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La Rosa G, Morillo CA, Quintanilla JG, Doltra A, Mont L, Rodríguez-Mañero M, Sarkozy A, Merino JL, Vivas D, Datino T, Calvo D, Pérez-Castellano N, Pérez-Villacastín J, Fauchier L, Lip G, Hatem SN, Jalife J, Sanchis L, Marín F, Filgueiras-Rama D. Practical approach for atrial cardiomyopathy characterization in patients with atrial fibrillation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00072-0. [PMID: 38428580 DOI: 10.1016/j.rec.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/16/2024] [Indexed: 03/03/2024]
Abstract
Atrial fibrillation (AF) causes progressive structural and electrical changes in the atria that can be summarized within the general concept of atrial remodeling. In parallel, other clinical characteristics and comorbidities may also affect atrial tissue properties and make the atria susceptible to AF initiation and its long-term persistence. Overall, pathological atrial changes lead to atrial cardiomyopathy with important implications for rhythm control. Although there is general agreement on the role of the atrial substrate for successful rhythm control in AF, the current classification oversimplifies clinical management. The classification uses temporal criteria and does not establish a well-defined strategy to characterize the individual-specific degree of atrial cardiomyopathy. Better characterization of atrial cardiomyopathy may improve the decision-making process on the most appropriate therapeutic option. We review current scientific evidence and propose a practical characterization of the atrial substrate based on 3 evaluation steps starting with a clinical evaluation (step 1), then assess outpatient complementary data (step 2), and finally include information from advanced diagnostic tools (step 3). The information from each of the steps or a combination thereof can be used to classify AF patients in 4 stages of atrial cardiomyopathy, which we also use to estimate the success on effective rhythm control.
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Affiliation(s)
- Giulio La Rosa
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Carlos A Morillo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jorge G Quintanilla
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Adelina Doltra
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Lluis Mont
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología y Unidad Coronaria, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrea Sarkozy
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - José Luis Merino
- Departamento de Cardiología, Hospital Universitario La Paz, IDIPaz, Universidad Autónoma, Madrid, Spain
| | - David Vivas
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Tomás Datino
- Departamento de Cardiología, Hospitales Universitarios Quirónsalud Pozuelo y Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - David Calvo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain
| | - Nicasio Pérez-Castellano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Julián Pérez-Villacastín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain; Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - Laurent Fauchier
- Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Stéphane N Hatem
- Sorbonne Université, Foundation for Innovation in Cardiometabolism and Nutrition - ICAN, INSERM UMRS 1166, Institute of Cardiology, AP-HP Pitié-Salpêtrière Paris, France
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Laura Sanchis
- Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Francisco Marín
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Pascual Parrilla), El Palmar, Murcia, Spain.
| | - David Filgueiras-Rama
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Programa Nuevos Mecanismos Arritmogénicos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Instituto Cardiovascular, Madrid, Spain.
