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Apostolos A, Tsiachris D, Drakopoulou M, Trantalis G, Oikonomou G, Ktenopoulos N, Simopoulou C, Katsaros O, Tsalamandris S, Aggeli C, Tsivgoulis G, Tsioufis C, Toutouzas K. Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management. J Am Heart Assoc 2024; 13:e034249. [PMID: 38639354 PMCID: PMC11179870 DOI: 10.1161/jaha.124.034249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/06/2024] [Indexed: 04/20/2024]
Abstract
This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Maria Drakopoulou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Trantalis
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Oikonomou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Chrysavgi Simopoulou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Odysseas Katsaros
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Constantina Aggeli
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Medical SchoolNational and Kapodistrian University of Athens, Attikon University Hospital of AthensAthensGreece
| | - Costas Tsioufis
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
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2
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Al-Ezzi SMS, Bista I, Al-Ezzi MM, Prajjwal P, Al-Ezzi SMS, Pattani HH, Amiri B, Marsool MDM. Updates in the management of atrial fibrillation: Emerging therapies and treatment. Dis Mon 2024; 70:101633. [PMID: 37716839 DOI: 10.1016/j.disamonth.2023.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
OBJECTIVE The most common and clinically important cardiac arrhythmia is atrial fibrillation (AF), which has a large negative impact on public health due to higher fatalities, morbidity, and healthcare expenditure rates. This study aims to provide valuable insights into the effectiveness and outcomes of various treatment approaches and interventions for AF. STUDY DESIGN Systematic review. METHOD The most pertinent published research (original papers and reviews) in the scientific literature were searched for and critically assessed using the online, internationally indexed databases PubMed, Medline, and Cochrane Reviews. These studies are summarised in this review. Keywords like "Atrial Fibrillation", "emerging therapies", "treatment", "catheter ablation", and "atrial appendage" were used to search the papers. The papers were researched and examined to be relevant to the topic. CONCLUSION A lot of work has gone into enhancing AF management to deal with this expanding public health concern. Significant developments and advances in the treatment of AF during the past few years have aided clinicians in giving AF patients better care. The most recent treatments for AF include medication, catheter ablation, cryo-balloon ablation, and left atrial appendage closure.
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Affiliation(s)
| | | | | | | | | | | | - Bita Amiri
- Tabriz University of Medical Sciences, Cardiovascular Research Center, Tabriz, Iran
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3
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Nasso G, Lorusso R, Di Bari N, Condello I, Agró FE, Fiore F, Bonifazi R, Santarpino G, Speziale G. Hybrid approach for long-standing persistent atrial fibrillation: immediate versus staged treatment. J Cardiothorac Surg 2022; 17:274. [PMID: 36289547 PMCID: PMC9609243 DOI: 10.1186/s13019-022-02019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The hybrid approach has become the most effective treatment option for restoring sinus rhythm and reducing the risk of atrial fibrillation (AF) recurrence. However, several issues remain to be clearly defined, including the appropriate timing of the staged procedure and the most effective strategy. Methods Over a 12-year period of activity, we performed 609 AF ablation procedures via a right mini-thoracotomy. From this general population, 60 patients underwent a hybrid procedure with catheter ablation performed at least 4 weeks after the surgical procedure to confirm if effective complete electrical isolation of pulmonary veins was achieved. In 20 patients, the second stage procedure was performed during the same hospitalization due to patient’s electrical instability. The results obtained in immediate versus staged patients were compared. Results All patients were discharged after the first stage procedure in sinus rhythm. The 20 immediate patients had a shorter hospital stay compared with the staged patients, in whom the two hospitalizations resulted in a longer hospital stay (immediate 5.5 ± 1.6 days versus staged 8.7 ± 1.4, P < 0.001). A significantly higher number of immediate patients had an associated ablation of the Bachmann’s bundle (n = 16 in the immediate group [80%] versus n = 14 in the staged group [45%]; P = 0.001). After a mean follow-up of 74 months, there was no significant difference in the risk of AF relapse between groups (immediate 1/20 [5%] versus staged 7/40 [17.5%]; P = 0.18). Conclusion The hybrid approach for the treatment of AF was safe and effective in immediate restoring sinus rhythm and in its maintenance at follow-up. Our preliminary results show that both immediate and staged procedures show similar efficacy but this result is strongly influenced by the concomitant ablation of the Bachmann’s bundle, which appears to be the most important component of the treatment strategy in order to reduce the risk of recurrent AF.
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Affiliation(s)
- Giuseppe Nasso
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Roberto Lorusso
- grid.412966.e0000 0004 0480 1382Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands ,grid.5012.60000 0001 0481 6099Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Nicola Di Bari
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Ignazio Condello
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Felice Eugenio Agró
- grid.9657.d0000 0004 1757 5329Department od Anaesthesiology, Campus Bio-Medico University, Rome, Italy
| | - Flavio Fiore
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Raffaele Bonifazi
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
| | - Giuseppe Santarpino
- grid.411489.10000 0001 2168 2547Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy ,grid.511981.5Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany ,Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care&Research, Lecce, Italy
| | - Giuseppe Speziale
- grid.513136.30000 0004 1785 1004Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Via Camillo Rosalba, 35/38, 70124 Bari, Italy
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4
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Wu Z, Liu Y, Tong L, Dong D, Deng D, Xia L. Current progress of computational modeling for guiding clinical atrial fibrillation ablation. J Zhejiang Univ Sci B 2021; 22:805-817. [PMID: 34636185 DOI: 10.1631/jzus.b2000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias, associated with high morbidity, mortality, and healthcare costs, and it places a significant burden on both individuals and society. Anti-arrhythmic drugs are the most commonly used strategy for treating AF. However, drug therapy faces challenges because of its limited efficacy and potential side effects. Catheter ablation is widely used as an alternative treatment for AF. Nevertheless, because the mechanism of AF is not fully understood, the recurrence rate after ablation remains high. In addition, the outcomes of ablation can vary significantly between medical institutions and patients, especially for persistent AF. Therefore, the issue of which ablation strategy is optimal is still far from settled. Computational modeling has the advantages of repeatable operation, low cost, freedom from risk, and complete control, and is a useful tool for not only predicting the results of different ablation strategies on the same model but also finding optimal personalized ablation targets for clinical reference and even guidance. This review summarizes three-dimensional computational modeling simulations of catheter ablation for AF, from the early-stage attempts such as Maze III or circumferential pulmonary vein isolation to the latest advances based on personalized substrate-guided ablation. Finally, we summarize current developments and challenges and provide our perspectives and suggestions for future directions.
