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Hong KL, Borges J, Glover B. Catheter ablation for the management of atrial fibrillation: current technical perspectives. Open Heart 2020; 7:openhrt-2019-001207. [PMID: 32393656 PMCID: PMC7223467 DOI: 10.1136/openhrt-2019-001207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 01/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
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Affiliation(s)
- Kathryn Lauren Hong
- Cardiology, University of Toronto, Toronto, Canada.,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jazlyn Borges
- Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benedict Glover
- Cardiology, University of Toronto, Toronto, Canada .,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
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Transthoracic echocardiography guided percutaneous laser ablation of the interventricular septum: A successful sheep model for septal thickness reduction and one year follow-up. Int J Cardiol 2019; 280:135-141. [PMID: 30665806 DOI: 10.1016/j.ijcard.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/24/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease, causing breathlessness, chest pain, syncope and sudden death. One-year outcome of echo-guided transthoracic percutaneous laser ablation (TPLA) of the sheep interventricular septum was studied as a novel treatment to reduce the septal thickness. It may partially address the limitations of surgical myectomy and alcohol septal ablation in terms of trauma, safety, and efficacy. METHODS Twelve healthy adult sheep were randomly categorized into two groups: with and without the laser application of TPLA of the interventricular septum (IVS) at the energy level of 5 W for 3 min. Echocardiography, electrocardiography (ECG), cardiac magnetic resonance (CMR), serological and pathological examinations were performed over a 12-month follow-up. RESULTS After the laser ablation all animals survived with normal cardiac function; No severe complications or bundle branch block were noted. The septal thickness (3.11 ± 1.14 vs. 8.40 ± 0.45 mm, p < 0.05), regional movement of ablated IVS and longitudinal strain significantly decreased when comparing the experimental and control groups. The Troponin I level was significantly elevated after the operation, which validated immediate cardiac coagulation necrosis. On cardiac magnetic resonance (CMR) imaging, the ablated myocardium showed significant fibrosis evidenced by late gadolinium enhancement. Pathological results revealed damaged ultra-structure of the ablated myocardium and development of fibrosis. CONCLUSIONS TPLA is a safe and effective minimally invasive method to reduce IVS thickness in the long term, making it a potential alternative for HOCM treatment.
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Figueras I Ventura RM, Mǎrgulescu AD, Benito EM, Alarcón F, Enomoto N, Prat-Gonzalez S, Perea RJ, Borràs R, Chipa F, Arbelo E, Tolosana JM, Brugada J, Berruezo A, Mont L. Postprocedural LGE-CMR comparison of laser and radiofrequency ablation lesions after pulmonary vein isolation. J Cardiovasc Electrophysiol 2018; 29:1065-1072. [PMID: 29722466 DOI: 10.1111/jce.13616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the anatomical characteristics of scar formation achieved by visual-guided laser balloon (Laser) and radiofrequency (RF) pulmonary vein isolation (PVI), using late-gadolinium-enhanced cardiac magnetic resonance imaging (LGE-CMR). METHODS AND RESULTS We included 17 patients with paroxysmal or early persistent drug resistant AF who underwent Laser ablation; 2 were excluded due to procedure-related complications. The sample was matched with a historical group of 15 patients who underwent PVI using RF. LGE-CMR sequences were acquired before and 3 months post-PVI. Ablation gaps were defined as pulmonary vein (PV) perimeter sections showing no gadolinium enhancement. The number of ablation gaps was lower in Laser versus RF ablations (median 7 vs. 14, P = 0.015). Complete anatomical PVI (circumferential scar around PV, without gaps) was more frequently achieved with Laser than with RF (39% vs. 19% of PVs, P = 0.025). Fewer gaps were present at the superior and anterior left PV and posterior right PV antral regions in the Laser group, compared to RF. Scar extension into the PVs was similar in both groups, although RF produced more extensive ablation scar toward the LA body. AF recurrences at 1 year were similar in both groups (Laser 36% vs. RF 27%, P = 1.00). CONCLUSIONS Compared to RF, Laser ablation achieved more complete anatomical PVI, with less LA scar extension. However, AF recurrence appears to be similar after Laser compared to RF ablation. Further studies are needed to assess whether the anatomical advantages of Laser ablation translate into clinical benefit in patients with AF.
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Affiliation(s)
- Rosa M Figueras I Ventura
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,Galgo Medical, Barcelona, Catalonia, Spain
| | - Andrei D Mǎrgulescu
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Eva M Benito
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Norihiro Enomoto
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Susanna Prat-Gonzalez
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Rosario J Perea
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Roger Borràs
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Fredy Chipa
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain
| | - Elena Arbelo
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Catalonia, Spain
| | - Jose M Tolosana
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Catalonia, Spain
| | - Josep Brugada
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Catalonia, Spain
| | - Antonio Berruezo
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Catalonia, Spain
| | - Lluis Mont
- Cardiovascular Clinical Institute, UFA (Unitat de Fibril·lació Auricular de l'Hospital Clínic), Hospital Clínic, Universitat de Barcelona, IDIBAPS (Institut d'Investigació Biomèdica August Pi i Sunyer), Barcelona, Catalonia, Spain.,CIBERCV (Centro de Investigación Biomédica en Red Cardiovascular), Barcelona, Catalonia, Spain
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