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Meretsky CR, Patel VK, Mahmoodi A, Schiuma AT. Cryoablation Utilizing the KODEX-EPD Mapping System Versus Conventional Cryoballoon Ablation in the Management of Patients With Atrial Fibrillation: A Literature Review and Meta-Analysis. Cureus 2024; 16:e59407. [PMID: 38826596 PMCID: PMC11140424 DOI: 10.7759/cureus.59407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Atrial fibrillation (AF) is the most commonly encountered cardiac arrhythmia globally. AF is associated with different consequences, such as peripheral vascular embolism, stroke, dementia, heart failure, and death. Catheter ablation (CA) has become a reliable therapeutic option for symptomatic AF. Utilizing mapping systems in conducting cryoablation is supposed to improve pulmonary vein isolation (PVI) durability and overall treatment success rate. We performed a review of relevant articles. We formulated a search strategy as follows: (atrial fibrillation AND ("cryoballoon ablation" OR cryoablation) AND (KODEX-EPD AND KODEX OR mapping). Data were collected from Web of Science, PubMed, Cochrane Library, and SCOPUS databases. We assessed the efficacy, procedural characteristics, and safety of cryoablation using the KODEX-EPD mapping system versus conventional cryoablation. We demonstrated the superiority of cryoablation guided by the KODEX-EPD system as it was associated with a significantly lower recurrence rate after the procedure (RR = 0.61, P = 0.03). Furthermore, it allowed a significant reduction in the volume of contrast medium used during the procedure (MD = -20.46, P = 0.04) when compared to the conventional cryoablation. We found no significant difference between both procedures in terms of successful cryoballoon-based PVI (P = 1.00), procedural duration (P = 0.95), procedural complications (P = 0.607), fluoroscopic time (P = 0.36), and fluoroscopic dose (P = 0.16). The use of the novel KODEX-EPD mapping system in the cryoablation procedure was associated with a significant reduction of the volume of contrast medium use and the recurrence rate compared with the conventional cryoablation while preserving similar efficacy, safety profile, and procedure time.
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Affiliation(s)
| | | | - Arshia Mahmoodi
- Surgery, St. George's University School of Medicine, Great River, USA
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Rottner L, Metzner A. Atrial Fibrillation Ablation: Current Practice and Future Perspectives. J Clin Med 2023; 12:7556. [PMID: 38137626 PMCID: PMC10743921 DOI: 10.3390/jcm12247556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Catheter ablation to perform pulmonary vein isolation (PVI) is established as a mainstay in rhythm control of atrial fibrillation (AF). The aim of this review is to provide an overview of current practice and future perspectives in AF ablation. The main clinical benefit of AF ablation is the reduction of arrhythmia-related symptoms and improvement of quality of life. Catheter ablation of AF is recommended, in general, as a second-line therapy for patients with symptomatic paroxysmal or persistent AF, who have failed or are intolerant to pharmacological therapy. In selected patients with heart failure and reduced left-ventricular fraction, catheter ablation was proven to reduce all-cause mortality. Also, optimal management of comorbidities can reduce AF recurrence after AF ablation; therefore, multimodal risk assessment and therapy are mandatory. To date, the primary ablation tool in widespread use is still single-tip catheter radiofrequency (RF) based ablation. Additionally, balloon-based pulmonary vein isolation (PVI) has gained prominence, especially due to its user-friendly nature and established safety and efficacy profile. So far, the cryoballoon (CB) is the most studied single-shot device. CB-based PVI is characterized by high efficiency, convincing success rates, and a beneficial safety profile. Recently, CB-PVI as a first-line therapy for AF was shown to be superior to pharmacological treatment in terms of efficacy and was shown to reduce progression from paroxysmal to persistent AF. In this context, CB-based PVI gains more and more importance as a first-line treatment choice. Non-thermal energy sources, namely pulsed-field ablation (PFA), have garnered attention due to their cardioselectivity. Although initially applied via a basket-like ablation tool, recent developments allow for point-by-point ablation, particularly with the advent of a novel lattice tip catheter.
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Affiliation(s)
- Laura Rottner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andreas Metzner
- University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
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Kawafuji S, Yamaji H, Kayama M, Akiyama A, Miyahara M, Tomiya T, Koumoto T, Akagi T, Higashiya S, Murakami T, Kusachi S. Usefulness of three-dimensional pulmonary vein-left atrium image reconstructed from non-enhanced computed tomography for atrial fibrillation ablation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2517-2526. [PMID: 37646891 DOI: 10.1007/s10554-023-02943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
Enhanced computed tomography (CT) is unsuitable for patients with reduced renal function and/or allergy for contrast medium (CM). CT image registration into an electroanatomic system (EAMS) is essential to perform pulmonary vein isolation (PVI) safely and smoothly in patients with atrial fibrillation (AF). To create three-dimensional pulmonary vein-left atrium (3D PV-LA) images from non-enhanced CT images to register them into EAMS for AF ablation. Using a non-enhanced ECG-gated image, 3D PV-LA images were generated by our developed techniques with an EnSite image analyzing tool for patients unfit for CM use (n = 100). Segmentation between tissues was performed as follows: tissues distal from or close to PV-LA were segmented in transverse slices to clearly show the whole LA. Tissues bordering PV-LA, including the pulmonary artery, left ventricle, and right atrium, were segmented manually with great care. Practical ablation parameters were compared with those obtained from enhanced CT (n = 100). 3D PV-LA image reconstruction from non-enhanced CT imaging required a longer time than that from enhanced CT (42 ± 6 vs 14 ± 3 min). All 100 PV-LA non-enhanced CT images were successfully reconstructed and registered into the EAM system without the need for re-segmentation. Practical ablation parameters, including procedural time and AF recurrence rate, did not differ between imaging methods. This study provides clinically useful information on a detailed methodology for 3D PV-LA image reconstruction using non-enhanced CT. Non-enhanced CT 3D PV-LA images were successfully registered into the EAM system and useful for patients unsuitable for CM use.
