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Choi JH, Hwang KW, Jung SM, Lee SY, Lee SH, Chon MK, Kim JS, Je HG, Park YH, Kim JH, Lee SK, Chun KJ. Incidence and clinical impact of early recurrence of atrial tachyarrhythmia after surgical ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2898-2906. [PMID: 32945008 DOI: 10.1111/jce.14749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial tachyarrhythmias (ATAs) are common within the 3-month blanking period after catheter ablation of atrial fibrillation (AF). However, little evidence is available regarding the current guidelines on the blanking period after surgical AF ablation. We investigate the incidence and significance of early recurrence of atrial tachyarrhythmia (ERAT) and evaluate the optimal blanking period after surgical AF ablation. METHODS Data from 259 patients who underwent surgical AF ablation from 2009 to 2016 were collected. ERAT was defined as documented ATA episodes lasting for 30 s. A multivariate Cox proportional hazard model was constructed to evaluate the role of ERAT as a predictor of late recurrences (LR) for AF. RESULTS In total, 127 patients (49.0%) experienced their last episodes of ERAT during the first (n = 65), second (n = 14), or third (n = 48) month of the 3-month blanking period (p < .001). One year freedom from ATAs was 97.8% in patients without ERAT compared with 95.4%, 64.3%, and 8.3% in patients with ERAT in the first, second, and third months after the index procedure, respectively (p < .001). Hazard ratios of LR according to the timing of the last episode of ERAT first, second, and third months after the procedure were 2.84, 16.70, and 119.75, respectively. CONCLUSIONS The ERAT occurred in 49.0% of patients within the first 3 months after surgical ablation. The occurrence of ERAT within 3 months after surgical AF ablation was a significant independent predictor of LR. Hence, the currently accepted 3-month blanking period may be considered for redefining in patients with AF surgical ablation.
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Affiliation(s)
- Jin Hee Choi
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soon Myung Jung
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Soo Yong Lee
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Hyun Lee
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Min-Ku Chon
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jeong-Su Kim
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyung Gon Je
- Department of Cardiovascular and Thoracic Surgery, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yong-Hyun Park
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - June Hong Kim
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang Kwon Lee
- Department of Cardiovascular and Thoracic Surgery, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Kook Jin Chun
- Division of Cardiology, Pusan National University, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Wang J, Li S, Ye Q, Ma X, Zhao Y, Han J, Li Y, Zheng S, Liu K, He M, Yu W, Sun J, Meng X. Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis. J Cardiothorac Surg 2020; 15:277. [PMID: 32993732 PMCID: PMC7526327 DOI: 10.1186/s13019-020-01336-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. METHODS A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. RESULTS The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan-Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047-0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357-09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359-0.981; P = 0.042) in catheter group. CONCLUSIONS Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.
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Affiliation(s)
- Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China.
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Ye
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Xiaolong Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Yichen Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Shuai Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Kemin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Meng He
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Wen Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Junhui Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China
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Wu T, Xia X, Fu J, Chen W, Zhang J. Left atrial appendage thrombus formation in a patient with atrial fibrillation on dabigatran therapy associated with CES1 and ABCB1 genetic polymorphisms: A case report. Medicine (Baltimore) 2020; 99:e22084. [PMID: 32899083 PMCID: PMC7478673 DOI: 10.1097/md.0000000000022084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Dabigatran is a direct thrombin inhibitor that is widely used to prevent the formation of thrombus formation. Amiodarone can increase the plasma concentration of dabigatran. CES1 (carboxylesterase 1) and ABCB1 (ATP-binding cassette subfamily B member 1) genetic polymorphisms associate with the pharmacokinetics of dabigatran. PATIENT CONCERNS A 62-year-old woman was admitted to the hospital due to chest tightness, fatigue, and discomfort despite long-term anticoagulation with dabigatran 110 mg twice daily for 6 months, with concomitant use of amiodarone. DIAGNOSES Left atrial appendage thrombus formation with a history of atrial fibrillation. INTERVENTIONS The clinician changed dabigatran to warfarin. To explore the causes of insufficient anticoagulation using dabigatran in this patient, we examined the ABCB1 and CES1 genes. Results showed that she carried ABCB1 variant alleles with 3 heterozygote single nucleotide polymorphisms (SNPs: rs4148738, rs1045642, rs2032582) and CES1 variant alleles with 2 heterozygote SNPs (rs2244613, rs4580160). OUTCOMES The left atrial appendage thrombus disappeared. LESSONS Multiple mutations in the ABCB1 and CES1 genes may influence the pharmacokinetics of dabigatran and could have contributed to the thrombus formation in the left atrial appendage.
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Affiliation(s)
- Tingting Wu
- Department of Pharmacy, Fujian Medical University Union Hospital
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaotong Xia
- Department of Pharmacy, Fujian Medical University Union Hospital
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Jinglan Fu
- Department of Pharmacy, Fujian Medical University Union Hospital
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Wenjun Chen
- Department of Pharmacy, Fujian Medical University Union Hospital
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Jinhua Zhang
- Department of Pharmacy, Fujian Medical University Union Hospital
- College of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
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54
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Yeung C, Enriquez A, Suarez-Fuster L, Baranchuk A. Atrial fibrillation in patients with inherited cardiomyopathies. Europace 2020; 21:22-32. [PMID: 29684120 DOI: 10.1093/europace/euy064] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) often complicates the course of inherited cardiomyopathies and, in some cases, may be the presenting feature. Each inherited cardiomyopathy has its own peculiar pathogenetic characteristics that can contribute to the development and maintenance of AF. Atrial fibrillation may occur as a consequence of disease-specific defects, non-specific cardiac chamber changes secondary to the primary illness, or a combination thereof. The presence of AF can denote a turning point in the progression of the disease, promoting clinical deterioration and increasing morbidity and mortality. Furthermore, the management of AF can be particularly challenging in patients with inherited cardiomyopathies. In this article, we review the current information on the prevalence, pathophysiology, risk factors, and treatment of AF in three different inherited cardiomyopathies: hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia/cardiomyopathy, familial dilated cardiomyopathy, and left ventricular non-compaction cardiomyopathy.
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Affiliation(s)
- Cynthia Yeung
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Andres Enriquez
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | | | - Adrian Baranchuk
- Kingston General Hospital, Queen's University, Kingston, ON, Canada
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55
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Matteucci F, Maesen B, De Asmundis C, Bidar E, Parise G, Maessen JG, La Meir M, Gelsomino S. Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting. J Interv Card Electrophysiol 2020; 61:567-575. [PMID: 32833110 PMCID: PMC8376704 DOI: 10.1007/s10840-020-00852-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
Purpose To make an in vitro evaluation of the lesion size and depth produced in two different sets of radio frequency energy bipolar delivery: simultaneous biparietal bipolar (SBB) and simultaneous uniparietal bipolar (SUB). Methods Two separate prototypes have been built for our purpose: one to be used in SBB mode and the other to be used SUB mode. Forty left atrium samples were taken from the hearts of freshly slaughtered pigs. They were ablated into a simulator ABLABOX, where blood flow, temperature, and contact force were controlled. After being sliced into a cryotome, the samples were digitalized by a flatbed scanner, and the images were analyzed by a computer morphometric software. Results Transmural lesions were achieved in 18/20 samples (90%) in SBB, while SUB showed transmurality in 9/20 samples (45%). Overall maximum diameter (DMAX) resulted larger in SUB than in SBB (2.43 ± 0.30 mm, 1.62 ± 0.14 mm, respectively; p < 0.05): Moreover, maximum epicardial and endocardial diameters (DEPI and DENDO, respectively) were wider in SUB group than SBB group (2.28 ± 0.30 mm, 2.26 ± 0.40 and 1.60 ± 0.14 mm, 1.59 ± 0.15 mm, respectively; p < 0.05). We observed the same tendency in lesion depth: The total area and volume (ATOT and VTOT) were broader in SUB group than in SBB one (581.01 ± 65.38 mm/mm2, 58.10 ± 6.53 mm/mm3 and 521.97 ± 73.05 mm/mm2, 52.19 ± 7.30 mm/mm3. respectively; p < 0.05). Conclusions In contrast with the smaller lesion sizes, the biparietal bipolar group showed a higher transmurality rate. These findings may suggest a better drive of the energy flow when compared with SUB lesions.
