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Dzhinsov KR. Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation. Folia Med (Plovdiv) 2023; 65:713-719. [PMID: 38351752 DOI: 10.3897/folmed.65.e103031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/16/2023] [Indexed: 02/16/2024] Open
Abstract
The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure.
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Clinical Significance of Adenosine-Induced Atrial Fibrillation after Complete Pulmonary Vein Isolation. J Clin Med 2022; 11:jcm11195679. [PMID: 36233544 PMCID: PMC9570534 DOI: 10.3390/jcm11195679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Adenosine can cause dormant electrical conduction between the pulmonary vein and left atrium after pulmonary vein isolation (PVI). Adenosine can also induce atrial fibrillation (AF) during catheter ablation. However, the clinical outcomes and effects of additional ablation for the trigger sites of adenosine-induced AF (AIAF) are unknown. This study therefore aimed to evaluate the clinical significance of AIAF. Methods: Between January 2010 and September 2019, we analyzed 616 consecutive patients with paroxysmal AF (PAF) who underwent radiofrequency catheter ablation (RFCA), including wide-area circumferential pulmonary vein isolation (PVI) and post-PVI adenosine testing. Results: Among 616 patients, 134 (21.7%) and 34 (5.5%) showed dormant conduction and AIAF, respectively. Eight patients (1.3%) had both dormant conduction and AIAF. The AF recurrence rate was not significantly different between patients with and without AIAF (16.7% vs. 18.6%, log-rank p = 0.827) during a mean follow-up period of 17.9 ± 18 months. Additional RFCA for the trigger site was attempted in 10 patients with AIAF; however, the recurrence rate of atrial arrhythmias was also not different between the groups with and without additional ablation (20% vs. 16.7%, log-rank p = 0.704). Conclusions: AIAF after PVI was not clinically associated with recurrence during long-term follow-up. Ablation of the trigger site in AIAF did not improve the clinical outcomes.
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Vassallo F, Serpa E, Walker BR, Meigre LL, Carloni H, Simões Jr A, Cunha C, Pezzin F, Loureiro K, Amaral D, Lovatto CA, Batista Jr. WD, Serpa R. Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i2.3440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Long-term freedom from atrial fibrillation (AF) after catheter ablation and, consequently, the potential for stroke reduction remain unpredictable. Recently, left atrial appendage closure (LAAC) became an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. Objective: This study aims to evaluate the feasibility and safety of combined treatment for AF with catheter ablation (CA) with the high-power short duration technique associated with LAAC in one single procedure. Methods: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective observational study. Between April 2018 and October 2020, 13 patients with AF were included, eight (61,54%) males, eight (61.54%) with persistent AF (PersAF), mean age 68.54 (65–84) years old, mean time from AF diagnosis to treatment 13.08 (3–33) months, mean CHA2VASC2 5.08 (3–7), all patients with coronary or vascular disease, 12 (92.31%) with hypertension, five (38.46%) with left ventricular dysfunction, four (30.77%) prior strokes using OAC and four (30.77%) patients with diabetes. Indications for LAAC included history of contraindication to OAC because of severe bleeding in eight (61.54%), previous stroke in four (30.77%) and two (13.08%) patients with LAA thrombus, despite the use of two different OAC (one associated with bleeding). One patient had a pseudoaneurysm in femoral artery, and two patients died of non-procedure complications after 30 days. At six months, angiotomography showed successful complete sealing of the LAA in seven (77.72%) of nine patients evaluated, and the two patients without it had a leak of less than 2 mm. After mean follow-up of 14 months (five to 33), 10 (90.91%) of the 11 patients were in sinus rhythm. Three (27.27%) patients, one in blanking period, recovered sinus rhythm after amiodarone. No cardioembolic or bleeding events occurred. Conclusion: In this small observational study, we showed the feasibility and safety of the combined therapy with AF catheter ablation with LAAC with a high rate of sinus rhythm and no cardioembolic event.
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Andelova K, Egan Benova T, Szeiffova Bacova B, Sykora M, Prado NJ, Diez ER, Hlivak P, Tribulova N. Cardiac Connexin-43 Hemichannels and Pannexin1 Channels: Provocative Antiarrhythmic Targets. Int J Mol Sci 2020; 22:ijms22010260. [PMID: 33383853 PMCID: PMC7795512 DOI: 10.3390/ijms22010260] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiac connexin-43 (Cx43) creates gap junction channels (GJCs) at intercellular contacts and hemi-channels (HCs) at the peri-junctional plasma membrane and sarcolemmal caveolae/rafts compartments. GJCs are fundamental for the direct cardiac cell-to-cell transmission of electrical and molecular signals which ensures synchronous myocardial contraction. The HCs and structurally similar pannexin1 (Panx1) channels are active in stressful conditions. These channels are essential for paracrine and autocrine communication through the release of ions and signaling molecules to the extracellular environment, or for uptake from it. The HCs and Panx1 channel-opening profoundly affects intracellular ionic homeostasis and redox status and facilitates via purinergic signaling pro-inflammatory and pro-fibrotic processes. These conditions promote cardiac arrhythmogenesis due to the impairment of the GJCs and selective ion channel function. Crosstalk between GJCs and HCs/Panx1 channels could be crucial in the development of arrhythmogenic substrates, including fibrosis. Despite the knowledge gap in the regulation of these channels, current evidence indicates that HCs and Panx1 channel activation can enhance the risk of cardiac arrhythmias. It is extremely challenging to target HCs and Panx1 channels by inhibitory agents to hamper development of cardiac rhythm disorders. Progress in this field may contribute to novel therapeutic approaches for patients prone to develop atrial or ventricular fibrillation.
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Affiliation(s)
- Katarina Andelova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia; (K.A.); (T.E.B.); (B.S.B.); (M.S.)
| | - Tamara Egan Benova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia; (K.A.); (T.E.B.); (B.S.B.); (M.S.)
| | - Barbara Szeiffova Bacova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia; (K.A.); (T.E.B.); (B.S.B.); (M.S.)
| | - Matus Sykora
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia; (K.A.); (T.E.B.); (B.S.B.); (M.S.)
| | - Natalia Jorgelina Prado
- Instituto de Medicina y Biología Experimental de Cuyo, Consejo Nacional de Investigaciones Científicas y Técnicas, M5500 Mendoza, Argentina; (N.J.P.); (E.R.D.)
| | - Emiliano Raul Diez
- Instituto de Medicina y Biología Experimental de Cuyo, Consejo Nacional de Investigaciones Científicas y Técnicas, M5500 Mendoza, Argentina; (N.J.P.); (E.R.D.)
| | - Peter Hlivak
- Department of Arrhythmias and Pacing, National Institute of Cardiovascular Diseases, Pod Krásnou Hôrkou 1, 83348 Bratislava, Slovakia;
| | - Narcis Tribulova
- Centre of Experimental Medicine, Slovak Academy of Sciences, Institute for Heart Research, 84104 Bratislava, Slovakia; (K.A.); (T.E.B.); (B.S.B.); (M.S.)
- Correspondence: ; Tel.: +421-2-32295-423
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Vassallo F, Meigre LL, Serpa E, Lovatto C, Cunha C, Carloni H, Simoes Jr. ASJ, Meira K, Pezzin F, Lacerda Jr. O, Batista Jr. W, Nogueira Jr. A, Amaral D. The First-Pass Isolation Effect in High-Power Short-Duration Compared to Low-Power Long-Duration Atrial Fibrillation Ablation: a Predictor of Success. JOURNAL OF CARDIAC ARRHYTHMIAS 2020. [DOI: 10.24207/jca.v33i3.3406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Different results are described after atrial fibrillation ablation and multiples predictors of recurrence are well established. Objective: Evaluate and analyze if first-pass isolation effect (FPI) during first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) can impact on late outcome. Methods: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD: 71 patients, 50 (70.42%) males, mean age 59.73 years, 52 (73.24%) hypertension, 44 (61.97%) obstructive apnea, 23 (32.39%) arterial disease, 20 (28.17%) diabetes, and 10(14.08%) stroke. CHADS2VASC2 2.57. CT: 73 patients, 50 (68.49%) males, mean age 60.7 years, 53 (72.60%) hypertension, 41 (56.16%) obstructive apnea, 28 (38.36%) arterial disease, 14 (19.17%) diabetes and 8 (10.96%) stroke. CHAD2SVASC2 2.22. Results: Recurrence occurred in 33 patients (22.92%) at 12 months follow-up, HPSD with 9 patients and LPLD with 24 patients. Higher rate of bilateral FPI were observed in HPSD patients with 62 of 71 patients comparing to 17 of 73 patients in LPLD (P < 0.00001). At the end of study 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD (P 0.0039). Conclusion: HPSD ablation produced higher rates of FPI comparing to LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months. At patients submitted to HPSD protocol ablation, FPI could predict higher rate of sinus rhythm at 12 months follow-up.