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2
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Cerantola M, Hanumanthu BKJ, Hyman MC. Ablation of perimitral flutter in a patient with a partially inaccessible left atrium. HeartRhythm Case Rep 2023; 9:704-708. [PMID: 38047205 PMCID: PMC10691951 DOI: 10.1016/j.hrcr.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Maxime Cerantola
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Balaram Krishna J. Hanumanthu
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C. Hyman
- Electrophysiology Section, Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Almorad A, O'Neill L, Wielandts JY, Gillis K, De Becker B, Nakatani Y, De Asmundis C, Iacopino S, Pambrun T, Marc LM, Jaïs P, Haïssaguerre M, Duytschaever M, Chierchia JB, Derval N, Knecht S. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery. Front Cardiovasc Med 2022; 9:928974. [PMID: 36620626 PMCID: PMC9811118 DOI: 10.3389/fcvm.2022.928974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Atrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery. Methods Sixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2). Results After the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) (p = 0.3). After 62 (48-84) months of follow-up and 2 (2-2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm (p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs (p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred. Conclusion Long-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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Affiliation(s)
- Alexandre Almorad
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Alexandre Almorad ✉
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Kris Gillis
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - La Meir Marc
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | | | - Jean-Baptista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Sébastien Knecht ✉
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Bertels J, Rottner L, Heeger CH, Maurer T, Reissmann R, Ouyang F, Mathew S, Wohlmuth P, Schlüter M, Kuck KH, Metzner A, Lemeš C. Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery. Pacing Clin Electrophysiol 2022; 45:1024-1031. [PMID: 35822917 DOI: 10.1111/pace.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perimitral flutter and atrial fibrillation may occur in patients with prior surgical mitral valve (MV) repair or replacement and can be challenging for percutaneous catheter ablation. This study sought to determine the feasibility, acute success and durability of catheter ablation of atrial fibrillation or atrial tachycardia by way of a mitral isthmus line (MIL) or an anterior line (AL). METHODS A total of 81 patients (49 males, mean age 62±11 years) with prior MV replacement (n = 30) or reconstruction (n = 51) underwent creation of a MIL (34) and/or an AL (72). RESULTS Acute bidirectional block of the MIL was successfully achieved in 24/34 cases and of the AL in 64/72 patients. Patients of the control group without prior MV surgery were matched 1:1 with the valve group. In the AL control subgroup, acute bidirectional block was achieved in 65/72 patients. Acute blockage in the MIL control subgroup could be achieved in 31/34 patients. The MIL valve subgroup showed the worst results in terms of durability, whereas a similar trend emerged in the control group and the AL valve subgroup (probability of failure in MIL valve subgroup 2.224 vs. MIL control subgroup 0.605 [Hazard Ratio (HR) = 0.27, 95% confidence interval (CI), 0.11-0.65), p = 0.004]; probability of failure in AL valve subgroup 0.844 vs. AL control subgroup 1.03 [HR = 1.22 (95% CI, 0.66-2.26), p = 0.523]). CONCLUSIONS Percutaneous creation of MIL and AL is feasible and safe in patients with prior MV replacement/repair and associated with moderate acute and long-term success rates to achieve bidirectional block. This article is protected by copyright. All rights reserved.
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Rozen G, Elbaz-Greener G, Andria N, Kevin Heist E, Ruskin JN, Roguin A, Carasso S, Birati E, Amir O, Marai I. Safety of Catheter Ablation for Atrial Fibrillation in Patients with Mechanical Prosthetic Valves. J Cardiovasc Electrophysiol 2022; 33:1128-1135. [PMID: 35304926 DOI: 10.1111/jce.15459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation (CA) for Atrial Fibrillation (AF) is increasingly utilized in the recent years, with promising results. We aimed to investigate the nationwide trends in utilization and procedural complications of CA for AF in patients with mechanical prosthetic valves (MPVs). METHODS AND RESULTS We drew data from the US National Inpatient Sample (NIS) database to identify cases of AF ablations in patients with MPVs, between 2003-2015. Sociodemographic and clinical data were collected, and incidence of procedural complications, mortality, and length of stay were analyzed. We compared the outcomes to a propensity matched cohort of patients without MPVs. The study included a weighted total of 1898 CA for AF cases in patients with MPVs. The median age of the study population was 67 (61-75) years and 53% were males. Despite the increasing age and significant uptrend in the prevalence of individual comorbidities and Deyo - Charlson Comorbidity Index (CCI) over the years, the risk of peri-procedural complications and mortality in the study group didn't change between the early (2003-2008) and late (2009-2015) study years. The peri-procedural complication rate (8.4% vs 10.4%, p=0.33) and in-hospital mortality (0.2% vs. 0.2%, p=0.9) did not differ significantly between patients with MPVs and 1901 matched patients without MPVs. Length of stay was higher among patients with prior MPVs compared to the controls (4.0±0.2 vs. 3.3±0.2 days, p=0.011). CONCLUSION This nationwide analysis shows that AF ablation in patients with mechanical valve prostheses bares similar risk of periprocedural complications and mortality as in patients without prosthetic valves. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Guy Rozen