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Affiliation(s)
- Zhenghong Wu
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China
| | - Yunlong Liu
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Lv Tong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Diandian Dong
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Dongdong Deng
- School of Biomedical Engineering, Dalian University of Technology, Dalian 116024, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310027, China.
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5
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Hao R, Erdem Tuna E, Çavuşoğlu MC. Contact Stability and Contact Safety of a Magnetic Resonance Imaging-Guided Robotic Catheter Under Heart Surface Motion. JOURNAL OF DYNAMIC SYSTEMS, MEASUREMENT, AND CONTROL 2021; 143:071010. [PMID: 33994580 PMCID: PMC8086176 DOI: 10.1115/1.4049837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Contact force quality is one of the most critical factors for safe and effective lesion formation during catheter based atrial fibrillation ablation procedures. In this paper, the contact stability and contact safety of a novel magnetic resonance imaging (MRI)-actuated robotic cardiac ablation catheter subject to surface motion disturbances are studied. First, a quasi-static contact force optimization algorithm, which calculates the actuation needed to achieve a desired contact force at an instantaneous tissue surface configuration is introduced. This algorithm is then generalized using a least-squares formulation to optimize the contact stability and safety over a prediction horizon for a given estimated heart motion trajectory. Four contact force control schemes are proposed based on these algorithms. The first proposed force control scheme employs instantaneous heart position feedback. The second control scheme applies a constant actuation level using a quasi-periodic heart motion prediction. The third and the last contact force control schemes employ a generalized adaptive filter-based heart motion prediction, where the former uses the predicted instantaneous position feedback, and the latter is a receding horizon controller. The performance of the proposed control schemes is compared and evaluated in a simulation environment.
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Affiliation(s)
- Ran Hao
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - E. Erdem Tuna
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
| | - M. Cenk Çavuşoğlu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH 44106
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6
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Nasso G, Lorusso R, Moscarelli M, De Martino G, Dell'Aquila AM, Motekallemi A, Di Bari N, Condello I, Mastroroberto P, Santarpino G, Speziale G. Catheter, surgical, or hybrid procedure: what future for atrial fibrillation ablation? J Cardiothorac Surg 2021; 16:186. [PMID: 34174911 PMCID: PMC8236186 DOI: 10.1186/s13019-021-01565-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called "hybrid procedure" that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established. METHODS From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann's bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. RESULTS The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence. CONCLUSIONS Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care&Research, Anthea Hospital, Via Camillo Rosalba, 35, /38, Bari, Italy.
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Marco Moscarelli
- Department of Cardiac Surgery, GVM Care&Research, Anthea Hospital, Via Camillo Rosalba, 35, /38, Bari, Italy
| | - Giuseppe De Martino
- Department of Cardiology and Electrophysiology, Clinica Mediterranea, Naples, Italy
| | | | - Arash Motekallemi
- Department of Cardiac Surgery, Münster Universität, Münster, Germany
| | - Nicola Di Bari
- Department of Cardiac Surgery, "Aldo Moro" University, Bari, Italy
| | - Ignazio Condello
- Department of Cardiac Surgery, GVM Care&Research, Anthea Hospital, Via Camillo Rosalba, 35, /38, Bari, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, GVM Care&Research, Anthea Hospital, Via Camillo Rosalba, 35, /38, Bari, Italy.,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care&Research, Anthea Hospital, Via Camillo Rosalba, 35, /38, Bari, Italy
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7
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De Martino G, Nasso G, Gasperetti A, Moscarelli M, Mancusi C, Della Ratta G, Calvanese C, Mitacchione G, Bonifazi R, Di Bari N, Vassallo E, Schiavone M, Gaudino M, Forleo GB, Speziale G. Targeting Bachmann's bundle in hybrid ablation for long-standing persistent atrial fibrillation: a proof of concept study. J Interv Card Electrophysiol 2021; 64:273-280. [PMID: 33683552 DOI: 10.1007/s10840-021-00971-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Catheter-based or surgical procedures in patients with long-standing persistent atrial fibrillation (LSPAF) remain a challenge. As a result, different approaches including hybrid (surgical and endocardial) ablation have been developed. Bachmann's bundle (BB) is a mainly epicardial structure capable of sustaining arrhythmic reentry that could be involved in the development and perpetuation of atrial fibrillation. We investigated the efficacy and safety of an adjunctive BB ablation in LSPAF patients undergoing hybrid ablation. METHODS In a two-arm non-randomized study, consecutive LSPAF patients undergoing epicardial isolation of pulmonary veins with left atrial posterior wall (box lesion) with (n = 30, BB group) and without additional BB ablation (n = 30, CONV group) were enrolled in the study. All patients underwent an endocardial procedure within 6 weeks post-surgery to assess for potential lesion gaps and additional atrial substrate modification. The primary endpoint was freedom from AF through 12 months of follow-up. RESULTS The two-staged hybrid ablation was successfully completed in all patients. One-year freedom from atrial arrhythmias recurrence rates was 96.6% in the BB group vs 76.6% in the CONV group (p = 0.025). At procedure completion, 30 (100%) and 17 (56%) patients had a spontaneous cardioversion in BB and CONV group, respectively (p < 0.001). No significant differences in quality of life or complication rates were observed. CONCLUSIONS This initial experience shows, for the first time, that adjunctive BB ablation in the setting of hybrid ablation for LSPAF is a feasible and effective approach in increasing maintenance of sinus rhythm without increasing complication rates.
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Affiliation(s)
| | | | - Alessio Gasperetti
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy
| | | | | | | | | | | | | | | | | | - Marco Schiavone
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy
| | | | - Giovanni B Forleo
- Ospedale Luigi Sacco - Polo Universitario, Via G.B. Grassi 74, 20157, Milan, Italy.
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8
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La Rosa G, Quintanilla JG, Salgado R, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Villacastín J, Jalife J, Pérez-Castellano N, Filgueiras-Rama D. Anatomical targets and expected outcomes of catheter-based ablation of atrial fibrillation in 2020. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:341-359. [PMID: 33283883 DOI: 10.1111/pace.14140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
Anatomical-based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter-based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point-by-point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow-up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.