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Affiliation(s)
- Souhei Kawafuji
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Hirosuke Yamaji
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan.
| | - Masaaki Kayama
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Akitaka Akiyama
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Motoaki Miyahara
- Division of Clinical Engineering, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takumi Tomiya
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takuto Koumoto
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takuya Akagi
- Division of Radiation, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shunichi Higashiya
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Takashi Murakami
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
| | - Shozo Kusachi
- Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Shikata 2-5-1, Kita-Ku, Okayama, 700-8558, Japan
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Lyu Y, Bennamoun M, Sharif N, Lip GYH, Dwivedi G. Artificial Intelligence in the Image-Guided Care of Atrial Fibrillation. Life (Basel) 2023; 13:1870. [PMID: 37763273 PMCID: PMC10532509 DOI: 10.3390/life13091870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Atrial fibrillation arises mainly due to abnormalities in the cardiac conduction system and is associated with anatomical remodeling of the atria and the pulmonary veins. Cardiovascular imaging techniques, such as echocardiography, computed tomography, and magnetic resonance imaging, are crucial in the management of atrial fibrillation, as they not only provide anatomical context to evaluate structural alterations but also help in determining treatment strategies. However, interpreting these images requires significant human expertise. The potential of artificial intelligence in analyzing these images has been repeatedly suggested due to its ability to automate the process with precision comparable to human experts. This review summarizes the benefits of artificial intelligence in enhancing the clinical care of patients with atrial fibrillation through cardiovascular image analysis. It provides a detailed overview of the two most critical steps in image-guided AF management, namely, segmentation and classification. For segmentation, the state-of-the-art artificial intelligence methodologies and the factors influencing the segmentation performance are discussed. For classification, the applications of artificial intelligence in the diagnosis and prognosis of atrial fibrillation are provided. Finally, this review also scrutinizes the current challenges hindering the clinical applicability of these methods, with the aim of guiding future research toward more effective integration into clinical practice.
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Affiliation(s)
- Yiheng Lyu
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
| | - Mohammed Bennamoun
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Naeha Sharif
- Department of Computer Science and Software Engineering, School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA 6009, Australia; (Y.L.); (M.B.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool L69 3BX, UK
- Liverpool John Moores University, Liverpool L3 5UX, UK
- Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research, The University of Western Australia, Perth, WA 6009, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia
- Medical School, The University of Western Australia, Perth, WA 6009, Australia
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Lemery R. Mortality of ablation of atrial fibrillation: 25 Years later, still too risky for too many. Heart Rhythm 2023; 20:842-843. [PMID: 36868543 DOI: 10.1016/j.hrthm.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Robert Lemery
- Arizona Heart Rhythm Center and St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
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Montserrat S, Gabrielli L, Borràs R, Cascos E, Castellá M, Sanchis L, Bijnens B, Mont L, Sitges M. Percutaneous or mini-invasive surgical radiofrequency re-ablation of atrial fibrillation: Impact on atrial function and echocardiographic predictors of short and long-term success. Front Cardiovasc Med 2022; 9:928090. [PMID: 36386342 PMCID: PMC9662301 DOI: 10.3389/fcvm.2022.928090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/12/2022] [Indexed: 09/08/2024] Open
Abstract
Objectives The aim of this study was to compare percutaneous catheter ablation vs. minimally invasive surgical ablation, evaluating the impact of repeated ablation on atrial function, and evaluating predictors of atrial fibrillation (AF) recurrence. Background When AF ablation fails, re-ablations are required in up to 40% of patients to treat recurrent arrhythmia; surgical ablation is more effective than catheter ablation. Methods Thirty-two patients with failed prior catheter ablation and referred for a second ablation (18 catheter and 14 surgical) were included in a descriptive observational study. Left atrial volumes, strain, and strain rate were measured with 2D speckle tracking echocardiography at baseline and 6 months after the procedures to assess left atrial functions. Patients received up to 1 year of clinical and Holter follow-up. Results At the 12-month follow-up, catheter ablation was effective in 56% and surgical ablation in 72% of patients (OR 2 (CI 0.45-8.84), p 0.36). Left atrial booster function was similar in all patients, but left atrial reservoir function was more impaired in those patients who underwent surgical ablation. Left atrial booster function was predictive of arrhythmia recurrence after both catheter and surgical ablation: late diastolic strain rate (LASRa) cut-off ≤ -0.89 s-1 (sensitivity 88%, specificity 70%, AUC 0.82) and ≤ -0.85 s-1 (sensitivity 60%, specificity 100%, AUC 0.82), respectively. Conclusion Surgical ablation has a more negative impact on LA reservoir function despite being slightly more effective in arrhythmia suppression. LA booster function is not significantly impaired by either procedure. LA booster function predicts arrhythmia elimination after a re-ablation (catheter or surgical).
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Affiliation(s)
- Sílvia Montserrat
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
- Department of Cardiology, Consorci Hospitalari de Vic, Universitat Central de Catalunya, Barcelona, Spain
| | - Luigi Gabrielli
- Advanced Center for Chronic Diseases, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roger Borràs
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Enric Cascos
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Manel Castellá
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Laura Sanchis
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Bart Bijnens
- Department of Engineering, Institució Catalana de Recerca i Estudis Avançats (ICREA)—Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluís Mont
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic, IDIBAPS, Institut Clinic Cardiovascular (ICCV), Centro de Investigación Biomédica en Red (CIBER), Cardiovascular Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
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Theofilis P, Oikonomou E, Antonopoulos AS, Siasos G, Tsioufis K, Tousoulis D. Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives. Biomedicines 2022; 10:2268. [PMID: 36140368 PMCID: PMC9496262 DOI: 10.3390/biomedicines10092268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.
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Affiliation(s)
- Panagiotis Theofilis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Evangelos Oikonomou
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Alexios S. Antonopoulos
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Gerasimos Siasos
- Third Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, University of Athens Medical School, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
| | - Dimitris Tousoulis
- First Department of Cardiology, “Hippokration” General Hospital, University of Athens Medical School, 11527 Athens, Greece
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Marini M, Pannone L, Della Rocca DG, Branzoli S, Bisignani A, Mouram S, Del Monte A, Monaco C, Gauthey A, Eltsov I, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Brugada P, La Meir M, Chierchia GB, De Asmundis C, Guarracini F. Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview. J Cardiovasc Dev Dis 2022; 9:jcdd9090302. [PMID: 36135447 PMCID: PMC9504578 DOI: 10.3390/jcdd9090302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
Electrical isolation of pulmonary veins (PVI) is the cornerstone of invasive treatment of atrial fibrillation (AF). However, arrhythmia-free survival of a PVI only approach is suboptimal in patients with persistent and long-term persistent AF. Hybrid AF ablation has been developed with the aim of combining the advantages of a thoracoscopic surgical ablation (direct visualization of anatomical structures to be spared and the possibility to perform epicardial lesions) and endocardial ablation (possibility to check line block, confirm PVI, and possibility to perform cavotricuspid isthmus ablation). Patient selection is of utmost importance. In persistent and long-term persistent AF, hybrid AF ablation demonstrated promising results in terms of AF free survival. It has been associated with a relatively low complication rate if performed in centers with expertise in hybrid procedures and experience with both surgical and endocardial ablation. Different techniques have been described, with different approaches and lesion sets. The aim of this review is to provide a state-of-the-art overview of hybrid AF ablation.