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Affiliation(s)
| | | | - Eduardo Serpa
- Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil
| | | | | | | | | | - Karla Meira
- Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil
| | - Flávia Pezzin
- Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil
| | | | | | | | - Dalton Amaral
- Hospital Santa Rita de Cassia – Vitória (ES), Brazil
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Vassallo F, Meigre LL, Serpa E, Cunha C, Simoes A, Carloni H, Amaral D, Meira K, Pezzin F. Changes and impacts in early recurrences after atrial fibrillation ablation in contact force era: comparison of high-power short-duration with conventional technique—FIRST experience data. J Interv Card Electrophysiol 2020; 62:363-371. [DOI: 10.1007/s10840-020-00911-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/31/2020] [Indexed: 11/27/2022]
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Kobayashi S, Fukaya H, Oikawa J, Saito D, Sato T, Matsuura G, Arakawa Y, Shirakawa Y, Nishinarita R, Horiguchi A, Ishizue N, Kishihara J, Niwano S, Ako J. Optimal interlesion distance in ablation index-guided pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 2020; 62:123-131. [PMID: 32975734 DOI: 10.1007/s10840-020-00881-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Ablation index (AI) is a useful tool of the CARTO® system to make effective lesions during pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the optimal distance between neighboring ablation points (interlesion distance (ILD)) is still unclear. Here, we evaluated the optimal ILDs in the AI-guided PVI. METHODS Forty-nine AF patients who underwent AI-guided PVI in our institute from July 2018 to March 2019 were retrospectively enrolled in this study. Target AI was set at 500 and 400 for anterior and posterior walls, respectively, and we compared the ILDs with and without electrical gaps after a first encircling PVI. RESULTS In both PV, the ILDs with electrical gaps were longer than those without electrical gaps. The best cutoff values of ILD to detect the electrical gaps using the ROC curve were 5.4 mm for the RPV anterior wall (AUC, 0.67; sensitivity, 0.42; specificity, 0.84, P < 0.01) and 4.4 mm for the RPV posterior wall (AUC, 0.68; sensitivity, 0.91; specificity, 0.39, P < 0.01). Similarly, the best cutoff values of ILD were 5.5 mm for the LPV anterior wall (AUC, 0.74; sensitivity, 0.65; specificity, 0.82, P < 0.01) and 5.1 mm for the LPV posterior wall (AUC, 0.67; sensitivity, 0.79; specificity, 0.53, P =0.03). CONCLUSION The optimal interlesion distances for PVI were different in each PV segment. To achieve the first-pass isolation, less than 5.4/4.4 mm for the RPV anterior/posterior and 5.5/5.1 mm for the LPV anterior/posterior walls of interlesion distances were the best cutoff values in the patients with AF.
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Affiliation(s)
- Shuhei Kobayashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan.
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Tetsuro Sato
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Arakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Yuki Shirakawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ryo Nishinarita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Ai Horiguchi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan
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Ücer E, Jungbauer C, Hauck C, Kaufmann M, Poschenrieder F, Maier L, Fredersdorf S. The low acute effectiveness of a high-power short duration radiofrequency current application technique in pulmonary vein isolation for atrial fibrillation. Cardiol J 2020; 28:663-670. [PMID: 32207843 DOI: 10.5603/cj.a2020.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/11/2020] [Accepted: 02/21/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Application of high power radiofrequency (RF) energy for a short duration (HPSD) to isolate pulmonary vein (PV) is an emerging technique. But power and duration settings are very different across different centers. Moreover, despite encouraging preclinical and clinical data, studies measuring acute effectiveness of various HPSD settings are limited. METHODS Twenty-five consecutive patients with symptomatic atrial fibrillation (AF) were treated with pulmonary vein isolation (PVI) using HPSD. PVI was performed with a contact force catheter (Thermocool SF Smart-Touch) and Carto 3 System. The following parameters were used: energy output 50 W, target temperature 43°C, irrigation 15 mL/min, targeted contact force of > 10 g. RF energy was applied for 6-10 s. Required minimal interlesion distance was 4 mm. Twenty minutes after each successful PVI adenosine provocation test (APT) was performed by administrating 18 mg adenosine to unmask dormant PV conduction. RESULTS All PVs (100 PVs) were successfully isolated. RF lesions needed per patient were 131 ± 41, the average duration for each RF application was 8.1 ± 1.7 s. Procedure time was 138 ± 21 min and average of total RF energy duration was 16.3 ± 5.2 min and average amount of RF energy was 48209 ± 12808 W. APT application time after PVI was 31.1 ± 8.3 min for the left sided PVs and 22.2 ± 4.6 min (p = 0.005) for the right sided PVs. APT was transiently positive in 18 PVs (18%) in 8 (32%) patients. CONCLUSIONS Pulmonary vein isolation with high power for 6-10 s is feasible and shortens the procedure and ablation duration. However, acute effectiveness of the HPSD seems to be lower than expected. Further studies combining other ablation parameters are needed to improve this promising technique.
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Affiliation(s)
- Ekrem Ücer
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany.
| | - Carsten Jungbauer
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany
| | - Christian Hauck
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany
| | - Manuel Kaufmann
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany
| | | | - Lars Maier
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany
| | - Sabine Fredersdorf
- Internal Medicine II, Cardiology, University Hospital Regensburg, Germany
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Üçer E, Fredersdorf S, Seegers J, Poschenrieder F, Hauck C, Maier L, Jungbauer C. High Predictive Value of Adenosine Provocation in Predicting Atrial Fibrillation Recurrence After Pulmonary Vein Isolation With Visually Guided Laser Balloon Compared With Radiofrequency Ablation. Circ J 2020; 84:404-410. [DOI: 10.1253/circj.cj-19-0993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ekrem Üçer
- Internal Medicine II, Cardiology, University Hospital Regensburg
| | | | | | | | - Christian Hauck
- Internal Medicine II, Cardiology, University Hospital Regensburg
| | - Lars Maier
- Internal Medicine II, Cardiology, University Hospital Regensburg
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Algül E, Sunman H, Dural M, Guliyev İ, Aker M, Felekoğlu MA, Erat M, Tulmaç M, Açıkel S, Çimen T. Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel. Turk J Med Sci 2019; 49:1358-1365. [PMID: 31549494 PMCID: PMC7018378 DOI: 10.3906/sag-1903-188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background/aim Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging. Results Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS
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Affiliation(s)
- Engin Algül
- Cardiology Clinics, Bitlis State Hospital, Bitlis, Turkey
| | - Hamza Sunman
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Muhammet Dural
- Department of Cardiology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - İlkin Guliyev
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mert Aker
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Felekoğlu
- Cardiology Clinics, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Mehmet Erat
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Murat Tulmaç
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sadık Açıkel
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tolga Çimen
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Vassallo F, Cunha C, Serpa E, Meigre LL, Carloni H, Simoes A, Hespanhol D, Lovatto CV, Batista W, Serpa R. Comparison of high‐power short‐duration (HPSD) ablation of atrial fibrillation using a contact force‐sensing catheter and conventional technique: Initial results. J Cardiovasc Electrophysiol 2019; 30:1877-1883. [DOI: 10.1111/jce.14110] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Fabricio Vassallo
- Electrophysiology Section of Institute of Cardiology of Espirito Santo Brazil
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Christiano Cunha
- Electrophysiology Section of Institute of Cardiology of Espirito Santo Brazil
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Eduardo Serpa
- Electrophysiology Section of Institute of Cardiology of Espirito Santo Brazil
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Lucas Luis Meigre
- Electrophysiology Section of Institute of Cardiology of Espirito Santo Brazil
| | - Hermes Carloni
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Aloyr Simoes
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Dalton Hespanhol
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | | | - Walter Batista
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
| | - Renato Serpa
- Electrophysiology Section of Institute of Cardiology of Espirito Santo Brazil
- Cardiology Section of Santa Rita de Cassia HospitalVitoria Espirito Santo Brazil
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Skala T, Precek J, Hutyra M, Moravec O, Tudos Z, Skalova J, Klementova O, Antonicka A, Zapletalova J, Taborsky M. Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:147-153. [PMID: 30829343 DOI: 10.5507/bp.2019.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. METHOD AND RESULTS Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure. CONCLUSION The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.