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Affiliation(s)
- Giulio La Rosa
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Jorge G Quintanilla
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Salgado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - David Filgueiras-Rama
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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9
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Mol D, Houterman S, Balt JC, Bhagwandien RE, Blaauw Y, Delnoy PPH, van Driel VJ, Driessen AH, Folkeringa RJ, Hassink RJ, van Huysduynen BH, Luermans JG, Ouss AJ, Stevenhagen YJ, van Veghel D, Westra SW, de Jong JS, de Groot JR. Complications in pulmonary vein isolation in the Netherlands Heart Registration differ with sex and ablation technique. Europace 2020; 23:216-225. [DOI: 10.1093/europace/euaa255] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/27/2020] [Indexed: 12/31/2022] Open
Abstract
Abstract
Aims
Pulmonary vein isolation (PVI) has become a cornerstone of the invasive treatment of atrial fibrillation. Severe complications are reported in 1–3% of patients. This study aims to compare complications and follow-up outcome of PVI in patients with atrial fibrillation.
Methods and results
The data were extracted from the Netherlands Heart Registration. Procedural and follow-up outcomes in patients treated with conventional radiofrequency (C-RF), multielectrode phased RF (Ph-RF), or cryoballoon (CB) ablation from 2012 to 2017 were compared. Subgroup analysis was performed to identify variables associated with complications and repeat ablations. In total, 13 823 patients (69% male) were included. The reported complication incidence was 3.6%. Patients treated with C-RF developed more cardiac tamponades (C-RF 0.8% vs. Ph-RF 0.3% vs. CB 0.3%, P ≤ 0.001) and vascular complications (C-RF 1.7% vs. Ph-RF 1.2% vs. CB 1.3%, P ≤ 0.001). Ph-RF was associated with fewer bleeding complications (C-RF: 1.0% vs. Ph-RF: 0.4% vs. CB: 0.7%, P = 0.020). Phrenic nerve palsy mainly occurred in patients treated with CB (C-RF: 0.1% vs. Ph-RF: 0.2% vs. CB: 1.5%, P ≤ 0.001). In total, 18.4% of patients were referred for repeat ablation within 1 year. Female sex, age, and CHA2DS2-VASc were independent risk factors for cardiac tamponade and bleeding complications, with an adjusted OR for female patients of 2.97 (95% CI 1.98–4.45) and 2.02 (95% CI 1.03–4.00) respectively.
Conclusion
The reported complication rate during PVI was low. Patients treated with C-RF ablation were more likely to develop cardiac tamponades and vascular complications. Female sex was associated with more cardiac tamponade and bleeding complications.
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Affiliation(s)
- Daniel Mol
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St. Antonius, Nieuwegein, The Netherlands
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Antoine H Driessen
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard J Folkeringa
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Justin G Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexandre J Ouss
- Department of Cardiology and Cardiac Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jonas S de Jong
- Department of Cardiology, OLVG, Oosterpark 9 1091 AC Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology and Cardiac Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
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10
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Huang H, Wang Q, Xu J, Wu Y, Xu C. Comparison of catheter and surgical ablation of atrial fibrillation: A systemic review and meta-analysis of randomized trials. J Thorac Cardiovasc Surg 2020; 163:980-993. [PMID: 32653280 DOI: 10.1016/j.jtcvs.2020.04.154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare both the beneficial and adverse effects of catheter ablation (CA) and surgical ablation (SA) on patients with atrial fibrillation (AF). METHODS We searched MEDLINE and 4 additional databases for randomized controlled trials that compared CA with SA. Following data extraction, we conducted a meta-analysis to estimate the efficacy and safety of CA relative to SA. The primary end point of this study was the absence of AF during a 12-month follow-up period without the use of antiarrhythmic drugs. RESULTS Seven trials comparing SA with CA met the inclusion criteria for efficacy outcome assessments. Following the meta-analysis, we obtained a summary odds ratio (OR) of achieving success 1 year after CA relative to SA was 0.37:1 (95% confidence interval [CI], 0.20-0.69). The result was robust in the subgroup analysis. CA was associated with a greater incidence of femoral vascular complications (OR, 5.81; 95% CI, 1.03-32.71), but a lower incidence of pneumothorax (OR, 0.09; 95% CI, 0.01-0.74) than SA. Statistically significant differences in the other safety outcomes were not observed between CA and SA. CONCLUSIONS SA confers a moderate advantage over CA in 1-year efficacy outcomes and may be safely performed by experienced surgeons.
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Affiliation(s)
- Haobin Huang
- Department of Cardiovascular Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Qinxue Wang
- Department of Geriatric Intensive Care Unit, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China; Department of Maternal, Child, and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yanhu Wu
- Department of Cardiovascular Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
| | - Cheng Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Key Laboratory of Modern Toxicology of Ministry of Education, Center for Global Health, Nanjing Medical University, Nanjing, China.
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11
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Lim B, Kim J, Hwang M, Song JS, Lee JK, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. In situ procedure for high-efficiency computational modeling of atrial fibrillation reflecting personal anatomy, fiber orientation, fibrosis, and electrophysiology. Sci Rep 2020; 10:2417. [PMID: 32051487 PMCID: PMC7016008 DOI: 10.1038/s41598-020-59372-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/06/2019] [Indexed: 12/22/2022] Open
Abstract
We previously reported the feasibility and efficacy of a simulation-guided clinical catheter ablation of atrial fibrillation (AF) in an in-silico AF model. We developed a highly efficient realistic AF model reflecting the patient endocardial voltage and local conduction and tested its clinical feasibility. We acquired > 500 endocardial bipolar electrograms during right atrial pacing at the beginning of the AF ablation procedures. Based on the clinical bipolar electrograms, we generated simulated voltage maps by applying fibrosis and local activation maps adjusted for the fiber orientation. The software's accuracy (CUVIA2.5) was retrospectively tested in 17 patients and feasibility prospectively in 10 during clinical AF ablation. Results: We found excellent correlations between the clinical and simulated voltage maps (R = 0.933, p < 0.001) and clinical and virtual local conduction (R = 0.958, p < 0.001). The proportion of virtual local fibrosis was 15.4, 22.2, and 36.9% in the paroxysmal AF, persistent AF, and post-pulmonary vein isolation (PVI) states, respectively. The reconstructed virtual bipolar electrogram exhibited a relatively good similarities of morphology to the local clinical bipolar electrogram (R = 0.60 ± 0.08, p < 0.001). Feasibility testing revealed an in situ procedural computing time from the clinical data acquisition to wave-dynamics analyses of 48.2 ± 4.9 min. All virtual analyses were successfully achieved during clinical PVI procedures. We developed a highly efficient, realistic, in situ procedural simulation model reflective of individual anatomy, fiber orientation, fibrosis, and electrophysiology that can be applied during AF ablation.