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Affiliation(s)
- Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Domenico G. Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Stefano Branzoli
- Department of Cardiac Surgery, S. Chiara Hospital, 38122 Trento, Italy
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ivan Eltsov
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 1050 Brussels, Belgium
| | - Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy
- Correspondence: or ; Tel.: +39-(0)461-903121; Fax: +39-(0)461-903122
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Garibaldi S, Chianca M, Fabiani I, Emdin M, Piacenti M, Passino C, Aimo A, Fedele A, Cipolla CM, Cardinale DM. Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation. J Clin Med 2022; 11:jcm11154452. [PMID: 35956068 PMCID: PMC9369260 DOI: 10.3390/jcm11154452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Longer life expectancy along with advancements in cancer and atrial fibrillation (AF) therapies and treatment strategies have led to an increase in the number of individuals with both diseases. As a result, the complicated management of these patients has become crucial, necessitating individualised treatment that considers the bi-directional relationship between these two diseases. On the one hand, giving appropriate pharmaceutical therapy is exceptionally difficult, considering the recognised thromboembolic risk posed by AF and malignancy, as well as the haemorrhagic risk posed by cancer. The alternative pulmonary vein isolation (PVI) ablation, on the other hand, has been inadequately explored in the cancer patient population; there is yet inadequate data to allow the clinician to unambiguously select patients that can undertake this therapeutic intervention. The goal of this review is to compile the most valuable data and supporting evidence about the characteristics, care, and therapy of cancer patients with AF. Specifically, we will evaluate the pharmaceutical options for a proper anticoagulant therapy, as well as the feasibility and safety of PVI in this population.
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Affiliation(s)
- Silvia Garibaldi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Michela Chianca
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Correspondence:
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Marcello Piacenti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Claudio Passino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Alberto Aimo
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Antonella Fedele
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Carlo Maria Cipolla
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Daniela Maria Cardinale
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
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10
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Kozuma K, Chikamori T, Hashimoto J, Honye J, Ikeda T, Ishiwata S, Kato M, Kondo H, Matsubara K, Matsumoto K, Matsumoto N, Motoyama S, Obunai K, Sakamoto H, Soejima K, Suzuki S, Abe K, Amano H, Hioki H, Iimori T, Kawai H, Kosuge H, Nakama T, Suzuki Y, Takeda K, Ueda A, Yamashita T, Hirao K, Kimura T, Nagai R, Nakamura M, Shimizu W, Tamaki N. JCS 2021 Guideline on Radiation Safety in Cardiology. Circ J 2022; 86:1148-1203. [DOI: 10.1253/circj.cj-21-0379] [Citation(s) in RCA: 2] [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)
- Ken Kozuma
- Division of Cardiology, Teikyo University Hospital
| | | | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine
| | - Junko Honye
- Department of Cardiology, Kikuna Memorial Hospital
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | - Mamoru Kato
- Department of Radiology, Akita Cerebrospinal and Cardiovascular Center
| | | | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Kazuma Matsumoto
- Department of Radiological Technology, Hyogo College of Medicine College Hospital
| | | | | | | | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Hospital
| | - Shigeru Suzuki
- Department of Radiology, Totsuka Kyouritsu Daini Hospital
| | - Koichiro Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Hideo Amano
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | | | | | - Hideki Kawai
- Department of Cardiology, Fujita Health University
| | | | | | | | | | - Akiko Ueda
- Division of Advanced Arrhythmia Management, Kyorin University Hospital
| | | | - Kenzo Hirao
- Division of Cardiovascular Medicine, AOI Universal Hospital
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Ryozo Nagai
- Department of Cardiovascular Medicine, Jichi Medical University
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine
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11
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Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol 2022; 65:287-326. [PMID: 35419669 DOI: 10.1007/s10840-022-01195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The aim of this review was to evaluate the progress made in the management of AF over the two last decades. RESULTS Clinical classification of AF is usually based on the presence of symptoms, the duration of AF episodes and their possible recurrence over time, although incidental diagnosis is not uncommon. The majority of patients with AF have associated cardiovascular diseases and more recently the recognition of modifiable risk factors both cardiovascular and non-cardiovascular which should be considered in its management. Among AF-related complications, stroke and transient ischaemic accidents (TIAs) carry considerable morbidity and mortality risk. The use of implantable devices such as pacemakers and defibrillators, wearable garments and subcutaneous cardiac monitors with recording capabilities has enabled to access the burden of "subclinical AF". The recent introduction of non-vitamin K antagonists has led to improve the prevention of stroke and peripheral embolism. Agents capable of reversing non-vitamin K antagonists have also become available in case of clinically relevant major bleeding. Transcatheter closure of left atrial appendage represents an option for patients unable to take oral anticoagulation. When treating patients with AF, clinicians need to select the most suitable strategy, i.e. control of heart rate and/or restoration and maintenance of sinus rhythm. The studies comparing these two strategies have not shown differences in terms of mortality. If an AF episode is poorly tolerated from a haemodynamic standpoint, electrical cardioversion is indicated. Otherwise, restoration of sinus rhythm can be obtained using intravenous pharmacological cardioversion and oral class I or class III antiarrhythmic is used to prevent recurrences. During the last two decades after its introduction in daily practice, catheter ablation has gained considerable escalation in popularity. Progress has also been made in AF associated with heart failure with reduced or preserved ejection fraction. CONCLUSIONS Significant progress has been made within the past 2 decades both in the pharmacological and non-pharmacological managements of this cardiac arrhythmia.
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12
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Gottlieb LA, Belterman C, van Amersfoorth S, Loyer V, Constantin M, Hocini M, Dekker LRC, Coronel R. Profibrillatory Structural and Functional Properties of the Atrial-Pulmonary Junction in the Absence of Remodeling. Front Physiol 2021; 12:748203. [PMID: 34899379 PMCID: PMC8654241 DOI: 10.3389/fphys.2021.748203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Sole pulmonary vein (PV) isolation by ablation therapy prevents atrial fibrillation (AF) in patients with short episodes of AF and without comorbidities. Since incomplete PV isolation can be curative, we tested the hypothesis that the PV in the absence of remodeling and comorbidities contains structural and functional properties that are proarrhythmic for AF initiation by reentry. Methods: We performed percutaneous transvenous in vivo endocardial electrophysiological studies and quantitative histological analysis of PV from healthy sheep. Results: The proximal PV contained more myocytes than the distal PV and a higher percentage of collagen and fat tissue relative to myocytes than the left atrium. Local fractionated electrograms occurred in both the distal and proximal PVs, but a large local activation (>0.75 mV) was more often present in the proximal PV than in the distal PV (86 vs. 50% of electrograms, respectively, p = 0.017). Atrial arrhythmias (run of premature atrial complexes) occurred more often following the premature stimulation in the proximal PV than in the distal PV (p = 0.004). The diastolic stimulation threshold was higher in the proximal PV than in the distal PV (0.7 [0.3] vs. 0.4 [0.2] mA, (median [interquartile range]), p = 0.004). The refractory period was shorter in the proximal PV than in the distal PV (170 [50] vs. 248 [52] ms, p < 0.001). A linear relation existed between the gradient in refractoriness (distal-proximal) and atrial arrhythmia inducibility in the proximal PV. Conclusion: The structural and functional properties of the native atrial-PV junction differ from those of the distal PV. Atrial arrhythmias in the absence of arrhythmia-induced remodeling are caused by reentry in the atrial-PV junction. Ablative treatment of early paroxysmal AF, rather than complete isolation of focal arrhythmia, may be limited to inhibition of reentry.