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Affiliation(s)
- Francesco Matteucci
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands. .,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
| | - Bart Maesen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Carlo De Asmundis
- Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Elham Bidar
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Gianmarco Parise
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Jos G Maessen
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
| | - Mark La Meir
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.,Cardiothoracic Department, Brussels University Hospital, Brussels, Belgium
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Osorio-Jaramillo E, Klenk S, Laufer G, Ehrlich MP. Noninvasive Electrocardiographic Imaging: A Novel Tool for Understanding Atrial Fibrillation in Candidates for Cardiac Surgery? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:410-415. [PMID: 32790514 DOI: 10.1177/1556984520943186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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57
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Andrade JG, Cheung CC, Deyell MW. Hemoptysis and Cryoballoon Ablation: Is it Crystal Clear? JACC Clin Electrophysiol 2020; 6:783-785. [PMID: 32703559 DOI: 10.1016/j.jacep.2020.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Québec, Canada; Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada.
| | - Christopher C Cheung
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Cardiovascular Innovation, Vancouver, British Columbia, Canada
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58
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Jalloul Y, Refaat MM. Catheter ablation of atrial tachycardias after mitral valve surgery. J Cardiovasc Electrophysiol 2020; 31:2642-2644. [PMID: 32652602 DOI: 10.1111/jce.14667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Youssef Jalloul
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan M Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon
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59
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Vogler J, Fink T, Sohns C, Sommer P, Pott A, Dahme T, Rottner L, Sciacca V, Sieren MM, Jacob F, Barkhausen J, Sano M, Eitel C, Metzner A, Ouyang F, Kuck KH, Tilz RR, Heeger CH. Acute Hemoptysis Following Cryoballoon Pulmonary Vein Isolation. JACC Clin Electrophysiol 2020; 6:773-782. [DOI: 10.1016/j.jacep.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
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60
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Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [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: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
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Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
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Haïssaguerre M, Duchateau J, Dubois R, Hocini M, Cheniti G, Sacher F, Lavergne T, Probst V, Surget E, Vigmond E, Welte N, Chauvel R, Derval N, Pambrun T, Jais P, Nademanee W, Bernus O. Idiopathic Ventricular Fibrillation: Role of Purkinje System and Microstructural Myocardial Abnormalities. JACC Clin Electrophysiol 2020; 6:591-608. [PMID: 32553208 PMCID: PMC7308805 DOI: 10.1016/j.jacep.2020.03.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022]
Abstract
Idiopathic ventricular fibrillation is diagnosed in patients who survived a ventricular fibrillation episode without any identifiable structural or electrical cause after extensive investigations. It is a common cause of sudden death in young adults. The study reviews the diagnostic value of systematic investigations and the new insights provided by detailed electrophysiological mapping. Recent studies have shown the high incidence of microstructural cardiomyopathic areas, which act as the substrate of ventricular fibrillation re-entries. These subclinical alterations require high-density endo- and epicardial mapping to be identified using electrogram criteria. Small areas are involved and located individually in various sites (mostly epicardial). Their characteristics suggest a variety of genetic or acquired pathological processes affecting cellular connectivity or tissue structure, such as cardiomyopathies, myocarditis, or fatty infiltration. Purkinje abnormalities manifesting as triggering ectopy or providing a substrate for re-entry represent a second important cause. The documentation of ephemeral Purkinje ectopy requires continuous electrocardiography monitoring for diagnosis. A variety of diseases affecting Purkinje cell function or conduction are potentially at play in their pathogenesis. Comprehensive investigations can therefore allow the great majority of idiopathic ventricular fibrillation to ultimately receive diagnoses of a cardiac disease, likely underlain by a mosaic of pathologies. Precise phenotypic characterization has significant implications for interpretation of genetic variants, the risk assessment, and individual therapy. Future improvements in imaging or electrophysiological methods may hopefully allow the identification of the subjects at risk and the development of primary prevention strategies.
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Affiliation(s)
- Michel Haïssaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France.
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Lavergne
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Elodie Surget
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Ed Vigmond
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Welte
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Remi Chauvel
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Wee Nademanee
- Cardiology Department, Bumrungrad International Hospital, Bangkok, Thailand
| | - Olivier Bernus
- Institut Hospitalo-Universitaire Electrophysiology and Heart Modeling Institute, Centre Hospitalier Universitaire de Bordeaux, France; Cardiothoracic Research Center Bordeaux, Université de Bordeaux, Bordeaux, France
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Palano F, Adduci C, Cosentino P, Silvetti G, Boldini F, Francia P. Assessing Atrial Fibrillation Substrates by P Wave Analysis: A Comprehensive Review. High Blood Press Cardiovasc Prev 2020; 27:341-347. [PMID: 32451990 DOI: 10.1007/s40292-020-00390-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Pharmacologic and non-pharmacologic rhythm control strategies impact on AF-related symptoms, while leaving largely unaffected the risk of stroke. Moreover, up to 20% of AF patients are asymptomatic during paroxysmal relapses of arrhythmia, thus underlying the need for early markers to identify at-risk patients and prevent cerebrovascular accidents. Indeed, non-invasive assessment of pre-clinical substrate changes that predispose to AF could provide early identification of at-risk patients and allow for tailored care paths. ECG-derived P wave analysis is a simple-to-use and inexpensive tool that has been successfully employed to detect AF-associated structural and functional atrial changes. Beyond standard electrocardiographic techniques, high resolution signal averaged electrocardiography (SAECG), by recording microvolt amplitude atrial signals, allows more accurate analysis of the P wave and possibly AF risk stratification. This review focuses on the evidence that support P wave analysis to assess AF substrates, predict arrhythmia relapses and guide rhythm-control interventions.
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Affiliation(s)
- Francesca Palano
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Pietro Cosentino
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Giacomo Silvetti
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Francesca Boldini
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University, Rome, Via di Grottarossa 1035, 00189, Rome, Italy
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Kumar N, Ranganathan MK, Mustafa S, Saraf K, Timmermans C, Gupta D. Hemoptysis After Cryoablation for Atrial Fibrillation. J Atr Fibrillation 2020; 12:2237. [PMID: 32435347 DOI: 10.4022/jafib.2237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/18/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
Aim Cryoballoon is a widely used tool for ablation for atrial fibrillation (AF). There are several complications after cryoablation. This paper assesses the incidence rate and severity of hemoptysis after cryo ablation for AF. Methods For current systemic review and meta-analysis, literature has been reviewed from 2008 to 2019 focusing on the incidence of hemoptysis after cryoballoon ablation for atrial fibrillation catheter ablation in PubMed, Cochrane library and EMBASE databases. Results This meta-analysis included 3534 patients from 20 studies; of mean age 54.0 ± 10.9 years. All patients had cryoballoon ablation for paroxysmal or persistent AF refractory to treatment and follow up duration for 8.2 ± 5.9 months with mean procedure duration of 153.4± 65.4 minutes. The mean cryoablation duration was 869.4 ± 148 sec with mean temperature of -59.7 ± 5.1 °C and a total of 109 patients (3.08%) had hemoptysis which was mild in the majority of cases (76.1%), mild to moderate in 20.2% and severe in only 3.7%. Hemoptysis onset was at 29.0 ± 56.5 day with median of 7 days, range (2 hours to 210 days). In 11 studies hemoptysis occurred early in 51 patients (95% CI for I2 was 0.0% to 0.0, P =0.95, I2 was 0.0%), but in 9 studies, hemoptysis occurred late in 58 patients (95% CI for I2 was 0.0% to 0.0, P =0.96, I2 was 0.0%). Conclusions Mild hemoptysis is experienced by significant number of cryoballoon AF ablation patients and severe type in 3.5 % attributed to significantly lower temperature in inferior pulmonary veins and is more often associated with bigger cryoballoon.
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Affiliation(s)
- Narendra Kumar
- Dept. Of Cardiology, Manchester University NHS Foundation Trust. Oxford Road, Manchester, M13 9WL, UK
| | | | - Shaimaa Mustafa
- Assistant professor of cardiovascular medicine, Benha University, faculty of Medicine, Egypt
| | - Karan Saraf
- Dept. Of Cardiology, Manchester University NHS Foundation Trust. Oxford Road, Manchester, M13 9WL, UK
| | - Carl Timmermans
- Department of Cardiology, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Dhiraj Gupta
- Dept of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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Sternik L. Commentary: Do teach old dogs new tricks. J Thorac Cardiovasc Surg 2020; 163:643-644. [PMID: 32482405 DOI: 10.1016/j.jtcvs.2020.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Center, Affiliated to Tel-Aviv University, Tel-Hashomer, Israel.
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van Rosmalen F, Delhaas T, Dagres N, Arbelo E, Blomström-Lundqvist C, Crijns HJGM, Da Costa A, Pytkowski M, Sharikov N, Laroche C, Tavazzi L, Brugada J, Pison L. Adenosine usage during AF ablation in Europe and selected long-term findings from the ESC-EHRA EORP Atrial Fibrillation Ablation Long-Term registry. J Interv Card Electrophysiol 2020; 60:395-406. [PMID: 32356163 PMCID: PMC8134287 DOI: 10.1007/s10840-020-00744-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
Background Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety. Methods The registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared. Results Adenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991). Conclusions The use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.
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Affiliation(s)
- Frank van Rosmalen
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institute, Hospital Clinic de Barcelona, Universitat de Barcelona, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Antoine Da Costa
- C.H.U. de Saint Etienne, Hôpital Nord, Saint-Priest-en-Jarez, France
| | - Mariusz Pytkowski
- Heart Rhythm Division of the 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warszawa, Poland
| | - Nikita Sharikov
- Department of Surgical Treatment of Complex Rhythm Disturbances and Electro-cardio-stimulation, District Clinical Hospital, Khanty-Mansiysk, Autonomous Okrug-Yugra, Russia
| | - Cécile Laroche
- EURObservational Research Programme (EORP), Scientific Division, European Society of Cardiology, Sophia Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S., Maria Cecilia Hospital, Cotignola, Italy
| | - Joseph Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium.
