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Rosman L, Burg MM, Lampert R. Catheter Ablation and Cognitive Impairment in Atrial Fibrillation: Another Hit or a Silver Bullet? Circ Arrhythm Electrophysiol 2019; 12:e007521. [PMID: 31442073 DOI: 10.1161/circep.119.007521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lindsey Rosman
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT.,Department of Anesthesiology (M.M.B.), Yale School of Medicine, New Haven, CT
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Department of Internal Medicine (L.R., M.M.B., R.L.), Yale School of Medicine, New Haven, CT
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Rozen G, Ptaszek LM, Zilberman I, Douglas V, Heist EK, Beeckler C, Altmann A, Ruskin JN, Govari A, Mansour M. Safety and efficacy of delivering high-power short-duration radiofrequency ablation lesions utilizing a novel temperature sensing technology. Europace 2018; 20:f444-f450. [DOI: 10.1093/europace/euy031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guy Rozen
- Cardiovascular Institute, Padeh Medical Center, Bar Ilan University Medical School, Poriya, Israel
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Victoria Douglas
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - E Kevin Heist
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Moussa Mansour
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kulkarni N, Su W, Wu R. How to Prevent, Detect and Manage Complications Caused by Cryoballoon Ablation of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2018; 7:18-23. [PMID: 29636968 DOI: 10.15420/aer.2017.32.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is increasing every year. Patients who fail to maintain sinus rhythm with use of anti-arrhythmic drug therapy are referred for catheter ablation. Cryoballoon (CB) ablation has emerged as an effective and alternative treatment option to traditional point-by-point radiofrequency ablation, but there can be complications. This article reviews the incidence, presentation, risk factors, management and preventative strategies of three major complications associated with CB ablation: phrenic nerve injury, atrial oesophageal fistula and bronchial injury. Although these complications are rare, electrophysiologists should institute measures to identify high-risk patients, implement best-practice techniques to minimise risks and maintain a high index of suspicion to recognise the complications quickly and implement correct treatment strategies.
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Affiliation(s)
- Nitin Kulkarni
- University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Wilber Su
- Banner University Medical Center, University of ArizonaPhoenix, AZ, USA
| | - Richard Wu
- University of Texas Southwestern Medical CenterDallas, TX, USA
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Lai E, Chung EH. Management of Arrhythmias in Athletes: Atrial Fibrillation, Premature Ventricular Contractions, and Ventricular Tachycardia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:86. [PMID: 28990149 DOI: 10.1007/s11936-017-0583-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OPINION STATEMENT Management of atrial fibrillation, premature ventricular contractions, and ventricular tachycardia without underlying cardiac disease or arrhythmogenic conditions differs in athletes from the general population. Athletes tend to be younger, healthier individuals with few comorbidities. Therapies that work well in the general population may not be appropriate or preferable for athletes. Management strategies include deconditioning, pharmacologic therapy, such as rate control with β-blockers or non-dihydropyridine calcium channel blockers and rhythm control with class I or class III antiarrhythmic drugs, and catheter ablation. Deconditioning is not preferred by athletes because of lost playing time. Pharmacologic therapy is well tolerated among most individuals, but is not as favorable in athletes. Rate control medications can reduce performance and β-blockers, in particular, are prohibited in many sports. Antiarrhythmic drugs are preferred over rate control with athletes, but many, especially younger athletes, may not like the idea of long-term medical therapy. Catheter ablation has been proven to be safe and efficacious, may eliminate the need for long-term medical therapy, and is supported by the major societies (AHA, ACC, ESC).
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Affiliation(s)
- Ernest Lai
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eugene H Chung
- Sports Cardiology Clinic, Frankel Cardiovascular Center, University of Michigan Medical School, Michigan Medicine, 1500 E Medical Center Dr SPC 5856, Ann Arbor, MI, 48109-5856, USA.
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Abstract
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations, dyspnoea and dizziness. The condition can also be associated with serious complications, including an increased risk of stroke. Important recent developments in the clinical epidemiology and management of AF have informed our approach to this arrhythmia. This Primer provides a comprehensive overview of AF, including its epidemiology, mechanisms and pathophysiology, diagnosis, screening, prevention and management. Management strategies, including stroke prevention, rate control and rhythm control, are considered. We also address quality of life issues and provide an outlook on future developments and ongoing clinical trials in managing this common arrhythmia.