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Affiliation(s)
- Lisa A Gottlieb
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands.,IHU Liryc, University of Bordeaux, Bordeaux, France
| | - Charly Belterman
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Shirley van Amersfoorth
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | | | | | - Lukas R C Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ruben Coronel
- Department of Experimental Cardiology, Location Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands.,IHU Liryc, University of Bordeaux, Bordeaux, France
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13
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Penela D, Cappato R. How effective is cryoablation in the treatment of atrial fibrillation? Eur Heart J Suppl 2021; 23:E51-E54. [PMID: 34650354 PMCID: PMC8503316 DOI: 10.1093/eurheartj/suab089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pulmonary vein isolation is the standard for atrial fibrillation ablation. Although the most commonly applied energy source is radiofrequency (RF), cryoablation has rapidly evolved as a powerful one-shot tool, particularly after the introduction of the second-generation catheter, gaining widespread use in recent years. The efficacy in maintaining sinus rhythm after a first ablative procedure is ∼70–80%, and the randomization studies comparing cryoablation to RF have not been able to reveal significant differences up to now. Although different baseline characteristics may influence the efficacy of cryoablation, we are not yet able to distinguish which patients may benefit from a personalized choice of ablative source. Regarding safety, cryoballoon ablation appears to be associated with a lower rate of pericardial effusion and cardiac tamponade, mainly due to the lack of risk of overheating. The other side of the coin is a higher incidence of phrenic nerve damage, which occurs in 1–2% of procedures. In conclusion, we do not yet have definitive data to affirm the superiority of the RF technique over that of cryoablation. The choice of energy source currently depends on the availability of the centre and on the experience of the operator.
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Affiliation(s)
- Diego Penela
- Centro di Aritmologia Clinica ed Elettrofisiologia, IRCCS Multimedica Group, Sesto San Giovanni, Milano, Italy
| | - Riccardo Cappato
- Centro di Aritmologia Clinica ed Elettrofisiologia, IRCCS Multimedica Group, Sesto San Giovanni, Milano, Italy
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14
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Left Atrial Appendage Exclusion in Atrial Fibrillation Radiofrequency Ablation during Mitral Valve Surgery: A Single-Center Experience. Cardiol Res Pract 2021; 2021:9999412. [PMID: 34394984 PMCID: PMC8355965 DOI: 10.1155/2021/9999412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background Atrial fibrillation surgical radiofrequency ablation (AFSA) during mitral valve surgery (MVS) has almost completely superseded the Cox-Maze procedure for the treatment of atrial fibrillation. Methods We retrospectively analyzed 100 patients who underwent MVS + AFSA in our institution from January 2008 to June 2017. We compared the effectiveness of AFSA in patients who underwent LAA exclusion to those who did not. Moreover, we analyzed the role of preoperative AF duration (≤ or >1 year) and medial-lateral left atrial dimensions (ML-LAD) (≤ or >6 cm). The efficacy endpoint was freedom from AF at discharge and at 2-year follow-up. The safety endpoints were need of a permanent pacemaker (PMK), surgical re-exploration, occurrence of stroke, and left circumflex artery or esophageal lesions. Results Overall, the rate of AF freedom was 69% at discharge and 80% at 2-year follow-up. LAA exclusion did not influence AF freedom at 2-year follow-up, and 84.6% of patients who underwent LAA exclusion were in the sinus rythm (SR) at 2 year compared to 75% of those who did not receive LAA exclusion free from AF as well (p=0.230). AF duration ≤1 or >1 year did not influence sinus rhythm (SR) maintenance (85.7% vs. 75.8%; p=0.224), and in these two groups, LAA exclusion did not change the efficacy of AFSA. ML-LAD ≤ 6 cm was associated with better results in terms of SR maintenance. A statistically significant association between LAA exclusion and SR maintenance at 2-year follow-up (p=0.017) was found among patients with ML-LAD ≤ 6 cm. Complications included 7 cases of PMK implantation, 2 cases of surgical re-exploration, and 1 case of stroke. No circumflex artery or esophageal lesions occurred after surgical procedures. Conclusions In our experience, AFSA during isolated MVS resulted in good outcomes in terms of SR maintenance and incidence of complications. AF duration ≤ 1 year did not influence results, while patients with ML-LAD ≤ 6 cm had significantly better results regarding SR at follow-up. In patients with ML-LAD ≤ 6 cm, LAA exclusion significantly increased the success rate of SR maintenance at 2-year follow-up.
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15
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Khoynezhad A, Warrier N, Worthington T, Shandling A. A narrative review of hybrid ablation for persistent and longstanding persistent atrial fibrillation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:947. [PMID: 34350262 PMCID: PMC8263859 DOI: 10.21037/atm-21-196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023]
Abstract
Atrial fibrillation is the most common sustained arrhythmia and is characterized by rapid and irregular atrial activation with loss of atrial contraction. There has been a significant evolution of treatments over the past 30 years. Initially, cardiac surgeons developed approaches via sternotomy with superior efficacy, however early iterations of the procedure were associated with prolonged recovery time and frequent need for pacemaker placement. The current surgical approach to the maze procedure via sternotomy yields excellent efficacy and is a Class 1 recommendation for patients with atrial fibrillation undergoing a concomitant procedure. Several years following the initial development of the surgical maze procedure, cardiac electrophysiologists developed less invasive, however less efficacious catheter ablation options by percutaneous approach. Both the surgical and transcatheter approaches have their advantages and disadvantages with varying risks of complications and efficacy. Through the combination of expertise of cardiac surgeons paired with the electrophysiology team, a hybrid ablation procedure has been developed offering an increased efficacy with a less-invasive approach than the current gold standard treatment of Cox-maze IV procedure. This review will discuss the hybrid ablation procedure, review recent associated clinical trials, and discuss advantages and challenges associated with this multidisciplinary approach for management of patients with AF.