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Dhillon GS, Honarbakhsh S, Di Monaco A, Coling AE, Lenka K, Pizzamiglio F, Hunter RJ, Horton R, Mansour M, Natale A, Reddy V, Grimaldi M, Neuzil P, Tondo C, Schilling RJ. Use of a multi-electrode radiofrequency balloon catheter to achieve pulmonary vein isolation in patients with paroxysmal atrial fibrillation: 12-Month outcomes of the RADIANCE study. J Cardiovasc Electrophysiol 2020; 31:1259-1269. [PMID: 32250514 DOI: 10.1111/jce.14476] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/16/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The RADIANCE first-in-man study evaluated acute (3-month) safety and design concept in terms of utility of a new multi-electrode radiofrequency (RF) balloon catheter (HELIOSTAR, Biosense Webster) to achieve pulmonary vein isolation (PVI). After study conclusion, a subset of patients was followed up to 12 months. METHODS Patients with drug refractory paroxysmal atrial fibrillation were enrolled. Neurological assessment, cardiac and cerebral magnetic resonance imagings were performed pre and post procedure. Ablation was delivered at 15 Watts to each PV for 60 seconds (electrodes adjacent to the posterior wall limited to 20 seconds). Adenosine or isoproterenol was administered to confirm PVI. Esophageal endoscopy was performed 48 hours post procedure. Patients were clinically followed up for 12 months. RESULTS Thirty-nine patients underwent catheter ablation from four centers. Mean age was 60.7 ± 10.0 years with 23 (57.5%) being male. Confirmation of PVI was performed in all PVs treated (152/152). Confirmation of isolation after one delivery was performed solely on 137 of 152 PVs of which 79.6% (109/137) achieved isolation with a single delivery of RF energy. Acute PV reconnection was seen in 4.6% (7/150) of PVs. Freedom from documented atrial arrhythmia at 12 months in those followed up was 86.4% (32/37). A total of 75.7% (28/37) of patients were free from atrial arrhythmia and off antiarrhythmic medications. CONCLUSION The HELIOSTAR RF balloon catheter allows for rapid and safe PVI with majority of PVs only requiring one application.
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Affiliation(s)
- Gurpreet Singh Dhillon
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Shohreh Honarbakhsh
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Antonio Di Monaco
- Dipartimento di Cardiologia, Ospdale Generale Regionale F. Miulli, Bari, Italy
| | | | - Kernerová Lenka
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | | | - Ross J Hunter
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Moussa Mansour
- Cardiac Arrythmia Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Texas Cardiac Arrhythmia Institute, Austin, Texas
| | - Vivek Reddy
- Department of Arrhythmia Services, Helmsley Electrophysiology Centre, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Massimo Grimaldi
- Dipartimento di Cardiologia, Ospdale Generale Regionale F. Miulli, Bari, Italy
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Claudio Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, Milan, Italy
| | - Richard J Schilling
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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Choi MS, On YK, Jeong DS, Park KM, Park SJ, Kim JS, Carriere KC. Usefulness of Postprocedural Electrophysiological Confirmation Upon Totally Thoracoscopic Ablation in Persistent Atrial Fibrillation. Am J Cardiol 2020; 125:1054-1062. [PMID: 31948665 DOI: 10.1016/j.amjcard.2019.12.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 01/10/2023]
Abstract
Little information is available concerning the usefulness of electrophysiological confirmation followed by totally thoracoscopic ablation. This study aimed to examine whether postprocedural electrophysiological confirmation is always necessary after totally thoracoscopic ablation (TTA) in patients with isolated persistent atrial fibrillation. Forty-five patients with isolated persistent atrial fibrillation were randomized into 2 groups those who received routine electrophysiological confirmation and additional catheter ablation after totally thoracoscopic ablation (the hybrid group [n = 22]) and those who did not (the TTA group [n = 23]). Electrophysiological study was performed 4 or 5 days after surgery. No early or late mortality occurred. In the hybrid group, 5 patients (23%, 5/22) required additional ablation due to residual potential in the left atrium. At a year postoperatively, normal sinus rhythm was observed in 89% of patients (40/45) and similar in both groups (Odds ratio 0.80, 95% confidence interval 0.32 to 1.99). During follow-up, sinus rhythm was maintained in 16 patients (70%) in the TTA group without additional catheter ablation, which was similar (p = 0.920) to the results in the hybrid group (n = 15, 68.2%). Event-free survival rate at 12 months did not differ between groups (TTA group vs hybrid group, 78% vs 77%; p = 0.633). In simple Cox regression analysis, preoperative left atrium volume index was associated with atrial arrhythmia (p = 0.030, hazards ratio 1.087, 95% confidence interval 1.01-1.18). In conclusion, thoracoscopic ablation provided good 1-year durability in patients with isolated persistent AF irrespective of postprocedural electrophysiological confirmation. Seventy-percent of the TTA group did not need additional catheter ablation.
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68
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Andrade JG, Deyell MW, Nattel S, Khairy P, Dubuc M, Champagne J, Leong-Sit P, Jolly U, Badra-Verdu M, Sapp J, Verma A, Macle L. Prevalence and clinical impact of spontaneous and adenosine-induced pulmonary vein reconduction in the Contact-Force vs. Cryoballoon Atrial Fibrillation Ablation (CIRCA-DOSE) study. Heart Rhythm 2020; 17:897-904. [PMID: 31978593 DOI: 10.1016/j.hrthm.2020.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Use of intraprocedural observation and pharmacologic challenges have been proposed as means to differentiate permanent pulmonary vein (PV)-left atrial conduction block from inadequate ablation lesions. OBJECTIVE The purpose of this study was to determine the prevalence and clinical impact of spontaneous and adenosine-provoked reconnection using contemporary atrial fibrillation (AF) ablation technologies. METHODS The CIRCA-DOSE (Cryoballoon vs. Irrigated Radiofrequency Catheter Ablation: Double Short vs. Standard Exposure Duration) study enrolled 346 patients with paroxysmal AF and randomized them to contact force-guided radiofrequency ablation (CF-RF) or cryoballoon ablation. Patients underwent provocative testing with adenosine after a 20-minute observation period. All patients received an implantable cardiac monitor for arrhythmia monitoring. RESULTS Spontaneous reconnection was observed in 5.4% of PVs (71/1318) during the 20-minute postprocedure observation period, and dormant conduction was elicited in 5.7% of PVs (75/1318). Both spontaneous reconnection and dormant conduction were more common after CF-RF compared to cryoballoon ablation (P = .03 and P <.0001, respectively). Acute PV reconnection (spontaneous or adenosine-provoked) was associated with a significantly higher incidence of recurrent atrial tachyarrhythmia in the cryoballoon group (hazard ratio [HR] 2.39; 95% confidence interval [CI] 1.44-3.96; P = .0007) but not in the CF-RF group (HR 1.47; 95% CI 0.84-2.58; P = .16). In the absence of acute reconnection, the freedom from recurrent arrhythmia did not differ between groups (HR 0.95; 95% CI 0.6057-1.495; P = .83). CONCLUSION Patients without spontaneous or adenosine-provoked reconnection had better outcomes compared to those with acute PV reconnection, suggesting that efforts should be directed toward ensuring an ideal ablation lesion at the first attempt in order to achieve durable PV isolation.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada; Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada; Center for Cardiovascular Innovation, Vancouver, Canada.
| | - Marc W Deyell
- Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada; Center for Cardiovascular Innovation, Vancouver, Canada
| | - Stanley Nattel
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | - Marc Dubuc
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
| | | | - Peter Leong-Sit
- Department of Medicine, University of Western Ontario, London, Canada
| | | | | | - John Sapp
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Canada
| | - Atul Verma
- Southlake Regional Health Center, Newmarket, Canada
| | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada
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Reddy VY, Schilling R, Grimaldi M, Horton R, Natale A, Riva S, Tondo C, Kuck KH, Neuzil P, McInnis K, Bishara M, Zhang B, Govari A, Abdelaal A, Mansour M. Pulmonary Vein Isolation With a Novel Multielectrode Radiofrequency Balloon Catheter That Allows Directionally Tailored Energy Delivery: Short-Term Outcomes From a Multicenter First-in-Human Study (RADIANCE). Circ Arrhythm Electrophysiol 2019; 12:e007541. [PMID: 31826648 DOI: 10.1161/circep.119.007541] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Balloon catheters facilitate pulmonary vein (PV) isolation, but current technology is limited by either a single ablative element, potentially leading to over-ablation of thin and under-ablation of thick tissue, or prolonged procedure times. Visualized by electroanatomical mapping, a novel compliant radiofrequency balloon catheter with 10 irrigated, flexible electrodes can simultaneously and independently deliver energy. Herein, we evaluated the feasibility, safety, and short-term efficacy of this radiofrequency balloon in a multicenter, single-arm, first-in-human study. METHODS Paroxysmal atrial fibrillation patients underwent PV isolation with the radiofrequency balloon delivered over-the-wire with a deflectable 13.5F sheath. Radiofrequency energy is delivered simultaneously from all electrodes-up to 30 s posteriorly and 60 s anteriorly. Esophageal temperature was monitored in all patients; the esophagus was also mechanically deviated in 10 patients. RESULTS At 4 sites, 39 patients were treated by 9 operators. The radiofrequency balloon isolated all targeted PVs (152/152), 79.6% with a single application. Electrical reconnection occurred in only 7/150 PVs (4.7%) on adenosine/isoproterenol challenge. Mean procedure, balloon dwell, and fluoroscopy times were 101.6, 40.5, and 17.4 min, respectively. Esophagogastroduodenoscopy revealed asymptomatic esophageal erythema in 5 patients. Phrenic nerve palsy occurred in a patient in whom phrenic pacing was inadvertently omitted. At 3 months, imaging revealed no PV stenosis, and early atrial arrhythmia recurrence occurred in only 10/39 (25.6%) patients. CONCLUSIONS The compliant radiofrequency balloon can directionally tailor energy delivery for efficient, effective, and reasonably safe acute PV isolation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: ISRCTN 11764506.