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Affiliation(s)
- Byounghyun Lim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jaehyeok Kim
- Yonsei University Health System, Seoul, Republic of Korea
| | - Minki Hwang
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Yonsei University Health System, Seoul, Republic of Korea
| | - Jung Ki 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
| | - Boyoung Joung
- Yonsei University Health System, Seoul, Republic of Korea
| | - Moon-Hyung Lee
- Yonsei University Health System, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Yonsei University Health System, Seoul, Republic of Korea.
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Circulating Galectin-3 and Atrial Fibrillation Recurrence after Catheter Ablation: A Meta-Analysis. Cardiovasc Ther 2019; 2019:4148129. [PMID: 31772609 PMCID: PMC6739774 DOI: 10.1155/2019/4148129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 12/12/2022] Open
Abstract
Background Galectin-3 (Gal-3) is involved in fibrosis and heart failure. However, epidemiological studies evaluating the association between Gal-3 and atrial fibrillation (AF) recurrence after catheter ablation showed inconsistent results. We conducted a meta-analysis to comprehensively evaluate the relationship between baseline circulating Gal-3 levels and AF recurrence in patients undergoing catheter ablation. Methods Relevant studies were identified by systematically searching the PubMed and Embase databases. A random-effect model was used to synthesize the results. Sensitivity analyses, performed by omitting one study at a time, were used to evaluate the robustness of the results. Results Seven prospective cohort studies including 645 AF patients were included. Within a follow-up duration of up to 18 months, 244 patients developed AF recurrence. Pooled results showed that baseline circulating Gal-3 levels were significantly higher in patients with AF recurrence compared to those without (standardized mean difference: 0.74; 95% confidence interval (CI): 0.21 - 1.27; p = 0.007; I2 = 89%). Moreover, higher baseline Gal-3 levels were independently associated with a significantly higher risk of AF recurrence after catheter ablation (risk ratio: 1.17 per unit of Gal-3; 95% CI: 1.01 - 1.35; p = 0.03; I2 = 40%), which was independent of age, gender, and left atrial dimension. Sensitivity analyses did not significantly affect the results. However, there was a significant publication bias for predicting efficacy of associating preprocedural Gal-3 levels with AF recurrence. Conclusions Higher preprocedural Gal-3 levels may be associated with increased risk of AF recurrence in patients undergoing catheter ablation.
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Zghaib T, Shahid A, Pozzessere C, Porter KK, Chu LC, Eng J, Calkins H, Kamel IR, Nazarian S, Zimmerman SL. Validation of contrast-enhanced time-resolved magnetic resonance angiography in pre-ablation planning in patients with atrial fibrillation: comparison with traditional technique. Int J Cardiovasc Imaging 2018; 34:1451-1458. [PMID: 29663178 DOI: 10.1007/s10554-018-1355-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 12/13/2022]
Abstract
Bolus timing is critical to optimal magnetic resonance angiography (MRA) acquisitions but can be challenging in some patients. Our purpose was to evaluate whether contrast-enhanced time-resolved magnetic resonance angiography (TR-MRA), a dynamic multiphase sequence that does not rely on bolus timing, is a viable alternative method to conventional 3D fast-long angle shot contrast-enhanced magnetic resonance angiography (CE-MRA). Coronal subtracted conventional CE-MRA images in 50 consecutive patients presenting for pre-atrial fibrillation ablation pulmonary venous (PV) mapping were compared with 50 TR-MRA images performed in 50 subsequent patients. The TR-MRA protocol was modified to optimize spatial resolution with slightly reduced temporal resolution (6.1 s scan time). Three experienced readers evaluated each scan's image quality and relative left atrial (LA) opacification based on a 4-point scale and diagnostic PV visualization in a binary fashion. Additionally, LA signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and PV dimensions were measured for both techniques. TR-MRA had significantly higher overall image quality (3.10 ± 0.69 vs. 2.42 ± 0.69, p < 0.0001), and LA opacification scores (3.33 ± 0.70 vs. 2.15 ± 1.13, p < 0.0001) compared to CE-MRA. The proportion of diagnostically visualized pulmonary veins was 137/150 (91%) in the CE-MRA group vs. 147/150 (98%) with TR-MRA (p = 0.010). Both SNR and CNR were higher with TR-MRA vs. CE-MRA (277.9 ± 48.9 vs. 106.8 ± 41, p = 0.002 and 100.3 ± 41.7 vs. 70.7 ± 48.0, p = 0.002, respectively). Inter-reader variance of individual PV measurements for each of the MR techniques ranged between 0.62 and 1.47 mm and the ICC for vein measurements was higher with TR-MRA (range: 0.62-0.81) compared to CE-MRA (range: 0.47-0.64). TR-MRA, modified to maximize spatial resolution, offers an alternative method for performing high quality MRA examinations in patients with AF. TR-MRA offers greater overall image quality, PV visualization, and similarly reproducible PV measurements compared to traditional CE-MRA, without the challenges of proper bolus timing.
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Affiliation(s)
- Tarek Zghaib
- Division of Cardiology, Johns Hopkins Medicine, 600 N Wolfe St, Carnegie 592, Baltimore, MD, 21287, USA.
| | - Adeel Shahid
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Chiara Pozzessere
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, USA
| | - Linda C Chu
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - John Eng
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Medicine, 600 N Wolfe St, Carnegie 592, Baltimore, MD, 21287, USA
| | - Ihab R Kamel
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Saman Nazarian
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Stefan L Zimmerman
- §Russell A. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medicine, Baltimore, MD, USA
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14
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Low heart deceleration capacity imply higher atrial fibrillation-free rate after ablation. Sci Rep 2018; 8:5537. [PMID: 29615802 PMCID: PMC5883009 DOI: 10.1038/s41598-018-23970-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/21/2018] [Indexed: 11/09/2022] Open
Abstract
How deceleration capacity (DC) and acceleration capacity (AC) of heart rate associated with atrial fibrillation (AF) and ablation is still not clear. The dynamic changes of AC, DC and conventional heart rate variability (HRV) parameters were characterized in 154 subjects before circumferential pulmonary veins isolation (CPVI) and three days, 3 months and 6 months after CPVI. The DCs of the recurrent group decreased significantly at each time point after CPVI; the DCs of the recurrence-free group before CPVI and three days, 3 months and 6 months after CPVI were 7.06 ± 1.77, 3.79 ± 1.18, 4.22 ± 1.96 and 3.97 ± 0.98 ms respectively, which also decreased significantly at each time point and were significantly lower than these of recurrent group. Conversely, the AC of recurrent and recurrence-free groups increased significantly at each time point after CPVI; the ACs of recurrence-fee group were significantly higher than these of recurrent group at each time point. No stable difference trend of HRV parameters was found between two groups. Further Kaplan–Meier analysis showed that DC < 4.8 ms or AC ≥ −5.1 ms displayed significant higher recurrence-free rates. In conclusion, high AC and low DC imply higher AF-free rate after ablation.