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Yousuf T, Keshmiri H, Bulwa Z, Kramer J, Sharjeel Arshad HM, Issa R, Woznicka D, Gordon P, Abi-Mansour P. Management of Atrio-Esophageal Fistula Following Left Atrial Ablation. Cardiol Res 2016; 7:36-45. [PMID: 28197267 PMCID: PMC5295533 DOI: 10.14740/cr454e] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/12/2022] Open
Abstract
Currently, no guidelines have been established for the treatment of atrio-esophageal fistula (AEF) secondary to left atrial ablation therapy. After comprehensive literature review, we aim to make suggestions on the management of this complex complication and also present a case series. We performed a review of the existing literature on AEF in the setting of atrial ablation. Using keywords atrial fibrillation, atrial ablation, fistula formation, atrio-esophageal fistula, complications, interventions, and prognosis, a search was made using the medical databases PUBMED and MEDLINE for reports in English from 2000 to April 2015. A statistical analysis was performed to compare the three different intervention arms: medical management, stent placement and surgical intervention. The results of our systematic review confirm the high mortality rate associated with AEF following left atrial ablation and the necessity to diagnose atrio-esophageal injury in a timely manner. The mortality rates of this complication are 96% with medical management alone, 100% with stent placement, and 33 % with surgical intervention. Atrio-esophageal injury and subsequent AEF is an infrequent but potentially fatal complication of atrial ablation. Early, prompt, and definitive surgical intervention is the treatment of choice.
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Affiliation(s)
- Tariq Yousuf
- Department of Internal Medicine, Advocate Christ Medical Center, 105 Covington Ct, Oak Brook, IL 60523, USA
| | - Hesam Keshmiri
- Department of Internal Medicine, Advocate Christ Medical Center, 105 Covington Ct, Oak Brook, IL 60523, USA
| | - Zachary Bulwa
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jason Kramer
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Rasha Issa
- Department of Internal Medicine, Advocate Christ Medical Center, 105 Covington Ct, Oak Brook, IL 60523, USA
| | - Daniel Woznicka
- Department of Internal Medicine, Advocate Christ Medical Center, 105 Covington Ct, Oak Brook, IL 60523, USA
| | - Paul Gordon
- Department of Cardiovascular Surgery, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Pierre Abi-Mansour
- Department of Cardiology, Advocate Christ Medical Center, Oak Lawn, IL, USA
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Scanavacca M, Pisani CF. Monitoring risk for oesophageal thermal injury during radiofrequency catheter ablation for atrial fibrillation: does the characteristic of the temperature probe matter? Europace 2015; 17:835-837. [DOI: 10.1093/europace/euv101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Chopra N, Shadchehr A. Achalasia cardia as a unique complication of pulmonary vein isolation. Heart Rhythm 2014; 11:2297-9. [DOI: 10.1016/j.hrthm.2014.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Indexed: 02/07/2023]
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Complications from Catheter Ablation of Atrial Fibrillation: Impact of Current and Emerging Ablation Technologies. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 16:344. [DOI: 10.1007/s11936-014-0344-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Jourda F, Providencia R, Marijon E, Bouzeman A, Hireche H, Khoueiry Z, Cardin C, Combes N, Combes S, Boveda S, Albenque JP. Contact-force guided radiofrequency vs. second-generation balloon cryotherapy for pulmonary vein isolation in patients with paroxysmal atrial fibrillation-a prospective evaluation. Europace 2014; 17:225-31. [PMID: 25186456 DOI: 10.1093/europace/euu215] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS In the setting of paroxysmal atrial fibrillation (AF), there are no available data comparing the mid-term outcome of patients undergoing pulmonary vein isolation (PVI) catheter ablation using contact-force (CF)-guided radiofrequency (RF) vs. second-generation balloon cryotherapy. METHODS AND RESULTS Prospective single-centre evaluation, carried out from March 2011 to February 2013, comparing CF radiofrequency (Thermocool(®) SmartTouch™, Biosense Webster, Inc.) (CF group) with cryoballoon ablation (Arctic Front Advance™ 28 mm cryoballoon, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 150 consecutive patients were enrolled (75 in each group). The characteristics of patients of both the groups were similar (61.2 ± 9.9 years, women 25.3%, mean AF duration 4.1 ± 4.0 years, mean CHA2DS2-VASc score 1.4 ± 1.3, mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CF group (110.7 ± 32.5 vs. 134.5 ± 48.3 min, P = 0.001), with a lower duration of fluoroscopy (21.5 ± 8.5 vs. 25.3 ± 9.9 min, P = 0.017) and X-ray exposure (4748 ± 2411 cGy cm² vs. 7734 ± 5361 cGy cm², P = 0.001). In contrast, no significant difference was found regarding significant procedural complication (2.7 vs. 1.3% in CF and CB groups, respectively; P = 0.56), and PVI was eventually achieved in all cases. At 12 months, AF recurrence occurred in 11 patients (14.7%) in the CB group and in 9 patients (12.0%) in the CF group (HR = 1.20 95% CI 0.50-2.90; log rank P = 0.682). CONCLUSIONS Our preliminary findings suggest that CF-guided radiofrequency and cryotherapy present very similar performances in the setting of paroxysmal AF catheter ablation.
