
Catheters used for endovascular navigation in interventional procedures lack dexterity at the distal tip. Neurointerventionists, in particular, encounter challenges in up to 25% of aneurysm cases largely due to the inability to steer and navigate the tip of the microcatheters through tortuous vasculature to access aneurysms. We overcome this problem with submillimeter diameter, hydraulically actuated hyperelastic polymer devices at the distal tip of microcatheters to enable active steerability. Controlled by hand, the devices offer complete 3D orientation of the tip. Using saline as a working fluid, we demonstrate guidewire-free navigation, access, and coil deployment in vivo, offering safety, ease of use, and design flexibility absent in other approaches to endovascular intervention. We demonstrate the ability of our device to navigate through vessels and to deliver embolization coils to the cerebral vessels in a live porcine model. This indicates the potential for microhydraulic soft robotics to solve difficult access and treatment problems in endovascular intervention.
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Affiliation(s)
- Tilvawala Gopesh
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | - Jessica H. Wen
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA
| | | | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J. Scott Pannell
- Department of Neurosurgery, University of California San Diego, USA
| | | | | | - James Friend
- Department of Mechanical and Aerospace Engineering, University of California San Diego, USA,Department of Surgery, University of California San Diego, USA,To whom correspondence should be addressed; , Medically Advanced Devices Laboratory, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5463] [Impact Index Per Article: 1821.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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19
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Pedersoli F, Hitpass L, Isfort P, Zimmermann M, Schulze-Hagen M, Gombert A, Kuhl CK, Bruners P, Keil S. Recanalization and Stenting of the Celiac and the Superior Mesenteric Artery Supported by Use of a Steerable Introducer Sheath: Report on 2 Years' Experience. Vasc Endovascular Surg 2020; 55:158-163. [PMID: 33213286 DOI: 10.1177/1538574420975264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To compare technical parameters and success of recanalization of celiac (CA) or superior mesenteric artery (SMA) with usage of steerable vs not steerable introducer sheaths. METHODS A retrospective analysis was performed on all consecutive patients who underwent recanalization with stent implantation of CA or SMA between 2015 and 2019. Data regarding technical success (successful stent placement with restoration of sufficient blood flow by the first attempt without changing kind of introducer sheath or access site), indication for treatment, vascular access, kind of introducer sheath, fluoroscopy time and radiation dose were collected. Preinterventional CT were analyzed to classify the difficulty of catheterization of target vessels. Technical parameters were compared with independent t-test (p ≤ 0.05). RESULTS 66 patients underwent recanalization of CA or SMA. Usage of steerable introducer sheaths was associated with higher technical success compared to not steerable introducer sheaths with transfemoral approach respectively of 8/8 vs 15/19 for the CA and 11/11 vs 17/20 for the SMA. Steerable introducer sheaths were used in recanalization considered more technically difficult compared to not steerable introducer sheaths (58% vs 33%). Usage of steerable introducer sheath showed a statistically significant reduction of radiation dose in the recanalization of the SMA (respectively 32035 ± 15716 cGy cm2 vs 60102 ± 28432 cGy cm2; p = 0.005). CONCLUSION Even if used in more difficult interventions, steerable introducer sheaths showed a higher technical success compared to not steerable introducer sheaths with transfemoral access.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Maximilian Schulze-Hagen
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- Department of Vascular Surgery, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, 39058RWTH University Hospital Aachen, Aachen, Germany
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Vassallo F, Meigre LL, Serpa E, Cunha C, Simoes A, Carloni H, Amaral D, Meira K, Pezzin F. Changes and impacts in early recurrences after atrial fibrillation ablation in contact force era: comparison of high-power short-duration with conventional technique—FIRST experience data. J Interv Card Electrophysiol 2020; 62:363-371. [DOI: 10.1007/s10840-020-00911-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/31/2020] [Indexed: 11/27/2022]
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21
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van Laar C, Bentala M, Weimar T, Doll N, Swaans MJ, Molhoek SG, Hofman FN, Kelder J, van Putte BP. Thoracoscopic ablation for the treatment of atrial fibrillation: a systematic outcome analysis of a multicentre cohort. Europace 2020; 21:893-899. [PMID: 30689852 DOI: 10.1093/europace/euy323] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS To perform a systematic outcome analysis in order to provide cardiologists and general pactitioners with more adequate information to guide their decision making regarding rhythm control. Totally thoracoscopic maze (TTmaze) for the treatment of atrial fibrillation (AF) is recommended as a Class 2a indication mainly based on single centre studies including small patient cohorts and inconsistent lesion sets. METHODS AND RESULTS We studied consecutive patients undergoing TTmaze in three European referral centres (2012-15). Primary outcome was freedom from atrial tachyarrhythmia (ATA). Secondary outcomes were 30-day complications, the composite endpoint of ischaemic stroke, haemorrhagic stroke or transient ischaemic attack (TIA), all-cause mortality, and predictors of ATA recurrence. Four hundred and seventy-five patients were included, with a mean age of 61 ± 9 years and 69.5% male. The mean CHA2DS2-VASc score was 1.7 ± 1.3. The overall freedom from ATA was 68.8% after a mean follow-up period of 20 ± 9 months. Freedom from ATA was 72.7% for paroxysmal AF, 68.9% for persistent AF, and 54.2% for longstanding persistent AF. Multivariate analysis revealed female gender [hazard ratio (HR): 1.87, P = 0.005], in-hospital AF (HR: 1.95, P = 0.040), longer duration of preoperative AF (HR: 1.06, P = 0.003) and mitral regurgitation (HR: 1.84, P = 0.025) as independent predictors of ATA recurrence. Overall 30-day freedom from any complication was 92.4%. Freedom from cerebrovascular events after mean follow-up of 30 ± 16 months was 98.7% and overall survival was 98.3%. The observed rate of ischaemic stroke, haemorrhagic stroke, or TIA was low (0.5 per 100 patient-years). CONCLUSION Totally thoracoscopic maze is a safe and effective rhythm control therapy.
