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Saad EB, d’Avila A. Atrial Fibrillation (Part 2) - Catheter Ablation. Arq Bras Cardiol 2021; 116:334-343. [PMID: 33656085 PMCID: PMC7909976 DOI: 10.36660/abc.20200477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/05/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
More than 20 years since its initial use, catheter ablation has become a routinely performed procedure for the treatment of patients with atrial fibrillation (AF). Initially based on the electrical isolation of pulmonary veins in patients with paroxysmal AF, subsequent advances in the understanding of pathophysiology led to additional techniques not only to achieve better results, but also to treat patients with persistent forms of arrhythmia, as well as patients with structural heart disease and heart failure.
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Affiliation(s)
- Eduardo B. Saad
- Hospital Pró-CardíacoServiço de Arritmias e Estimulação Cardíaca ArtificialRio de JaneiroRJBrasilHospital Pró-Cardíaco - Serviço de Arritmias e Estimulação Cardíaca Artificial, Rio de Janeiro, RJ - Brasil
- Hospital SamaritanoRio de JaneiroRJBrasilHospital Samaritano, Rio de Janeiro, RJ - Brasil
| | - Andre d’Avila
- Hospital SOS CardioFlorianópolisSCBrasilHospital SOS Cardio, Florianópolis, SC - Brasil
- Beth Israel Deaconess HospitalHarvard Medical SchoolBostonEUABeth Israel Deaconess Hospital, Harvard Medical School, Boston - EUA
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2
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Wijesuriya N, Papageorgiou N, Maclean E, Saberwal B, Ahsan S. The Role of the Electrophysiologist in Convergent Ablation. Arrhythm Electrophysiol Rev 2020; 9:8-14. [PMID: 32637114 PMCID: PMC7330726 DOI: 10.15420/aer.2019.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.
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Affiliation(s)
| | | | - Edd Maclean
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Bunny Saberwal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Syed Ahsan
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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3
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Della Rocca DG, Mohanty S, Mohanty P, Trivedi C, Gianni C, Al‐Ahmad A, Burkhardt JD, Gallinghouse GJ, Hranitzky P, Sanchez JE, Horton RP, Di Biase L, Natale A. Long‐term outcomes of catheter ablation in patients with longstanding persistent atrial fibrillation lasting less than 2 years. J Cardiovasc Electrophysiol 2018; 29:1607-1615. [DOI: 10.1111/jce.13721] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Domenico G. Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Department of Cardiovascular MedicineUniversity of Tor VergataRome Italy
| | | | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Amin Al‐Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - J. David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | | | - Patrick Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Javier E. Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Rodney P. Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Arrhythmia Services, Department of MedicineMontefiore Medical Center, Albert Einstein College of MedicineBronx New York
- Department of Clinical and Experimental MedicineUniversity of FoggiaFoggia Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical CenterAustin Texas
- Interventional Electrophysiology, Scripps ClinicLa Jolla California
- Department of CardiologyMetroHealth Medical Center, Case Western Reserve University School of MedicineCleveland Ohio
- Division of Cardiology, Stanford UniversityStanford California
- Atrial Fibrillation and Arrhythmia Center, California Pacific Medical CenterSan Francisco California
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4
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Grossi S, Grassi F, Galleani L, Bianchi F, Conte MR. A comparison of contact force and remote magnetic navigation on lesion formation for the ablation of atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:450-458. [DOI: 10.1111/pace.13295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/01/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Francesco Grassi
- Department of Electronics and Telecommunications; Politecnico di Torino; Turin Italy
| | - Lorenzo Galleani
- Department of Electronics and Telecommunications; Politecnico di Torino; Turin Italy
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5
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AlTurki A, Proietti R. Remote magnetic navigation versus contact force technology: The two faces of the ablation lesion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:447-449. [PMID: 29405323 DOI: 10.1111/pace.13297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed AlTurki
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Riccardo Proietti
- Department of Cardiac, Thoracic, and Vascular Sciences, Padua, Italy
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6
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Kis Z, Muka T, Franco OH, Bramer WM, De Vries LJ, Kardos A, Szili-Torok T. The Short and Long-Term Efficacy of Pulmonary Vein Isolation as a Sole Treatment Strategy for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis. Curr Cardiol Rev 2017; 13:199-208. [PMID: 28124593 PMCID: PMC5633714 DOI: 10.2174/1573403x13666170117125124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Pulmonary vein isolation (PVI) is an accepted treatment strategy for catheter ablation (CA) of paroxysmal atrial fibrillation (PAF). In this study, we aimed to assess the short, mid- and long-term outcome of PVI as a sole treatment strategy for PAF. Methods: Six bibliographic electronic databases were searched to identify all published relevant stud-ies until December 14, 2015. Search of the scientific literature was performed for studies describing outcomes with mean follow-up > 24 months after PAF ablation. Only articles with 1, 3 or 5-year fol-low up were included, from the same group of investigators. Results: Of the 2398 references reviewed for eligibility, 13 articles (enrolling a total of 1774 patients) were included in the final analysis. Pooled analysis showed that the 12- and 62 -month success rate of a single CA procedure was 78% (95% CI 0.76% to 0.855) and 59% (95% CI 0.56% to 0.64%), re-spectively. The results did not differ by type of CA performed. Major complications mentioned in the enrolled studies were cerebrovascular event, pericardial tamponade and PV stenosis. Conclusion: There is a progressive and significant decline in freedom from AF between 1, 3 and 5-year after successful PVI in patients with PAF. Our analysis suggests that a high short-time success rate after PVI does not necessarily result in high chronic success rate.
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Affiliation(s)
- Zsuzsanna Kis
- Erasmus Medical Center, Department of Cardiology, Electrophysiology, Rotterdam, Netherlands
| | - Taulant Muka
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - Oscar H Franco
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
| | - Wichor M Bramer
- Erasmus Medical Center, Department of Biomedicine, Rotterdam, Netherlands
| | - Lennart J De Vries
- Erasmus Medical Center, Department of Cardiology, Electrophysiology, Rotterdam, Netherlands
| | - Attila Kardos
- Gottsegen György National Cardiology Institute, Department of Electrophysiology, Budapest, Hungary
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, Netherlands
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7
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Yoshimura A, Iriki Y, Ichiki H, Oketani N, Okui H, Maenosono R, Namino F, Miyata M, Ohishi M. Evaluation of safety and efficacy of periprocedural use of rivaroxaban and apixaban in catheter ablation for atrial fibrillation. J Cardiol 2017; 69:228-235. [DOI: 10.1016/j.jjcc.2016.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
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Monroy E, Azpiri J, De La Peña C, Cardona C, Hinojosa M, Zamarripa R, Assad J. Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging Post-robotic Radiosurgical Pulmonary Vein Isolation (RRPVI): First Case in the World. Cureus 2016; 8:e738. [PMID: 27660737 PMCID: PMC5025292 DOI: 10.7759/cureus.738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF).