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Affiliation(s)
- Vivek Y Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R.).,Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.)
| | - Richard Schilling
- Health NHS Trust St, Bartholomew's Hospital West, London, United Kingdom (R.S.)
| | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, Austin (R.H., A.N.)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin (R.H., A.N.)
| | - Stefania Riva
- Centro Cardiologico Monzino, Milan, Italy (S.R., C.T.)
| | - Claudio Tondo
- Centro Cardiologico Monzino, Milan, Italy (S.R., C.T.)
| | - Karl-Heinz Kuck
- Asklepios Hospital St Georg Cardiology, Hamburg, Germany (K.-H.K.)
| | - Petr Neuzil
- Homolka Hospital, Prague, Czech Republic (V.Y.R., P.N.)
| | - Kendra McInnis
- Biosense Webster Inc, Irvine, CA (K.M., M.B., B.Z., A.G., A.A.)
| | - Moe Bishara
- Biosense Webster Inc, Irvine, CA (K.M., M.B., B.Z., A.G., A.A.)
| | - Baohui Zhang
- Biosense Webster Inc, Irvine, CA (K.M., M.B., B.Z., A.G., A.A.)
| | - Assaf Govari
- Biosense Webster Inc, Irvine, CA (K.M., M.B., B.Z., A.G., A.A.)
| | - Ahmed Abdelaal
- Biosense Webster Inc, Irvine, CA (K.M., M.B., B.Z., A.G., A.A.)
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Attenhofer Jost CH, Tan NY, Hassan A, Vargas ER, Hodge DO, Dearani JA, Connolly H, Asirvatham SJ, McLeod CJ. Sudden death in patients with Ebstein anomaly. Eur Heart J 2019; 39:1970-1977a. [PMID: 29315367 DOI: 10.1093/eurheartj/ehx794] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/20/2017] [Indexed: 12/17/2022] Open
Abstract
Aims Ventricular dysfunction or structural alteration of either ventricle is a well-established risk factor for sudden death (SD). Ebstein anomaly (EA) can present with both right and left heart abnormalities; however, predictors of SD have not been described. We therefore sought to characterize the incidence and risk factors of SD among a large cohort of patients with EA. Methods and results All EA patients who underwent evaluation at a high-volume institution over a 4-decade period were retrospectively reviewed. Clinical variables, cardiovascular surgical procedure(s), and cause of death were recorded. Sudden death incidence from birth and following tricuspid valve (TV) surgery were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify clinical and surgical predictors of SD. The cohort comprised of 968 patients [mean age 25.3 years, 41.5% male; 79.8% severe EA, 18.6% accessory pathway, 0.74% implantable cardioverter-defibrillator (ICD) placement]. The 10-, 50-, and 70-year cumulative incidences of SD from birth were 0.8%, 8.3%, and 14.6%, respectively. Prior ventricular tachycardia [hazard ratio (HR) 6.37, P < 0.001)], heart failure (HR 5.64, P < 0.001), TV surgery (HR 5.94, P < 0.001), syncope (HR 2.03, P = 0.019), pulmonic stenosis (HR 3.42, P = 0.001), and haemoglobin > 15 g/dL (HR 2.05, P = 0.026) were multivariable predictors of SD. In a similar subgroup analysis of patients who underwent TV surgery, all of the above factors except syncope were significantly associated with post-operative SD on multivariable analysis. Conclusion Patients with EA are at significant risk for SD. Key clinical SD predictors identified can aid in risk stratification and potentially guide primary prevention ICD implantation.
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Affiliation(s)
| | - Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Abdalla Hassan
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Chicago, IL 60657, USA
| | - Emily R Vargas
- Health Sciences Research, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - David O Hodge
- Health Sciences Research, Mayo Clinic Florida, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Heidi Connolly
- Department of Cardiovascular Disease, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Disease, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Christopher J McLeod
- Department of Cardiovascular Disease, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Zhang D, Shi J, Quan H, Liu L, Zhang J, Guo Y. Five-year results of a modified left atrial maze IV procedure in the treatment of atrial fibrillation: a randomized study. ANZ J Surg 2019; 90:602-607. [PMID: 31742849 PMCID: PMC7217219 DOI: 10.1111/ans.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/05/2023]
Abstract
Background The left atrial maze IV (LAM‐IV) alone has been used to eliminate atrial fibrillation (AF) without severe right heart diseases. However, we felt that it could be improved and developed a modified LAM‐IV (MLAM‐IV). In this prospective trial, we aimed to investigate 5‐year clinical outcomes of AF in patients treated by the novel MLAM‐IV technique. Methods Between September 2012 and October 2013, 120 patients who underwent valve surgery and bipolar radiofrequency ablation for AF were randomized into the LAM‐IV group (n = 60) or MLAM‐IV group (n = 60). At postoperative follow‐up examinations, data were recorded at 1, 3 and 6 months, and annually thereafter. Results The mean ablation time and postoperative ventilation time were shorter in the MLAM‐IV group than in the LAM‐IV group (P < 0.001 and P = 0.03, respectively). At 5 years, the rate of freedom from AF was 69.0% in the MLAM‐IV group and 60.0% in the LAM‐IV group (hazard ratio 0.71, 95% confidence interval 0.39 to 1.32, P = 0.42). There were no differences with respect to the early operative mortality and major complications, late mortality, and major adverse events. Conclusions The MLAM‐IV provides a technically simpler ablation process. The MLAM‐IV was associated with less ventilation support in the early postoperative period. The long‐term efficacy of the MLAM‐IV in the treatment of AF is comparable to that of the LAM‐IV.
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Affiliation(s)
- Dengshen Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Shi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huayan Quan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Cho MS, Heo R, Jin X, Lee JB, Lee S, Kim DH, Kim JB, Kim J, Jung SH, Choo SJ, Song JM, Nam GB, Choi KJ, Kang DH, Chung CH, Lee JW, Kim YH, Song JK. Sick Sinus Syndrome After the Maze Procedure Performed Concomitantly With Mitral Valve Surgery. J Am Heart Assoc 2019; 7:e009629. [PMID: 30371317 PMCID: PMC6404888 DOI: 10.1161/jaha.118.009629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background To characterize the development of sick sinus syndrome (SSS) after the additive maze procedure (MP) during mitral valve surgery. Methods and Results Follow‐up data (median, 3.6 years) of 750 patients with a prevalence of rheumatic cause of 57.6% were analyzed. SSS occurred in 35 patients with a time‐dependent increase: the incidence rates at 1, 2, and 4 years after surgery were 2.9%, 3.7%, and 4.3%, respectively. The additive MP showed higher risks of SSS development (hazard ratio, 7.44; 95% confidence interval, 3.45–16.05; P<0.001) and pacemaker implantation (hazard ratio, 3.61; 95% confidence interval, 1.95–6.67; P<0.001). Patients who developed SSS showed higher 4‐year rates of clinical events (death, stroke, and hospital admission) (67.5±8.5% versus 33.0±1.9%; P<0.001). After adjustment for age and preoperative peak systolic pulmonary artery pressure, the lesion extent (biatrial versus left atrial MP), not the underlying cause (rheumatic versus nonrheumatic), was independently associated with SSS development (hazard ratio, 3.58; 95% confidence interval, 1.08–11.86; P=0.037). The adverse effect of the biatrial MP was confirmed in patients with trivial or mild preoperative tricuspid regurgitation showing higher SSS incidence (4.6±1.4% versus 1.0±0.7%; P=0.023), not in those with moderate‐to‐severe tricuspid regurgitation (6.8±1.7% versus 3.8±3.8%; P=0.337). Recurrence of atrial fibrillation was not associated with the lesion extent of the MP. Conclusions After the additive MP, the ongoing risk of SSS development should be acknowledged irrespective of the underlying cause. Considering additive risk of biatrial MP with similar atrial fibrillation recurrence rate, minimizing lesion extent is warranted.