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Affiliation(s)
- Charlotte van Laar
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Mohamed Bentala
- Department of Cardiothoracic Surgery, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands
| | - Timo Weimar
- Sana HerzchirurgischeKlinik Stuttgart GmbH, Department of Cardiac Surgery, Herdweg 2, Stuttgart, Baden-Württemberg, Germany
| | - Nicolas Doll
- Sana HerzchirurgischeKlinik Stuttgart GmbH, Department of Cardiac Surgery, Herdweg 2, Stuttgart, Baden-Württemberg, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Sander G Molhoek
- Department of Cardiology, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Johannes Kelder
- St. Antonius Hospital, Department of Research & Development, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, the Netherlands
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22
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Do U, Kim J, Kim M, Cho MS, Nam GB, Choi KJ, Kim YH. Association of pericardial effusion after pulmonary vein isolation and outcomes in patients with paroxysmal atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1132-1138. [PMID: 32840867 DOI: 10.1111/pace.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/04/2020] [Accepted: 08/23/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The clinical implications of pericardial effusion (PE) after catheter ablation for atrial fibrillation (AF) are not well understood. We evaluated the association between newly developed PE after pulmonary vein isolation (PVI) for paroxysmal AF and arrhythmic recurrence. METHODS From a prospective AF ablation registry, 184 patients (mean age 59 ± 10 years, 65% male) who underwent first-time PV isolation using a smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA) were analyzed. Postablation transthoracic echocardiography (TTE) was performed within 1-3 days after ablation, and the occurrence of PE was assessed. RESULTS PE developed in 91 patients (49.5%), and most were of minimal severity (minimal, 93.4%; mild, 6.6%). Patients with PE had significantly lower body mass index and underwent cavotricuspid isthmus ablation more frequently. Early arrhythmic recurrence (EAR) (within 3 months) was observed in 28.8% of patients and was not different according to the PE development (PE [+]: 29.7% vs PE [-]: 28.0%; P = .80). During a median follow-up of 696 days, the cumulative rate of the late arrhythmic recurrence (LAR) (after 3 months) was 36.4%, and there was no difference between groups (PE [+]: 36.7% vs PE [-]: 35.1%; P = .988). The only predictor of LAR was EAR, and no echocardiographic parameters showed a significant correlation with LAR. CONCLUSIONS Minimal or mild PE after PVI for paroxysmal AF is a frequent echocardiographic finding, and it had no significant association with AF recurrence. Routine TTE after AF ablation has no clinical implication.