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Santangeli P, Lin D. Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation? Methodist Debakey Cardiovasc J 2016; 11:71-5. [PMID: 26306122 DOI: 10.14797/mdcj-11-2-71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pulmonary vein isolation (PVI) is the cornerstone of current ablation techniques to eliminate atrial fibrillation (AF), with the greatest efficacy as a stand-alone procedure in patients with paroxysmal AF. Over the years, techniques for PVI have undergone a profound evolution, and current guidelines recommend PVI with confirmation of electrical isolation. Despite significant efforts, PV reconnection is still the rule in patients experiencing post-ablation arrhythmia recurrence. In recent years, use of general anesthesia with or without jet ventilation, open-irrigated ablation catheters, and steerable sheaths have been demonstrated to increase the safety and efficacy of PVI, reducing the rate of PV reconnection over follow-up. The widespread clinical availability of ablation catheters with real-time contact force information will likely further improve the effectiveness and safety of PVI. In a small but definite subset of patients, post-ablation recurrent arrhythmia is due to non-PV triggers, which should be eliminated in order to improve success. Typically, non-PV triggers cluster in specific regions such as the coronary sinus, the inferior mitral annulus, the interatrial septum, the left atrial appendage, the Eustachian ridge, the crista terminalis region, the superior vena cava, and the ligament of Marshall. Focal ablation targeting the origin of the trigger is recommended in most cases. Empirical non-PV ablation targeting the putative substrate responsible for AF maintenance with ablation lines and/or elimination of complex fractionated electrograms has not been shown to improve success compared to PVI alone. Similarly, the role of novel substrate-based ablation approaches targeting putative localized sources of AF (e.g., rotors) identified by computational mapping techniques is unclear, as they have never been compared to PVI and non-PV trigger ablation in an adequately designed randomized trial. This review highlights PVI techniques and outcomes in treating recurrent drug-refractory AF and discusses the potential role of additional non-PV ablation.
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Affiliation(s)
| | - David Lin
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Syed FF, Oral H. Electrophysiological Perspectives on Hybrid Ablation of Atrial Fibrillation. J Atr Fibrillation 2015; 8:1290. [PMID: 27957227 DOI: 10.4022/jafib.1290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022]
Abstract
To overcome limitations of minimally invasive surgical ablation as a standalone procedure in eliminating atrial fibrillation (AF), hybrid approaches incorporating adjunctive endovascular catheter ablation have been proposed in recent years. The endovascular component targets residual conduction gaps and identifies additional electrophysiological targets with the goal of minimizing recurrent atrial arrhythmia. We performed a systematic review of published studies of hybrid AF ablation, analyzing 432 pooled patients (19% paroxysmal, 29% persistent, 52% long-standing persistent) treated using three different approaches: A. bilateral thoracoscopy with bipolar radiofrequency (RF) clamp-based approach; B. right thoracoscopic suction monopolar RF catheter-based approach; and C. subxiphoid posterior pericardioscopic ("convergent") approach. Freedom from recurrence off antiarrhythmic medications at 12 months was seen in 88.1% [133/151] for A, 73.4% [47/64] for B, and 59.3% [80/135] for C, with no significant difference between paroxysmal (76.9%) and persistent/long-standing persistent AF (73.4%). Death and major surgical complications were reported in 8.5% with A, 0% with B and 8.6% with C. A critical appraisal of hybrid ablation is presented, drawing from experiences and insights published over the years on catheter ablation of AF, with a discussion of the rationale underlying hybrid ablation, its strengths and limitations, where it may have a unique role in clinical management of patients with AF, which questions remain unanswered and areas for further investigation.
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Affiliation(s)
- Faisal F Syed
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
| | - Hakan Oral
- Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI
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11
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Abstract
Catheter ablation of atrial fibrillation (AF) is performed increasingly worldwide and with the development of new technologies the procedures have become safer and more effective after a single attempt, particularly with paroxysmal AF. However, success rates for persistent AF ablation remain far lower than paroxysmal AF and there is large variation in the strategies used worldwide. This review describes the background to persistent AF ablation, the different strategies used and their associated risks and benefits, developing technologies and the authors' perspective on the future of this rapidly evolving area.
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Affiliation(s)
- Kim Rajappan
- Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
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12
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Namino F, Iriki Y, Maenosono R, Ichiki H, Okui H, Yoshimura A, Oketani N, Matsushita M, Ohishi M, Hashiguchi T. The optimal setting of complex fractionated atrial electrogram software in substrate ablation for atrial fibrillation. J Arrhythm 2014; 31:6-11. [PMID: 26336516 DOI: 10.1016/j.joa.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Complex fractionated atrial electrogram (CFAE)-targeted catheter ablation (CFAE ablation) requires a high rate of atrial fibrillation (AF) termination to provide good outcomes. We determined the optimal settings of CFAE software. METHODS In our 430 consecutive patients, AF was terminated in 97 (234/242) and 79% (149/188) of patients with paroxysmal and persistent AF, respectively, by CFAE ablation combined with (31%) or without (69%) pulmonary vein isolation, occasionally with nifekalant infusion. We analyzed 109 consecutive patients who underwent CFAE ablation to determine the optimal settings for comparing subjective versus objective decisions by the CFAE software on CARTO3. We compared three settings: the default setting (0.05-0.15 mV, 50-120 ms) and two modified settings (#1: 0.05-0.30 mV, 40-70 ms, #2: 0.05-0.13 mV, 10-20 ms). We retrospectively analyzed 11,425 points during left atrial mapping before ablation and 10,306 points that were subjectively detected and ablated as CFAE points. An interval confidence level ≥6 denoted a site with CFAE. RESULTS With the default setting, the accuracy, sensitivity, specificity, positive productive value, and negative productive values were 67, 42, 77, 48, and 73%, respectively. With modified setting #1, the values were 78, 55, 87, 74, and 77%, respectively, versus 64, 82, 60, 53, and 91%, respectively, for modified setting #2. CONCLUSION These data suggest that setting #1 was generally superior to the default setting, whereas setting #2 was optimal for excluding areas not requiring ablation. The optimal CFAE software setting was a voltage of 0.05-0.30 mV and an interval parameter of 40-70 ms.