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Affiliation(s)
- Min Soo Cho
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Ran Heo
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Xin Jin
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jung-Bok Lee
- 2 Division of Biomedical Statistics Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sahmin Lee
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Dae-Hee Kim
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Joon Bum Kim
- 3 Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jun Kim
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Sung-Ho Jung
- 3 Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Suk Jung Choo
- 3 Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jong-Min Song
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Gi-Byoung Nam
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Kee-Joon Choi
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Duk-Hyun Kang
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Cheol Hyun Chung
- 3 Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jae Won Lee
- 3 Department of Thoracic and Cardiovascular Surgery Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - You-Ho Kim
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
| | - Jae-Kwan Song
- 1 Division of Cardiology Asan Medical Center University of Ulsan College of Medicine Seoul Korea
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Cappabianca G, Ferrarese S, Tutino C, Corazzari C, Matteucci M, Mantovani V, Musazzi A, De Ponti R, Beghi C. Safety and efficacy of biatrial vs left atrial surgical ablation during concomitant cardiac surgery: A meta-analysis of clinical studies with a focus on the causes of pacemaker implantation. J Cardiovasc Electrophysiol 2019; 30:2150-2163. [PMID: 31402470 DOI: 10.1111/jce.14117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The latest STS guidelines recommend concomitant atrial fibrillation (AF) ablation not only during mitral surgery (Class IA) but also during other-than-mitral cardiac surgery procedures (Class IB) in patients with preoperative AF. Conventional Cox-Maze III/IV procedures are performed on both atria (BA), but several studies reported excellent results with left atrial only (LA) ablations: the scope of this study is to compare the safety and efficacy of BA vs LA approach. METHODS AND RESULTS Pubmed, Scopus, and WOS were searched from inception to November 2018: 28 studies including 7065 patients and comparing the performance of BA vs LA approaches were identified: of these, 16 (57.1%) enrolled exclusively patients with non-paroxysmal AF forms, 10 (35.7%) focused on mitral surgery as main procedure, and 16 (57.1%) regarded patients undergone Cox-Maze with radiofrequency. The 6- and 12-months prevalence of sinus rhythm were higher in the BA group (OR, 1.37, CI, 1.09-1.73, P = .008 and OR, 1.37, CI, 0.99-1.88, P = .05 respectively). Permanent pacemaker (PPM) implantation (OR, 1.85, CI, 1.38-2.49, P < .0001) and reopening for bleeding (OR, 1.70, CI, 1.05-2.75, P = .03) were higher in the BA group. Among patients undergone PPM implantation, BA group had a significantly higher risk of sinoatrial node dysfunction (OR, 3.01, CI, 1.49-6.07, P = .002). CONCLUSIONS Concomitant BA ablation appears superior to LA ablation in terms of efficacy but is associated with a higher risk of bleeding and of PPM implantation, more frequently due to sinoatrial node dysfunction. LA approach should be preferable in patients with a higher risk of bleeding or with perioperative risk factors for PPM implantation.
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Affiliation(s)
- Giangiuseppe Cappabianca
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Cassandra Tutino
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Matteo Matteucci
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Andrea Musazzi
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
| | - Cesare Beghi
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy.,Cardiac Surgery Research Center, University of Insubria, Varese, Italy
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Hassanabad AF, Jefferson HL, Shanmugam G, Kent WDT. Atrial fibrillation: Current and emerging surgical strategies. J Card Surg 2019; 34:1305-1320. [PMID: 31441538 DOI: 10.1111/jocs.14194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE (a) To provide a comprehensive review of current literature on the surgical management of atrial fibrillation (AF), highlighting surgical approaches and outcomes. (b) To summarize the latest guidelines pertinent to the surgical management of AF. BACKGROUND AF is associated with high rates of morbidity and mortality, primarily related to the associated risk of stroke. The mainstay of management is pharmacologic rate or rhythm control and catheter-based ablation. Surgical ablation (SA) is an alternative strategy that is effective in select patient populations. Recently, novel techniques and technologies have been introduced and this has expanded the surgical capacity to manage AF. METHODS A comprehensive review of the literature was conducted. RESULTS Surgery can be a highly effective alternative therapeutic option for the management of AF in the appropriate patient population. The need for permanent pacemaker implantation is controversial among patients undergoing surgical intervention for AF. Surgical outcomes are promising, with long-term control of AF and symptomatic relief achieved in select groups of patients. CONCLUSIONS This article provides a comprehensive review of the surgical management of AF. We have summarized the latest surgical outcomes and contextualized the most recent guidelines.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Hallie L Jefferson
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Shanmugam
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - William D T Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Brito V G, N V, L T, Jj J, I M, L B, S O, S R, G A, A G, F S. Second Generation Cryoballoon vs. Radiofrequency Ablation in Paroxysmal Atrial Fibrillation: Outcomes Beyond One-Year Follow-up. J Atr Fibrillation 2019; 11:2147. [PMID: 31384365 DOI: 10.4022/jafib.2147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/14/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022]
Abstract
Aims Pulmonary vein isolation (PVI) can be accomplished using radiofrequency (RF) or second generation cryoballoon (CB2). We aimed to compare the freedom from very late recurrence (VLR) defined as recurrence beyond one year in patients who were AF-free during the first post-procedural year after PVI using CB2 or RF. Methods Consecutive patients who underwent PVI by RF or CB2 ablation between August 2014 and December 2015 were included. The primary endpoint was the occurrence of VLR in follow-up after 12 months. Patients who experienced recurrence between the first 3 to 12 months after PVI and those who did not complete 15-month follow-up time were excluded. Results 139 patients were included: 68 underwent PVI by CB2 and 71 using RF. The global VLR rate was of 22.15%. The freedom from VLR beyond 12-month follow-up was of 84.5% (57 patients) for the CB2 group vs. 71% (50 patients) in the RF group (p=0.037). 15 patients underwent re-ablation (11 of the RF group and 4 of the CB2 group): all of the patients who had undergone PVI by RF in the index procedure were found to have vein reconnection, whereas none of the CB2 group had reconnected veins (3 cavotricuspid isthmus and 1 mitral isthmus). Conclusion In patients free of recurrence during the first post-procedural year after pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: second generation cryoballoon ablation showed a significantly lower very late recurrence rate compared to radiofrequency ablation. Condensed abstract The present study evaluates the freedom from very late recurrence (VLR), defined as recurrence in patients who were arrhythmia-free during the first post-procedural year after pulmonary vein isolation using second generation cryoballoon (CB2) or radiofrequency (RF). CB2 ablation had a lower VLR rate compared to RF.
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Affiliation(s)
- Galizia Brito V
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Vecchio N
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Tomas L
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Jarma Jj
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mondragon I
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Burgos L
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ordoñez S
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rivera S
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Albina G
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Giniger A
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Scazzuso F
- Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Acute Hemoptysis and Bronchoscopic Follow-up After Cryoablation of the Pulmonary Veins. J Bronchology Interv Pulmonol 2019; 26:e37-e40. [PMID: 31233476 DOI: 10.1097/lbr.0000000000000585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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77
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Skala T, Precek J, Hutyra M, Moravec O, Tudos Z, Skalova J, Klementova O, Antonicka A, Zapletalova J, Taborsky M. Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:147-153. [PMID: 30829343 DOI: 10.5507/bp.2019.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. METHOD AND RESULTS Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure. CONCLUSION The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.
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Affiliation(s)
- Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Ondrej Moravec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Jitka Skalova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Andrea Antonicka
- Cardiovascular Center, Tomas Bata County Hospital, Zlin, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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Rosenberg JH, Werner JH, Plitt GD, Noble VV, Spring JT, Stephens BA, Siddique A, Merritt-Genore HL, Moulton MJ, Agrawal DK. Immunopathogenesis and biomarkers of recurrent atrial fibrillation following ablation therapy in patients with preexisting atrial fibrillation. Expert Rev Cardiovasc Ther 2019; 17:193-207. [PMID: 30580643 PMCID: PMC6386629 DOI: 10.1080/14779072.2019.1562902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/20/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recurrent atrial fibrillation (RAF) following ablation therapy occurs in about 50% of patients. The pathogenesis of RAF is unknown, but is believed to be driven by atrial remodeling in the setting of background inflammation. Structural, electrophysiological and mechanical remodeling has been associated with atrial fibrillation (AF). Inflammation and fibrotic remodeling are the major factors perpetuating AF, as mediators released from the atrial tissues and cardiomyocytes due to mechanical and surgical injury could initiate the inflammatory process. In this article, we have critically reviewed the key mediators that may serve as potential biomarkers to predict RAF. Areas covered: Damage associated molecular patterns, heat shock proteins, inflammatory cytokines, non-inflammatory markers, markers of inflammatory cell activity, and markers of collagen deposition and metabolism are evaluated as potential biomarkers with molecular treatment options in RAF. Expert commentary: Establishing biomarkers to predict RAF could be useful in reducing morbidity and mortality. Investigations into the role of DAMPs participating in a sterile immune response may provide greater insight into the pathogenesis of RAF. Markers evaluating immune cell activity, collagen deposition, and levels of heat shock proteins show the greatest promise as potential biomarkers to predict RAF and develop novel therapies.