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Affiliation(s)
- Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Ondrej Moravec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Jitka Skalova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Andrea Antonicka
- Cardiovascular Center, Tomas Bata County Hospital, Zlin, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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13
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Chen C, Li D, Ho J, Liu T, Li X, Wang Z, Lin Y, Zou F, Tse G, Xia Y. Clinical Implications of Unmasking Dormant Conduction After Circumferential Pulmonary Vein Isolation in Atrial Fibrillation Using Adenosine: A Systematic Review and Meta-Analysis. Front Physiol 2019; 9:1861. [PMID: 30705634 PMCID: PMC6345194 DOI: 10.3389/fphys.2018.01861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/11/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose: Circumferential pulmonary vein isolation (CPVI) is a routine ablation strategy of atrial fibrillation (AF). The adenosine test can be used to unmask dormant conduction (DC) of pulmonary veins after CPVI, thereby demonstrating possible pulmonary vein re-connection and the need for further ablation. However, whether adenosine test could help improve the long term successful rate of CPVI is still controversial. This systemic review and meta-analysis was to determine the clinical utility of the adenosine test. Methods: PubMed, EMBASE, Web of Science and Cochrane Library database were searched through July 2016 to identify relevant studies using the keywords “dormant pulmonary vein conduction,” “adenosine test,” “circumferential pulmonary vein isolation,” and “atrial fibrillation.” A random-effects model was used to compare pooled outcomes and tested for heterogeneity. Results: A total of 17 studies including 5,169 participants were included in the final meta-analysis. Two groups of comparisons were classified: (1) Long-term successful rate in those AF patients underwent CPVI with and without adenosine test [Group A (+) and Group A (−)]; (2) Long-term successful rate in those patients who had adenosine test with and without dormant conduction [Group DC (+) and Group DC (−)]. The overall meta-analysis showed that no significant difference can be observed between Group A (+) and Group A (−) (RR 1.08; 95% CI 0.97–1.19; P = 0.16; I2 = 66%) and between Group DC (+) and Group DC (−) (RR 1.01; 95% CI 0.91–1.12; P = 0.88; I2 = 60%). Conclusion: Pooled meta-analysis suggested adenosine test may not improve long-term successful rate in AF patients underwent CPVI. Furthermore, AF recurrence may not be decreased by eliminating DC provoked by adenosine, even though adenosine test was applied after CPVI.
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Affiliation(s)
- Cheng Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Daobo Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jeffery Ho
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xintao Li
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhao Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yajuan Lin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fuquan Zou
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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14
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Kottmaier M, Bourier F, Wünscher S, Kornmayer M, Semmler V, Lengauer S, Telishevska M, Koch-Büttner K, Risse E, Brooks S, Hessling G, Deisenhofer I, Reents T. Repeat ablation for paroxysmal atrial fibrillation - Does adenosine play a role in predicting pulmonary vein reconnection patterns? Indian Pacing Electrophysiol J 2018; 18:203-207. [PMID: 30290206 PMCID: PMC6302775 DOI: 10.1016/j.ipej.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/05/2018] [Accepted: 09/27/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pulmonary vein (PV) reconduction after PV isolation (PVI) unmasked by adenosine is associated with a higher risk for paroxysmal atrial fibrillation (PAF) recurrence. It is unknown if the reconnected PVs after adenosine testing and immediate re-ablation can predict reconnection and reconnection patterns of PVs at repeat procedures. We assessed reconnection of PVs with and without dormant-conduction (DC) during the first and the repeat procedure. METHODS We included 67 patients undergoing PVI for PAF and a second procedure for PAF recurrence. DC during adenosine administration at first procedure was seen in 31 patients (46%). 264 PVs were tested with adenosine; DC was found in 48 PVs (18%) and re-ablated during first procedure. During the second procedure, all PVs where checked for reconnection. RESULTS Fifty-eight patients (87%) showed PV reconnection during the second procedure. Reconnection was found in 152/264 PVs (58%). Of 216 PVs without reconnection during adenosine testing at the first ablation, 116 PVs (53.7%) showed reconnection at the repeat procedure. Overall, 14.9% of patients showed the same PV reconnection pattern in the first and second procedure, expected statistical probability of encountering the same reconnection pattern was only 6.6%(p = 0.012). CONCLUSIONS In repeat procedures PVs showed significantly more often the same reconnection pattern as during first procedure than statistically expected. More than 50% of initial isolated PVs without reconnection during adenosine testing showed a reconnection during repeat ablation. Techniques to detect susceptibility for PV re-connection like prolonged waiting-period should be applied. Elimination of DC should be expanded from segmental to circumferential re-isolation or vaster RF application.
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Affiliation(s)
- M Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany.
| | - F Bourier
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Wünscher
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Kornmayer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - V Semmler
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - M Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - K Koch-Büttner
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - E Risse
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - S Brooks
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - G Hessling
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - I Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
| | - T Reents
- Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Germany
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15
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Efficacy of adjunctive measures used to assist pulmonary vein isolation for atrial fibrillation: a systematic review. Curr Opin Cardiol 2018; 32:58-68. [PMID: 27755138 DOI: 10.1097/hco.0000000000000347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Pulmonary vein reconnection leading to recurrence of atrial arrhythmias after pulmonary vein isolation (PVI) for atrial fibrillation remains a significant challenge. A number of adjunctive measures during PVI have been used to attempt to reduce pulmonary vein reconnection and recurrence of atrial arrhythmias. We performed a systematic review of the literature and meta-analysis of studies evaluating the efficacy of adjunctive measures used during PVI in reducing recurrent atrial arrhythmias. RECENT FINDINGS Our literature search found four interventions that met the prespecified definition of adjunctive measure: adenosine testing post-PVI, contact force-guided PVI, pacing inexcitability of the ablation line during PVI and additional ablation based on the computed tomography thickness of the pulmonary vein-left atrial appendage ridge. Sixteen studies enrolling 3507 patients met all inclusion and exclusion criteria. PVI performed with adjunctive measures was shown to reduce the 1-year recurrence rate of atrial arrhythmias. The point estimate for the combined relative risk of atrial arrhythmia recurrence was 0.56 [95% confidence interval (CI): 0.43-0.73; P value <0.001] in the PVI with adjunctive measures group. SUMMARY PVI for atrial fibrillation assisted by adjunctive measures results in clinically significant reduction of recurrent atrial arrhythmias. Additional research is required to assess the relative efficacy of individual or combined adjunctive strategies used during PVI for atrial fibrillation.