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15
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Shim J, Hwang M, Song JS, Lim B, Kim TH, Joung B, Kim SH, Oh YS, Nam GB, On YK, Oh S, Kim YH, Pak HN. Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study. Front Physiol 2017; 8:792. [PMID: 29075201 PMCID: PMC5641589 DOI: 10.3389/fphys.2017.00792] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF. Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8 ± 9.9 years), and randomly assigned them to the V-ABL (n = 53) and Em-ABL (n = 55) groups. Five different in-silico ablation lesion sets [1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation] were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. Results: The pre-procedural computing time for five different ablation strategies was 166 ± 11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time (p = 0.403), ablation time (p = 0.510), and major complication rate (p = 0.900). During 12.6 ± 3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group (p = 0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p = 0.027). Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.
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Affiliation(s)
- Jaemin Shim
- Cardiovascular Center, Korea University, Seoul, South Korea
| | - Minki Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Jun-Seop Song
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Byounghyun Lim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Boyoung Joung
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Catholic University of Korea, Seoul, South Korea
| | - Yong-Seog Oh
- Division of Cardiology, Catholic University of Korea, Seoul, South Korea
| | - Gi-Byung Nam
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Young Keun On
- Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | - Seil Oh
- Division of Cardiology, Seoul National University, Seoul, South Korea
| | - Young-Hoon Kim
- Cardiovascular Center, Korea University, Seoul, South Korea
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, South Korea
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16
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Abstract
Patients with repaired or unrepaired congenital heart anomalies are at increased risk for arrhythmia development throughout their lives, often paralleling the need for reoperations for hemodynamic residua. The ability to incorporate arrhythmia surgery into reoperations can result in improvement in functional class and decreased need for antiarrhythmic medications. Every reoperation for congenital heart disease can be viewed as an opportunity to assess the electrical and arrhythmia substrates and to intervene to improve the arrhythmias and the hemodynamic condition of the patient. The authors review and summarize the operative techniques for arrhythmia surgery that are based on the arrhythmia mechanisms.
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Affiliation(s)
- Barbara J Deal
- Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL 60611, USA.
| | - Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, 2501 N Orange Avenue, Suite 540, Orlando, FL 32804, USA
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Mini Electrodes on Ablation Catheters: Valuable Addition or Redundant Information?-Insights from a Computational Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2017; 2017:1686290. [PMID: 28553365 PMCID: PMC5434470 DOI: 10.1155/2017/1686290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/02/2017] [Accepted: 02/16/2017] [Indexed: 12/11/2022]
Abstract
Radiofrequency ablation has become a first-line approach for curative therapy of many cardiac arrhythmias. Various existing catheter designs provide high spatial resolution to identify the best spot for performing ablation and to assess lesion formation. However, creation of transmural and nonconducting ablation lesions requires usage of catheters with larger electrodes and improved thermal conductivity, leading to reduced spatial sensitivity. As trade-off, an ablation catheter with integrated mini electrodes was introduced. The additional diagnostic benefit of this catheter is still not clear. In order to solve this issue, we implemented a computational setup with different ablation scenarios. Our in silico results show that peak-to-peak amplitudes of unipolar electrograms from mini electrodes are more suitable to differentiate ablated and nonablated tissue compared to electrograms from the distal ablation electrode. However, in orthogonal mapping position, no significant difference was observed between distal electrode and mini electrodes electrograms in the ablation scenarios. In conclusion, catheters with mini electrodes bring about additional benefit to distinguish ablated tissue from nonablated tissue in parallel position with high spatial resolution. It is feasible to detect conduction gaps in linear lesions with this catheter by evaluating electrogram data from mini electrodes.
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Miranda-Hoyos AC, de la Ossa-Aguirre M. Utilidad de los catéteres con sensor de fuerza de contacto en la ablación de la fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Certain congenital heart anomalies make patients more susceptible to arrhythmia development throughout their lives. This poses the question whether prophylactic arrhythmia surgery should be incorporated into reparative open heart procedures for congenital heart disease. There is currently no consensus on what constitutes a standard prophylactic procedure, owing to the questions that remain regarding lesions to be performed; energy sources to use; proximity of energy source or incisions to coronary arteries, sinoatrial node, atrioventricular node; circumstances for right atrial, left atrial, or biatrial appendectomy; and whether to perform a right, left, or biatrial maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually develop an arrhythmia in his or her lifetime. By reviewing and summarizing the literature, congenital heart disease patients who are at risk for developing atrial arrhythmias can be identified and lesion sets can be suggested in an effort to standardize experimental protocols for prophylactic arrhythmia surgery.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida, USA
| | - Barbara J Deal
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Spatial distribution of electrical reconnection after pulmonary vein isolation in patients with recurrent paroxysmal atrial fibrillation. Neth Heart J 2016; 24:481-7. [PMID: 27220967 PMCID: PMC4943887 DOI: 10.1007/s12471-016-0842-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Recurrence of atrial fibrillation after pulmonary vein isolation (PVI) occurs frequently and may be associated with electrical reconnection of the pulmonary veins (PV). We investigated spatial distribution of electrical reconnection during re-do procedures in patients with paroxysmal atrial fibrillation who had previous successful acute electrical PVI with either single irrigated tip, antral ablation (s-RF; n = 38) or multi-electrode, duty-cycled ablation (PVAC; n = 48). Methods and Results EP navigator, mapping and irrigated tip ablation catheters were used in all re-do procedures. Sites of reconnection were assessed in a 12-segment model. Baseline clinical and demographic characteristics were similar in both groups. The number of PVs reconnected per patient was similar in both groups (2.9 ± 0.9 and 3.2 ± 0.7 (p = 0.193), s‑RF and PVAC, respectively), and each PV was equally affected. However, the inferior quadrant of the right lower PV was significantly more vulnerable to reconnection after previous PVAC ablation, whereas the superior quadrant of the right upper PV showed significantly more reconnection in the s‑RF group. Conclusion The overall number of PVs reconnected was equally high in both groups, and each PV was affected equally. However, there were significant differences in the spatial distribution of electrical reconnection. Better understanding of predilection sites for reconnection might help to improve the long-term success rate of PVI.