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Affiliation(s)
- Ungjeong Do
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minsoo Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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23
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Peigh G, Kaplan RM, Bavishi A, Diaz CL, Baman JR, Matiasz R, Trivedi A, Sattayaprasert P, Wasserlauf J, Shen MJ, Potpara TS, Chicos AB, Arora R, Kim S, Lin A, Verma N, Knight BP, Passman RS. A novel risk model for very late return of atrial fibrillation beyond 1 year after cryoballoon ablation: the SCALE-CryoAF score. J Interv Card Electrophysiol 2020; 58:209-217. [PMID: 31327104 PMCID: PMC7025863 DOI: 10.1007/s10840-019-00588-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Cryoballoon ablation (CBA) is an effective technique for pulmonary vein isolation (PVI). To date, there are no risk models to predict very late recurrence of atrial fibrillation (VLRAF) after CBA. METHODS Retrospective analysis of a single-center database was performed. Inclusion criteria included PVI using CBA for atrial fibrillation (AF) without additional ablation targets, follow-up > 365 days, and no recurrent AF between 90 and 365 days after procedure. The primary endpoint was recurrent AF > 30 s > 12 months post-CBA. A risk model was created using clinical variables. RESULTS Of 674 CBA performed from 2011 to 2016, 300 patients (200 male, 62.0 ± 9.9 years) met inclusion criteria. Of these, 159 (53.0%) patients had paroxysmal AF. Patients had an average of 9.5 ± 2.7 cryoballoon freezes, and no patients required additional radiofrequency ablation lesion sets. Over a follow-up of 995 ± 490 days, 77/300 (25.7%) patients exhibited VLRAF. Univariate and multivariate analyses demonstrated that Structural heart disease (1 point), Coronary artery disease (3 points), left Atrial diameter > 43 mm (1 point), Left bundle branch block (3 points), Early return of AF (4 points), and non-paroxysmal AF (3 points) were risk factors for VLRAF. Combining these variables into a risk model, SCALE-CryoAF, (min 0; max 15) predicted VLRAF with an area under the curve of 0.73. CONCLUSION SCALE-CryoAF is the first risk model to specifically predict first recurrence of AF beyond 1 year, VLRAF, after CBA. Model discrimination demonstrates that SCALE-CryoAF predicts VLRAF after CBA significantly better than other risk models for AF recurrence.
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Affiliation(s)
- Graham Peigh
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Rachel M Kaplan
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Aakash Bavishi
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Celso L Diaz
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Jayson R Baman
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Richard Matiasz
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Amar Trivedi
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Prasongchai Sattayaprasert
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Jeremiah Wasserlauf
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Mark J Shen
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | | | - Alexandru B Chicos
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Rishi Arora
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Susan Kim
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Albert Lin
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Nishant Verma
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Bradley P Knight
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA
| | - Rod S Passman
- Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Northwestern University, 251 E Huron St. Rm. 8-340, Chicago, IL, 60611, USA.
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24
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Steerable Sheath for Cannulation and Bridging Stenting of Challenging Target Visceral Vessels in Fenestrated and Branched Endografting. Ann Vasc Surg 2020; 67:26-34. [DOI: 10.1016/j.avsg.2019.11.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 11/22/2022]
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25
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Mehra N, Kowlgi GN, Deshmukh AJ. Predictors of Outcomes in Patients with Atrial Fibrillation: What Can Be Used Now and What Hope Is in the Future. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00645-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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26
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Yang DY, Cheng ZW, Liu YT, Gao P, Chen TB, Deng H, Cheng KA, Fan JB, Fang Q. Noninvasive electrocardiography monitoring for very early recurrence predicts long-term outcome in patients after atrial fibrillation ablation. Ann Noninvasive Electrocardiol 2020; 25:e12785. [PMID: 32588512 PMCID: PMC7679836 DOI: 10.1111/anec.12785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/09/2020] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common sustained arrhythmia, and catheter ablation has been shown to be a highly effective treatment for patients with symptomatic AF. Very early recurrence (VER) of AF within 7 days after catheter ablation is common, but the clinical significance of VER remains unclear. We have examined the usefulness of the noninvasive electrocardiography monitor for the detection of VER and the relationship between VER and late recurrence (LR). Methods Eighty‐eight patients with paroxysmal or persistent atrial fibrillation were retrospectively included. All patients underwent primary catheter ablation at a large general hospital between March 2016 and August 2018. All patients were followed up in atrial fibrillation clinic at an interval of every 3 months for late recurrence of AF. VER was evaluated by one‐lead continuous noninvasive electrocardiography monitoring device for 7 days after ablation. The association between VER and LR was analyzed by univariate and multivariate Cox regression model. Results Mean age was 62.9 ± 9.7 years, and 39.8% were female. Thirty‐two patients (36.4%) experienced VER. After a mean follow‐up of 539.36 ± 211.66 days, 17 patients (19.3%) experienced LR. Multivariate Cox regression analysis revealed VER was an independent predictor of LR: HR 3.6 (95% CI, 1.2–10.8), p = .020. In addition, diabetes was also associated with LR of atrial fibrillation. Conclusions Noninvasive electrocardiography monitoring was a useful tool for detecting VER and VER after catheter ablation was associated with LR.
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Affiliation(s)
- De-Yan Yang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhong-Wei Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yong-Tai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tai-Bo Chen
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hua Deng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kang-An Cheng
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jing-Bo Fan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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27
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Cherian TS, Callans DJ. Recurrent Atrial Fibrillation After Radiofrequency Ablation: What to Expect. Card Electrophysiol Clin 2020; 12:187-197. [PMID: 32451103 DOI: 10.1016/j.ccep.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recurrent atrial fibrillation after radiofrequency ablation is observed in up to 50% of patients within 3 months. Early and multiple recurrences predict late recurrences within 1 year, which occurs in 20% to 50% of patients. Although no consensus exists regarding patient selection and timing of redo ablation, we refer symptomatic patients with multiple recurrences and persistent atrial fibrillation for ablation. Reisolation of reconnected pulmonary veins and ablation of nonpulmonary vein triggers is the primary ablation strategy. In addition to repeat ablation, we recommend weight loss, treatment of sleep-disordered breathing, and management of comorbid conditions for durable maintenance of sinus rhythm.