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16
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Ücer E, Janeczko Y, Seegers J, Fredersdorf S, Friemel S, Poschenrieder F, Maier LS, Jungbauer CG. A RAndomized Trial to compare the acute reconnection after pulmonary vein ISolation with Laser-BalloON versus radiofrequency Ablation: RATISBONA trial. J Cardiovasc Electrophysiol 2018; 29:733-739. [DOI: 10.1111/jce.13465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/21/2018] [Accepted: 02/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ekrem Ücer
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
| | - Yvette Janeczko
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
| | - Joachim Seegers
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
| | - Sabine Fredersdorf
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
| | - Selina Friemel
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
| | | | - Lars Siegfried Maier
- Internal Medicine II, Cardiology; University Hospital Regensburg; Regensburg Germany
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17
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Blandino A, Biondi-Zoccai G, Battaglia A, Grossi S, Bianchi F, Conte MR, Rametta F, Gaita F. Impact of targeting adenosine-induced transient venous reconnection in patients undergoing pulmonary vein isolation for atrial fibrillation: a meta-analysis of 3524 patients. J Cardiovasc Med (Hagerstown) 2018; 18:478-489. [PMID: 28514791 DOI: 10.2459/jcm.0000000000000408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Atrial fibrillation recurrences after pulmonary vein isolation (PVI) are not uncommon and are frequently related to pulmonary vein reconnection. Adenosine/ATP can reveal dormant pulmonary vein conduction after PVI. Previous studies revealed that adenosine-guided Additional ablation could improve arrhythmia-free survival. We performed a meta-analysis to assess the impact of additional ablation to eliminate adenosine-induced transient pulmonary vein reconnection in terms of atrial fibrillation recurrence at follow-up. METHODS MEDLINE/PubMed, Cochrane Library and references reporting atrial fibrillation ablation and adenosine/ATP-following PVI were screened, and studies were included if they matched inclusion and exclusion criteria. RESULTS A total of 3524 patients were enrolled with a median follow-up of 13 (6-20) months. Overall, 70% (60-85) of patients in ATP-guided ablation vs. 63% (48-79) in no ATP-guided ablation were free of atrial fibrillation at follow-up. Pooled results revealed that ATP-guided ablation reduced the risk of atrial fibrillation recurrence of 42% [odds ratio (OR) 0.58, 0.41-0.81], but this result was primary because of the contribution of retrospective over-randomized studies [OR 0.48 (0.35-0.65) vs. 0.76 (0.42-1.40), respectively]. 3.2% of patients experienced an adverse event. ATP-guided ablation is related to a nonsignificant increase in fluoroscopy time (OR 1.71, 0.98-2.96) and to a significant increase in procedure time (OR 2.84, 1.32-6.09). CONCLUSION Additional ablation aiming to eliminate adenosine-induced transient pulmonary vein reconnection failed to reduce the risk of atrial fibrillation recurrence at follow-up. Moreover, although adenosine-guided PVI is not affected by an augmented risk of adverse events, it is associated with a NS increased fluoroscopy exposure and significantly longer procedure duration. Further studies are required to identify the actual role of adenosine in PVI.
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Affiliation(s)
- Alessandro Blandino
- aDivision of Cardiology, S. Andrea Hospital, VercellibDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, LatinacDepartment of AngioCardioNeurology, IRCCS Neuromed, PozzillidDivision of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of TurineDivision of Cardiology, Mauriziano Umberto I Hospital, Turin, Italy
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18
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Iqbal M, Jena A, Park HS, Baek YS, Lee KN, Roh SY, Shim JM, Choi JI, Kim YH. Value of adenosine test to reveal dormant conduction or adenosine-induced atrial fibrillation after pulmonary vein isolation. J Arrhythm 2017; 33:602-607. [PMID: 29255508 PMCID: PMC5728995 DOI: 10.1016/j.joa.2017.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/03/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background Recent studies investigating the implications of additional ablation guided by dormant pulmonary vein (PV) conduction testing using adenosine showed conflicting results, and the data about atrial fibrillation (AF) recurrence after trigger site elimination in adenosine-induced AF are still lacking. Methods Of 846 patients with paroxysmal AF (PAF) who underwent PV isolation (PVI), adenosine test after PVI was performed in 148 patients. Results PVI was successfully achieved in 846 patients. We excluded 58 patients due to loss to the follow-up. A higher rate of AF recurrence was found in the group without adenosine test (136/644, 21%) compared to the group with adenosine test (20/144, 13%, log-rank P=0.047). In multivariate analysis model for AF freedom during the follow-up period, the only significant clinical predictor of AF freedom was adenosine test (hazard ratio [HR] 1.97; 95% confidence interval [CI]: 1.2-3.23; P=0.007).Among 148 patients with adenosine test, 114 (77%) patients showed neither dormant conductions nor AF-induced, 22 (15%) showed positive dormant conductions only, and 12 (8%) revealed adenosine-induced AF (6 of them also showed dormant conduction). After additional ablation in positive dormant conduction group and adenosine-induced AF group, AF recurrence was noted in 4/21 (19%) patients in positive dormant conduction group and 2/11 (18%) patients in adenosine-induced AF group, which was not different from that of patients in negative dormant conduction/ no AF-induced group (14/112, 12%, log-rank P=0.67). Conclusions Adenosine test after PVI to confirm the absence of dormant conduction and triggers initiating AF is beneficial to improve the outcomes after catheter ablation of PAF.
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Affiliation(s)
- Mohammad Iqbal
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea.,Department of Cardiology and Vascular Medicine, Universitas Padjadjaran, Jalan Eyckman 38, Bandung 40161, Indonesia
| | - Anupam Jena
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jae-Min Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-Ro, Seongbuk-Gu, Seoul 02841, Republic of Korea
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19
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Wang N, Phan S, Kanagaratnam A, Kumar N, Phan K. Adenosine Testing After Atrial Fibrillation Ablation: Systematic Review and Meta-Analysis. Heart Lung Circ 2017; 27:601-610. [PMID: 28655535 DOI: 10.1016/j.hlc.2017.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adenosine can be used to reveal dormant pulmonary vein (PV) conduction after pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). We performed a systematic review and meta-analysis to assess the impact of adenosine administration in patients undergoing PVI for AF. METHODS Meta-analysis of 22 studies was performed to assess the rates of freedom from AF in 1) patients with dormant PV conduction versus patients without dormant PV conduction, and 2) patients given routine adenosine post PVI versus patients not given adenosine. Relative-risks (RR) were calculated using random effects modelling. RESULTS In 18 studies, 3038 patients received adenosine and freedom from AF in those patients with dormant PV reconnection was significantly lower (62.9%) compared to patients without PV reconnection (67.2%) (RR 0.87; 95% CI: 0.78-0.98). In seven studies with 3049 patients, the freedom from AF was significantly higher in patients who received adenosine (67%) versus those patients who did not receive adenosine (63%) (RR: 1.11; 95% CI: 1.01-1.22). CONCLUSIONS The present study showed clear benefits of adenosine testing for freedom from AF recurrence. Adenosine-guided dormant conduction is associated with higher AF recurrence despite further ablation. Future studies should investigate the optimal methodology, including dosage and waiting time between PVI and adenosine administration.
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Affiliation(s)
- Nelson Wang
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia.