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Affiliation(s)
- Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, Long Beach, CA, USA
| | - Nikhil Warrier
- MemorialCare Heart and Vascular Institute, Long Beach, CA, USA
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16
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La Rosa G, Quintanilla JG, Salgado R, González-Ferrer JJ, Cañadas-Godoy V, Pérez-Villacastín J, Jalife J, Pérez-Castellano N, Filgueiras-Rama D. Anatomical targets and expected outcomes of catheter-based ablation of atrial fibrillation in 2020. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:341-359. [PMID: 33283883 DOI: 10.1111/pace.14140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
Anatomical-based approaches, targeting either pulmonary vein isolation (PVI) or additional extra PV regions, represent the most commonly used ablation treatments in symptomatic patients with atrial fibrillation (AF) recurrences despite antiarrhythmic drug therapy. PVI remains the main anatomical target during catheter-based AF ablation, with the aid of new technological advances as contact force monitoring to increase safety and effective radiofrequency (RF) lesions. Nowadays, cryoballoon ablation has also achieved the same level of scientific evidence in patients with paroxysmal AF undergoing PVI. In parallel, electrical isolation of extra PV targets has progressively increased, which is associated with a steady increase in complex cases undergoing ablation. Several atrial regions as the left atrial posterior wall, the vein of Marshall, the left atrial appendage, or the coronary sinus have been described in different series as locations potentially involved in AF initiation and maintenance. Targeting these regions may be challenging using conventional point-by-point RF delivery, which has opened new opportunities for coadjuvant alternatives as balloon ablation or selective ethanol injection. Although more extensive ablation may increase intraprocedural AF termination and freedom from arrhythmias during the follow-up, some of the targets to achieve such outcomes are not exempt of potential severe complications. Here, we review and discuss current anatomical approaches and the main ablation technologies to target atrial regions associated with AF initiation and maintenance.
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Affiliation(s)
- Giulio La Rosa
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Jorge G Quintanilla
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ricardo Salgado
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain
| | - Juan José González-Ferrer
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Cañadas-Godoy
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Julián Pérez-Villacastín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - José Jalife
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Nicasio Pérez-Castellano
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Fundación Interhospitalaria para la Investigación Cardiovascular (FIC), Madrid, Spain
| | - David Filgueiras-Rama
- Department of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Cardiovascular Institute, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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17
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Mascia G, Giaccardi M. A New Era in Zero X-ray Ablation. Arrhythm Electrophysiol Rev 2020; 9:121-127. [PMID: 33240507 PMCID: PMC7675142 DOI: 10.15420/aer.2020.02] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
In this article, the authors focus on the importance of the zero X-ray ablation approach in electrophysiology. Radiation exposure related to conventional transcatheter ablation carries small but non-negligible stochastic and deterministic effects on health. Non-fluoroscopic mapping systems can significantly reduce, or even completely avoid, radiological exposure. The zero X-ray approach determines potential clinical benefits in terms of reduction of ionising radiation exposure, as well as safe technical advantages. The use of this method can result in similar outcomes when compared to the conventional fluoroscopic technique. These results are achieved without altering the duration, or compromising the effectiveness and safety, of the procedure. The zero X-ray ablation approach is a feasible and safe alternative to fluoroscopy, which is often only used in selected cases for troubleshooting. The non-fluoroscopic approach is considered a milestone for cancer prevention in ablation procedures.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Marzia Giaccardi
- Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
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18
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Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol 2020; 18:210-225. [PMID: 33051613 DOI: 10.1038/s41569-020-00451-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
Catheter ablation for atrial fibrillation (AF) has emerged as an important rhythm-control strategy and is by far the most common cardiac ablation procedure performed worldwide. Current guidelines recommend the procedure in symptomatic patients with paroxysmal or persistent AF who are refractory or intolerant to antiarrhythmic drugs. The procedure might also be considered as a first-line approach in selected asymptomatic patients. Data from large registries indicate that AF ablation might reduce mortality and the risk of heart failure and stroke, but evidence from randomized controlled trials is mixed. Pulmonary vein isolation using point-by-point radiofrequency or with the cryoballoon remains the cornerstone technique in AF ablation. Additional atrial ablation can be performed in patients with persistent AF, but its benefits are largely unproven. Technological advances in the past decade have focused on achieving durable vein isolation, reducing procedure duration and improving safety. Numerous exciting new technologies are in various stages of development. In this Review, we discuss the relevant data to support the recommended and evolving indications for catheter ablation of AF, describe the different ablation techniques, and highlight the latest advances in technology that aim to improve its safety and efficacy. We also discuss lifestyle modification strategies to improve ablation outcomes.
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Affiliation(s)
- Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Ahmed M Al-Kaisey
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. .,Department of Medicine, University of Melbourne, Melbourne, Australia.
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19
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Rottner L, Waddell D, Lin T, Metzner A, Rillig A. Innovative tools for atrial fibrillation ablation. Expert Rev Med Devices 2020; 17:555-563. [DOI: 10.1080/17434440.2020.1768846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Laura Rottner
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
| | - Daniela Waddell
- Department of Cardiology, Asklepios Klinik Sankt Georg , Hamburg, Germany
| | - Tina Lin
- Department of Cardiology, GenesisCare , Melbourne, Australia
| | - Andreas Metzner
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Universitäres Herzzentrum Hamburg-Eppendorf , Hamburg, Germany
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20
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Kim Y, Chen S, Ernst S, Guzman CE, Han S, Kalarus Z, Labadet C, Lin Y, Lo L, Nogami A, Saad EB, Sapp J, Sticherling C, Tilz R, Tung R, Kim YG, Stiles MK. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm 2020; 36:215-270. [PMID: 32256872 PMCID: PMC7132207 DOI: 10.1002/joa3.12308] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/20/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young‐Hoon Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
| | - Shih‐Ann Chen
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Sabine Ernst
- Department of CardiologyRoyal Brompton and Harefield HospitalImperial College LondonLondonUK
| | | | - Seongwook Han
- Division of CardiologyDepartment of Internal MedicineKeimyung University School of MedicineDaeguRepublic of Korea
| | - Zbigniew Kalarus
- Department of CardiologyMedical University of SilesiaKatowicePoland
| | - Carlos Labadet
- Cardiology DepartmentArrhythmias and Electrophysiology ServiceClinica y Maternidad Suizo ArgentinaBuenos AiresArgentina
| | - Yenn‐Jian Lin
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Li‐Wei Lo
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiROC
| | - Akihiko Nogami
- Department of CardiologyFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Eduardo B. Saad
- Center for Atrial FibrillationHospital Pro‐CardiacoRio de JaneiroBrazil
| | - John Sapp
- Division of CardiologyDepartment of MedicineQEII Health Sciences CentreDalhousie UniversityHalifaxNSCanada
| | | | - Roland Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine)University Hospital Schleswig‐Holstein (UKSH) – Campus LuebeckLuebeckGermany
| | - Roderick Tung
- Center for Arrhythmia CarePritzker School of MedicineUniversity of Chicago MedicineChicagoILUSA
| | - Yun Gi Kim
- Department of Internal MedicineArrhythmia CenterKorea University Medicine Anam HospitalSeoulRepublic of Korea
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21
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Patel NJ, Maradey JA, Bhave PD. Atrial Fibrillation Ablation: Indications and Techniques. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:43. [PMID: 31342171 DOI: 10.1007/s11936-019-0747-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) predisposes to embolic strokes and reduced quality of life. Ablation (catheter-based or surgically performed) can be employed to promote the maintenance of sinus rhythm in a carefully selected subset of patients with AF. The goal of this review is to discuss the indications and techniques for AF ablation, as well as post-procedural outcomes. RECENT FINDINGS Atrial fibrillation ablation improves quality of life in patients with atrial fibrillation although no clear reduction in stroke or overall mortality has been shown. Familiarity with the indications for AF ablation is important for all cardiologists, as is having a sound understanding of the efficacy of the procedure and potential complications. Furthermore, acquiring a grasp of the different modalities of AF ablation (including percutaneous endocardial techniques and surgical ablation approaches) will help to facilitate effective and appropriate referrals.