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Affiliation(s)
- François Jourda
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Rui Providencia
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Eloi Marijon
- Paris Cardiovascular Research Centre and Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Abdeslam Bouzeman
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Hassiba Hireche
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Ziad Khoueiry
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Christelle Cardin
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Stéphane Combes
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
| | - Jean-Paul Albenque
- Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
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Providencia R, Marijon E, Albenque JP, Combes S, Combes N, Jourda F, Hireche H, Morais J, Boveda S. Rivaroxaban and dabigatran in patients undergoing catheter ablation of atrial fibrillation. Europace 2014; 16:1137-1144. [DOI: 10.1093/europace/euu007] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Providência R, Albenque JP, Combes S, Bouzeman A, Casteigt B, Combes N, Narayanan K, Marijon E, Boveda S. Safety and efficacy of dabigatran versus warfarin in patients undergoing catheter ablation of atrial fibrillation: a systematic review and meta-analysis. Heart 2014; 100:324-35. [PMID: 23878175 PMCID: PMC3913219 DOI: 10.1136/heartjnl-2013-304386] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dabigatran etexilate, a new thrombin inhibitor, has been shown to be comparable to warfarin in patients with atrial fibrillation (AF). However, there is a limited body of evidence on the efficacy and safety of using dabigatran among patients undergoing AF catheter ablation. OBJECTIVE A random effects meta-analysis was performed of controlled trials comparing dabigatran and warfarin in paroxysmal/persistent AF patients undergoing catheter ablation. METHODS Data sources included Medline, Embase, and Cochrane (from inception to April 2013). Three independent reviewers selected studies comparing warfarin to dabigatran. Descriptive and quantitative information was extracted from each selected study, regarding periprocedural all cause mortality, thromboembolic events and major bleeding, as well as modalities of periprocedural anticoagulation bridging. RESULTS After a detailed screening of 228 search results, 14 studies were identified enrolling a total of 4782 patients (1823 treated with dabigatran and 2959 with warfarin). No deaths were reported. No significant differences were found between patients treated with dabigatran and warfarin as regards thromboembolic events (0.55% dabigatran vs 0.17% warfarin; risk ratios (RR)=1.78, 95% CI 0.66 to 4.80; p=0.26) and major bleeding (1.48% dabigatran vs 1.35% warfarin; RR=1.07, 95% CI 0.51 to 2.26; p=0.86). No difference was found between the 110 mg twice daily and 150 mg twice daily dabigatran dosages concerning major bleeding (0% vs 1.62%, respectively; RR=0.19, 95% CI 0.01 to 3.18; p=0.25) and thromboembolism (0% vs 0.40%, respectively; RR=0.72, 95% CI 0.04 to 12.98; p=0.82). CONCLUSIONS In the specific setting of AF catheter ablation, this first pooled analysis suggests that patients treated with dabigatran have a similar incidence of thromboembolic events and major bleeding compared to warfarin, with low event rates overall.
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Affiliation(s)
- Rui Providência
- Département de Rythmologie, Clinique Pasteur, Toulouse, France
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Stephane Combes
- Département de Rythmologie, Clinique Pasteur, Toulouse, France
| | | | | | - Nicolas Combes
- Département de Rythmologie, Clinique Pasteur, Toulouse, France
| | - Kumar Narayanan
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Eloi Marijon
- Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
- Paris Cardiovascular Research Center, Paris, France
| | - Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulouse, France
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Weber H, Sagerer-Gerhardt M. Open-irrigated laser catheter ablation: relationship between the level of energy, myocardial thickness, and collateral damages in a dog model. Europace 2013; 16:142-8. [PMID: 23736805 DOI: 10.1093/europace/eut150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To evaluate laser lesion formation in the beating hearts of dogs by using an open-irrigated electrode-laser mapping and ablation heart catheter. METHODS AND RESULTS A total of 50 laser applications at 15 W (n = 31) and 20 W (n = 19) for 10-50 s, with an irrigation flow of 35 mL/min were aimed at the right (n = 15) and left (n = 9) atrial, right (n = 15) and left (n = 11) ventricular walls in five dogs (6-16/dog), by using an open-irrigated laser ablation catheter. The 1064 nm diode laser was provided with a light control system, a Flowmeter, and a transoesophageal laser sensor. Lesions were measured and were evaluated morphometrically. Transmural lesions were achieved in seconds regardless of the level of energy applied. Laser applications at 15 W > 10 s aimed at the atrial walls produced collateral lesions to the lung or to the oesophagus. Laser applications at 20 W > 30 s aimed at the ventricular walls may result in steam pop with intramural cavitations and arrhythmias. Collateral damages to the oesophagus occurred only when the transoesophageal light sensor was deactivated. CONCLUSION To avoid unwanted effects during laser catheter ablation by using an open-irrigated laser catheter energy delivery must be adapted to the thickness of the myocardial wall. Light control system and a transoesophageal light sensor may help reduce the risks of myocardial and collateral damages.