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Affiliation(s)
- Tharian S Cherian
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9.129 Founders Pavilion, 3400 Spruce Street, Philadelphia PA 19104, USA. https://twitter.com/tscherian
| | - David J Callans
- Cardiovascular Division, Electrophysiology Section, Hospital of the University of Pennsylvania, 9.129 Founders Pavilion, 3400 Spruce Street, Philadelphia PA 19104, USA.
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28
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Mazzaccaro D, Castronovo EL, Righini P, Nano G. Use of steerable catheters for endovascular procedures: Report of a CASE and literature review. Catheter Cardiovasc Interv 2020; 95:971-977. [PMID: 31231978 DOI: 10.1002/ccd.28380] [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: 12/26/2018] [Revised: 05/29/2019] [Accepted: 06/10/2019] [Indexed: 11/11/2022]
Abstract
We report a case of a celiac trunk stenting using a steerable guiding catheter, to fix a residual endoleak following fenestrated endovascular repair (FEVAR) of a thoraco-abdominal aortic aneurysm (TAAA). A systematic search of the literature about the use of steerable catheters was also performed on Pubmed according to the PRISMA Guidelines, including all papers in which the device was used for in vivo endovascular procedures. In our case report, the patient had undergone a failed attempt of cannulation due to the presence of a severely angulated and stenosed ostium of the vessel. A steerable catheter was then used to fix the residual endoleak. The search of the Literature retrieved 544 papers. Of them, 13 met the inclusion criteria and were therefore assessed. The use of steerable sheaths and catheters was reported as effective and safe for the cannulation of 157 target vessels in 131 endovascular procedures, with a success rate of 95.5% and no complications. The use of a steerable guiding catheter in our experience was safe and effective for the selective cannulation of a severely stenosed and angulated celiac trunk, to correct a residual endoleak after FEVAR for TAAA. Steerable catheters could be useful tools for the selective cannulation of target vessels with a challenging ostium.
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Affiliation(s)
- Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Paolo Righini
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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29
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Simonte G, Fino G, Isernia G, Parlani G, Cieri E, Baccani L, Lenti M. Forced Complete Femoral Approach for Urgent Thoracoabdominal Aneurysm Repair Using an Inner Branched Endograft. Ann Vasc Surg 2020; 64:412.e7-412.e13. [DOI: 10.1016/j.avsg.2019.10.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/16/2022]
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30
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Wang Q, Sun X, Zhuo C, Chen M, Wu M, Zhao J, Lin Z, Huang Y, Lai J, Shu Z, Zheng L. Investigation of proper home blood pressure with atrial fibrillation recurrence in patients undergoing radiofrequency catheter ablation. Minerva Cardioangiol 2020; 68:224-233. [PMID: 32107893 DOI: 10.23736/s0026-4725.20.05116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypertension is an important target for interventions to improve ablation outcome in atrial fibrillation (AF) patients. No studies to date have determined the blood pressure level at which AF is less likely to recur in patients without hypertension. METHODS A total of 503 AF patients undergoing radiofrequency catheter ablation (RFCA) (mean age, 59.6±9.6 years; 319 males [63.4%]) were identified for the study cohort and analysis. Patients received a pocket diary to record their home blood pressure (HBP) before RFCA and routine 48-hour Holter-ECGs to evaluate AF recurrence after RFCA. RESULTS A total of 383 (76.1%) patients were free of AF recurrence one year after RFCA. Blood pressure (BP), including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), had different effects on AF recurrence one year after RFCA. A χ2 test showed that when SBP was <110 mmHg, it was associated with a lower AF recurrence in patients with hypertension (P=0.029). AF recurrence decreased (P=0.002) when SBP increased from <110 mmHg to >130 mmHg in patients without hypertension. Regression analysis indicated a significant linear correlation between BP and LAD in all patients. CONCLUSIONS SBP should be strictly maintained at 110 mmHg after RFCA to minimize AF recurrence in patients with hypertension. Low SBP might be a risk factor for AF recurrence among patients without hypertension.