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Affiliation(s)
- Fuminori Namino
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan ; Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasuhisa Iriki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Ryuichi Maenosono
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan
| | - Hitoshi Ichiki
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hideki Okui
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Akino Yoshimura
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Naoya Oketani
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Teruto Hashiguchi
- Clinical Laboratory Unit, Kagoshima University Hospital, Kagoshima, Japan ; Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Lim KT, Matsuo S, O'Neill MD, Knecht S, Arantes L, Derval N, Jaïs P, Hocini M, Clémenty J, Haïssaguerre M. Catheter ablation of persistent and permanent atrial fibrillation: Bordeaux experience. Expert Rev Cardiovasc Ther 2014; 5:655-62. [PMID: 17605644 DOI: 10.1586/14779072.5.4.655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The seminal observation that ectopics from the pulmonary veins may initiate paroxysmal atrial fibrillation (AF) heralded an era of potentially curative catheter ablation therapy for AF. In recent years, catheter ablation has been performed for not only paroxysmal but also persistent and permanent AF. It is anticipated that the number of procedures will continue to increase and the indication for catheter ablation will expand. This article details our experience with catheter ablation therapy for patients with persistent and chronic AF.
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Affiliation(s)
- Kang-Teng Lim
- Hôpital Cardiologique du Haut Lévêque, and Université Victor Segalen Bordeaux II, 33604 Bordeaux, Pessac, France.
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Abstract
Atrial fibrillation is the most common arrhythmia and is associated with important morbidity and mortality. Antiarrhythmic therapy is recommended as initial therapy but is associated with modest efficacy and significant side effects. Over the past several years, catheter ablation has been demonstrated to provide effective and safe curative therapy for atrial fibrillation. Future investigations will assess advances in catheter ablation technology and will help to define the precise role of catheter ablation relative to alternative therapies, such as rate-control and antiarrhythmic therapy.
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Affiliation(s)
- Emile G Daoud
- Richard M. Ross Heart Hospital, Division of Cardiology, Ohio State University Medical Center, Columbus, OH, USA.
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de Vries LJ, Akca F, Khan M, Dabiri-Abkenari L, Janse P, Theuns DAMJ, Peters E, de Ruiter G, Szili-Torok T. Clinical outcome of ablation for long-standing persistent atrial fibrillation with or without defragmentation. Neth Heart J 2014; 22:30-6. [PMID: 24155102 PMCID: PMC3890005 DOI: 10.1007/s12471-013-0483-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the outcome and associated risks of atrial defragmentation for the treatment of long-standing persistent atrial fibrillation (LSP-AF). METHODS Thirty-seven consecutive patients (60.4 ± 7.3 years; 28 male) suffering from LSP-AF who underwent pulmonary vein isolation (PVI) and linear ablation were compared. All patients were treated with the Stereotaxis magnetic navigation system (MNS). Two groups were distinguished: patients with (n = 20) and without (n = 17) defragmentation. The primary endpoint of the study was freedom of AF after 12 months. Secondary endpoints were AF termination, procedure time, fluoroscopy time and procedural complications. Complications were divided into two groups: major (infarction, stroke, major bleeding and tamponade) and minor (fever, pericarditis and inguinal haematoma). RESULTS No difference was seen in freedom of AF between the defragmentation and the non-defragmentation group (56.2 % vs. 40.0 %, P = 0.344). Procedure times in the defragmentation group were longer; no differences in fluoroscopy times were observed. No major complications occurred. A higher number of minor complications occurred in the defragmentation group (45.0 % vs. 5.9 %, P = 0.009). Mean hospital stay was comparable (4.7 ± 2.2 vs. 3.4 ± 0.8 days, P = 0.06). CONCLUSION Our study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy.
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Affiliation(s)
- L J de Vries
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, the Netherlands
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16
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Di Biase L, Paoletti Perini A, Mohanty P, Goldenberg AS, Grifoni G, Santangeli P, Santoro F, Sanchez JE, Horton R, Joseph Gallinghouse G, Conti S, Mohanty S, Bailey S, Trivedi C, Garg A, Grogan AP, Wallace DT, Padeletti L, Reddy V, Jais P, Haïssaguerre M, Natale A. Visual, tactile, and contact force feedback: which one is more important for catheter ablation? Results from an in vitro experimental study. Heart Rhythm 2013; 11:506-13. [PMID: 24252284 DOI: 10.1016/j.hrthm.2013.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND During radiofrequency ablation, effective contact is crucial in determining lesions efficacy. OBJECTIVE The purpose of this study was to compare operators' ability to assess contact pressure using visual and tactile feedbacks together or alone in an experimental model. METHODS In a in vitro experimental setup replicating manual catheter manipulation and recording the applied force, evaluators were asked to identify three levels of force (first, ablation, and maximum contact) as the catheter contacted the tissue model using (1) visual feedback only by fluoroscopy, "blinded" to touch; (2) tactile feedback only, blinded to fluoroscopy; and (3) both tactile and visual feedback together. The latter was regarded as reference. The experiment was repeated using a catheter force sensing technology during robotic navigation. RESULTS During manual navigation, tighter association was shown for the visual method than for the tactile method: median difference with reference: first contact -1 (P = .97) vs -2 (P = .90); ablation contact 2 (P = .1) vs -7 (P = .03); maximum contact 2 (P = .06) vs -28 (P = .02). Bland-Altman plot and Deming regression confirmed for the visual method the good agreement with reference and the absence of bias at any level and showed for the tactile higher values and proportional bias that reached statistical significance at ablation and maximum contact. During robotic navigation, agreement was higher for the tactile than for the visual only method. CONCLUSION During manual navigation, visual feedback alone is in better agreement with the reference compared to the tactile only approach. During robotic navigation, agreement is looser for the visual only approach. More objective feedback of contact pressure during ablation procedures is desirable.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York; Department of Biomedical Engineering, University of Texas, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | | | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | - Gino Grifoni
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Francesco Santoro
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Cardiology, University of Foggia, Foggia, Italy
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | - Sergio Conti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Shane Bailey
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | | | | | | | - Luigi Padeletti
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Vivek Reddy
- Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, New York
| | - Pierre Jais
- Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France
| | - Michelle Haïssaguerre
- Bordeaux University Hospital and LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, France
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas; Department of Biomedical Engineering, University of Texas, Austin, Texas; Division of Cardiology, Stanford University, California; Case Western Reserve University, Cleveland, Ohio; EP Services, California Pacific Medical Center, San Francisco, California; Interventional Electrophysiology, Scripps Clinic, San Diego, California.