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Affiliation(s)
- John H Rosenberg
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - John H Werner
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Gilman D Plitt
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Victoria V Noble
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Jordan T Spring
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Brooke A Stephens
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
| | - Aleem Siddique
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | | | - Michael J Moulton
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE USA
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Knight BP, Novak PG, Sangrigoli R, Champagne J, Dubuc M, Adler SW, Svinarich JT, Essebag V, Hokanson R, Kueffer F, Jain SK, John RM, Mansour M, Knight B, Novak P, Sangrigoli R, Champagne J, Dubuc M, Essebag V, Adler S, Jain S, Svinarich T, John R, Lockwood E, Gandhi G, Wish M, Levy M, Gassis S, Johnson E, Seger J, Remole S, Collins HW, Oren J, Andrade J, Bernabei M, Osman A, Wu R, Merliss A, Mansour M, Miles W, Su W, Blatt J, Seide H, Becker G, Souza J, Lloyd M, Cameron C, Baker J, Mitra R, Packer D, McLeod C, DeVille B, Compton S. Long-Term Outcomes After Ablation for Paroxysmal Atrial Fibrillation Using the Second-Generation Cryoballoon. JACC Clin Electrophysiol 2019; 5:306-314. [DOI: 10.1016/j.jacep.2018.11.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022]
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80
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Characterization of pulmonary vein reconnection post Cryoballoon ablation. Indian Pacing Electrophysiol J 2019; 19:129-133. [PMID: 30796960 PMCID: PMC6697463 DOI: 10.1016/j.ipej.2019.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/18/2019] [Indexed: 11/24/2022] Open
Abstract
Background The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. Methods This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure. PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. Results All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. Conclusion During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values.
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81
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Chen C, Li D, Ho J, Liu T, Li X, Wang Z, Lin Y, Zou F, Tse G, Xia Y. Clinical Implications of Unmasking Dormant Conduction After Circumferential Pulmonary Vein Isolation in Atrial Fibrillation Using Adenosine: A Systematic Review and Meta-Analysis. Front Physiol 2019; 9:1861. [PMID: 30705634 PMCID: PMC6345194 DOI: 10.3389/fphys.2018.01861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/11/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose: Circumferential pulmonary vein isolation (CPVI) is a routine ablation strategy of atrial fibrillation (AF). The adenosine test can be used to unmask dormant conduction (DC) of pulmonary veins after CPVI, thereby demonstrating possible pulmonary vein re-connection and the need for further ablation. However, whether adenosine test could help improve the long term successful rate of CPVI is still controversial. This systemic review and meta-analysis was to determine the clinical utility of the adenosine test. Methods: PubMed, EMBASE, Web of Science and Cochrane Library database were searched through July 2016 to identify relevant studies using the keywords “dormant pulmonary vein conduction,” “adenosine test,” “circumferential pulmonary vein isolation,” and “atrial fibrillation.” A random-effects model was used to compare pooled outcomes and tested for heterogeneity. Results: A total of 17 studies including 5,169 participants were included in the final meta-analysis. Two groups of comparisons were classified: (1) Long-term successful rate in those AF patients underwent CPVI with and without adenosine test [Group A (+) and Group A (−)]; (2) Long-term successful rate in those patients who had adenosine test with and without dormant conduction [Group DC (+) and Group DC (−)]. The overall meta-analysis showed that no significant difference can be observed between Group A (+) and Group A (−) (RR 1.08; 95% CI 0.97–1.19; P = 0.16; I2 = 66%) and between Group DC (+) and Group DC (−) (RR 1.01; 95% CI 0.91–1.12; P = 0.88; I2 = 60%). Conclusion: Pooled meta-analysis suggested adenosine test may not improve long-term successful rate in AF patients underwent CPVI. Furthermore, AF recurrence may not be decreased by eliminating DC provoked by adenosine, even though adenosine test was applied after CPVI.
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Affiliation(s)
- Cheng Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Daobo Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jeffery Ho
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xintao Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhao Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yajuan Lin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fuquan Zou
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Caruso MV, Gramigna V, Fragomeni G. A CFD investigation of intra-aortic balloon pump assist ratio effects on aortic hemodynamics. Biocybern Biomed Eng 2019. [DOI: 10.1016/j.bbe.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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83
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Kumar N, Ranganathan M, James C, Mustafa S, Jha A, Aksoy I, Barman M. Right atrial myxoma presenting as pyrexia of unknown origin. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_16_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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84
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Trujillo TC, Dobesh PP, Crossley GH, Finks SW. Contemporary Management of Direct Oral Anticoagulants During Cardioversion and Ablation for Nonvalvular Atrial Fibrillation. Pharmacotherapy 2018; 39:94-108. [PMID: 30548542 DOI: 10.1002/phar.2205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
As overall prevalence of atrial fibrillation (AF) continues to rise, the number of patients who undergo ablation, or electrical/chemical cardioversion, to restore normal sinus rhythm continues to increase as well. As direct oral anticoagulants (DOACs) have continued to be incorporated into clinical practice for long-term anticoagulation for AF, experience with how best to manage use of DOACs during electrophysiologic procedures is evolving. This review is intended to provide health care providers with a summary of current evidence regarding the use of DOACs during cardioversion and catheter ablation and provide key considerations for their use during such electrophysiologic procedures. PubMed and MEDLINE were searched from inception through June 2018 for studies in humans comparing DOACs alone or against vitamin K antagonists (VKAs) in adult patients (> 18 yrs) who underwent cardioversion or AF catheter ablation using the following key words: "rivaroxaban," "dabigatran," "apixaban," "edoxaban," "non-vitamin K antagonists," "direct or new oral anticoagulants," "warfarin," "vitamin K antagonists," "cardioversion," "ablation of atrial fibrillation," "uninterrupted," and "catheter ablation." Four retrospective studies and three prospective trials comparing DOACs with VKA in patients undergoing cardioversion and three prospective studies in patients undergoing catheter ablation for AF were identified. Observational data and meta-analyses were also critically reviewed. Prospective trials to date suggest similar efficacy and safety with using DOACs in the setting of cardioversion and AF ablation compared to traditional therapy with VKA, with or without bridging. Injectable anticoagulant overlap can be avoided in patients receiving DOACs in the setting of cardioversion for AF. Minimal interruption in anticoagulation may be only necessary for AF ablation in those with highest bleeding risk, such as in renal dysfunction and where drug-drug interactions may increase risk for anticoagulant accumulation. Periprocedural advantages of DOACs include convenience, rapid and predictable onset of effect, improved patient satisfaction, and potential for reduced costs.
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Affiliation(s)
- Toby C Trujillo
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
| | - Paul P Dobesh
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - George H Crossley
- Department of Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shannon W Finks
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee, Memphis, Tennessee
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86
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Zehr KJ. What can we learn from a novel "Global Positioning System" in persistent atrial fibrillation? J Thorac Cardiovasc Surg 2018; 157:232-233. [PMID: 30342759 DOI: 10.1016/j.jtcvs.2018.08.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Kenton J Zehr
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.
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87
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Comparison of efficacy and safety of laser balloon and cryoballoon ablation for atrial fibrillation—a meta-analysis. J Interv Card Electrophysiol 2018; 54:237-245. [DOI: 10.1007/s10840-018-0474-4] [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: 07/09/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
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88
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Watanabe R, Okumura Y, Nagashima K, Iso K, Takahashi K, Arai M, Wakamatsu Y, Kurokawa S, Ohkubo K, Nakai T, Yoda S, Watanabe I, Hirayama A, Sonoda K, Tosaka T. Influence of balloon temperature and time to pulmonary vein isolation on acute pulmonary vein reconnection and clinical outcomes after cryoballoon ablation of atrial fibrillation. J Arrhythm 2018; 34:511-519. [PMID: 30327696 PMCID: PMC6174370 DOI: 10.1002/joa3.12108] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/30/2018] [Accepted: 07/20/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Limited data exist on indicators of durable pulmonary vein isolation (PVI) undergoing cryoballoon ablation (CBA) for atrial fibrillation (AF). We investigated whether balloon temperature and time to PVI can be used to predict early PV reconduction (EPVR), including residual PV conduction and adenosine triphosphate-induced dormant conduction and the relation between touch-up ablation of EPVR sites and mid-term recurrence of AF. METHODS We obtained procedural and outcome data from the records of 130 consecutive patients who underwent CBA and followed up for 13.4 months. RESULTS EPVR was identified in 86 (17%) PVs of 61 (47%) patients. Balloon temperatures during 30 seconds (-27 ± 5.7°C vs -31 ± 5.5°C), 60 seconds (-36 ± 5.6°C vs -41 ± 5.4°C), and at the nadir point (-41 ± 7.4°C vs -49 ± 7.0°C) were significantly higher, and the time to PVI was longer (90 ± 50 seconds vs 52 ± 29 seconds) in PVs with EPVR than in those without (P < 0.0001 for all). Among PVs without EPVR, the time to PVI was longer and balloon temperature was lower for the left superior pulmonary vein/ right inferior pulmonary vein (LSPV/RIPV) than for the right superior pulmonary vein/left inferior pulmonary vein (RSPV/LIPV) (time: 60 ± 25/73 ± 37 seconds vs 41 ± 31/45 ± 20 seconds, P < 0.0001) (temp: -39.2 ± 11.3/-39.4 ± 8.3°C vs -33.8 ± 10.6/-33.6 ± 6.8°C, P = 0.0023). AF recurrence rates were equivalent between patients with and without EPVR (13% [8/69] vs 15% [9/61], P = 0.845). CONCLUSIONS Cryoballoon temperature and time to PVI appear to be useful in predicting durable PVI, that is, prevention of EPVR, but the balloon temperature and time required for PVI differ between PVs. Although EPVR does not predict AF recurrence, high success rates can be expected when touch-up ablation of EPVR sites is performed.