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Naniwadekar A, Joshi K, Greenspan A, Mainigi S. Use of the new contact force sensing ablation catheter dramatically reduces fluoroscopy time during atrial fibrillation ablation procedures. Indian Pacing Electrophysiol J 2016; 16:83-87. [PMID: 27788997 PMCID: PMC5067844 DOI: 10.1016/j.ipej.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/29/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the impact of contact force (CF) sensing on fluoroscopy, procedure, left atrial (LA) and ablation times and number of ablations during atrial fibrillation (AF) ablation. BACKGROUND Catheter ablation is an effective treatment for symptomatic AF. Recently a new ablation catheter providing real-time CF has been approved for use. METHODS A nested case-control study was performed comparing radiofrequency ablation of AF using the irrigated CF-sensing ThermoCool SmartTouch catheter versus open-irrigated ThermoCool SF catheter (Biosense Webster, Inc., Diamond Bar, California). Demographic and procedure data were obtained and student t-test was used to compare data between groups. RESULTS Thirty consecutive adult patients were included with 15 patients in each group. Mean fluoroscopy time was significantly lower in CF group (19.4 ± 8 vs 40.7 ± 8 min, p < 0.0001). LA time was significantly lower in CF group (151.7 ± 44 vs 185.7 ± 35 min, p = 0.01). There were no significant differences in procedure time between CF and SF groups (204 ± 37 vs 207 ± 36 min) and ablation time (121 ± 32 vs 122 ± 37 min). When patients who only underwent pulmonary vein isolation (PVI) were compared, fluoroscopy time was significantly lower in CF group (18 ± 9 vs 37.8 ± 5 min, p < 0.0001) as was LA time (141.4 ± 39 vs 171.8 ± 30 min, p = 0.04). Fluoroscopy time was also significantly lower in CF subgroup with additional ablation (20.9 ± 7 vs 44.9 ± 10 min, p < 0.001). CONCLUSION Use of CF-sensing catheter significantly reduced fluoroscopy and LA times during AF ablation with similar acute efficacy.
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Affiliation(s)
- Aditi Naniwadekar
- Division of Cardiovascular Medicine, Einstein Medical Center, Philadelphia, PA, USA.
| | - Kamal Joshi
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Allan Greenspan
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
| | - Sumeet Mainigi
- Division of Cardiac Electrophysiology, Einstein Medical Center, Philadelphia, PA, USA
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Quintanilla JG, Pérez-Villacastín J, Pérez-Castellano N, Pandit SV, Berenfeld O, Jalife J, Filgueiras-Rama D. Mechanistic Approaches to Detect, Target, and Ablate the Drivers of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:e002481. [PMID: 26729850 DOI: 10.1161/circep.115.002481] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jorge G Quintanilla
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
| | - Julián Pérez-Villacastín
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
| | - Nicasio Pérez-Castellano
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
| | - Sandeep V Pandit
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
| | - Omer Berenfeld
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
| | - José Jalife
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.).
| | - David Filgueiras-Rama
- From the Advanced Development in Arrhythmia Mechanisms and Therapy Laboratory, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (J.G.Q., J.J., D.F.R.); Arrhythmia Unit, Cardiovascular Institute, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain (J.G.Q., J.P.V., N.P.C, D.F.R.); and Center for Arrhythmia Research, Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor (S.V.P., O.B., J.J.)
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Hwang M, Song JS, Lee YS, Li C, Shim EB, Pak HN. Electrophysiological Rotor Ablation in In-Silico Modeling of Atrial Fibrillation: Comparisons with Dominant Frequency, Shannon Entropy, and Phase Singularity. PLoS One 2016; 11:e0149695. [PMID: 26909492 PMCID: PMC4766081 DOI: 10.1371/journal.pone.0149695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although rotors have been considered among the drivers of atrial fibrillation (AF), the rotor definition is inconsistent. We evaluated the nature of rotors in 2D and 3D in- silico models of persistent AF (PeAF) by analyzing phase singularity (PS), dominant frequency (DF), Shannon entropy (ShEn), and complex fractionated atrial electrogram cycle length (CFAE-CL) and their ablation. METHODS Mother rotor was spatiotemporally defined as stationary reentries with a meandering tip remaining within half the wavelength and lasting longer than 5 s. We generated 2D- and 3D-maps of the PS, DF, ShEn, and CFAE-CL during AF. The spatial correlations and ablation outcomes targeting each parameter were analyzed. RESULTS 1. In the 2D PeAF model, we observed a mother rotor that matched relatively well with DF (>9 Hz, 71.0%, p<0.001), ShEn (upper 2.5%, 33.2%, p<0.001), and CFAE-CL (lower 2.5%, 23.7%, p<0.001). 2. The 3D-PeAF model also showed mother rotors that had spatial correlations with DF (>5.5 Hz, 39.7%, p<0.001), ShEn (upper 8.5%, 15.1%, p <0.001), and CFAE (lower 8.5%, 8.0%, p = 0.002). 3. In both the 2D and 3D models, virtual ablation targeting the upper 5% of the DF terminated AF within 20 s, but not the ablations based on long-lasting PS, high ShEn area, or lower CFAE-CL area. CONCLUSION Mother rotors were observed in both 2D and 3D human AF models. Rotor locations were well represented by DF, and their virtual ablation altered wave dynamics and terminated AF.
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Affiliation(s)
- Minki Hwang
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Jun-Seop Song
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Young-Seon Lee
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Changyong Li
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea
- * E-mail: (HNP); (EBS)
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea
- * E-mail: (HNP); (EBS)
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Clauss S, Sinner MF, Kääb S, Wakili R. The Role of MicroRNAs in Antiarrhythmic Therapy for Atrial Fibrillation. Arrhythm Electrophysiol Rev 2015; 4:146-55. [PMID: 26835117 DOI: 10.15420/aer.2015.4.3.146] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/23/2015] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and has an enormous impact on our healthcare system as it is a major contributor of morbidity and mortality. Although there are several therapeutic options available, treatment of AF still remains challenging. AF pathophysiology is complex and still incompletely understood. In general, our understanding of AF is based on two mechanistic paradigms as functional hallmarks of AF: ectopic activity and reentry. Both ectopic activity and reentry are the result of remodelling processes. Functional and/or expressional changes in ion channels, connexins or calcium-handling proteins are important factors in electrical remodelling, whereas signalling processes leading to atrial dilatation and atrial fibrosis are key factors of structural remodelling. In recent years, new intriguing key players in AF pathophysiology have been identified: microRNAs (miRNAs). MiRNAs are short, non-coding RNA fragments that can regulate gene expression and have been demonstrated as important modifiers in signalling cascades leading to electrical and structural remodelling. In this article we review the miRNA-mediated molecular mechanisms underlying AF with special emphasis on the perspective of miRNAs as potential therapeutic targets for AF treatment.