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17
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Corradi D, Callegari S, Gelsomino S, Lorusso R, Macchi E. Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation. Int J Cardiol 2013; 168:1769-78. [DOI: 10.1016/j.ijcard.2013.06.141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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Wu SH, Jiang WF, Gu J, Zhao L, Wang YL, Liu YG, Zhou L, Gu JN, Xu K, Liu X. Benefits and risks of additional ablation of complex fractionated atrial electrograms for patients with atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol 2013; 169:35-43. [PMID: 24083885 DOI: 10.1016/j.ijcard.2013.08.083] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 07/27/2013] [Accepted: 08/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND The benefits and risks of additional complex fractionated atrial electrograms (CFAE) ablation in patients with atrial fibrillation (AF) remain unclear. METHODS Trials were identified in PubMed, Embase, Web of Science, and Cochrane Database, reviews, and reference lists of relevant papers. The primary end point was the recurrence of atrial arrhythmias after a single ablation. RESULTS We meta-analyzed 11 studies (total, n=983) using random-effects model to compare PVI (n=478) with PVI plus CFAE ablation (PVI+CFAE) (n=505). Additional CFAE ablation reduced recurrence of atrial tachyarrhythmia after a single procedure (pooled RR 0.73; 95% CI 0.61, 0.88; P=0.0007) at ≥ 3-month follow-up. There was no evidence of heterogeneity among studies (I(2)=33%). Subgroup analysis demonstrated that additional CFAE ablation reduced rates of recurrence in nonparoxysmal AF (RR 0.68; 95% CI 0.47, 0.99; P=0.05), whereas had no effect on patients with paroxysmal AF (RR 0.79; 95% CI 0.59, 1.06; P=0.12). Eight studies reported results of post-procedure ATs. The addition of CFAE ablation increased the rate of post-procedure ATs (RR 1.77; 95% CI 1.02, 3.07; P=0.04). Additional CFAE ablation significantly increased mean procedural times (245.4+75.7 vs. 189.5+62.3 min, P<0.001), mean fluoroscopy (72.1+25.6 vs. 59.5+19.3 min, P<0.001), and mean RF energy application times (75.3+38.6 vs. 53.2+27.5 min, P<0.001). CONCLUSIONS The adjunctive CFAE ablation could provide additional benefit in terms of reducing recurrence of atrial tachyarrhythmia for patients with nonparoxysmal AF but not for patients with paroxysmal AF after a single procedure with or without antiarrhythmic drugs (AADs). The main risk of adjunctive CFAE ablation is the increasing rate of untraceable postablation ATs.
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Affiliation(s)
- Shao-Hui Wu
- Department of Cardiology, Shanghai Chest Hospital affiliated to Shanghai Jiaotong University, China
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19
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Curnis A, Bisleri G, Bontempi L, Salghetti F, Cerini M, Lipari A, Pagnoni C, Vassanelli F, Muneretto C. Hybrid Therapy for Atrial Fibrillation: where the Knife meets the Catheter. J Atr Fibrillation 2013; 6:775. [PMID: 28496850 DOI: 10.4022/jafib.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/18/2013] [Accepted: 03/28/2013] [Indexed: 11/10/2022]
Abstract
During the past decades there has been a consistent evolution of both surgical and catheter-based techniques for the treatment of stand-alone atrial fibrillation, as alternatives or in combination with anti-arrhythmic drugs. Transcatheter ablation has significantly improved outcomes, despite often requiring multiple procedures and with limited success rates especially in presence of persistent atrial fibrillation. Surgical procedures have dramatically evolved from the original cut-and-sew Maze operation, allowing nowadays for closed-chest epicardial ablations on the beating heart. Recently, the concept of a close collaboration between the cardiac surgeon and the electrophysiologist has emerged as an intriguing option in order to overcome the drawbacks and suboptimal results of both techniques; therefore, the hybrid approach has been proposed as a potentially more successful strategy, allowing for a patient-tailored therapeutical approach. We reviewed the recent advancements either from the transcatheter and surgical standpoint, with a peculiar focus on the current option to merge both techniques along with an up-to-date review of the preliminary clinical experiences with the hybrid, surgical-transcatheter treatment of stand-alone atrial fibrillation.
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Affiliation(s)
- Antonio Curnis
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Luca Bontempi
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Francesca Salghetti
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Manuel Cerini
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Lipari
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Carlo Pagnoni
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Francesca Vassanelli
- Section of Electrophysiology, Division of Cardiology, Spedali Civili, University of Brescia Medical School, Brescia, Italy
| | - Claudio Muneretto
- Division of Cardiac Surgery, Spedali Civili, University of Brescia Medical School, Brescia, Italy
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20
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Chen WS, Gao BR, Chen WQ, Li ZZ, Xu ZY, Zhang YH, Yang K, Guan XQ. Comparison of pharmacological and electrical cardioversion in permanent atrial fibrillation after prosthetic cardiac valve replacement: A prospective randomized trial. J Int Med Res 2013; 41:1067-73. [PMID: 23794519 DOI: 10.1177/0300060513489800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the efficacy of electrical versus pharmacological cardioversion following prosthetic cardiac valve replacement in patients with permanent atrial fibrillation (AF). Methods Patients with permanent AF who had undergone prosthetic cardiac valve replacement, who had a cardiothoracic ratio ≤0.5 and a left atrial diameter ≤50 mm for ≥6 months after surgery were randomly divided to receive either electrical or pharmacological cardioversion. Patients in the electrical cardioversion group were given direct-current synchronized electrical defibrillation under general anaesthesia. Patients in the pharmacological cardioversion group were given oral combination therapy with amiodarone, captopril and simvastatin for 3 months. Results A total of 115 patients received either electrical cardioversion ( n = 59) or pharmacological cardioversion ( n = 56); reversion to sinus rhythm occurred in 98.3% and 26.8%, respectively. Recurrence rates were similar in the two groups (3.4% and 6.7% for electrical and pharmacological cardioversion, respectively). No deaths or severe complications were reported. Conclusion Electrical cardioversion has a favourable safety profile and appears to be a more effective method than pharmacological cardioversion for the treatment of permanent AF after cardiac valve replacement, once the heart has returned close to its normal size.
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Affiliation(s)
- Wen Sheng Chen
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Bing Ren Gao
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Wen Qin Chen
- Department of Radiology, First People's Hospital of Baiyin, Baiyin, China
| | - Zhen Zhen Li
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Zhi Yi Xu
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Yan Hua Zhang
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Kun Yang
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
| | - Xin Qiang Guan
- Department of Cardiac Surgery, Second Hospital of Lanzhou University, Lanzhou, China
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21
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Raviele A, Natale A, Calkins H, Camm JA, Cappato R, Ann Chen S, Connolly SJ, Damiano R, DE Ponti R, Edgerton JR, Haïssaguerre M, Hindricks G, Ho SY, Jalife J, Kirchhof P, Kottkamp H, Kuck KH, Marchlinski FE, Packer DL, Pappone C, Prystowsky E, Reddy VK, Themistoclakis S, Verma A, Wilber DJ, Willems S. Venice Chart international consensus document on atrial fibrillation ablation: 2011 update. J Cardiovasc Electrophysiol 2013; 23:890-923. [PMID: 22953789 DOI: 10.1111/j.1540-8167.2012.02381.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Antonio Raviele
- Cardiovascular Department, Arrhythmia Center and Center for Atrial Fibrillation, Dell'Angelo Hospital, Venice-Mestre, Italy.