| | - Steven Phan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia
| | | | - Narendra Kumar
- Department of Cardiology, Paras HMRI Hospitals, Raja Bazar, Patna, India
| | - Kevin Phan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Collaborative Research (CORE) Group, Macquarie University, Sydney, NSW, Australia
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20
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Morales G, Darrat YH, Lellouche N, Kim SM, Butt M, Bidwell K, Lippert W, Ogunbayo G, Hamon D, Di Biase L, Natale A, Parrott K, Elayi CS. Use of adenosine to shorten the post ablation waiting period for cavotricuspid isthmus-dependent atrial flutter. J Cardiovasc Electrophysiol 2017; 28:876-881. [DOI: 10.1111/jce.13233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Gustavo Morales
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - Yousef H. Darrat
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | | | - Sun Moon Kim
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - Muhammad Butt
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - Katrina Bidwell
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - William Lippert
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - Gbolahan Ogunbayo
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - David Hamon
- Service de Cardiologie; CHU Henri Mondor; Creteil France
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
- Department of Cardiology; University of Foggia; Foggia Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute; St. David's Medical Center; Austin TX USA
- Department of Biomedical Engineering; University of Texas; Austin TX USA
- Dell Medical School; University of Texas; Austin TX USA
| | - Kevin Parrott
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
| | - Claude S Elayi
- Gill Heart Institute; University of Kentucky; Lexington Kentucky USA
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21
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Chen YH, Lin H, Xie CL, Hou JW, Li YG. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis. Europace 2017; 19:552-559. [PMID: 28431050 DOI: 10.1093/europace/euw201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/08/2016] [Indexed: 10/13/2023] Open
Abstract
AIMS Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). METHODS AND RESULTS We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). CONCLUSION From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Hui Lin
- Department of Respiratory, The Second Af?liated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, Shanghai 200092, China
| | - Jian-Wen Hou
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital Affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China
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22
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Letsas KP, Georgopoulos S, Efremidis M, Liu T, Bazoukis G, Vlachos K, Karamichalakis N, Lioni L, Sideris A, Ehrlich JR. Adenosine-guided radiofrequency catheter ablation of atrial fibrillation: A meta-analysis of randomized control trials. J Arrhythm 2017; 33:247-255. [PMID: 28765753 PMCID: PMC5529608 DOI: 10.1016/j.joa.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/16/2017] [Accepted: 02/19/2017] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The prognostic significance of adenosine-mediated dormant pulmonary vein conduction, and whether such dormant conduction should be eliminated, remains controversial. We sought to perform a meta-analysis of data from eligible studies to delineate the prognostic impact of adenosine-guided radiofrequency catheter ablation of atrial fibrillation. METHODS A systematic literature search was performed using online databases in order to identify relevant studies from January 2004 to September 2016. Ten studies [six observational and four randomized control trials (RCTs)] were included in the analysis. RESULTS Five studies (two observational and three RCTs) compared the efficacy of adenosine-mediated elimination of dormant conduction versus no adenosine test. Overall, the adenosine-guided ablation strategy displayed better long-term outcomes as compared with no adenosine testing (RR 1.08, 95% CI 1.01-1.14, p=0.02; Heterogeneity: I2=42%, p: 0.14). The meta-analysis of only RCTs failed to show any differences between the two strategies (RR 1.03, 95% CI 0.96-1.11, p=0.37; Heterogeneity: I2 0%, p: 0.41). Eight studies (five observational and three RCTs) addressed the efficacy of adenosine-induced dormant conduction and additional ablation versus no dormant conduction during adenosine challenge. Overall, a trend towards a better outcome in those without dormant conduction during drug challenge was noted (RR 0.89, 95% CI 0.77-1.03, p=0.11; Heterogeneity: I2 65% p: 0.006). The pooled analysis of RCTs failed to show any differences between the two arms (RR 0.90, 95% CI 0.62-1.30, p= 0.57; Heterogeneity: I2 88%, p: 0.0002). CONCLUSIONS Adenosine-guided radiofrequency catheter ablation of atrial fibrillation does not provide additional benefit in terms of freedom of arrhythmia recurrence.
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Affiliation(s)
- Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Stamatis Georgopoulos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Michael Efremidis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People׳s Republic of China
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Konstantinos Vlachos
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | | | - Louiza Lioni
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
| | - Antonios Sideris
- Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece
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23
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Adenosine administration during hybrid atrial fibrillation ablation to test dormant pulmonary vein conduction. J Interv Card Electrophysiol 2017; 49:59-65. [PMID: 28285383 PMCID: PMC5403878 DOI: 10.1007/s10840-017-0239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/01/2017] [Indexed: 11/22/2022]
Abstract
Background Adenosine administration after initial pulmonary vein isolation (PVI) reveals dormant conduction and predicts atrial fibrillation (AF) recurrence. Elimination of dormant conduction when present may increase a long-term success rate of AF ablation procedures. There are no studies till date using adenosine to reveal acute reconduction of pulmonary veins (PVs) after epicardial PVI during a hybrid AF ablation procedure. Methods We included 24 patients (21 male, 55 ± 9 years) undergoing hybrid ablation for symptomatic paroxysmal (n = 12) and persistent (n = 12) AF, using an epicardial bipolar radiofrequency clamp to perform PVI. All antiarrhythmic medications were discontinued 5 days prior to the procedure, except for patients on amiodarone. Thirty minutes after PVI and once sinus rhythm was obtained, a bolus of adenosine (12 to 36 mg) was administered intravenously. The subsequent response was assessed for each PV (n = 96) using an in situ circular mapping catheter. Results Dormant conduction (i.e., the reappearance of PV potentials during at least one beat) was seen in 1 out of 96 PVs (1%). If reconduction was seen, further endocardial ablation using a 3.5-mm irrigated tip catheter was performed until no more reconduction occurred after repeating the adenosine bolus. Conclusions Adenosine administration after PVI with the use of an epicardial bipolar radiofrequency clamp in the setting of hybrid AF ablation reveals acute reconduction in 1% of the PVs.
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McLellan AJ, Prabhu S, Voskoboinik A, Wong MC, Walters TE, Pathik B, Morris GM, Nisbet A, Lee G, Morton JB, Kalman JM, Kistler PM. Isolation of the posterior left atrium for patients with persistent atrial fibrillation: routine adenosine challenge for dormant posterior left atrial conduction improves long-term outcome. Europace 2017; 19:1958-1966. [DOI: 10.1093/europace/euw231] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/29/2016] [Indexed: 11/12/2022] Open
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Papageorgiou N, Providência R, Srinivasan N, Bronis K, Costa FM, Cavaco D, Adragão P, Tousoulis D, Hunter RJ, Schilling RJ, Segal OR, Chow A, Rowland E, Lowe M, Lambiase PD. Adenosine-guided pulmonary vein isolation versus conventional pulmonary vein isolation in patients undergoing atrial fibrillation ablation: An updated meta-analysis. Int J Cardiol 2017; 227:151-160. [DOI: 10.1016/j.ijcard.2016.11.152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/06/2016] [Indexed: 01/11/2023]
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26
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PRABHU SANDEEP, MACKIN VINCENT, MCLELLAN ALEXJ, PHAN TUONG, MCGLADE DESMOND, LING LIANGHAN, PECK KAHY, VOSKOBOINIK ALEXANDR, PATHIK BUPESH, NALLIAH CHRISHANJ, WONG GEOFFR, AZZOPARDI SONIAM, LEE GEOFFREY, MARIANI JUSTIN, TAYLOR ANDREWJ, KALMAN JONATHANM, KISTLER PETERM. Determining the Optimal Dose of Adenosine for Unmasking Dormant Pulmonary Vein Conduction Following Atrial Fibrillation Ablation: Electrophysiological and Hemodynamic Assessment. DORMANT-AF Study. J Cardiovasc Electrophysiol 2016; 28:13-22. [DOI: 10.1111/jce.13107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- SANDEEP PRABHU
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | | | - ALEX J.A. MCLELLAN
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - TUONG PHAN
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | | | - LIANG-HAN LING
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - KAH Y. PECK
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
| | - ALEXANDR VOSKOBOINIK
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - BUPESH PATHIK
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - CHRISHAN J. NALLIAH
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - GEOFF R. WONG
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - SONIA M. AZZOPARDI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - GEOFFREY LEE
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - JUSTIN MARIANI
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
| | - ANDREW J. TAYLOR
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
| | - JONATHAN M. KALMAN
- Cardiology Department; Royal Melbourne Hospital; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
| | - PETER M. KISTLER
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
- Baker IDI Heart and Diabetes Institute; Cabrini Health; Melbourne Victoria Australia
- Faculty of Medicine, Dentistry, and Health Sciences; University of Melbourne; Melbourne Victoria Australia
- Cabrini Health; Melbourne Victoria Australia
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Sadek MM, Maeda S, Chik W, Santangeli P, Zado ES, Schaller RD, Supple GE, Frankel DS, Hutchinson MD, Garcia FC, Riley MP, Lin D, Dixit S, Callans DJ, Marchlinski FE. Recurrent atrial arrhythmias in the setting of chronic pulmonary vein isolation. Heart Rhythm 2016; 13:2174-2180. [DOI: 10.1016/j.hrthm.2016.08.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Indexed: 10/21/2022]
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Teunissen C, Clappers N, Kassenberg W, Hassink RJ, van der Heijden JF, Loh P. Time matters: adenosine testing immediately after pulmonary vein isolation does not substitute a waiting period. Europace 2016; 19:1140-1145. [DOI: 10.1093/europace/euw173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/15/2016] [Indexed: 11/12/2022] Open
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EFREMIDIS MICHAEL, LETSAS KONSTANTINOSP, LIONI LOUIZA, VLACHOS KONSTANTINOS, GEORGOPOULOS STAMATIS, SAPLAOURAS ATHANASIOS, GELADARI ELENI, GIANNOPOULOS GEORGE, LIU TONG, DEFTEREOS SPYRIDON, SIDERIS ANTONIOS. Adenosine-Guided Pulmonary Vein Antral Isolation for Paroxysmal Atrial Fibrillation: A Randomized Study. J Cardiovasc Electrophysiol 2016; 27:1288-1292. [DOI: 10.1111/jce.13059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- MICHAEL EFREMIDIS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - KONSTANTINOS P. LETSAS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - LOUIZA LIONI
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - KONSTANTINOS VLACHOS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - STAMATIS GEORGOPOULOS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - ATHANASIOS SAPLAOURAS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - ELENI GELADARI
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
| | - GEORGE GIANNOPOULOS
- Second Department of Cardiology; National and Kapodistrian University of Athens Medical School; Athens Greece
| | - TONG LIU
- Department of Cardiology, Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; People's Republic of China
| | - SPYRIDON DEFTEREOS
- Second Department of Cardiology; National and Kapodistrian University of Athens Medical School; Athens Greece
| | - ANTONIOS SIDERIS
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology; “Evangelismos” General Hospital of Athens; Athens Greece
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Darby AE. Recurrent Atrial Fibrillation After Catheter Ablation: Considerations For Repeat Ablation And Strategies To Optimize Success. J Atr Fibrillation 2016; 9:1427. [PMID: 27909521 DOI: 10.4022/jafib.1427] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/10/2022]
Abstract
Recurrent AF after catheter ablation occurs in at least 20 to 40% of patients. Repeat ablation is primarily considered for those with symptomatic AF recurrences (often drug-refactory) occurring at least 3 months or more post-ablation. Pulmonary vein reconnection is almost universally encountered, and repeat isolation of electrically connected pulmonary veins should be the primary ablation strategy. Beyond repeat PVI and possible ablation of non-PV triggers, there is little to no evidence that additional substrate modification improves outcomes. In addition to repeat ablation, it is critical to address and treat comorbid conditions which increase arrhythmia risk post-ablation. Specifically, obesity, hypertension, and sleep-disordered breathing should be targeted and modified to increase the likelihood of success.