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Affiliation(s)
- Qiqi Wang
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xingang Sun
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chengui Zhuo
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Miao Chen
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Minglan Wu
- Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, Research Center for Clinical Pharmacy, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jianqiang Zhao
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhongyuan Lin
- Department of Cardiovascular Medicine, Haining People's Hospital, Jiaxing, China
| | - Yuan Huang
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiangtao Lai
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zheyue Shu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Liangrong Zheng
- Department of Cardiology, Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University, Hangzhou, China -
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31
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Long-term results of monopolar versus bipolar radiofrequency ablation procedure for atrial fibrillation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:152-158. [PMID: 32082846 DOI: 10.5606/tgkdc.dergisi.2019.17105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to evaluate the long-term outcomes of monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery in patients with atrial fibrillation. Methods We retrospectively evaluated a total of 167 patients (67 males, 100 females; mean age 56.8±6.9 years; range, 48 to 65 years) with atrial fibrillation who underwent monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery between September 2001 and January 2015. The patients were divided into two groups according to the procedure applied as those undergoing monopolar ablation (group 1, n=68) and those undergoing bipolar ablation (group 2, n=99). All patients were followed by electrocardiogram and 24-h Holter monitoring. Echocardiography was performed before discharge, at three and 12 months postoperatively, and annually thereafter. Left atrial volume index, left atrial diameter, and left ventricular ejection fraction were recorded. Results There was no significant correlation between the procedure applied and hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, history of the cerebrovascular events (p>0.05). The mean preoperative left atrial diameter decreased from 5.3±0.5 cm to 4.9±0.5 cm postoperatively in all patients (p=0.0001). The mean preoperative left atrial volume index decreased from 53.8±0.4 mL/m2 t o 43.7±6.2 m L/m2 i n t he postoperative period (p=0.0001). During follow-up, 61.8% (n=42) of the patients in group 1 and 62.6% (n=62) of the patients in group 2 remained in sinus rhythm. One patient (1.5%) in group 1 and two patients (2.0%) in group 2 developed early postoperative cerebrovascular accident. Conclusion Monopolar and bipolar ablation methods are safe and effective methods to ensure long-term sinus rhythm. Both procedures do not increase the morbidity risk with very low thromboembolic complication rates.
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32
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Olshausen G, Uijl A, Jensen‐Urstad M, Schwieler J, Drca N, Bastani H, Tapanainen J, Saluveer O, Bourke T, Kennebäck G, Insulander P, Deisenhofer I, Braunschweig F. Early recurrences of atrial tachyarrhythmias post pulmonary vein isolation. J Cardiovasc Electrophysiol 2020; 31:674-681. [DOI: 10.1111/jce.14368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Gesa Olshausen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Alicia Uijl
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholm Sweden
- Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht University The Netherlands
- Health Data Research UK London, Institute for Health InformaticsUniversity College London London United Kingdom
| | - Mats Jensen‐Urstad
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jonas Schwieler
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Nikola Drca
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Hamid Bastani
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Jari Tapanainen
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Ott Saluveer
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Tara Bourke
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Göran Kennebäck
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Per Insulander
- Heart and Vascular DivisionKarolinska University HospitalStockholm Sweden
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz‐ und KreislauferkrankungenTechnische Universität MünchenMunich Germany
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Barrio-Lopez MT, Sanchez-Quintana D, Garcia-Martinez J, Betancur A, Castellanos E, Arceluz M, Ortiz M, Nevado-Medina J, Garcia F, Almendral J. Epicardial Connections Involving Pulmonary Veins. Circ Arrhythm Electrophysiol 2020; 13:e007544. [DOI: 10.1161/circep.119.007544] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background:
The presence of epicardial connections (ECs) between pulmonary veins (PVs) and other anatomic structures may hinder PV isolation. In this study, we analyzed their prevalence, location, associated factors, and clinical implications.
Methods:
Five hundred thirty-four consecutive patients with atrial fibrillation undergoing radiofrequency ablation were included. We considered that an EC was present if: (1) the first pass around the PV antrum did not produce PV isolation and (2) subsequent atrial activation during PV pacing showed that the earliest site was located away from the ablation line and later activation sites were observed near the ablation line. Clinical and electrophysiological variables were collected from all patients. Patients were followed during 12.9±9.4 months, and any documented atrial tachyarrhythmia after the 3-month blanking period was classified as a recurrence.
Results:
Out of the 534 patients included, 72 (13.5%) were found to have 81 ECs. There was a significant association between the presence of ECs and structural heart disease (15.3% in patients without ECs versus 36.5% in patient with ECs;
P
<0.001) and patent foramen ovale (4.6% versus 13.5%;
P
=0.002). The presence of a left common trunk was significantly associated with the absence of ECs (29.6% in patients without ECs versus 16.2% in patients with ECs;
P
=0.014). Patients with ECs had lower acute success in PV isolation compared with patients without ECs (99.1% versus 86.1%;
P
<0.001). After adjusting for age, sex, type of atrial fibrillation, left atrium area, hypertension, structural heart disease, presence of left common trunk, patent foramen ovale, and time for atrial fibrillation diagnosis to the ablation, we found a significantly higher risk of atrial tachyarrhythmia recurrences in patients with ECs compared with patients without ECs (hazard ratio, 1.7 [95% CI, 1.1–2.9];
P
=0.04).