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Affiliation(s)
- Helmut Weber
- CCEP Center, Section Research and Development, Taufkirchen, Schlesierst. 4, D-82024 Taufkirchen, Germany
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Haines DE, Mead-Salley M, Salazar M, Marchlinski FE, Zado E, Calkins H, Yarmohammadi H, Nademanee K, Amnueypol M, Skanes AC, Saklani P. Dabigatran versus warfarin anticoagulation before and after catheter ablation for the treatment of atrial fibrillation. J Interv Card Electrophysiol 2013; 37:233-9. [PMID: 23740224 DOI: 10.1007/s10840-013-9800-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Systemic thromboembolism and bleeding remain the two most common and serious complications of catheter ablation of atrial fibrillation. A variety of periprocedure anticoagulation strategies have been proposed to mitigate these risks. Although operators are now routinely administering dabigatran for anticoagulation in this setting, its relative safety and effectiveness compared to warfarin are unknown. METHODS AND RESULTS A total of 202 patients received dabigatran as part of their periprocedural anticoagulation regimen at the time of initial or redo catheter ablation for symptomatic atrial fibrillation. A comparison group of 202 patients treated with warfarin was randomly selected from patients undergoing atrial fibrillation (AF) ablation during the same time period. AF types were paroxysmal in 223 patients, persistent in 158 patients, and longstanding persistent in 13 patients. Mean age was 60.0 ± 10.5 years, 55 % had a history of hypertension, and mean CHADS-VASc score was 1.7 ± 1.3. "Continuous" warfarin or dabigatran was administered in 80 and 32 % of patients, respectively. Time to first dose of dabigatran post-procedure was 12.2 ± 10.3 h. Two dabigatran and no warfarin-treated patients had systemic thromboembolism (p = NS); five dabigatran and three warfarin-treated patients had bleeding complications (p = NS, combined endpoint p = 0.116). One dabigatran patient had severe pericardial bleeding (3 L blood loss). CONCLUSIONS In a retrospective pilot trial comparing the risks of systemic thromboembolism or bleeding complications in patients treated with warfarin or dabigatran anticoagulation, the outcomes were similar. A prospective trial is warranted.
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Affiliation(s)
- David E Haines
- Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, MI 48073, USA.
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Weber HP, Sagerer-Gerhardt M. Open-irrigated laser catheter ablation produces flow-dependent sizes of lesions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1132-7. [PMID: 23663238 DOI: 10.1111/pace.12152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/28/2013] [Accepted: 03/03/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Growth and sizes of lesions produced during catheter ablation is difficult to control. Laser lesion formation was evaluated during various flow rates and energy settings by using an open-irrigated laser catheter on a thigh-muscle dog model. METHODS Laser radiation at 15 W or 20 W was applied in blood for 10 seconds, 20 seconds, 30 seconds, 40 seconds, and 50 seconds during an irrigation flow of 16 mL/min or 35 mL/min, in direct contact, and in a noncontact mode of laser application. Lesions were evaluated morphometrically. RESULTS There was a linear increase of lesions with the increase of the level of energy applied. Maximal depth of lesions achieved during a flow rate of 16 mL/min at 15 W/50 seconds increased significantly from 9.9 ± 0.3 mm to 12.1 ± 0.5 mm, and at 20 W/50 seconds from 11.1 ± 0.55 mm to 12.4 ± 0.26 mm, when irrigation flow was 35 mL/min (P < 0.5). However, difference of lesion increase between 15 W and 20 W was not significant (P = 0.30). Lesions were achieved also in a noncontact mode of radiation at a distance of 1-2 mm, but not at 5 mm away. Radiation at 20 W > 40 seconds and a flow rate of 35 mL/min may cause steam pop with intramural cavitation. CONCLUSIONS By using an open-irrigated laser catheter augmentation of catheter flow increases lesion sizes. Lesions can be achieved also in a noncontact mode of radiation. In order to avoid unwanted effects the level of energy applied must be limited.
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