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center. The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nizar Andria
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Medical Center, Poriya, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - E Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ariel Roguin
- Cardiology Division, Hillel Yaffe Medical Center, Hadera, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shemy Carasso
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Medical Center, Poriya, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Edo Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Medical Center, Poriya, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center. The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ibrahim Marai
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Baruch Padeh Medical Center, Poriya, The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Uhm J, Kim J, Jin M, Kim I, Cho MS, Yang P, Yu HT, Kim T, Joung B, Pak H, Nam G, Choi K, Kim Y, Hwang C, Lee M. Radiofrequency catheter ablation of accessory pathways at the site of prior valve surgery. J Arrhythm 2019; 35:645-653. [PMID: 31410235 PMCID: PMC6686296 DOI: 10.1002/joa3.12213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/02/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Radiofrequency catheter ablation (RFCA) for accessory pathways (APs) at the site of prior valve surgery (VS) remains challenging. We aimed to clarify the factors associated with successful RFCA for such APs. METHODS Upon reviewing a RFCA registry and previous case reports, we included nine patients who underwent RFCA of APs at the site of prior VS (total-VS group; age, 34.0 [24.5-45.0] years; men, 4/9) and 196 patients who underwent RFCA of APs with no history of VS (no-VS group; age, 40.5 [23.0-54.0] years; men, 114/196). Electrophysiological features, procedural details, and outcomes were examined. RESULTS Accessory pathway exhibited decremental conduction in four of nine patients in the total-VS group. The number of RFCA attempts was significantly higher in the total-VS group than in the no-VS group (10.0 [4.5-14.5] vs 2.0 [1.0-3.0]; P < 0.001). In four patients who underwent mitral VS, successful RFCA was achieved using the transaortic approach, coronary sinus (CS) approach, or bipolar ablation. In three patients who underwent tricuspid VS, successful RFCA was achieved using the above-prosthetics or trans-prosthetics approach. In two patients, RFCA failed. The trans-prosthetics approach and bipolar ablation technique were effective. The transaortic and CS approaches were occasionally effective. The transseptal approach was ineffective. CONCLUSIONS Successful RFCA of APs at the site of prior VS can be achieved by detailed mapping of the areas both above and below the prosthetic valve, as well as by ensuring effective radiofrequency energy delivery using various catheter approaches and RFCA techniques.
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Affiliation(s)
- Jae‐Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Moo‐Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - In‐Soo Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Pil‐Sung Yang
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Tae‐Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Hui‐Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
| | - Gi‐Byoung Nam
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Kee‐Joon Choi
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - You‐Ho Kim
- Department of Cardiology, Asan Medical Center, The Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Chun Hwang
- Department of CardiologyRevere HealthProvoUtah
| | - Moon‐Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulRepublic of Korea
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Kim JO, Shim J, Lee SH, Yu HT, Kim TH, Uhm JS, Choi JI, Choi JY, Lee MH, Kim YH, Chang BC, Pak HN. Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation. J Cardiol 2019; 73:488-496. [PMID: 30850308 DOI: 10.1016/j.jjcc.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. METHODS We compared 77 patients with VAF (46.8% male, 52.7±8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. RESULTS The left atrial (LA) diameter was greater (p<0.001), LA voltage lower (p<0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p=0.004) for VAF than NVAF. During 70.2±1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p=0.399), even after excluding patients with maze procedures (log rank p=0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p=0.244), or between patients with prior maze procedures and those without (log rank p=0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. CONCLUSIONS Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation.
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Affiliation(s)
- Jung Ok Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jaemin Shim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Seung-Hyun Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hee Tae Yu
- Yonsei University Health System, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jong-Il Choi
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | - Jae Young Choi
- Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyung Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Korea University Cardiovascular Center, Seoul, Republic of Korea
| | | | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Lee SH, Choi HO, Hwang KW. Cavotricuspid isthmus ablation using multimodality imaging in Ebstein anomaly with a mechanical tricuspid valve replacement. HeartRhythm Case Rep 2018; 4:346-349. [PMID: 30116707 PMCID: PMC6092982 DOI: 10.1016/j.hrcr.2018.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sang Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Republic of Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Republic of Korea
- Address reprint requests and correspondence: Dr Ki Won Hwang, Department of Internal Medicine, Pusan National University Yangsan Hospital, Geumo St 20, Mulgeum-eup, Yangsan 50612, Republic of Korea.