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Affiliation(s)
- Sebastian Clauss
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, US; University Hospital Munich, Ludwig-Maximilians University Munich; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Germany
| | - Moritz F Sinner
- University Hospital Munich, Ludwig-Maximilians University Munich
| | - Stefan Kääb
- University Hospital Munich, Ludwig-Maximilians University Munich; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Germany
| | - Reza Wakili
- University Hospital Munich, Ludwig-Maximilians University Munich; DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Germany
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25
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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Schotten U, Hatem S, Ravens U, Jaïs P, Müller FU, Goette A, Rohr S, Antoons G, Pieske B, Scherr D, Oto A, Casadei B, Verheule S, Cartlidge D, Steinmeyer K, Götsche T, Dobrev D, Kockskämper J, Lendeckel U, Fabritz L, Kirchhof P, Camm AJ. The European Network for Translational Research in Atrial Fibrillation (EUTRAF): objectives and initial results. Europace 2015; 17:1457-66. [DOI: 10.1093/europace/euv252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/29/2015] [Indexed: 01/25/2023] Open
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DeSIMONE CV, Holmes DR, Ebrille E, Syed FF, Ladewig DJ, Mikell SB, Powers J, Suddendorf SH, Gilles EJ, Danielsen AJ, Hodge DO, Kapa S, Asirvatham SJ. Direct Pulmonary Vein Ablation With Stenosis Prevention Therapy. J Cardiovasc Electrophysiol 2015; 26:1000-1006. [PMID: 26075706 DOI: 10.1111/jce.12732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/29/2015] [Accepted: 05/04/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The dominant location of electrical triggers for initiating atrial fibrillation (AF) originates from the muscle sleeves inside pulmonary veins (PVs). Currently, radiofrequency ablation (RFA) is performed outside of the PVs to isolate, rather than directly ablate these tissues, due to the risk of intraluminal PV stenosis. METHODS In 4 chronic canine experiments, we performed direct PV muscle sleeve RFA ± postablation drug-coated balloon (DCB) treatment with paclitaxel/everolimus. Of the 4 PVs, 2 PVs were ablated and treated with DCB, 1 PV was ablated without DCB treatment (positive control), and 1 PV was left as a negative control. Local electrograms were assessed in PVs for near-field signals and were targeted for ablation. After 12-14 weeks survival, PVs were interrogated for absence of near-field PV potentials, and each PV was assessed for stenosis. RESULTS All canines survived the study period without cardiorespiratory complications, and remained ambulatory. In all canines, PVs that were ablated and treated with DCB remained without any significant intraluminal stenosis. In contrast, PVs that were ablated and not treated with DCB showed near or complete intraluminal stenosis. At terminal study, PV potentials remained undetectable. A blinded, histologic analysis demonstrated that ablated PVs without DCB treatment had extensive thrombus, fibrin, mineralization, and elastin disruption. CONCLUSION Our chronic canine data suggest that direct PV tissue ablation without subsequent stenosis is feasible with the use of postablation DCBs.
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Affiliation(s)
- Christopher V DeSIMONE
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elisa Ebrille
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Italy
| | - Faisal F Syed
- Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Susan B Mikell
- Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA
| | - Joanne Powers
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott H Suddendorf
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily J Gilles
- Mayo Clinic Ventures, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Suraj Kapa
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Singh-Moon RP, Marboe CC, Hendon CP. Near-infrared spectroscopy integrated catheter for characterization of myocardial tissues: preliminary demonstrations to radiofrequency ablation therapy for atrial fibrillation. BIOMEDICAL OPTICS EXPRESS 2015; 6:2494-2511. [PMID: 26203376 PMCID: PMC4505704 DOI: 10.1364/boe.6.002494] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 05/18/2023]
Abstract
Effects of radiofrequency ablation (RFA) treatment of atrial fibrillation can be limited by the ability to characterize the tissue in contact. Parameters obtained by conventional catheters, such as impedance and temperature can be insufficient in providing physiological information pertaining to effective treatment. In this report, we present a near-infrared spectroscopy (NIRS)-integrated catheter capable of extracting tissue optical properties. Validation experiments were first performed in tissue phantoms with known optical properties. We then apply the technique for characterization of myocardial tissues in swine and human hearts, ex vivo. Additionally, we demonstrate the recovery of critical parameters relevant to RFA therapy including contact verification, and lesion transmurality. These findings support the application of NIRS for improved guidance in RFA therapeutic interventions.
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Affiliation(s)
- Rajinder P. Singh-Moon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY 10027, USA
| | - Charles C. Marboe
- Department of Pathology, Columbia University Medical Center, 630 W 168th Street, New York, NY 10032, USA
| | - Christine P. Hendon
- Department of Electrical Engineering, Columbia University, 500 W 120th Street, New York, NY 10027, USA
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Mavroudis C, Stulak JM, Ad N, Siegel A, Giamberti A, Harris L, Backer CL, Tsao S, Dearani JA, Weerasena N, Deal BJ. Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations. Ann Thorac Surg 2014; 99:352-9. [PMID: 25442995 DOI: 10.1016/j.athoracsur.2014.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/03/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
Specific congenital heart anomalies significantly increase the risk for late atrial arrhythmias, raising the question whether prophylactic arrhythmia operations should be incorporated into reparative open heart procedures. Currently no consensus exists regarding standard prophylactic arrhythmia procedures. Questions remain concerning the arrhythmia-specific lesions to perform, energy sources to use, need for atrial appendectomy, and choosing a right, left, or biatrial Maze procedure. These considerations are important because prophylactic arrhythmia procedures are performed without knowing if the patient will actually experience an arrhythmia. This review identifies congenital defects with a risk for the development of atrial arrhythmias and proposes standardizing lesion sets for prophylactic arrhythmia operations.