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22
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Padanilam BJ, Prystowsky EN. Ablation as First-Line Therapy for Atrial Fibrillation: Not Yet for All. Card Electrophysiol Clin 2012; 4:299-304. [PMID: 26939949 DOI: 10.1016/j.ccep.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Studies have established the superiority of atrial fibrillation ablation in controlling the rhythm compared with medical therapy. The procedure, however, has significant associated risks. Whether ablation therapy would improve the major outcomes of survival and stroke is not yet established. Until this information becomes available, ablation should continue to be used as a second-line option for most patient subgroups when one or more antiarrhythmic medications are ineffective.
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Affiliation(s)
- Benzy J Padanilam
- St Vincent Medical Group, 8333 Naab Road, #400, Indianapolis, IN 46260, USA
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23
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Maenosono R, Oketani N, Ishida S, Iriki Y, Ichiki H, Okui H, Ninomiya Y, Hamasaki S, Namino F, Matsushita M, Tei C, Hashiguchi T. Effectiveness of esophagus detection by three-dimensional electroanatomical mapping to avoid esophageal injury during ablation of atrial fibrillation. J Cardiol 2012; 60:119-25. [DOI: 10.1016/j.jjcc.2012.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 02/27/2012] [Accepted: 02/29/2012] [Indexed: 11/30/2022]
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24
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Wang XH, Huang CX, Liu X, Shi HF, Tan HW, Jiang WF, Wang YL. Ablation of atrial tachycardia occurring after catheter ablation of atrial fibrillation in patients with corrected rheumatic valve disease. J Interv Card Electrophysiol 2012; 35:45-56. [PMID: 22576271 DOI: 10.1007/s10840-012-9678-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/27/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the mechanism and the effectiveness of ablation of atrial tachycardia (AT) recurring after atrial fibrillation (AF) ablation in patients with rheumatic valvular disease (RVD) and mitral valve prosthesis. METHODS Twenty-eight consecutive patients with RVD and mitral valve prosthesis and a 1:2 matched control group (n = 56) without RVD underwent reablation for recurrent AT after catheter ablation of long-standing persistent AF. RESULTS Macro- or localized reentrant ATs were identified in 47 (87 %) of 54 ATs from RVD group and in 65 (78.3 %) of 83 ATs from control. There were more average ATs per patient in the RVD group than in the control (1.9 ± 0.6 vs.1.5 ± 0.6, P = 0.002). The proportion of patients having ≥2 ATs was significantly higher in the RVD group than in the control (78.6 vs.41.1 %, P = 0.001). In the RVD group, ATs were successfully ablated in 44 (81.5 %) of 54 ATs and terminated in 18 (64.3 %) of 28 patients. In the control, ATs were successfully ablated in 72 (86.7 %) of 83 ATs and terminated in 45 (80.4 %) of 56 patients, P = 0.54 and 0.10, respectively. After a mean follow-up of 13 months, 16 patients (57.1 %) from the RVD group and 45 patients (80.4 %) from the control were free of further recurrence, P = 0.02. CONCLUSIONS Macro- or localized reentries were the predominant type of recurrent AT after long-standing persistent AF ablation in both the RVD and the control groups. Compared with patients without RVD, patients with RVD had more average number of ATs and had higher probability of further recurrence despite the similar acute effectiveness of reablation.
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Affiliation(s)
- Xin-Hua Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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25
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Ichiki H, Oketani N, Ishida S, Iriki Y, Okui H, Maenosono R, Ninomiya Y, Matsushita T, Miyata M, Hamasaki S, Tei C. Incidence of Asymptomatic Cerebral Microthromboembolism After Atrial Fibrillation Ablation Guided by Complex Fractionated Atrial Electrogram. J Cardiovasc Electrophysiol 2012; 23:567-73. [PMID: 22313240 DOI: 10.1111/j.1540-8167.2011.02259.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hitoshi Ichiki
- Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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26
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Santangeli P, Di Biase L, Burkhardt DJ, Horton R, Sanchez J, Bai R, Pump A, Perez M, Wang PJ, Natale A, Al-Ahmad A. Catheter ablation of atrial fibrillation. J Cardiovasc Med (Hagerstown) 2012; 13:108-24. [DOI: 10.2459/jcm.0b013e32834f2371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Relationship between clinical outcomes and unintentional pulmonary vein isolation during substrate ablation of atrial fibrillation guided solely by complex fractionated atrial electrogram mapping. J Cardiol 2011; 58:278-86. [DOI: 10.1016/j.jjcc.2011.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 06/22/2011] [Accepted: 07/04/2011] [Indexed: 11/18/2022]
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Castrejón-Castrejón S, Ortega M, Pérez-Silva A, Doiny D, Estrada A, Filgueiras D, López-Sendón JL, Merino JL. Organized atrial tachycardias after atrial fibrillation ablation. Cardiol Res Pract 2011; 2011:957538. [PMID: 21941669 PMCID: PMC3175708 DOI: 10.4061/2011/957538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 04/17/2011] [Accepted: 05/17/2011] [Indexed: 11/20/2022] Open
Abstract
The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required.
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Affiliation(s)
- Sergio Castrejón-Castrejón
- Robotic Cardiac Electrophysiology Unit, Department of Cardiology, University Hospital La Paz, Paseo de la castellana, No 261, 28046 Madrid, Spain
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29
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Kurotobi T, Shimada Y, Kino N, Inoue K, Kimura R, Okuyama Y, Nanto S. Inducible atrial tachycardias with multiple circuits in a stepwise approach are associated with increased episodes of atrial tachycardias after catheter ablation. J Electrocardiol 2011; 45:102-8. [PMID: 21872263 DOI: 10.1016/j.jelectrocard.2011.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial tachycardia (AT) is commonly observed during catheter ablation (CA) in patients with atrial fibrillation (AF) undergoing a stepwise extensive CA. In this study, we examined the hypothesis that the presence of multiple inducible ATs (multiple-ATs), which allow for latent multiple reentrant circuits, might increase the potential for following AT episodes after CA. METHODS AND RESULTS The study population consisted of 347 consecutive AF patients undergoing CA with a stepwise approach. A total of 366 ATs (tricuspid isthmus dependent, 101; mitral annulus, 62; septal, 26; roof dependent, 22; left atrial anterior wall, 13; upper loop, 8; surrounding the left pulmonary veins, 6; surrounding the right pulmonary veins, 6; left atrial appendage, 4; and Cs ostium, 3) occurring during the CA were found in 216 (62.2%) of 347 patients. Multiple-ATs (≥2) during the CA were observed in 93 (26.8%) of 347 patients. The incidence of AT episodes significantly increased as the number of inducible ATs increased (no AT, 7.8%; single AT, 13.7%; and multiple-ATs, 24.2%; P < .001), and multiple-ATs were an independent risk factor for AT episodes (3.07 [1.39-6.78]; P = .005). The impact of the multiple-ATs on the AT episodes was pronounced especially in the patients with coinducible residual AF (with coresidual AF vs without coresidual AF, 8.1% vs 47.7%; P < .001). CONCLUSIONS The presence of an atrial substrate allowing for multiple-ATs was associated with increased AT episodes during follow-up.