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Kocyigit D, Canpolat U, Aytemir K. Who Needs Catheter Ablation And Which Approach? J Atr Fibrillation 2016; 8:1335. [PMID: 27957233 DOI: 10.4022/jafib.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
Abstract
Catheter ablation therapy for atrial fibrillation (AF) has gained a significant role during maintenance of sinus rhythm compared to anti-arrhythmic medication. Catheter ablation techniques are also improved and progressed over years in parallel to better understanding of disease mechanisms and technological advancements. However, due to invasive nature of the therapy with its pertinent procedural risks, both appropriate patient selection and use of relevant approach should be considered by all electrophysiologists before decide to perform catheter ablation.
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Affiliation(s)
- Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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10
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Wang J, Han J, Li Y, Ye Q, Meng F, Luo T, Tian B, Zhang H, Jia Y, Zeng W, Xu C, Han W, Jiao Y, Meng X. Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right-Sided Heart Remodeling After Mitral-Valve Surgery: A Propensity-Score Matching Analysis. J Am Heart Assoc 2016; 5:e004213. [PMID: 27919928 PMCID: PMC5210400 DOI: 10.1161/jaha.116.004213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/24/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND This study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right-sided heart remodeling in patients after mitral valve procedure. METHODS AND RESULTS Between 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity-score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate-to-severe TR, as well as echocardiography indices in long-term follow-up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081-2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299-5.466; P=0.008), and moderate-to-severe TR (HR, 1.436; 95% CI, 1.059-1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right-sided heart remodeling after 5-year follow-up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5-year follow-up. The recurrent group showed significantly higher risks of moderate-to-severe TR (HR, 2.427; 95% CI, 1.261-4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right-sided heart remodeling. CONCLUSIONS In a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right-sided heart remodeling, which are alleviated by surgical ablation.
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Affiliation(s)
- Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Ye
- The Heart Center, First Hospital of Tsinghua University, Beijing, China
| | - Fei Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tiange Luo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Baiyu Tian
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yixin Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Zeng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunlei Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuqing Jiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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11
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Ablation of Atrial Fibrillation in a Patient with a Mechanical Mitral Valve. Card Electrophysiol Clin 2016; 8:155-9. [PMID: 26920185 DOI: 10.1016/j.ccep.2015.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinicians must be mindful of the left ventricular lead when cannulating the coronary sinus with a decapolar catheter or an ablation catheter. Left atrial catheter ablation for the treatment of atrial fibrillation in patients with a mechanical mitral valve, when approached carefully, can be performed safely and effectively. Block across linear lines should be confirmed using differential activation and/or differential pacing to decrease risks of proarrhythmias.
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12
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Liu H, Chen L, Xiao Y, Ma R, Hao J, Chen B, Qin C, Cheng W. Early Efficacy Analysis of Biatrial Ablation versus Left and Simplified Right Atrial Ablation for Atrial Fibrillation Treatment in Patients with Rheumatic Heart Disease. Heart Lung Circ 2015; 24:789-95. [DOI: 10.1016/j.hlc.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 01/26/2015] [Accepted: 02/08/2015] [Indexed: 02/05/2023]
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13
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Deng WN, Chen KE, Bai R, Zhang ZJ, Li SN, Wen ZY, Zhang C, Yu RH, Long DY, Tang RB, Sang CH, Liu N, Guo XY, Wu XY, Nie JG, Du X, Dong JZ, Ma CS. Pouched mitral isthmus is associated with incomplete linear block in atrial fibrillation patients with mechanical mitral valve replacement. J Cardiovasc Electrophysiol 2015; 26:501-8. [PMID: 25726963 DOI: 10.1111/jce.12649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/19/2015] [Accepted: 02/03/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previous studies have described the impact of mitral isthmus (MI) anatomy on the likelihood of achieving MI linear block in patients with native mitral valves (NMV) who underwent atrial fibrillation (AF) ablation. However, none have investigated that issue in AF patients with mechanical mitral valve replacements (MMVR). METHODS AND RESULTS Twenty-nine consecutive patients who developed symptomatic persistent AF post-MMVR and referred for ablation were enrolled. Twenty-nine patients with NMV who underwent ablation of persistent AF during the same period were matched. With preprocedural cardiac computed tomographic imaging, MI anatomical features of all the participants were analyzed. Pouched MI was observed in 19 (65.5%) MMVR patients versus to 6 (20.7%) controls (P = 0.001). Bidirectional linear block across MI was achieved in 21 (72.4%) MMVR patients and 22 (75.9%) in the controls (P = 0.764). In the multivariable analysis, pouched MI was an independent predictor of incomplete MI block. CONCLUSIONS Pouched MI accounts for the majority of AF patients with MMVR and may be associated with incomplete bidirectional linear block of MI.