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Affiliation(s)
- Neel J Patel
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Joan A Maradey
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Prashant D Bhave
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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22
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Ota T, Degani A, Zubiate B, Wolf A, Choset H, Schwartzman D, Zenati MA. Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 1:335-340. [PMID: 17895961 PMCID: PMC1993852 DOI: 10.1097/imi.0b013e31802f43b1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. Methods In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. Results Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. Conclusions We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype.
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Affiliation(s)
- Takeyoshi Ota
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amir Degani
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Brett Zubiate
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Alon Wolf
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Howie Choset
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - David Schwartzman
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marco A. Zenati
- Division of Cardiac Surgery, The Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
- Bio Robotics Lab, Carnegie Mellon University, Pittsburgh, Pennsylvania
- Atrial Arrhythmia Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Yu HT, Jeong DS, Pak HN, Park HS, Kim JY, Kim J, Lee JM, Kim KH, Yoon NS, Roh SY, Oh YS, Cho YJ, Shim J. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part II. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zedira A, Greffier J, Brunet X, Pereira F, Winum PF, Granier M. Decreased operator X-ray exposure by optimized fluoroscopy during radiofrequency ablation of common atrial flutter. Diagn Interv Imaging 2018; 99:625-632. [PMID: 29754870 DOI: 10.1016/j.diii.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/15/2018] [Accepted: 04/06/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate operator and patient irradiation during radiofrequency ablation (RFA) of common atrial flutter (AF) using three different fluoroscopy settings. MATERIAL AND METHOD A total of 38 patients who underwent RFA of AF with three different fluoroscopy settings (low dose, standard dose and collimated field) were included. Twelve patients (11 men, 1 woman; mean age, 67±12 [SD]years) were included in the low dose group (3.75 frames per second), 13 patients (13 men; mean age, 66±8 [SD]years) were included in the standard dose group (7.5 frames per second) and 13 patients (13 men; mean age, 71±12 [SD]years) were included in the collimated field group (7.5 frames per second). Operator and patient exposure were compared between groups. RESULT No differences in procedure time and radiation exposure were found between the three groups. In the low dose group, mean operator X-ray exposures of eye-lens (4.7±2.9 [SD]μSv/h; range: 0.9-10.5μSv/h), whole body (1.6±1.2 [SD]μSv/h; range 0.5-3.6μSv/h) and hand skin (11.1±10.8 [SD] μSv/h; range 2.4-35.4μSv/h) were significantly lower than those in the standard dose group (P<0.001). Significant patient dose reduction was found between low dose group (0.7±0.4 [SD]Gy/h; range: 0.3-0.9Gy/h) and standard (1.7±0.5 [SD]Gy/h; range: 0.8 to 3.9Gy/h) and collimated (1.8±0.5 [SD]Gy/h; range: 0.7-3.0Gy/h) groups (P<0.01). CONCLUSION The use of a low dose setting (3.75 f/s) during fluoroscopy dramatically reduces operator's irradiation during RFA of AF by a mean of 90%.
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Affiliation(s)
- A Zedira
- Department of Cardiology, centre hospitalier universitaire de Nîmes, Nîmes, France
| | - J Greffier
- Department of Radiology, Medical Imaging Group, EA 2415, centre hospitalier Universitaire de Nîmes, 30900 Nîmes, France
| | - X Brunet
- Department of Cardiology, centre hospitalier universitaire de Nîmes, Nîmes, France
| | - F Pereira
- Department of Radiology, Medical Imaging Group, EA 2415, centre hospitalier Universitaire de Nîmes, 30900 Nîmes, France
| | - P-F Winum
- Department of Cardiology, centre hospitalier universitaire de Nîmes, Nîmes, France
| | - M Granier
- Department of Cardiology, centre hospitalier universitaire de Nîmes, Nîmes, France.
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Grossi S, Grassi F, Galleani L, Bianchi F, Conte MR. A comparison of contact force and remote magnetic navigation on lesion formation for the ablation of atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:450-458. [DOI: 10.1111/pace.13295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/01/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | - Francesco Grassi
- Department of Electronics and Telecommunications; Politecnico di Torino; Turin Italy
| | - Lorenzo Galleani
- Department of Electronics and Telecommunications; Politecnico di Torino; Turin Italy
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26
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 727] [Impact Index Per Article: 121.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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27
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1415] [Impact Index Per Article: 202.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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29
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Xu FQ, Yu RH, Guo JJ, Bai R, Liu N, An YI, Guo XY, Tang RB, Long DEY, Sang CH, DU X, Dong JZ, Ma CS. Catheter Ablation of Recurrent Paroxysmal Atrial Fibrillation: Is Gap-Closure Combining Ganglionated Plexi Ablation More Effective? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:672-682. [PMID: 28251658 DOI: 10.1111/pace.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND For repeat treatment with paroxysmal atrial fibrillation (PAF) recurrence, gap-closure at pulmonary vein ostia alone is not enough. Many recent studies indicated that ganglionated plexi (GPs) denervation could reduce the recurrence of AF. However, it is unclear whether the clinical outcomes of additional GP ablation plus pulmonary veins (PVs ) reisolation during a repeat procedure were associated with less recurrence in PAF patients. The purpose of this study was to evaluate if a repeat procedure of GP ablation (GPA) combining repeated procedure of pulmonary vein isolation (re-PVI), i.e., gap-closure, can offer additional benefit for patients with PAF recurrence. METHOD A total of 123 consecutive patients with PAF recurrence who underwent success repeat procedures were retrospectively analyzed in our center (2014-2015). Note that 64 patients (group 1, GPA group) were performed with GPA plus re-PVI, while 59 patients (group 2, re-PVI group) had re-PVI (gap-closure) alone. Organized atrial tachycardias (OATs) documented or induced at the end of the procedure were all mapped and ablated. Patients were scheduled for a 12-month follow-up. Clinical presentation and outcome data for the two groups were assessed. RESULT At the 12-month follow-up 58 of 64 patients (90.6%) in group 1 and 46 of 59 patients (78%) in group 2 remained in sinus rhythm (SR) off antiarrhythmia drugs (AADs) (P = 0.045). CONCLUSION GPA conferred incremental benefit when performed in addition to re-PVI in patients with PAF recurrence; the GPA group yielded higher success rates than the re-PVI group.