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Affiliation(s)
- Andrew E Darby
- Assistant Professor, University of Virginia, Charlottesville, VA
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31
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Zhang N, Chen KY, Zhao J, Xu G, Li G, Liu T. Another side effect of ticagrelor: Atrial fibrillation. Int J Cardiol 2016; 212:242-4. [PMID: 27045879 DOI: 10.1016/j.ijcard.2016.03.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/19/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Nixiao Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Kang-Yin Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Jianping Zhao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Gang Xu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin, Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
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DAS MOLOY, WYNN GARETHJ, MORGAN MAUREEN, RONAYNE CHRISTINA, WAKTARE JOHANE, TODD DERICKM, HALL MARKC, SNOWDON RICHARDL, MODI SIMON, GUPTA DHIRAJ. Reablated Sites of Acute Reconnection After Pulmonary Vein Isolation Do Not Predict Sites of Late Reconnection at Repeat Electrophysiology Study. J Cardiovasc Electrophysiol 2016; 27:381-9. [DOI: 10.1111/jce.12933] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/02/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- MOLOY DAS
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - GARETH J. WYNN
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - MAUREEN MORGAN
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - CHRISTINA RONAYNE
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - JOHAN E.P. WAKTARE
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - DERICK M. TODD
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - MARK C.S. HALL
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - RICHARD L. SNOWDON
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - SIMON MODI
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
| | - DHIRAJ GUPTA
- Institute of Cardiovascular Medicine and Science, Department of Cardiology; Liverpool Heart and Chest Hospital; Liverpool UK
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The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review. Cardiol Res Pract 2016; 2016:8632509. [PMID: 26981309 PMCID: PMC4770126 DOI: 10.1155/2016/8632509] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/04/2016] [Indexed: 01/19/2023] Open
Abstract
The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.
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Ghanbari H, Jani R, Hussain-Amin A, Al-Assad W, Huether E, Ansari S, Jongnarangsin K, Crawford T, Latchamsetty R, Bogun F, Morady F, Oral H, Chugh A. Role of adenosine after antral pulmonary vein isolation of paroxysmal atrial fibrillation: A randomized controlled trial. Heart Rhythm 2016; 13:407-15. [DOI: 10.1016/j.hrthm.2015.10.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Indexed: 11/27/2022]
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35
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Kumar S, Barbhaiya CR, Balindger S, John RM, Epstein LM, Koplan BA, Tedrow UB, Stevenson WG, Michaud GF. Better Lesion Creation And Assessment During Catheter Ablation. J Atr Fibrillation 2015; 8:1189. [PMID: 27957200 DOI: 10.4022/jafib.1189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
Abstract
Permanent destruction of abnormal cardiac tissue responsible for cardiac arrhythmogenesis whilst avoiding collateral tissue injury forms the cornerstone of catheter ablation therapy. As the acceptance and performance of catheter ablation increases worldwide, limitations in current technology are becoming increasingly apparent in the treatment of complex arrhythmias such as atrial fibrillation. This review will discuss the role of new technologies aimed to improve lesion formation with the ultimate goal of improving arrhythmia-free survival of patients undergoing catheter ablation of atrial arrhythmias.
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Affiliation(s)
- Saurabh Kumar
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Chirag R Barbhaiya
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Samuel Balindger
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Roy M John
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Laurence M Epstein
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Bruce A Koplan
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Usha B Tedrow
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - William G Stevenson
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
| | - Gregory F Michaud
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115
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IWAYAMA TADATERU, ARIMOTO TAKANORI, ISHIGAKI DAISUKE, HASHIMOTO NAOAKI, KUMAGAI YU, KOYAMA YO, KIRIBAYASHI NOBUYUKI, NETSU SHUNSUKE, NISHIYAMA SATOSHI, TAKAHASHI HIROKI, SHISHIDO TETSURO, MIYAMOTO TAKUYA, SATO TOSHIMITSU, WATANABE TETSU, KUBOTA ISAO. The Clinical Value of Nongated Dual-Source Computed Tomography in Atrial Fibrillation Catheter Ablation. J Cardiovasc Electrophysiol 2015; 27:34-40. [DOI: 10.1111/jce.12826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/15/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022]
Affiliation(s)
- TADATERU IWAYAMA
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - TAKANORI ARIMOTO
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - DAISUKE ISHIGAKI
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - NAOAKI HASHIMOTO
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - YU KUMAGAI
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - YO KOYAMA
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - NOBUYUKI KIRIBAYASHI
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - SHUNSUKE NETSU
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - SATOSHI NISHIYAMA
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - HIROKI TAKAHASHI
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - TETSURO SHISHIDO
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - TAKUYA MIYAMOTO
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - TOSHIMITSU SATO
- Division of Radiology; Yamagata University School of Medicine; Yamagata Japan
| | - TETSU WATANABE
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
| | - ISAO KUBOTA
- Department of Cardiology, Pulmonology, and Nephrology; Yamagata University School of Medicine; Yamagata Japan
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Bhatt HV, Syros G, Greco M, Miller M, Fischer GW. Ablation Therapy for Atrial Fibrillation: Implications for the Anesthesiologist. J Cardiothorac Vasc Anesth 2015; 29:1341-56. [DOI: 10.1053/j.jvca.2015.05.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 11/11/2022]
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Gerstenfeld EP, Duggirala S. Atrial Fibrillation Ablation: Indications, Emerging Techniques, and Follow-Up. Prog Cardiovasc Dis 2015; 58:202-12. [DOI: 10.1016/j.pcad.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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SCHAEFFER BENJAMIN, WILLEMS STEPHAN, SULTAN ARIAN, HOFFMANN BORISA, LÜKER JAKOB, SCHREIBER DOREEN, AKBULAK RUKEN, MOSER JULIA, KUKLIK PAWEL, STEVEN DANIEL. Loss of Pace Capture on the Ablation Line During Pulmonary Vein Isolation versus “Dormant Conduction”: Is Adenosine Expendable? J Cardiovasc Electrophysiol 2015; 26:1075-80. [DOI: 10.1111/jce.12759] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- BENJAMIN SCHAEFFER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - STEPHAN WILLEMS
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - ARIAN SULTAN
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
| | - BORIS A. HOFFMANN
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - JAKOB LÜKER
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
| | - DOREEN SCHREIBER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - RUKEN AKBULAK
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - JULIA MOSER
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - PAWEL KUKLIK
- Department of Cardiology - Electrophysiology, University Hospital Hamburg; University Heart Center; Hamburg
| | - DANIEL STEVEN
- Department of Cardiology - Electrophysiology; University Hospital Cologne; Cologne Germany
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Theis C, Konrad T, Mollnau H, Sonnenschein S, Kämpfner D, Potstawa M, Ocete BQ, Bock K, Himmrich E, Münzel T, Rostock T. Arrhythmia Termination Versus Elimination of Dormant Pulmonary Vein Conduction as a Procedural End Point of Catheter Ablation for Paroxysmal Atrial Fibrillation: A Prospective Randomized Trial. Circ Arrhythm Electrophysiol 2015; 8:1080-7. [PMID: 26297786 PMCID: PMC4608486 DOI: 10.1161/circep.115.002786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/30/2015] [Indexed: 11/16/2022]
Abstract