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Affiliation(s)
- Wen-Ning Deng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - K E Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhi-Jun Zhang
- Department of Cardiology, Shanxi Dayi Hospital, Taiyuan, Shanxi, China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhao-Ying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chen Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun-Gang Nie
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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14
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Gurbuz O, Ercan A, Ozkan H, Kumtepe G, Karal IH, Ener S. Case report: paravalvular leak as a complication of percutaneous catheter ablation for atrial fibrillation. J Cardiothorac Surg 2014; 9:187. [PMID: 25515423 PMCID: PMC4279701 DOI: 10.1186/s13019-014-0187-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/20/2014] [Indexed: 01/19/2023] Open
Abstract
An increasing number of reports reveal the safety and efficacy of catheter ablation for atrial fibrillation therapy even in patients with a history of prosthetic heart valve. This case report presents a 60 year old female patient who had a prosthetic mitral paravalvular leak as a complication of radiofrequency ablation. Surgery revealed a 15 mm hole and three broken knots in the posterolateral mitral annulus. This report demonstrates radiofrequency ablation for atrial fibrillation in patients with prosthetic mitral valve may cause a paravalvular leak likely as a result of thermal injury. Moreover, patient can be asymptomatic at first. The clinician should keep in mind such complication and the patient should be evaluated in terms of paravalvular leakage.
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Affiliation(s)
- Orcun Gurbuz
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir, 10010, Turkey.
| | - Abdulkadir Ercan
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir, 10010, Turkey.
| | - Hakan Ozkan
- Department Of Cardiology, Bahcesehir University Faculty of Medicine, Istanbul, Turkey.
| | - Gencehan Kumtepe
- Department of Cardiovascular Surgery, Balikesir University, School of Medicine, Balikesir, 10010, Turkey.
| | - Ilker H Karal
- Department of Cardiovascular Surgery, Samsun Hospital for Education and Research, Samsun, Turkey.
| | - Serdar Ener
- Department of Cardiovascular Surgery, Acıbadem Bursa Hospital, Bursa, Turkey.
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15
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Chen L, Xiao Y, Ma R, Chen B, Hao J, Qin C, Cheng W, Wen R. Bipolar radiofrequency ablation is useful for treating atrial fibrillation combined with heart valve diseases. BMC Surg 2014; 14:32. [PMID: 24884667 PMCID: PMC4039985 DOI: 10.1186/1471-2482-14-32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/14/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is a common arrhymia, and it results in increased risk of thromboembolism and decreased cardiac function. In patients undergoing cardiac surgery, concomitant radiofrequency ablation to treat AF is effective in restoring sinus rhythm (SR). This study is an observational cohort study aimed to investigate the safety and efficacy of bipolar radiofrequency ablation (BRFA) for treating AF combined with heart valve diseases. METHODS Clinical data were analyzed retrospectively from 324 cases of rheumatic heart disease combined with persistent AF patients who underwent valve replacement concomitant BRFA. The modified left atrial and the simplified right atrial ablation were used for AF treatments. Of the 324 patients, 248 patients underwent mitral valve replacement and 76 patients underwent double valve replacement. Meanwhile, 54 patients underwent concomitant thrombectomy and 97 underwent tricuspid valvuloplasty. And all of them received temporary pacemaker implantation. The 24 hours holter electrocardiogram (ECG) monitoring and echocardiography was performed before the operation, on the first day after operation, on discharge day, and at 6 and 12 months after operation. RESULTS There were 299 patients with SR on the first day after operation (92.30%), 12 patients with junctional rhythm (3.70%), 11 patients with AF (3.39%), and 2 patients with atrial flutter (0.62%). The temporary pacemaker was used in 213 patients (65.74%) with heart rates less than 70 beat/minute in the ICU. Two patients died early and the mortality rate was 0.62%. Two patients had left ventricular rupture and the occurrence rate was 0.62%. They both recovered. There was no degree III atrioventricular blockage and no permanent pacemaker implantation. Overall survival rate was 99.38% (322 cases) with SR conversion rate of 89.13% (287 cases) at discharge. The SR conversion rate was 87.54% and 87.01% at 6 and 12 months after operation. Sinus bradycardia occurred in 3.42% of patients at 6 months after operation and in 3.03% of patients at 12 months after operation. Echocardiography showed that the left atrial diameter was significantly decreased, and ejection fraction and fractional shortening were significantly improved. CONCLUSIONS BRFA for treating AF in concomitant valve replacement is safe and with good efficacy.