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Affiliation(s)
- Toshiya Kurotobi
- Caridiovascular Division, Shiroyama Hospital, Habikino City, Osaka, Japan.
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30
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Pulmonary vein isolation of symptomatic refractory paroxysmal and persistent atrial fibrillation: A single centre and single operator experience in the Netherlands. Neth Heart J 2011; 17:366-72. [PMID: 19949645 DOI: 10.1007/bf03086286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Aim. To investigate long-term outcome and to determine predictors of successful pulmonary vein isolation (PVI) in patients with symptomatic paroxysmal or persistent atrial fibrillation (AF) who are refractory or intolerant to antiarrhythmic drugs.Background. The treatment of AF has traditionally been pharmacological aimed at rate or rhythm control. However, rhythm control remains difficult to establish. PVI is reported to be effective in selected patient groups.Methods. Ninety-nine consecutive patients with a mean age of 54+/-10 years who had paroxysmal or persistent AF were treated in the University Medical Center Groningen. All patients underwent PVI by the same electrophysiologist. Successful PVI was defined as absence of AF on Holter or electrocardiogram (ECG), and no symptoms of AF.Results. After six months of follow-up, 60 (61%) patients were free of AF episodes, both on 96-hour Holter monitoring and on ECGs, and had no symptoms related to AF. Thirty-nine of these 60 patients (65%) were no longer treated with any class I or III antiarrhythmic drugs. Independent determinants of successful PVI were paroxysmal AF (OR 18 [3.5-93], p=0.001), and left pulmonary vein ablation time >55 minutes (OR 15 [2.7-81], p=0.002). Left atrial (parasternal view 42+/-6 vs. 40+/-5 mm, p<0.05 and apical view 61+/-9 vs. 58+/-8 mm, p<0.05) and right atrial (59+/-7 vs. 56+/-5 mm, p<0.05) sizes decreased significantly in the successfully treated patients after six months of follow-up.Conclusion. Independent determinants of a successful outcome after PVI are paroxysmal AF and a longer left atrial ablation time. (Neth Heart J 2009;17:366-72.).
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31
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ELAYI CLAUDES, DI BIASE LUIGI, BAI RONG, BURKHARDT JDAVID, MOHANTY PRASANT, SANCHEZ JAVIER, SANTANGELI PASQUALE, HONGO RICHARD, GALLINGHOUSE GJOSEPH, HORTON RODNEY, BAILEY SHANE, ZAGRODZKY JASON, BEHEIRY SALWA, NATALE ANDREA. Identifying the Relationship Between the Non-PV Triggers and the Critical CFAE Sites Post-PVAI to Curtail the Extent of Atrial Ablation in Longstanding Persistent AF. J Cardiovasc Electrophysiol 2011; 22:1199-205. [DOI: 10.1111/j.1540-8167.2011.02122.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Kurotobi T, Iwakura K, Inoue K, Kimura R, Tosyoshima Y, Ito N, Mizuno H, Shimada Y, Kinoh N, Fujii K, Nanto S, Komuro I. Electrophysiological features of atrial tachyarrhythmias after the creation of a left atrial roof line during catheter ablation of atrial fibrillation. Int Heart J 2011; 52:92-7. [PMID: 21483167 DOI: 10.1536/ihj.52.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left atrial roof line (LARL) can prevent the perpetuation of atrial fibrillation (AF) by delineation of the arrhythmogenic substrate, but it may be associated with an increased incidence of atrial tachycardia (AT). This study was performed to evaluate the characteristics and clinical implications of inducible AT after LARL.A total of 139 consecutive patients with AF who underwent catheter ablation were prospectively enrolled in this study. LARL was required to prevent the perpetuation of AF in 98 of 139 patients (71%). LARL significantly reduced the incidence of inducible AF (before versus after: 100% versus 44%, respectively, P < 0.01), whereas it significantly increased the incidence of AT (18% versus 63%, P < 0.01). ATs were observed after LARL in 62 of 98 patients (63%), and these circuits were determined in 99 of 112 stable ATs (88%), including tricuspid isthmus-dependent (n = 35), mitral annulus (n = 22), septal (n = 15), surrounding right pulmonary veins (PVs) (n = 12), coronary sinus (CS) ostium (n = 4), upper loop (n = 4), surrounding left PVs (n = 4), and LA anterior wall (n = 3). Catheter ablation (CA) successfully terminated 111 of 122 stable ATs (91%) during CA. The occurrence of AT after CA was significantly higher in patients with than in those without residual AT (26% versus 2%, P < 0.05).Induced AT with a stable circuit after LARL creation could be mapped, and delineation of the induced AT may lead to a favorable outcome.
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Affiliation(s)
- Toshiya Kurotobi
- Cardiovascular Division, Shiroyama Hospital, Osaka University Graduate School of Medicine, Osaka, Japan
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33
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Santangeli P, Di Biase L, Pelargonio G, Dello Russo A, Casella M, Sanchez J, Horton R, Gallinghouse GJ, Natale A. Catheter ablation of atrial fibrillation: randomized controlled trials and registries, a look back and the view forward. J Interv Card Electrophysiol 2011; 31:69-80. [DOI: 10.1007/s10840-011-9562-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Accepted: 02/27/2011] [Indexed: 10/18/2022]
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Daccarett M, McGann CJ, Akoum NW, MacLeod RS, Marrouche NF. MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2011; 9:105-11. [PMID: 21166532 DOI: 10.1586/erc.10.177] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation is a significant public health burden, with clinically, epidemiologically and economically significant repercussions. In the last decade, catheter ablation has provided an improvement in morbidity and quality of life, significantly reducing long-term healthcare costs and avoiding recurrences compared with drug therapy. Despite recent progress in techniques, current catheter ablation success rates fall short of expectations. Late gadolinium-enhancement cardiovascular MRI is a well-established tool to image the myocardium and, most specifically, the left atrium. Unique imaging protocols allow for left atrial structural remodeling and fibrosis assessment, which has been demonstrated to correlate with clinical outcomes after catheter ablation, assessment of the individual's risks of thromboembolic events, and effective imaging of patients with left atrial appendage thrombus. Late gadolinium-enhancement MRI aids in the individualized treatment of atrial fibrillation, stratifying recurrence risk and guiding specific ablation strategies. Real-time MRI offers significant safety and effectiveness profiles that would optimize the invasive treatment of atrial fibrillation.