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Affiliation(s)
- Ryuta Watanabe
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yasuo Okumura
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Koichi Nagashima
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Kazuki Iso
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Keiko Takahashi
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Masaru Arai
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Yuji Wakamatsu
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Sayaka Kurokawa
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Kimie Ohkubo
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Toshiko Nakai
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Shunichi Yoda
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Ichiro Watanabe
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Atsushi Hirayama
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Kazumasa Sonoda
- Division of CardiologyDepartment of MedicineTokyo Rinkai HospitalTokyoJapan
| | - Toshimasa Tosaka
- Division of CardiologyDepartment of MedicineTokyo Rinkai HospitalTokyoJapan
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Weiner MM, Baron EL, Joshi K, Villablanca P, Briceno D, Torregrossa G, Evans AS, Augoustides Y, Ramakrishna H. Catheter Versus Surgical Ablation of Atrial Fibrillation: An Analysis of Outcomes. J Cardiothorac Vasc Anesth 2018; 32:2435-2443. [DOI: 10.1053/j.jvca.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Indexed: 11/11/2022]
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Noninvasive mapping before surgical ablation for persistent, long-standing atrial fibrillation. J Thorac Cardiovasc Surg 2018; 157:248-256. [PMID: 30482525 DOI: 10.1016/j.jtcvs.2018.07.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/22/2018] [Accepted: 07/23/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation. METHODS In this pilot trial, 10 patients (6 male; mean age, 70 ± 10 years) with persistent atrial fibrillation were mapped preoperatively with a noninvasive surface system (ECVUE, CardioInsight, Medtronic Inc, Minneapolis, Minn). Eight patients were candidates for mitral valve surgery, 1 patient was a candidate for aortic valve and ascending aortic replacement, and 1 patient was a candidate for coronary bypass surgery. In 5 patients, tricuspid valve repair was also performed. The Cox-Maze III/IV was performed using combined cryoablation and bipolar radiofrequency, and the left appendage was removed in all cases. The median preprocedural duration of atrial fibrillation was 30 months, and the diameter of the left atrium was 63 mm. Atrial regions were divided according to the Bordeaux classification. RESULTS Preoperative mapping was successful in all patients with clear identification of the potential mechanism of atrial fibrillation. Biatrial pathology was recognized in all subjects. Rotor and macro re-entry activity were present in all patients, whereas focal activity was demonstrated in only 6 patients. Rotor activity in the right atrium was documented in all patients. CONCLUSIONS This is the first report on the preoperative use of the ECUVE in surgical candidates for concomitant surgical procedures. The fact that a biatrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Cox-Maze III/IV procedure to treat patients with valvular heart disease and nonparoxysmal atrial fibrillation. Preoperative mapping has the potential to significantly improve our understanding of the pathophysiology in atrial fibrillation and better guide the surgical ablation procedure of choice in a single patient.
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Life-Threatening Massive Hemoptysis After Cryoablation for Atrial Fibrillation. J Bronchology Interv Pulmonol 2018; 25:67-69. [PMID: 28915140 DOI: 10.1097/lbr.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 59-year-old man developed massive hemoptysis, 1 month after undergoing cryoablation procedure for atrial fibrillation. He underwent emergent bronchoscopy that revealed massive, active bleeding with clots requiring repeated suctioning, epinephrine, and cold saline injection. The source of bleeding was identified in a follow-up bronchoscopy performed few days later-a 2×3 cm area of ulceration of the left main stem bronchus which was missed in the initial bronchoscopy owing to blood obscuring the field of vision. Considering the timeline, the ulcer most likely resulted from cryoablation-induced bronchial injury. Patient remained asymptomatic after stabilization and 2 months following discharge, another bronchoscopy was performed which showed the ulcer to be healing. Hemoptysis following cryoablation is quite rare with a reported incidence <2%. The cases of hemoptysis reported thus far have all been mild and self-limiting and manifesting within hours to days following the procedure. To our knowledge, this is the first reported case of massive hemoptysis associated with cryoballoon ablation, presenting 1 month after procedure.
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Wei HQ, Guo XG, Zhou GB, Sun Q, Yang JD, Luo B, Ma J. Predictors of hemoptysis in the setting of pulmonary vein isolation using the second-generation cryoballoon. J Cardiovasc Electrophysiol 2018; 29:958-965. [PMID: 29858877 DOI: 10.1111/jce.13644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/31/2018] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To assess the predictors of hemoptysis using second-generation cryoballoon (CB). METHODS Thirty patients with hemoptysis after second-generation CB ablation and 60 age-, gender-, and body mass index-matched controls were recruited. Anatomic parameters were obtained from preprocedural cardiac computed tomography (CT). Pulmonary vein isolation was performed with 28-mm balloon using single 3-minute freeze technique. RESULTS Clinical and procedural characteristics were similar between the groups. A shorter distance between left superior PV (LSPV) and left main bronchus (LMB) was associated with hemoptysis (7.8 ± 4.3 mm vs. 12.5 ± 3.5 mm, P < 0.001), whereas no significant difference in the distance between right superior PV (RSPV) and right main bronchus (RMB) was found between groups (11.9 ± 3.5 mm vs. 12.9 ± 4.6 mm, P = 0.089). Additionally, the mean thickness of the connective tissue interposed between RSPV and RMB was significantly thicker than that between LSPV and LMB in both groups (both P < 0.001). A stepwise logistic multivariate analysis identified only the LMB-LSPV distance as an independent predictor of hemoptysis (odd ratio [OR] 2.676; 95% CI 1.121-4.843, P < 0.001). A cutoff value ≤ 9.5 mm predicted hemoptysis after CB ablation with 93.8% sensitivity and 75.0% specificity. CONCLUSION Hemoptysis is a relatively rare event following second-generation CB ablation. The bronchi location obtained from CT aids in identifying high-risk population for the complication.
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Affiliation(s)
- Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Biatrial versus Isolated Left Atrial Ablation in Atrial Fibrillation: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3651212. [PMID: 29854748 PMCID: PMC5949196 DOI: 10.1155/2018/3651212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/10/2018] [Accepted: 03/14/2018] [Indexed: 11/18/2022]
Abstract
Objective The outcomes of biatrial ablation (BA) and isolated left atrial ablation (LA) in atrial fibrillation remain inconclusive. In this meta-analysis, we assess the currently available evidence to compare outcomes between BA and LA. Methods Electronic searches were performed from database inception to December 2016, and relevant studies were accessed. Odds ratios and weight mean differences with 95% confidence intervals are reported. Twenty-one studies comprising 3609 patients were included in the present meta-analysis. Results The prevalence of sinus rhythm in the BA cohort was similar to that in the LA cohort at discharge, at 12 months, and after more than 1 year of follow-up. However, at 6 months, the prevalence of sinus rhythm was higher in the BA cohort than in the LA cohort. The rate of permanent pacemaker implantation was higher in the BA cohort than in the LA cohort. However, 30-day and late mortality and neurological events were similar between the BA and LA groups. Conclusion There was no significant difference in the rate of restored sinus rhythm, the risk of death, and cerebrovascular events between BA and LA, but BA had a higher rate of permanent pacemaker implantation.
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Ghia S, Dhawan R, Chaney MA, Jeevanandam V, Stone M, Pawale A, Sladen RN. Can I Go Home With That Balloon Pump? J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Nagashima K, Okumura Y, Watanabe I, Nakahara S, Hori Y, Iso K, Watanabe R, Arai M, Wakamatsu Y, Kurokawa S, Mano H, Nakai T, Ohkubo K, Hirayama A. Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2018; 11:e005861. [DOI: 10.1161/circep.117.005861] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (S.N., Y.H.)
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan (S.N., Y.H.)
| | - Kazuki Iso
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Ryuta Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Masaru Arai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Hiroaki Mano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N., Y.O., I.W., K.I., R.W., M.A., Y.W., S.K., H.M., T.N., K.O., A.H.)
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Hohnloser SH, Camm J, Cappato R, Diener HC, Heidbuchel H, Lanz HJ, Mont L, Morillo CA, Smolnik R, Yin OQP, Kautzner J. Uninterrupted administration of edoxaban vs vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation: Rationale and design of the ELIMINATE-AF study. Clin Cardiol 2018; 41:440-449. [PMID: 29663464 DOI: 10.1002/clc.22918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/22/2018] [Accepted: 02/02/2018] [Indexed: 12/29/2022] Open
Abstract
Patients with atrial fibrillation (AF) are at an approximately 0.5% to 3% increased risk of thromboembolism during and immediately after catheter ablation. Treatment guidelines recommend periprocedural oral anticoagulation plus unfractionated heparin during ablation. Rivaroxaban and dabigatran are the only non-vitamin K oral anticoagulants for which there are randomized controlled trials assessing uninterrupted anticoagulation in patients undergoing catheter ablation of AF. Edoxaban, a direct factor Xa inhibitor, is noninferior vs warfarin for the prevention of stroke or systemic embolism with less major bleeding in patients with nonvalvular AF. The ELIMINATE-AF (Evaluation of Edoxaban Compared With VKA in Subjects Undergoing Catheter Ablation of Nonvalvular Atrial Fibrillation) trial is a multinational, multicenter, prospective, randomized, open-label, parallel-group, blinded-endpoint evaluation (PROBE) study to assess the safety and efficacy of once-daily edoxaban 60 mg (30 mg in patients indicated for a dose reduction) vs vitamin K antagonists (VKA) in patients with nonvalvular AF undergoing catheter ablation (http://www.ClinicalTrials.gov: NCT02942576). A total of 560 patients are planned for randomization to edoxaban or VKA (2:1 ratio) to obtain 450 patients fully compliant with the protocol. Patients will complete 21 to 28 days of anticoagulation prior to the ablation and a 90-day post-ablation period. The primary efficacy endpoint is the composite of all-cause death, stroke, and major bleeding. The primary safety endpoint is major bleeding. A magnetic resonance imaging substudy will assess the incidence of silent cerebral lesions post-ablation. ELIMINATE-AF will define the efficacy and safety of edoxaban for uninterrupted oral anticoagulation during catheter ablation of AF.