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Affiliation(s)
- Lin Chen
- Department of Cardiovascular Surgery, Xinqiao Hospital, Third Military Medical University, 7F, Second in-Patient Building, 183 Xinqiao St, Shapingba District, Chongqing 400037, P, R, China.
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16
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BAI RONG, DI BIASE LUIGI, MOHANTY PRASANT, SANTANGELI PASQUALE, MOHANTY SANGHAMITRA, PUMP AGNES, ELAYI CLAUDES, REDDY YERUVAMADHU, FORLEO GIOVANNIB, HONGO RICHARD, BEHEIRY SALWA, RUSSO ANTONIODELLO, CASELLA MICHELA, PELARGONIO GEMMA, SANTARELLI PIETRO, HORTON RODNEY, SANCHEZ JAVIER, GALLINGHOUSE JOSEPH, BURKHARDT JDAVID, MA CHANGSHENG, LAKKIREDDY DHANUNJAYA, TONDO CLAUDIO, NATALE ANDREA. Catheter Ablation of Atrial Fibrillation in Patients with Mechanical Mitral Valve: Long-Term Outcome of Single Procedure of Pulmonary Vein Antrum Isolation with or without Nonpulmonary Vein Trigger Ablation. J Cardiovasc Electrophysiol 2014; 25:824-833. [DOI: 10.1111/jce.12433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- RONG BAI
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Cardiology; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - LUIGI DI BIASE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Cardiology; University of Foggia; Foggia Italy
- Institute of Cardiology; Catholic University of the Sacred Heart; Rome Italy
- Albert Einstein College of Medicine at Montefiore Hospital; New York USA
| | - PRASANT MOHANTY
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - PASQUALE SANTANGELI
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - SANGHAMITRA MOHANTY
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - AGNES PUMP
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Heart Institute; Faculty of Medicine; University of Pecs; Pecs Hungary
| | - CLAUDE S. ELAYI
- Division of Cardiovascular Medicine; Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - YERUVA MADHU REDDY
- Center for Excellence in Atrial Fibrillation and EP Research; Bloch Heart Rhythm Center; Mid-America Cardiology at Kansas University Hospital; Kansas City Kansas USA
| | | | - RICHARD HONGO
- Division of Electrophysiology; California Pacific Medical Center; San Francisco California USA
| | - SALWA BEHEIRY
- Division of Electrophysiology; California Pacific Medical Center; San Francisco California USA
| | | | | | - GEMMA PELARGONIO
- Institute of Cardiology; Catholic University of the Sacred Heart; Rome Italy
| | - PIETRO SANTARELLI
- Institute of Cardiology; Catholic University of the Sacred Heart; Rome Italy
| | - RODNEY HORTON
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
| | - JAVIER SANCHEZ
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - JOSEPH GALLINGHOUSE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - J. DAVID BURKHARDT
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
| | - CHANGSHENG MA
- Department of Cardiology; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - DHANUNJAYA LAKKIREDDY
- Center for Excellence in Atrial Fibrillation and EP Research; Bloch Heart Rhythm Center; Mid-America Cardiology at Kansas University Hospital; Kansas City Kansas USA
| | | | - ANDREA NATALE
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center; Austin Texas USA
- Division of Electrophysiology; California Pacific Medical Center; San Francisco California USA
- Division of Cardiology; Stanford University; Palo Alto California USA
- Department of Biomedical Engineering; University of Texas; Austin Texas USA
- Interventional Electrophysiology; Scripps Clinic; San Diego California USA
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17