Conclusions:
ECs between PVs and other adjacent structures are frequent in patient with atrial fibrillation (prevalence: 13.5%). Structural heart disease and a patent foramen ovale are strongly associated with the presence of ECs. ECs reduce the acute and chronic success of PV isolation.
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Affiliation(s)
- Maria Teresa Barrio-Lopez
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Damian Sanchez-Quintana
- Anatomy and Cell Biology Department, School of Medicine, University of Badajoz, Spain (D.S.-Q., J.N.-M.)
| | - Joaquin Garcia-Martinez
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Andres Betancur
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Eduardo Castellanos
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Martín Arceluz
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Mercedes Ortiz
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
| | - Jorge Nevado-Medina
- Anatomy and Cell Biology Department, School of Medicine, University of Badajoz, Spain (D.S.-Q., J.N.-M.)
| | - Fermin Garcia
- Cardiac Electrophysisology Program, Hospital of the Univeristy of Pennsylvania, Perlman School of Medicine, Philadelphia (F.G.)
| | - Jesús Almendral
- Electrophysiology and Arrhythmia Unit, Centro integral de Enfermedades Cardiovasculares (HM CIEC), Hospital Universitario HM Monteprincipe, HM Hospitales, University CEU-San Pablo, Madrid, Spain (M.T.B.-L., J.G.-M., A.B., E.C., M.A., M.O., J.A.)
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34
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Bajraktari G, Bytyçi I, Henein MY. Left atrial structure and function predictors of recurrent fibrillation after catheter ablation: a systematic review and meta-analysis. Clin Physiol Funct Imaging 2020; 40:1-13. [PMID: 31556215 DOI: 10.1111/cpf.12595] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF. METHODS We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included. RESULTS The pooled analysis showed that after a follow-up period of 21 ± 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2·99 ([95% CI 2·50-3·47], P<0·001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0·0001 for both), larger LA area (P<0·0001), lower LA strain (P<0·0001) and lower LA total emptying fraction (LA EF) (P<0·0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3·1[95% CI, -1.3-10·4], P<0·0001), followed by LA diameter ≥50 mm (OR: 2·75, [95% CI 1·66-4·56,] P<0·0001), and LAVmax >150 ml (OR: 2·25, [95% CI, 1.1-5·6], P = 0·0002). CONCLUSIONS Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Molecular & Clinical Sciences Research Institute, St George University, London, UK
- Brunel University, London, UK
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35
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Vaishnav AS, Levine E, Coleman KM, Beldner SJ, Chinitz JS, Bhasin K, Bernstein NE, Skipitaris NT, Mountantonakis SE. Early recurrence of atrial fibrillation after pulmonary vein isolation: a comparative analysis between cryogenic and contact force radiofrequency ablation. J Interv Card Electrophysiol 2019; 57:67-75. [DOI: 10.1007/s10840-019-00639-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
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36
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Wang Q, Zhuo C, Shang Y, Zhao J, Chen N, Lv N, Huang Y, Zheng L, Lai J, Han J, Shu Z. U-Shaped Relationship Between Left Atrium Size on Echocardiography and 1-Year Recurrence of Atrial Fibrillation After Radiofrequency Catheter Ablation - Prognostic Value Study. Circ J 2019; 83:1463-1471. [PMID: 31178525 DOI: 10.1253/circj.cj-19-0167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The larger the left atrium anteroposterior dimension (LAD) and left atrium volume (LAV), the stronger the association with recurrent atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). Patients with a smaller left atrium (LA) size, however, also have increased AF recurrence.Methods and Results:In 521 patients, routine 48-h Holter electrocardiogram and echocardiography were obtained at each outpatient visit every 3 months for 12 months. On multivariate analysis, AF type, LAD, and LAV calculated using the ellipsoid model/body surface area (LAVe/BSA) were independent predictors of AF recurrence. Patients were divided into 7 groups at 0.4-cm increments of LAD: ≤3 cm, LAD≤3 cm, 3.0<LAD≤3.4 cm, 3.4<LAD≤3.8 cm, 3.8<LAD≤4.2 cm, 4.2<LAD≤4.6 cm, 4.6<LAD≤5.0 cm; and LAD>5.0 cm. Compared with the 3.4-3.8-cm group, the adjusted HR were 3.88 (95% CI: 2.02-7.46, P<0.001), 1.03 (95% CI: 0.50-2.12, P=0.939), 0.96 (95% CI: 0.52-1.77, P=0.901), 1.36 (95% CI: 0.72-2.57, P=0.347), 3.04 (95% CI: 1.67-5.53, P<0.001), and 4.07 (95% CI: 1.93-8.60, P<0.001), respectively. Similarly, we divided LAVe/BSA into 8 groups and also observed a U-shaped curve for AF recurrence. CONCLUSIONS Both larger and smaller LAD and LAVe/BSA were associated with a higher risk of AF recurrence 1 year after RFCA. The association of LA size and AF recurrence after RFCA is represented by a U-shaped curve.