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Affiliation(s)
- Marcos Daccarett
- Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
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Komatsu Y, Uno K, Otomo K, Nagata Y, Taniguchi H, Ogura K, Egami Y, Takayama K, Kakita K, Iesaka Y. Atrial defibrillation threshold as a novel predictor of clinical outcome of catheter ablation for persistent atrial fibrillation. Europace 2010; 13:213-20. [DOI: 10.1093/europace/euq357] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khan A, Mittal S, Kamath GS, Garikipati NV, Marrero D, Steinberg JS. Pulmonary vein isolation alone in patients with persistent atrial fibrillation: an ablation strategy facilitated by antiarrhythmic drug induced reverse remodeling. J Cardiovasc Electrophysiol 2010; 22:142-8. [PMID: 20812936 DOI: 10.1111/j.1540-8167.2010.01886.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) alone has been thought to be insufficient in patients with persistent atrial fibrillation (PersAF). We hypothesized that preablation treatment of PersAF with a potent antiarrhythmic drug (AAD) would facilitate reverse atrial remodeling and result in high procedural efficacy after PVI alone. METHODS AND RESULTS Seventy-one consecutive patients (59.4 ± 9.8 years) with PersAF and prior AAD failure were treated with oral dofetilide (768 ± 291 mcg/day) for a median of 85 days pre-PVI. P-wave duration (Pdur) on ECG was used to assess reverse atrial remodeling. Thirty-five patients with paroxysmal (P) AF not treated with an AAD served as controls. All patients underwent PVI alone; dofetilide was discontinued 1-3 mos postablation. In the PersAF patients, the Pdur decreased from 136.3 ± 21.7 ms (assessed postcardioversion on dofetilide) to 118.6 ± 20.4 ms (assessed immediately prior to PVI) (P < 0.001). In contrast, no change in Pdur (122.6 ± 11.5 ms vs. 121.3 ± 13.7 ms, P = NS) was observed in PAF patients. The 6 and 12 mos AAD-free response to ablation was 76% and 70%, respectively, in PersAF patients, similar to the 80% and 75%, response in PAF patients (P = NS). A decline in Pdur in response to dofetilide was the only predictor of long-term clinical response to PVI in patients with PersAF. CONCLUSIONS Pre-treatment with AAD resulted in a decrease in Pdur suggesting reverse atrial electrical remodeling in PersAF patients. This may explain the excellent clinical outcomes using PVI alone, and may suggest an alternative ablation strategy for PersAF.
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Affiliation(s)
- Aslam Khan
- Division of Cardiology, Al-Sabah Arrhythmia Institute, St. Luke's and Roosevelt Hospitals, Columbia University College of Physicians & Surgeons, New York, NY, USA
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Brooks AG, Stiles MK, Laborderie J, Lau DH, Kuklik P, Shipp NJ, Hsu LF, Sanders P. Outcomes of long-standing persistent atrial fibrillation ablation: A systematic review. Heart Rhythm 2010; 7:835-46. [PMID: 20206320 DOI: 10.1016/j.hrthm.2010.01.017] [Citation(s) in RCA: 357] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
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Senga M, Fujii E, Sugiura S, Yamazato S, Sugiura E, Nakamura M, Miyahara M, Ito M. Efficacy of linear block at the left atrial roof in atrial fibrillation. J Cardiol 2010; 55:322-7. [DOI: 10.1016/j.jjcc.2009.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 12/10/2009] [Accepted: 12/15/2009] [Indexed: 11/16/2022]
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Mansour M, Forleo GB, Pappalardo A, Barrett C, Heist EK, Avella A, Bencardino G, Dello Russo A, Casella M, Ruskin JN, Tondo C. Combined use of cryoballoon and focal open-irrigation radiofrequency ablation for treatment of persistent atrial fibrillation: Results from a pilot study. Heart Rhythm 2010; 7:452-8. [PMID: 20188229 DOI: 10.1016/j.hrthm.2009.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 12/11/2009] [Indexed: 10/20/2022]
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Di Biase L, Wang Y, Horton R, Gallinghouse GJ, Mohanty P, Sanchez J, Patel D, Dare M, Canby R, Price LD, Zagrodzky JD, Bailey S, Burkhardt JD, Natale A. Ablation of atrial fibrillation utilizing robotic catheter navigation in comparison to manual navigation and ablation: single-center experience. J Cardiovasc Electrophysiol 2010; 20:1328-35. [PMID: 19656244 DOI: 10.1111/j.1540-8167.2009.01570.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic catheter navigation and ablation either with magnetic catheter driving or with electromechanical guidance have emerged in the recent years for the treatment of atrial fibrillation. OBJECTIVE The aim of this study was to compare our center's experience of atrial fibrillation ablation using the Hansen Robotic Medical System with our current manual ablation technique in terms of acute and chronic success, as well as procedure time and radiation exposure to both the patient and the operator. METHODS A total of 390 consecutive patients with symptomatic and drug-resistant atrial fibrillation (289 males, 62 +/- 11 years) were prospectively enrolled in the study. All patients underwent the procedure either with conventional manual ablation (group 1, n = 197) or with the robotic navigation system (RNS) (group 2, n = 193). RESULTS The success rate for RNS was 85% (164 patients), while for manual ablation it was 81% (159 patients) (p = 0.264) at 14.1 +/- 1.3 months with AADs previously ineffective. Fluoroscopy time was significantly lower for RNS (48.9 +/- 24.6 minutes for RNS vs. 58.4 +/- 20.1 minutes for manual ablation, P < 0.001). Mean fluoroscopy time was statistically reduced after 50 procedures (61.8 +/- 23.2 minutes for first 50 cases vs. 44.5 +/- 23.6 minutes for subsequent procedures, P < 0.0001). CONCLUSION Robotic navigation and ablation of atrial fibrillation is safe and effective. Fluoroscopy time decreases with experience.
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Affiliation(s)
- Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA
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le Polain de Waroux JB, Talajic M, Khairy P, Guerra PG, Roy D, Thibault B, Dubuc M, Macle L. Pulmonary vein isolation for the treatment of atrial fibrillation: past, present and future. Future Cardiol 2010; 6:51-66. [DOI: 10.2217/fca.09.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with impaired quality of life and an increased risk of stroke and mortality. Antiarrhythmic drugs, currently the first-line therapy for patients without permanent atrial fibrillation, fail to prevent recurrences in over 50% and are associated with significant adverse effects. In the majority of cases, atrial fibrillation arises from the repetitive firing of myocytes in muscle sleeves that extend from the left atrium into the pulmonary veins. Pulmonary vein isolation has emerged as an effective treatment in selected patients. In this paper, the past and present roles of pulmonary vein isolation are described and the future developments of this technique are explored.