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Affiliation(s)
- Feng-Qiang Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.,Department of Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, Qingdao, China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jun-Jie Guo
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Y I An
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - DE-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin DU
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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30
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Han X, Li J. Catheter Ablation of Atrial Fibrillation: Where Are We? CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2016.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Benscoter MA, Iaizzo PA. Visualization of catheter ablation for atrial fibrillation: Impact of devices and anatomy. World J Cardiol 2015; 7:754-764. [PMID: 26635923 PMCID: PMC4660470 DOI: 10.4330/wjc.v7.i11.754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/26/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Endocardial access to the left atrium is commonly achieved to treat patients with atrial fibrillation, using different device delivery systems for cardiac ablation. But the large variation in human anatomy presses the limits of existing medical devices. In this unique study, we directly visualized the device-tissue interface in fresh reanimated human hearts using Visible Heart® methodologies. Our goal was to better understand any opportunities to improve therapeutic approaches. The visual images obtained in this study (also featured in this article) allow a more intimate grasp of the key steps required in various ablation procedures, as well as some limitations of current device designs. These images show the potential risks of conducting transseptal punctures and the difficulties of placing catheter tips in certain scenarios (e.g., when creating circumferential lesions); they also demonstrate potential problems that could occur while attempting to place catheter tips on such anatomies like the mitral isthmus. In our analysis of these images, we focus on where enhancements are needed to refine device functionality.
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Schmidt EJ, Tse ZTH, Reichlin TR, Michaud GF, Watkins RD, Butts-Pauly K, Kwong RY, Stevenson W, Schweitzer J, Byrd I, Dumoulin CL. Voltage-based device tracking in a 1.5 Tesla MRI during imaging: initial validation in swine models. Magn Reson Med 2015; 71:1197-209. [PMID: 23580479 DOI: 10.1002/mrm.24742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Voltage-based device-tracking (VDT) systems are commonly used for tracking invasive devices in electrophysiological cardiac-arrhythmia therapy. During electrophysiological procedures, electro-anatomic mapping workstations provide guidance by integrating VDT location and intracardiac electrocardiogram information with X-ray, computerized tomography, ultrasound, and MR images. MR assists navigation, mapping, and radiofrequency ablation. Multimodality interventions require multiple patient transfers between an MRI and the X-ray/ultrasound electrophysiological suite, increasing the likelihood of patient-motion and image misregistration. An MRI-compatible VDT system may increase efficiency, as there is currently no single method to track devices both inside and outside the MRI scanner. METHODS An MRI-compatible VDT system was constructed by modifying a commercial system. Hardware was added to reduce MRI gradient-ramp and radiofrequency unblanking pulse interference. VDT patches and cables were modified to reduce heating. Five swine cardiac VDT electro-anatomic mapping interventions were performed, navigating inside and thereafter outside the MRI. RESULTS Three-catheter VDT interventions were performed at >12 frames per second both inside and outside the MRI scanner with <3 mm error. Catheters were followed on VDT- and MRI-derived maps. Simultaneous VDT and imaging was possible in repetition time >32 ms sequences with <0.5 mm errors, and <5% MRI signal-to-noise ratio (SNR) loss. At shorter repetition times, only intracardiac electrocardiogram was reliable. Radiofrequency heating was <1.5°C. CONCLUSION An MRI-compatible VDT system is feasible.
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Affiliation(s)
- Ehud J Schmidt
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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MALLIET NICOLAS, ANDRADE JASONG, KHAIRY PAUL, NGUYEN THANH HIENKIEM, VENIER SANDRINE, DUBUC MARC, DYRDA KATIA, GUERRA PETER, MONDÉSERT BLANDINE, RIVARD LÉNA, TADROS RAFIK, TALAJIC MARIO, THIBAULT BERNARD, ROY DENIS, MACLE LAURENT. Impact of a Novel Catheter Tracking System on Radiation Exposure during the Procedural Phases of Atrial Fibrillation and Flutter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:784-90. [DOI: 10.1111/pace.12611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- NICOLAS MALLIET
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - JASON G. ANDRADE
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
- Department of Medicine; The University of British Columbia; Vancouver Canada
| | - PAUL KHAIRY
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - HIEN KIEM NGUYEN THANH
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - SANDRINE VENIER
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - MARC DUBUC
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - KATIA DYRDA
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - PETER GUERRA
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - BLANDINE MONDÉSERT
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - LÉNA RIVARD
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - RAFIK TADROS
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - MARIO TALAJIC
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - BERNARD THIBAULT
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - DENIS ROY
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
| | - LAURENT MACLE
- Electrophysiology Service; Montreal Heart Institute; Montreal Canada
- Department of Medicine; Université de Montréal; Montreal Canada
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CERESNAK SCOTTR, DUBIN ANNEM, KIM JEFFREYJ, VALDES SANTIAGOO, FISHBERGER STEVENB, SHETTY IRA, ZIMMERMAN FRANK, TANEL RONNE, EPSTEIN MICHAELR, MOTONAGA KARAS, CAPONE CHRISTINEA, NAPPO LYNN, GATES GREGORYJ, PASS ROBERTH. Success Rates in Pediatric WPW Ablation Are Improved with 3-Dimensional Mapping Systems Compared with Fluoroscopy Alone: A Multicenter Study. J Cardiovasc Electrophysiol 2015; 26:412-416. [DOI: 10.1111/jce.12623] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/26/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- SCOTT R. CERESNAK
- Department of Pediatrics; Lucile Packard Children's Hospital, Stanford University; Palo Alto California USA
| | - ANNE M. DUBIN
- Department of Pediatrics; Lucile Packard Children's Hospital, Stanford University; Palo Alto California USA
| | - JEFFREY J. KIM
- Department of Pediatric Medicine, Baylor College of Medicine; Texas Children's Hospital; Houston Texas USA
| | - SANTIAGO O. VALDES
- Department of Pediatric Medicine, Baylor College of Medicine; Texas Children's Hospital; Houston Texas USA
| | | | - IRA SHETTY
- Department of Pediatrics; Advocate Children's Hospital; Oak Lawn Illinois USA
| | - FRANK ZIMMERMAN
- Department of Pediatrics; Advocate Children's Hospital; Oak Lawn Illinois USA
| | - RONN E. TANEL
- Department of Pediatrics, UCSF School of Medicine; UCSF Benioff Children's Hospital; San Francisco California USA
| | | | - KARA S. MOTONAGA
- Department of Pediatrics; Lucile Packard Children's Hospital, Stanford University; Palo Alto California USA
| | - CHRISTINE A. CAPONE
- Department of Pediatrics, Albert Einstein College of Medicine; The Children's Hospital at Montefiore; Bronx New York USA
| | - LYNN NAPPO
- Department of Pediatrics, Albert Einstein College of Medicine; The Children's Hospital at Montefiore; Bronx New York USA
| | - GREGORY J. GATES
- Department of Pediatrics, Albert Einstein College of Medicine; The Children's Hospital at Montefiore; Bronx New York USA
| | - ROBERT H. PASS
- Department of Pediatrics, Albert Einstein College of Medicine; The Children's Hospital at Montefiore; Bronx New York USA