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Affiliation(s)
- Qiqi Wang
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Chengui Zhuo
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Yunpeng Shang
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Jianqiang Zhao
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Nan Chen
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Ning Lv
- Department of Pharmacy, First Affiliated Hospital of Zhejiang University
| | - Yuan Huang
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Liangrong Zheng
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Jiangtao Lai
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Jie Han
- Department of Cardiology and Atrial Fibrillation Center, First Affiliated Hospital of Zhejiang University
| | - Zheyue Shu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Zhejiang University
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37
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Bavishi AA, Kaplan RM, Peigh G, Diaz CL, Baman JR, Trivedi A, Wasserlauf J, Shen MJ, Sattayaprasert P, Chicos AB, Kim S, Verma N, Arora R, Lin A, Knight BP, Passman RS. Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:694-704. [PMID: 30912155 DOI: 10.1111/pace.13669] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND While several studies have evaluated predictors for atrial fibrillation (AF) recurrence following catheter ablation, there are limited data specific to cryoballoon ablation (CBA). METHODS We analyzed a prospective registry of patients at a single institution who underwent CBA. Recurrence of AF (RAF) was defined as recurrence of AF by 12-month follow-up, excluding the 3-month blanking period. Univariate analysis was performed to evaluate predictors of RAF. Receiver operating characteristic analysis was used to compare and evaluate the performance of various risk scores for discriminating risk of RAF. RESULTS There were 542 patients included in the analysis with mean age 61.3 ± 10.6 years, 67.9% male, and 51.6% paroxysmal AF (PAF). Overall, only left atrial diameter (LAD) > 40 mm and ERAF (early recurrence of AF within 0-3 month blanking period) were significant predictors of RAF. In the PAF specific subgroup, LAD > 40 mm, AF duration > 12 months, prior stroke or transient ischemic attack, ERAF, and having previously failed an antiarrhythmic drug were significant predictors of RAF. In persistent AF (PeAF) subgroup, obstructive sleep apnea (OSA) and ERAF were significant predictors of RAF. Out of clinical risk scores tested, BASEAF2 had the highest performance with area under the curve of 0.646 (95% confidence interval [0.548, 0.708]; P < .01). CONCLUSIONS In this single-center retrospective study of CBA, we found only LAD > 40 mm and ERAF to be predictors of RAF. We identified OSA as a potential targetable risk factor in PeAF patients undergoing CBA. Out of risk scores tested for discriminating risk of RAF, BASEAF2 had the best performance.
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Affiliation(s)
- Aakash A Bavishi
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rachel M Kaplan
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Graham Peigh
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Celso L Diaz
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jayson R Baman
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amar Trivedi
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mark J Shen
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Prasongchai Sattayaprasert
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Susan Kim
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Nishant Verma
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rishi Arora
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Albert Lin
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
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38
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Wang Y, Xu Y, Ling Z, Chen W, Su L, Du H, Xiao P, Liu Z, Yin Y. Radiofrequency catheter ablation for paroxysmal atrial fibrillation: outcomes during a 3-year follow-up period. J Int Med Res 2019; 47:1636-1648. [PMID: 30803295 PMCID: PMC6460609 DOI: 10.1177/0300060519828522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective This study was performed to observe the effect of radiofrequency catheter ablation (RFCA) in patients with paroxysmal atrial fibrillation (PAF) and to explore the risk factors for late recurrence of atrial fibrillation (LRAF) after a single RFCA session. Methods In this retrospective study, 243 patients with PAF underwent RFCA and were followed up regularly. Results At a median follow-up of 37 months after a single procedure, 60.5% of patients maintained sinus rhythm (SR), and at a median follow-up of 42 months after multiple procedures, 74.9% of patients maintained SR. The statistically significant risk factors for LRAF after a single RFCA session were the left atrial diameter (LAD), left inferior pulmonary vein superior–inferior diameter (LIPV SID), PV number variation, circumferential pulmonary vein isolation (CPVI) combined with additional ablation, and early recurrence of atrial fibrillation (ERAF). The best cut-off value for LAD was 35.5 mm. Conclusions During a 3-year follow-up, about 70% of the patients with PAF maintained SR. LRAF after a single procedure was associated with the LAD, LIPV SID, PV number variation, CPVI combined with additional ablation, and ERAF.