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Affiliation(s)
- Constantine Mavroudis
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida.
| | - John M Stulak
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Niv Ad
- Inova Fairfax Hospital, Cardiac Surgery Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Allison Siegel
- Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida
| | - Alessandro Giamberti
- Pediatric and Adult Congenital Heart Surgery, IRCSS Policlinico San Donato, San Donato M.se (MI), Italy
| | - Louise Harris
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto Congenital Cardiac Centre for Adults, Toronto, Ontario, Canada
| | - Carl L Backer
- Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sabrina Tsao
- Division of Cardiology and the Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Joseph A Dearani
- Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nihal Weerasena
- Division of Cardiothoracic Surgery, The General Infirmary, Leeds, United Kingdom
| | - Barbara J Deal
- Division of Cardiology and the Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Fukushima K, Fukushima N, Ejima K, Kato K, Sato Y, Uematsu S, Arai K, Manaka T, Takagi A, Ashihara K, Shoda M, Hagiwara N. Left atrial appendage flow velocity and time from P-wave onset to tissue Doppler-derived A' predict atrial fibrillation recurrence after radiofrequency catheter ablation. Echocardiography 2014; 32:1101-8. [PMID: 25362992 DOI: 10.1111/echo.12823] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with atrial remodeling. We investigate the abilities of preprocedural echocardiographic parameters reflecting atrial remodeling to predict AF recurrence after radiofrequency catheter ablation (RFCA) for paroxysmal AF (PAF). METHODS Preprocedural echocardiographic parameters were measured during sinus rhythm in 105 patients with PAF undergoing RFCA. Electrical remodeling was assessed by the time from the onset of the P-wave to the peak A'-wave on the tissue Doppler imaging (PA-TDI), functional remodeling was assessed by the left atrial appendage flow velocity (LAAFV), and structural remodeling was assessed by the left atrial volume index (LAVI). PA-TDI, LAAFV, and LAVI values were divided into tertiles, and their abilities to predict AF recurrence were assessed using Cox regression analysis. RESULTS AF recurrence occurred in 39/105 (37.1%) patients. After adjustment for confounders, the rate of AF recurrence was significantly higher in the highest tertile of PA-TDI compared with the lowest tertile (≥151.3 msec vs. <131.0 msec; hazard ratio [HR]: 2.477, 95% confidence interval [CI]: 1.031-5.950; P = 0.042), and in the lowest tertile of LAAFV compared with the highest tertile (<48.5 cm/sec vs. ≥64.9 cm/sec; HR: 2.680, 95% CI: 1.136-6.318; P = 0.024). The risk of AF recurrence was also higher in the highest tertile of LAVI (≥34.2 mL/m(2) ) compared with the lowest tertile, but this difference was not significant (HR: 2.146, 95% CI: 0.834-5.523; P = 0.113). CONCLUSIONS LAAFV (reflecting functional remodeling) and PA-TDI (reflecting electrical remodeling) are independent predictors of AF recurrence after RFCA for PAF.
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Affiliation(s)
- Keiko Fukushima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoko Uematsu
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tetsuyuki Manaka
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Takagi
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 116:40-7. [PMID: 25261813 DOI: 10.1016/j.pbiomolbio.2014.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. METHODS We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. RESULTS 1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols. CONCLUSION Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.
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Naccarelli GV, Cappato R, Hohnloser SH, Marchlinski FE, Wilber DJ, Xiang J, Ma C, Hess S, Davies DW, Fields LE, Natale A. Rationale and design of VENTURE-AF: a randomized, open-label, active-controlled multicenter study to evaluate the safety of rivaroxaban and vitamin K antagonists in subjects undergoing catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 2014; 41:107-16. [PMID: 25005452 DOI: 10.1007/s10840-014-9924-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/20/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety of uninterrupted rivaroxaban, a novel oral anticoagulant that directly inhibits factor Xa, and a vitamin K antagonist (VKA) in eligible adult patients with nonvalvular AF (NVAF) who are scheduled for a catheter ablation. METHODS/DESIGN This is a prospective, randomized, open-label, active-controlled, global multicenter safety study of up to 250 randomized patients. Eligible patients with paroxysmal or persistent NVAF, a left ventricular ejection fraction >40 %, and a creatinine clearance >50 mL/min will be randomized 1:1 to rivaroxaban 20 mg orally once daily or to dose-adjusted oral VKA (recommended international normalized ratio (INR) 2.0-3.0) and stabilized on anticoagulation therapy for 1-7 days (if no intracardiac thrombus on transesophageal echocardiogram (TEE) immediately prerandomization/post-randomization or if 3 weeks of sufficient anticoagulation is documented) or for 4-5 weeks (if no TEE, no documented 3 weeks of sufficient anticoagulation, or by patient choice). During catheter ablation, heparin will be administered (ACT-targeted range = 300-400 s) after catheter ablation, and VKA will be managed per usual care. The next dose of rivaroxaban will be provided at least 6 h after establishment of hemostasis. The primary endpoint will be the incidence of post-procedure major bleeding events observed during the first 30 ± 5 days post-ablation. Secondary endpoints will include post-procedure thromboembolic events, additional bleeding, time-to-event, and medication adherence. RELEVANCE This study is intended to provide information about the safety characteristics of rivaroxaban in patients with NVAF undergoing catheter ablation.
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Affiliation(s)
- Gerald V Naccarelli
- Heart and Vascular Institute, Penn State University College of Medicine, P. O. Box 850, MC H047, 500 University Drive, Room H1511, Hershey, PA, 17033, USA,
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Woods CE, Olgin J. Atrial fibrillation therapy now and in the future: drugs, biologicals, and ablation. Circ Res 2014; 114:1532-46. [PMID: 24763469 PMCID: PMC4169264 DOI: 10.1161/circresaha.114.302362] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/03/2014] [Indexed: 01/26/2023]
Abstract
Atrial fibrillation (AF) is a complex disease with multiple inter-relating causes culminating in rapid, seemingly disorganized atrial activation. Therapy targeting AF is rapidly changing and improving. The purpose of this review is to summarize current state-of-the-art diagnostic and therapeutic modalities for treatment of AF. The review focuses on reviewing treatment as it relates to the pathophysiological basis of disease and reviews preclinical and clinical evidence for potential new diagnostic and therapeutic modalities, including imaging, biomarkers, pharmacological therapy, and ablative strategies for AF. Current ablation and drug therapy approaches to treating AF are largely based on treating the arrhythmia once the substrate occurs and is more effective in paroxysmal AF rather than persistent or permanent AF. However, there is much research aimed at prevention strategies, targeting AF substrate, so-called upstream therapy. Improved diagnostics, using imaging, genetics, and biomarkers, are needed to better identify subtypes of AF based on underlying substrate/mechanism to allow more directed therapeutic approaches. In addition, novel antiarrhythmics with more atrial specific effects may reduce limiting proarrhythmic side effects. Advances in ablation therapy are aimed at improving technology to reduce procedure time and in mechanism-targeted approaches.
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Affiliation(s)
- Christopher E Woods
- From the Division of Cardiology, University of California at San Francisco (C.E.W., J.O.); and Division of Cardiology Research, AUST Development, LLC, Mountain View, CA (C.E.W.)
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