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Affiliation(s)
| | - Mario Talajic
- Montreal Heart Institute, Université de Montréal, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Canada
| | - Peter G Guerra
- Montreal Heart Institute, Université de Montréal, Canada
| | - Denis Roy
- Montreal Heart Institute, Université de Montréal, Canada
| | | | - Marc Dubuc
- Montreal Heart Institute, Université de Montréal, Canada
| | - Laurent Macle
- Division of Electrophysiology, Montreal Heart Institute, Université de Montréal, 5000 Bélanger, Montreal H1T 1C8, Quebec, Canada
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Ghanbari H, Schmidt M, Machado C, Segerson NM, Daccarett M. Ablation strategies for atrial fibrillation. Expert Rev Cardiovasc Ther 2009; 7:1091-101. [PMID: 19764862 DOI: 10.1586/erc.09.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation remains the most common arrhythmia in the USA and is associated with an increased risk for stroke, congestive heart failure and overall mortality. There has been a tremendous advance in the field of catheter ablation of atrial fibrillation that has resulted in better outcomes for patients. The approach for ablation of atrial fibrillation can be different depending on patients' presentation of paroxysmal or persistent atrial fibrillation. Pulmonary vein isolation remains the cornerstone of any ablation strategy for atrial fibrillation; however, further ablation, end points of the procedure, clinical end points for successful ablation and appropriate follow-up remain controversial. We aim to discuss these different approaches and the major controversies in catheter ablation of atrial fibrillation.
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Affiliation(s)
- Hamid Ghanbari
- Division of Cardiac Electrophysiology, Providence Hospital and Medical Center/Wayne State University, Southfield, MI, USA
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Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol 2009; 3:32-8. [PMID: 19995881 DOI: 10.1161/circep.109.859116] [Citation(s) in RCA: 1405] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study was to provide an updated worldwide report on the methods, efficacy, and safety of catheter ablation of atrial fibrillation (AF). METHODS AND RESULTS A questionnaire with 46 questions was sent to 521 centers from 24 countries in 4 continents. Complete interviews were collected from 182 centers, of which 85 reported to have performed 20,825 catheter ablation procedures on 16,309 patients with AF between 2003 and 2006. The median number of procedures per center was 245 (range, 2 to 2715). All centers included paroxysmal AF, 85.9% also included persistent and 47.1% also included long-lasting AF. Carto-guided left atrial circumferential ablation (48.2% of patients) and Lasso-guided ostial electric disconnection (27.4%) were the most commonly used techniques. Efficacy data were analyzed with centers representing the unit of analysis. Of 16,309 patients with full disclosure of outcome data, 10 488 (median, 70.0%; interquartile range, 57.7% to 75.4%) became asymptomatic without antiarrhythmic drugs and another 2047 (10.0%; 0.5% to 17.1%) became asymptomatic in the presence of previously ineffective antiarrhythmic drugs over 18 (range, 3 to 24) months of follow-up. Success rates free of antiarrhythmic drugs and overall success rates were significantly larger in 9590 patients with paroxysmal AF (74.9% and 83.2%) than in 2800 patients with persistent AF (64.8% and 75.0%) and 1108 patients with long-lasting AF (63.1% and 72.3%) (P<0.0001). Major complications were reported in 741 patients (4.5%). CONCLUSIONS When analyzed in a large number of electrophysiology laboratories worldwide, catheter ablation of AF shows to be effective in approximately 80% of patients after 1.3 procedures per patient, with approximately 70% of them not requiring further antiarrhythmic drugs during intermediate follow-up.
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Affiliation(s)
- Riccardo Cappato
- Arrhythmias and Electrophysiology Center, IRCCS, Policlinico San Donato, Milan, Italy.
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Knecht S, Castro-Rodriguez J, Wright M, Tran-Ngoc E, Morissens M, Tatnga V, Catez E, Peperstraete B, Zaoui N, Op de Beek V, Vivian GF, Mandag NN, Decoodt P, Verbeet T. Catheter ablation for the treatment of persistent atrial fibrillation. Interv Cardiol 2009. [DOI: 10.2217/ica.09.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Badger TJ, Adjei-Poku YA, Marrouche NF. MRI in cardiac electrophysiology: the emerging role of delayed-enhancement MRI in atrial fibrillation ablation. Future Cardiol 2009; 5:63-70. [PMID: 19371204 DOI: 10.2217/14796678.5.1.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Catheter ablation of atrial fibrillation has emerged as a viable therapeutic option for those patients who have failed conventional medical therapy. This treatment strategy has been introduced in the past decade following the discovery of ectopic foci in the pulmonary veins capable of initiating this arrhythmia. The basis of current ablation techniques relies on inducing myocardial necrosis at distinct anatomical landmarks in order to electrically isolate these ectopic foci and to disrupt pulmonary vein and left atrial conduction pathways. The recent introduction of a delayed-enhancement cardiac MRI sequence now allows for the noninvasive assessment of the location and extent of left atrial scarring following the ablation procedure. In this review, we describe this novel scan sequence and its current and potential role in catheter ablation of atrial fibrillation.
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Affiliation(s)
- Troy J Badger
- Atrial Fibrillation Program, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT 84132-2400, USA.
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DE FILIPPO PAOLO, HE DINGSHENG, BRAMBILLA ROBERTA, GAVAZZI ANTONELLO, CANTÙ FRANCESCO. Clinical Experience with a Single Catheter for Mapping and Ablation of Pulmonary Vein Ostium. J Cardiovasc Electrophysiol 2009; 20:367-73. [DOI: 10.1111/j.1540-8167.2008.01340.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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O'Neill MD, Wright M, Knecht S, Jaïs P, Hocini M, Takahashi Y, Jönsson A, Sacher F, Matsuo S, Lim KT, Arantes L, Derval N, Lellouche N, Nault I, Bordachar P, Clémenty J, Haïssaguerre M. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. Eur Heart J 2009; 30:1105-12. [PMID: 19270341 DOI: 10.1093/eurheartj/ehp063] [Citation(s) in RCA: 245] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mark D O'Neill
- Service de Rythmologie, Hôpital Cardiologique du Haut Lévêque, Avenue de Magellan, 33604 Bordeaux, Pessac, France
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Callahan TD, Di Biase L, Horton R, Sanchez J, Gallinghouse JG, Natale A. Catheter Ablation of Atrial Fibrillation. Cardiol Clin 2009; 27:163-78, x. [DOI: 10.1016/j.ccl.2008.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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