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A Review of JACC Articles on the Topic of Heart Rhythm Disorders: 2011–2012. J Am Coll Cardiol 2013; 62:e451-e519. [DOI: 10.1016/j.jacc.2013.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Santangeli P, Di Biase L, Bai R, Horton R, Burkhardt JD, Sanchez J, Price J, Natale A. Advances in catheter ablation: atrial fibrillation ablation in patients with mitral mechanical prosthetic valve. Curr Cardiol Rev 2012; 8:362-7. [PMID: 23003204 PMCID: PMC3492819 DOI: 10.2174/157340312803760767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 05/26/2012] [Accepted: 05/26/2012] [Indexed: 11/30/2022] Open
Abstract
Atrial fibrillation (AF) is common in patients with mitral valve replacement (MVR). Treatment of AF in these subjects is challenging, as the arrhythmia is often refractory to antiarrhythmic drug therapy. Radiofrequency catheter ablation (RFCA) is usually avoided or delayed in patients with MVR due to the higher perceived risks and difficulty of left atrial catheter manipulation in the presence of a mechanical valve. Over the last few years, several investigators have reported the feasibility and safety of RFCA of AF in patients with MVR. Five case-control studies have evaluated the feasibility and safety of RFCA of AF or perimitral flutter (PMFL) in patients with MVR. Overall, a total of 178 patients with MVR have been included (21 undergoing ablation of only PMFL), and have been compared with a matched control group of 285 patients. Total procedural duration (weigthed mean difference [WMD] = +24.5 min, 95% confidence interval [CI] +10.2 min to +38.8 min, P = 0.001), and fluoroscopy time (WMD = +13.5 min, 95% CI +3.7 min to +23.4 min, P = 0.007) were longer in the MVR group. After a mean follow-up of 11.5 ± 8.6 months, 64 (36%) patients in the MVR group experienced recurrence of AF/PMFL, as compared to 73 (26%) patients in the control group, accounting for a trend toward an increased rate of recurrences in patients with MVR (odds ratio [OR] = 1.66, 95% CI 0.99 to 2.78, P = 0.053). Periprocedural complications occurred in 10 (5.6%) patients in the MVR group, and in 8 (2.8%) patients in the control group (OR = 2.01, 95% CI 0.56 to 7.15, P = 0.28). In conclusion, a quantitative analysis of the available evidence supports a trend toward a worse arrhythmia-free survival and a higher absolute rate of periprocedural complications in patients with MVR undergoing RFCA of AF or PMFL, as compared to a matched control group without mitral valve disease. These data would encourage the adoption of RFCA of AF in MVR patients mostly by more experienced Institutions.
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Affiliation(s)
- Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute - St. David's Medical Center, Austin, TX 78705, USA
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Abstract
Cardiac transplant recipients demonstrate a unique substrate for atrial tachyarrhythmias owing to the surgical techniques involved. Surgical modification of the atria during transplant surgery has both proarrhythmic and antiarrhythmic effects detailed in this paper. Cavotricuspid isthmus-dependent right atrial flutter is the most common arrhythmia identified. Atrial fibrillation is uncommon owing to obligatory surgical pulmonary vein isolation. Donor hearts can also contain pre-existing accessory pathways or dual AV nodal physiology causing supraventricular tachycardia for which adenosine treatment is not recommended, but catheter ablation is curable.
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Affiliation(s)
- Daniel J Cantillon
- Cardiac Electrophysiology and Pacing, Heart and Vascular Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-2, Cleveland, OH 44195, USA
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