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Affiliation(s)
- Yubing Wang
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China.,2 Affiliated Hospital of North Sichuan Medical College, Sichuan, China
| | - Yanping Xu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zhiyu Ling
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Weijie Chen
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Li Su
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Huaan Du
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Peilin Xiao
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Zengzhang Liu
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
| | - Yuehui Yin
- 1 Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Cardiac Arrhythmia Service Center, Chongqing, China
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39
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Kaur D, Narasimhan C. Predictors of recurrence of paroxysmal atrial fibrillation following cryoablation based pulmonary vein isolation. Indian Pacing Electrophysiol J 2019; 19:7-8. [PMID: 30447287 PMCID: PMC6354236 DOI: 10.1016/j.ipej.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Daljeet Kaur
- CARE Hospital, Banjara Hills, Hyderabad, Telangana, India
| | - C Narasimhan
- CARE Hospital, Banjara Hills, Hyderabad, Telangana, India.
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40
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Park HS, Jeong DS, Yu HT, Pak HN, Shim J, Kim JY, Kim J, Lee JM, Kim KH, Roh SY, Cho YJ, Kim YH, Yoon NS. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part I. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.011] [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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41
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Lee JM, Jeong DS, Yu HT, Park HS, Shim J, Kim JY, Kim J, Yoon NS, Oh S, Roh SY, Cho YJ, Kim KH. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part III. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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42
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43
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Ferreira‐Martins J, Howard J, Al‐Khayatt B, Shalhoub J, Sohaib A, Shun‐Shin MJ, Novak PG, Leather R, Sterns LD, Lane C, Lim PB, Kanagaratnam P, Peters NS, Francis DP, Sikkel MB. Outcomes of paroxysmal atrial fibrillation ablation studies are affected more by study design and patient mix than ablation technique. J Cardiovasc Electrophysiol 2018; 29:1471-1479. [DOI: 10.1111/jce.13745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Affiliation(s)
- João Ferreira‐Martins
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - James Howard
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
| | - Becker Al‐Khayatt
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
| | - Joseph Shalhoub
- Department of Surgery and CancerImperial College LondonLondon UK
| | - Afzal Sohaib
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - Matthew J. Shun‐Shin
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
| | - Paul G. Novak
- Department of MedicineRoyal Jubilee HospitalVictoria Canada
| | - Rick Leather
- Department of MedicineRoyal Jubilee HospitalVictoria Canada
| | | | | | - Phang Boon Lim
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - Prapa Kanagaratnam
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - Nicholas S. Peters
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - Darrel P. Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
- Department of CardiologyImperial College Healthcare NHS Trust, Hammersmith HospitalLondon UK
| | - Markus B. Sikkel
- Department of MedicineRoyal Jubilee HospitalVictoria Canada
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College LondonLondon UK
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44
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Makaloski V, Tsilimparis N, Rohlffs F, Spanos K, Debus ES, Kölbel T. Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms. J Endovasc Ther 2018; 25:566-570. [DOI: 10.1177/1526602818794965] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched aortic stent-graft. Technique: Following femoral cutdown, a stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. Conclusion: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.
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Affiliation(s)
- Vladimir Makaloski
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E. Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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45
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Mesquita J, Cavaco D, Ferreira AM, Costa FM, Carmo P, Morgado F, Mendes M, Adragão P. Very long-term outcomes after a single catheter ablation procedure for the treatment of atrial fibrillation—the protective role of antiarrhythmic drug therapy. J Interv Card Electrophysiol 2018; 52:39-45. [DOI: 10.1007/s10840-018-0340-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/14/2018] [Indexed: 11/24/2022]
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46
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Liang JJ, Dixit S. Early Recurrences During the Blanking Period after Atrial Fibrillation Ablation. J Atr Fibrillation 2018; 10:1726. [PMID: 29988237 DOI: 10.4022/jafib.1726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 02/23/2018] [Accepted: 02/24/2018] [Indexed: 11/10/2022]
Abstract
Early recurrences of atrial arrhythmias (ERAA) after ablation are common and predict late recurrences and ablation failure.However,becausea proportion of patients with ERAA will have no subsequent arrhythmias after the blanking period, consensus guidelines recommend against immediate repeat ablation for ERAA episodes occurring during the first 3 months post-ablation. In this review, we summarize the predictors, significance, and treatment of ERAA after AF ablation.
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Affiliation(s)
- Jackson J Liang
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dixit
- Division of Cardiology, Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, PA
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47
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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: 727] [Impact Index Per Article: 121.2] [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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48
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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: 1415] [Impact Index Per Article: 202.1] [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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49
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Radiofrequency Catheter Ablation For Atrial Fibrillation: Approaches And Outcomes. Heart Lung Circ 2017; 26:941-949. [DOI: 10.1016/j.hlc.2017.05.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/16/2017] [Indexed: 01/27/2023]
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50
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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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