Background— Pulmonary vein isolation (PVI) is still associated with a substantial number of arrhythmia recurrences in paroxysmal atrial fibrillation (AF). This prospective, randomized study aimed to compare 2 different procedural strategies. Methods and Results— A total of 152 patients undergoing de novo ablation for paroxysmal AF were randomized to 2 different treatment arms. The procedure in group A consisted of PVI exclusively. In this group, all isolated PVs were challenged with adenosine to reveal and ablate dormant conduction. In group B, PVI was performed with the patient either in spontaneous or in induced AF. If AF did not terminate with PVI, ablation was continued by targeting extra-PV AF sources with the desired procedural end point of termination to sinus rhythm. Primary study end point was freedom from arrhythmia during 1-year follow-up. In group A, adenosine provoked dormant conduction in 31 (41%) patients with a mean of 1.6±0.8 transiently recovered PVs per patient. Termination of AF during PVI was observed in 31 (65%) patients, whereas AF persisted afterward in 17 (35%) patients. AF termination occurred in 13 (76%) patients by AF source ablation. After 1-year follow-up, significantly more group B patients were free of arrhythmia recurrences (87 versus 68%; P=0.006). During redo ablation, the rate of PV reconduction did not differ between both groups (group A: 55% versus group B: 61%; P=0.25). Conclusions— Elimination of extra-PV AF sources after PVI is superior to sole PV isolation with the adjunct of abolishing potential dormant conduction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02238392.
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Affiliation(s)
- Cathrin Theis
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Torsten Konrad
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Hanke Mollnau
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Sebastian Sonnenschein
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Denise Kämpfner
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Maik Potstawa
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Blanca Quesada Ocete
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Karsten Bock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Ewald Himmrich
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
| | - Thomas Rostock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.
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Macle L, Khairy P, Weerasooriya R, Novak P, Verma A, Willems S, Arentz T, Deisenhofer I, Veenhuyzen G, Scavée C, Jaïs P, Puererfellner H, Levesque S, Andrade JG, Rivard L, Guerra PG, Dubuc M, Thibault B, Talajic M, Roy D, Nattel S. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet 2015. [PMID: 26211828 DOI: 10.1016/s0140-6736(15)60026-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Catheter ablation is increasingly used to manage atrial fibrillation, but arrhythmia recurrences are common. Adenosine might identify pulmonary veins at risk of reconnection by unmasking dormant conduction, and thereby guide additional ablation to improve arrhythmia-free survival. We assessed whether adenosine-guided pulmonary vein isolation could prevent arrhythmia recurrence in patients undergoing radiofrequency catheter ablation for paroxysmal atrial fibrillation. METHODS We did this randomised trial at 18 hospitals in Australia, Europe, and North America. We enrolled patients aged older than 18 years who had had at least three symptomatic atrial fibrillation episodes in the past 6 months, and for whom treatment with an antiarrhythmic drug failed. After pulmonary vein isolation, intravenous adenosine was administered. If dormant conduction was present, patients were randomly assigned (1:1) to additional adenosine-guided ablation to abolish dormant conduction or to no further ablation. If no dormant conduction was revealed, randomly selected patients were included in a registry. Patients were masked to treatment allocation and outcomes were assessed by a masked adjudicating committee. Patients were followed up for 1 year. The primary outcome was time to symptomatic atrial tachyarrhythmia after a single procedure in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT01058980. FINDINGS Adenosine unmasked dormant pulmonary vein conduction in 284 (53%) of 534 patients. 102 (69·4%) of 147 patients with additional adenosine-guided ablation were free from symptomatic atrial tachyarrhythmia compared with 58 (42·3%) of 137 patients with no further ablation, corresponding to an absolute risk reduction of 27·1% (95% CI 15·9-38·2; p<0·0001) and a hazard ratio of 0·44 (95% CI 0·31-0·64; p<0·0001). Of 115 patients without dormant pulmonary vein conduction, 64 (55·7%) remained free from symptomatic atrial tachyarrhythmia (p=0·0191 vs dormant conduction with no further ablation). Occurrences of serious adverse events were similar in each group. One death (massive stroke) was deemed probably related to ablation in a patient included in the registry. INTERPRETATION Adenosine testing to identify and target dormant pulmonary vein conduction during catheter ablation of atrial fibrillation is a safe and highly effective strategy to improve arrhythmia-free survival in patients with paroxysmal atrial fibrillation. This approach should be considered for incorporation into routine clinical practice. FUNDING Canadian Institutes of Health Research, St Jude Medical, Biosense-Webster, and M Lachapelle (Montreal Heart Institute Foundation).
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Affiliation(s)
- Laurent Macle
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Paul Khairy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Rukshen Weerasooriya
- University of Western Australia and Hollywood Private Hospital, Perth, WA, Australia
| | - Paul Novak
- Royal Jubilee Hospital, Victoria, BC, Canada
| | - Atul Verma
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | | | | | | | | | | | | | - Sylvie Levesque
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jason G Andrade
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Lena Rivard
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Peter G Guerra
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Marc Dubuc
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Bernard Thibault
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mario Talajic
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Denis Roy
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stanley Nattel
- Montreal Heart Institute and Montreal Health Innovations Coordinating Centre, Department of Medicine, Université de Montréal, Montreal, QC, Canada
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Datino T. ADVICE on adenosine to improve atrial fibrillation ablation. Lancet 2015. [PMID: 26211829 DOI: 10.1016/s0140-6736(15)60241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tomás Datino
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain.
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Tebbenjohanns J, Höfer C, Bergmann L, Dedroogh M, Gaudin D, von Werder A, Rühmkorf K. Shortening of freezing cycles provides equal outcome to standard ablation procedure using second-generation 28 mm cryoballoon after 15-month follow-up. Europace 2015; 18:206-10. [DOI: 10.1093/europace/euv189] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/27/2015] [Indexed: 11/14/2022] Open
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Michaud GF, Kumar S. Catheter Ablation for Paroxysmal Atrial Fibrillation. JACC Clin Electrophysiol 2015; 1:136-138. [DOI: 10.1016/j.jacep.2015.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/17/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Üçer E, Fredersdorf S, Jungbauer CG, Seegers J, Debl K, Riegger G, Maier LS. Unmasking the dormant pulmonary vein conduction with adenosine administration after pulmonary vein isolation with laser energy. Europace 2015; 17:1376-82. [PMID: 25759410 DOI: 10.1093/europace/euu368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/01/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS The isolation of the pulmonary veins (PVs) is the mainstay of atrial fibrillation (AF) ablation, which with current ablation techniques can be achieved in almost all cases. Reconnection of PVs constitutes the most frequent cause of AF recurrence. Visually guided laser balloon ablation (VGLA) is a novel system with very high rate of persistence of pulmonary vein isolation (PVI) three months after the first procedure shown in preclinical and clinical studies. We aimed to determine the acute efficiency of the laser energy during PVI with the help of adenosine provocation. METHODS AND RESULTS Twenty-six patients (19 male; mean age 64 ± 9 years) with symptomatic paroxysmal AF were included in the study. Pulmonary vein isolation was performed using the VGLA system. After successful PVI, we studied the effects of intravenous adenosine (18 mg) on activation of each PV at least 20 min after PVI. A total of 104 PVs were targeted. The balloon catheter could not be placed in two PVs. Of the remaining 102 PVs 99 (97% of the ablated PVs) could be successfully isolated. Adenosine was administered for each isolated PV in 25 patients. Only six PVs (6.7%) in five patients (20%) showed a PV reconnection during adenosine provocation. CONCLUSION Pulmonary vein isolation with VGLA is a feasible technique for PVI with a very effective acute lesion formation. The clinical significance of this low reconnection rate has to be determined.