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Affiliation(s)
- Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J.W. Goethe University, Frankfurt, Germany
| | - John Camm
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, London, UK
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Research Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Hans-Christoph Diener
- Department of Neurology, University Hospital Essen and Medical Faculty of the University Duisburg-Essen, Essen, Germany
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Hans-Joachim Lanz
- Department of Global Medical Affairs, Daiichi-Sankyo Europe GmbH, Munich, Germany
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Carlos A Morillo
- Department of Cardiac Sciences, Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rüdiger Smolnik
- Department of Global Medical Affairs, Daiichi-Sankyo Europe GmbH, Munich, Germany
| | - Ophelia Q P Yin
- Pharma Development, Modeling, and Simulation, Daiichi-Sankyo, Basking Ridge, New Jersey
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Engelsgaard CS, Pedersen KB, Riber LP, Pallesen PA, Brandes A. The long-term efficacy of concomitant maze IV surgery in patients with atrial fibrillation. IJC HEART & VASCULATURE 2018; 19:20-26. [PMID: 29946559 PMCID: PMC6016068 DOI: 10.1016/j.ijcha.2018.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/01/2018] [Accepted: 03/31/2018] [Indexed: 01/08/2023]
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, and associated with increased risk of morbidity and mortality. AF surgery is widely used for rhythm control of AF, but previous studies have shown varying results. This study sought to investigate the long-term efficacy of concomitant maze IV (CMIV) surgery in an unselected AF population and identify predictors of late AF recurrence. Methods In total 144 consecutive patients, who underwent CMIV between January 2006 and December 2010 were enrolled. By data from electronic medical records, registers, and rhythm prints, late AF recurrences and heart rhythm at latest follow-up were retrospectively registered. All patients still alive were invited to an ambulant follow-up to update rhythm status. Results During a median (IQR) follow-up of 7.39 (2.67) years, 114 (79.2%) patients had recurrence. The cumulative incidence of sinus rhythm (SR) without antiarrhythmic drugs (AADs) was 52.3% after 1 year. Long-term results after 2, 5 and 7 years were 47.9%, 32.6% and 25.1%, respectively. At latest follow-up 34.7% were in SR off AADs. No difference in 10-year event-free survival stratified by recurrence were found (p = 0.678). Contrary, time to death (5.40 vs. 3.43 years, p = 0.004) revealed death as competing risk event. The Fine-Gray model identified preoperative sustained AF (SAF) (SHR 3.54, 95%CI [2.35;5.32], p < 0.001), AF duration (1.08, [1.05;1.11], p < 0.001), and postoperative atrial tachyarrhythmia (ATA) (2.29, [1.21;4.35], p = 0.011) as predictors. Conclusion CMIV in the present cohort provided limited long-term success in obtaining SR. SAF, longer AF duration, and postoperative ATA were associated with late AF recurrence.
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Affiliation(s)
| | | | - Lars Peter Riber
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Periprocedural Management of Direct Oral Anticoagulants Surrounding Cardioversion and Invasive Electrophysiological Procedures. Cardiol Rev 2018; 26:245-254. [PMID: 29621010 PMCID: PMC6082596 DOI: 10.1097/crd.0000000000000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Supplemental Digital Content is available in the text. As direct oral anticoagulants (DOACs) have demonstrated favorable efficacy and safety outcomes compared with vitamin K antagonists for the treatment and prevention of venous thromboembolism and the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, their role in the management of anticoagulation during electrophysiological procedures continues to evolve. At present, guidelines are limited regarding specific recommendations for the use of DOACs in these clinical settings. Here, we review available data regarding the risks and benefits associated with various periprocedural anticoagulation management approaches when patients receiving DOACs undergo electrophysiologic procedures including cardioversion, ablation, and device implantation. This discussion is intended to provide clinicians with an overview of available evidence and best practices to minimize the risk of both thromboembolic and bleeding events in the periprocedural setting.
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99
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Rostagno C, Gelsomino S, Stefàno PL, Padeletti L. Rhythmic and haemodynamic determinants of long-term survival after radiofrequency ablation of atrial fibrillation in mitral valve surgery. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 2:285-290. [PMID: 29474714 DOI: 10.1093/ehjqcco/qcw021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/17/2016] [Indexed: 12/26/2022]
Abstract
Aims The aim of the present study was to evaluate the effects of sinus rhythm recovery on long-term survival after radiofrequency (RF) ablation in patients with permanent atrial fibrillation (AF) undergoing surgery for mitral valve disease. Methods and results This study included 173 consecutive patients (101 men and 72 women, age 67 ± 9 years) with AF and mitral valve disease who underwent RF ablation procedure associated with mitral valve surgery. Four patients died during hospitalization. At the 6-year follow-up, sinus rhythm was present in 68% of the surviving patients. Thirty-nine patients remained in persistent AF after hospital discharge. In patients with stable sinus rhythm, mortality (10 vs. 30%) and recurrent hospitalization were significantly lower than in patients with persistent AF, but functional capacity improved. The incidence of stroke was also lower in patients with stable sinus rhythm. A pre-operative higher right and left atrial area, pulmonary hypertension, and rheumatic disease were associated with the persistence of AF despite RF ablation. At multivariate analysis, only age and concomitant tricuspid valve repair were independently associated with mortality, whereas the right atria area and tricuspid valve repair were associated with persistent AF. Conclusion Although the re-establishment of sinus rhythm by unipolar RF ablation is associated with a higher survival rate after mitral valve surgery, our data suggest that a more severe haemodynamic impairment, in particular in patients with rheumatic valve disease, may be responsible both for higher long-term mortality and lower rate of sinus rate maintenance.
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Affiliation(s)
- Carlo Rostagno
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134 Firenze, Italy.,Medicina Interna e Postchirurgica AOU Careggi, Firenze, Italy
| | | | | | - Luigi Padeletti
- Dipartimento Medicina Sperimentale e Clinica, Università di Firenze, Viale Morgagni 85, 50134 Firenze, Italy
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100
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Furniss GO, Panagopoulos D, Kanoun S, Davies EJ, Tomlinson DR, Haywood GA. The Effect of Atrial Fibrillation Ablation Techniques on P Wave Duration and P Wave Dispersion. Heart Lung Circ 2018; 28:389-396. [PMID: 29501465 DOI: 10.1016/j.hlc.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/10/2018] [Accepted: 02/04/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND A reduction in surface electrocardiogram (ECG) P wave duration and dispersion is associated with improved outcomes in atrial fibrillation ablation. We investigated the effects of different ablation strategies on P wave duration and dispersion, hypothesising that extensive left atrial (LA) ablation with left atrial posterior wall isolation would give a greater reduction in P wave duration than more limited ablation techniques. METHODS A retrospective analysis of ECGs from patients who have undergone atrial fibrillation (AF) ablation was performed and pre-procedural sinus rhythm ECGs were compared with the post procedure ECGs. Maximal P wave duration was measured in leads I or II, minimum P wave duration in any lead and values were calculated for P wave duration and dispersion. Left atrial dimensions and medications at the time of ECG were documented. Ablation strategies compared were; pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) and the persistent AF (PsAF) ablation strategies of pulmonary vein isolation plus additional linear lesions (Lines), left atrial posterior wall isolation via catheter (PWI) and left atrial posterior wall isolation via staged surgical and catheter ablation (Hybrid). RESULTS Sixty-nine patients' ECGs were analysed: 19 PVI, 21 Lines, 14 PWI, 15 Hybrid. Little correlation was seen between pre-procedure left atrial size and P wave duration (r=0.24) but LA size and P wave duration was larger in PsAF patients. A significant difference was seen in P wave reduction driven by Hybrid AF ablation (p<0.005) and Lines (<0.02). There was no difference amongst P wave dispersion between groups but the largest reduction was seen in the Hybrid ablation group. CONCLUSIONS P wave duration increased with duration of continuous atrial fibrillation. Hybrid AF ablation significantly reduced P wave duration and dispersion compared to other ablation strategies including posterior wall isolation via catheter despite this being the same lesion set.
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Affiliation(s)
- Guy O Furniss
- Musgrove Park Hospital, Taunton, UK; University of Plymouth, Plymouth, UK; Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK.
| | | | - Sadeek Kanoun
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | - Edward J Davies
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
| | | | - Guy A Haywood
- Southwest Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
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