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Affiliation(s)
- Ekrem Üçer
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Sabine Fredersdorf
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Carsten Gerald Jungbauer
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Joachim Seegers
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Kurt Debl
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Günter Riegger
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
| | - Lars Siegfried Maier
- University Hospital Regensburg, Internal Medicine II - Cardiology, Franz Josef Strauss Allee 11-93053, Regenburg, Germany
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Burnstock G, Pelleg A. Cardiac purinergic signalling in health and disease. Purinergic Signal 2015; 11:1-46. [PMID: 25527177 PMCID: PMC4336308 DOI: 10.1007/s11302-014-9436-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 01/09/2023] Open
Abstract
This review is a historical account about purinergic signalling in the heart, for readers to see how ideas and understanding have changed as new experimental results were published. Initially, the focus is on the nervous control of the heart by ATP as a cotransmitter in sympathetic, parasympathetic, and sensory nerves, as well as in intracardiac neurons. Control of the heart by centers in the brain and vagal cardiovascular reflexes involving purines are also discussed. The actions of adenine nucleotides and nucleosides on cardiomyocytes, atrioventricular and sinoatrial nodes, cardiac fibroblasts, and coronary blood vessels are described. Cardiac release and degradation of ATP are also described. Finally, the involvement of purinergic signalling and its therapeutic potential in cardiac pathophysiology is reviewed, including acute and chronic heart failure, ischemia, infarction, arrhythmias, cardiomyopathy, syncope, hypertrophy, coronary artery disease, angina, diabetic cardiomyopathy, as well as heart transplantation and coronary bypass grafts.
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Affiliation(s)
- Geoffrey Burnstock
- Autonomic Neuroscience Centre, University College Medical School, Rowland Hill Street, London, NW3 2PF, UK,
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Squara F, Liuba I, Chik W, Santangeli P, Maeda S, S. Zado E, Callans D, Marchlinski FE. Electrical connection between ipsilateral pulmonary veins: Prevalence and implications for ablation and adenosine testing. Heart Rhythm 2015; 12:275-82. [DOI: 10.1016/j.hrthm.2014.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Indexed: 11/28/2022]
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Squara F, Liuba I, Chik W, Santangeli P, Zado ES, Callans DJ, Marchlinski FE. Loss of local capture of the pulmonary vein myocardium after antral isolation: prevalence and clinical significance. J Cardiovasc Electrophysiol 2014; 26:242-50. [PMID: 25404507 DOI: 10.1111/jce.12585] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Capture of the myocardial sleeves of the pulmonary veins (PV) during PV pacing is mandatory for assessing exit block after PV isolation (PVI). However, previous studies reported that a significant proportion of PVs failed to demonstrate local capture after PVI. We designed this study to evaluate the prevalence and the clinical significance of loss of PV capture after PVI. METHODS AND RESULTS Thirty patients (14 redo) undergoing antral PVI were included. Before and after PVI, local PV capture was assessed during circumferential pacing (10 mA/2 milliseconds) with a circular multipolar catheter (CMC), using EGM analysis from each dipole of the CMC and from the ablation catheter placed in ipsilateral PV. Pacing output was varied to optimize identification of sleeve capture. All PVs demonstrated sleeve capture before PVI, but only 81% and 40% after first time and redo PVI, respectively (P < 0.001 vs. before PVI). In multivariate analysis, absence of spontaneous PV depolarizations after PVI and previous PVI procedures were associated with less PV sleeve capture after PVI (40% sleeve capture, P < 0.001 for both). Loss of PV local capture by design was coincident with the development of PV entrance block and importantly predicted absence of acute reconnection during adenosine challenge with 96% positive predictive value (23% negative predictive value). CONCLUSION Loss of PV local capture is common after antral PVI resulting in entrance block, and may be used as a specific alternate endpoint for PV electrical isolation. Additionally, loss of PV local capture may identify PVs at very low risk of acute reconnection during adenosine challenge.
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Affiliation(s)
- Fabien Squara
- Department of Cardiology, Pasteur University Hospital, Nice, France
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49
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Progress toward the prevention and treatment of atrial fibrillation: A summary of the Heart Rhythm Society Research Forum on the Treatment and Prevention of Atrial Fibrillation, Washington, DC, December 9-10, 2013. Heart Rhythm 2014; 12:e5-e29. [PMID: 25460864 DOI: 10.1016/j.hrthm.2014.11.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 02/07/2023]
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50
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McCready J, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Rowland ER, Bradley RJW, Paisey J, Roberts P, Morgan JM, Sandilands A, Yue A, Lambiase PD. Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial. Europace 2014; 16:1145-53. [PMID: 24843051 PMCID: PMC4114331 DOI: 10.1093/europace/euu064] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aims The current challenge in atrial fibrillation (AF) treatment is to develop effective, efficient, and safe ablation strategies. This randomized controlled trial assesses the medium-term efficacy of duty-cycled radiofrequency ablation via the circular pulmonary vein ablation catheter (PVAC) vs. conventional electro-anatomically guided wide-area circumferential ablation (WACA). Methods and results One hundred and eighty-eight patients (mean age 62 ± 12 years, 116 M : 72 F) with paroxysmal AF were prospectively randomized to PVAC or WACA strategies and sequentially followed for 12 months. The primary endpoint was freedom from symptomatic or documented >30 s AF off medications for 7 days at 12 months post-procedure. One hundred and eighty-three patients completed 12 m follow-up. Ninety-four patients underwent PVAC PV isolation with 372 of 376 pulmonary veins (PVs) successfully isolated and all PVs isolated in 92 WACA patients. Three WACA and no PVAC patients developed tamponade. Fifty-six percent of WACA and 60% of PVAC patients were free of AF at 12 months post-procedure (P = ns) with a significant attrition rate from 77 to 78%, respectively, at 6 months. The mean procedure (140 ± 43 vs. 167 ± 42 min, P<0.0001), fluoroscopy (35 ± 16 vs. 42 ± 20 min, P<0.05) times were significantly shorter for PVAC than for WACA. Two patients developed strokes within 72 h of the procedure in the PVAC group, one possibly related directly to PVAC ablation in a high-risk patient and none in the WACA group (P = ns). Two of the 47 patients in the PVAC group who underwent repeat ablation had sub-clinical mild PV stenoses of 25–50% and 1 WACA patient developed delayed severe PV stenosis requiring venoplasty. Conclusion The pulmonary vein ablation catheter is equivalent in efficacy to WACA with reduced procedural and fluoroscopy times. However, there is a risk of thrombo-embolic and pulmonary stenosis complications which needs to be addressed and prospectively monitored. ClinicalTrials.gov Identifier NCT00678340.
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Affiliation(s)
- J McCready
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - A W Chow
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - M D Lowe
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - O R Segal
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - S Ahsan
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - J de Bono
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - M Dhaliwal
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - C Mfuko
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - A Ng
- Cardiology Department, Glenfield Heart Centre, Leicester, Leicestershire LE39QP, UK
| | - E R Rowland
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - R J W Bradley
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
| | - J Paisey
- Cardiology Department, Royal Bournemouth Hospital Castle Lane East Bournemouth, Bournemouth BH7 7DW, UK
| | - P Roberts
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - J M Morgan
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - A Sandilands
- Cardiology Department, Glenfield Heart Centre, Leicester, Leicestershire LE39QP, UK
| | - A Yue
- Cardiology Department, Southampton General Hospital, Southampton, Hampshire SO16 6YD, UK
| | - P D Lambiase
- Cardiology Department, The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London W1G 8PH, UK
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