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Santos SND, Henz BD, Zanatta AR, Barreto JR, Loureiro KB, Novakoski C, Santos MVND, Giuseppin FF, Oliveira EM, Leite LR. Impact of atrial fibrillation ablation on left ventricular filling pressure and left atrial remodeling. Arq Bras Cardiol 2015; 103:485-92. [PMID: 25590928 PMCID: PMC4290739 DOI: 10.5935/abc.20140152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 07/31/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is associated with new-onset atrial fibrillation (AF), and the estimation of elevated LV filling pressures by E/e' ratio is related to worse outcomes in patients with AF. However, it is unknown if restoring sinus rhythm reverses this process. OBJECTIVE To evaluate the impact of AF ablation on estimated LV filling pressure. METHODS A total of 141 patients underwent radiofrequency (RF) ablation to treat drug-refractory AF. Transthoracic echocardiography was performed 30 days before and 12 months after ablation. LV functional parameters, left atrial volume index (LAVind), and transmitral pulsed and mitral annulus tissue Doppler (e' and E/e') were assessed. Paroxysmal AF was present in 18 patients, persistent AF was present in 102 patients, and long-standing persistent AF in 21 patients. Follow-up included electrocardiographic examination and 24-h Holter monitoring at 3, 6, and 12 months after ablation. RESULTS One hundred seventeen patients (82.9%) were free of AF during the follow-up (average, 18 ± 5 months). LAVind reduced in the successful group (30.2 mL/m(2) ± 10.6 mL/m(2) to 22.6 mL/m(2) ± 1.1 mL/m(2), p < 0.001) compared to the non-successful group (37.7 mL/m(2) ± 14.3 mL/m(2) to 37.5 mL/m(2) ± 14.5 mL/m(2), p = ns). Improvement of LV filling pressure assessed by a reduction in the E/e' ratio was observed only after successful ablation (11.5 ± 4.5 vs. 7.1 ± 3.7, p < 0.001) but not in patients with recurrent AF (12.7 ± 4.4 vs. 12 ± 3.3, p = ns). The success rate was lower in the long-standing persistent AF patient group (57% vs. 87%, p = 0.001). CONCLUSION Successful AF ablation is associated with LA reverse remodeling and an improvement in LV filling pressure.
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Affiliation(s)
| | - Benhur Davi Henz
- Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil
| | | | | | | | | | | | - Fabio F Giuseppin
- Instituto Brasília de Arritmia, Universidade de Brasília, DF, Brazil
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Left atrial deformation predicts success of first and second percutaneous atrial fibrillation ablation. Heart Rhythm 2015; 12:11-8. [DOI: 10.1016/j.hrthm.2014.08.032] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 12/12/2022]
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Vizzardi E, Curnis A, Latini MG, Salghetti F, Rocco E, Lupi L, Rovetta R, Quinzani F, Bonadei I, Bontempi L, D'Aloia A, Dei Cas L. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med (Hagerstown) 2014; 15:235-53. [PMID: 23114271 DOI: 10.2459/jcm.0b013e328358554b] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atrial fibrillation is the most common arrhythmia managed in clinical practice and it is associated with an increased risk of mortality, stroke and peripheral embolism. Unfortunately, the incidence of atrial fibrillation recurrence ranges from 40 to 50%, despite the attempts of electrical cardioversion and the administration of antiarrhythmic drugs. In this review, the literature data about predictors of atrial fibrillation recurrence are highlighted, with special regard to clinical, therapeutic, biochemical, ECG and echocardiographic parameters after electrical cardioversion and ablation. Identifying predictors of success in maintaining sinus rhythm after cardioversion or ablation may allow a better selection of patients to undergo these procedures. The aim is to reduce healthcare costs and avoid exposing patients to unnecessary procedures and related complications. Recurrent atrial fibrillation depends on a combination of several parameters and each patient should be individually assessed for such a risk of recurrence.
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Affiliation(s)
- Enrico Vizzardi
- Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
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Casella M, Russo E, Pizzamiglio F, Conti S, Al-Mohani G, Colombo D, Casula V, D Alessandra Y, Biagioli V, Carbucicchio C, Riva S, Fassini G, Moltrasio M, Tundo F, Zucchetti M, Majocchi B, Marino V, Forleo G, Santangeli P, Di Biase L, Dello Russo A, Natale A, Tondo C. The Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab. J Atr Fibrillation 2014; 7:1104. [PMID: 27957101 DOI: 10.4022/jafib.1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/10/2022]
Abstract
Most of interventional procedures in cardiology are carried out under fluoroscopic imaging guidance. Besides other peri-interventional risks, radiation exposure should be considered for its stochastic (inducing malignancy) and deterministic effects on health (tissue reactions like erythema, hair loss and cataracts). In this article we analized the radiation risk from cardiovascular imaging to both patients and medical staff and discusses how customize the X-ray system and how to implement shielding measures in the cath lab. Finally, we reviewed the most recent developments and the latest findings in catheter navigation and 3D electronatomical mapping systems that may help to reduce patient and operator exposure.
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Affiliation(s)
- Michela Casella
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Eleonora Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | | | - Sergio Conti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Ghaliah Al-Mohani
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Daniele Colombo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Victor Casula
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu
| | - Yuri D Alessandra
- Laboratory of immunology and functional genomics, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Viviana Biagioli
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Corrado Carbucicchio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Stefania Riva
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Gaetano Fassini
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Martina Zucchetti
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Benedetta Majocchi
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Vittoria Marino
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Giovanni Forleo
- Division of Cardiology, Policlinico Tor Vergata, Rome, Italy
| | - Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute at St David?s Medical Center, Austin, TX, USA
| | - Antonio Dello Russo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
| | - Andrea Natale
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA
| | - Claudio Tondo
- CardiacArrhythmia Research Centre, Centro CardiologicoMonzino IRCCS, Milan, Italy
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Mahida S, Berte B, Yamashita S, Derval N, Denis A, Shah A, Amraoui S, Hocini M, Haissaguerre M, Jais P, Sacher F. New Ablation Technologies and Techniques. Arrhythm Electrophysiol Rev 2014; 3:107-12. [PMID: 26835075 PMCID: PMC4711538 DOI: 10.15420/aer.2014.3.2.107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/28/2014] [Indexed: 11/04/2022] Open
Abstract
Catheter ablation is an established treatment strategy for a range of different cardiac arrhythmias. Over the past decade two major areas of expansion have been ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) in the context of structurally abnormal hearts. In parallel with the expanding role of catheter ablation for AF and VT, multiple novel technologies have been developed which aim to increase safety and procedural success. Areas of development include novel catheter designs, novel navigation technologies and higher resolution imaging techniques. The aim of the present review is to provide an overview of novel developments in AF ablation and VT ablation in patients with of structural cardiac diseases.
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Affiliation(s)
- Saagar Mahida
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Benjamin Berte
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Seigo Yamashita
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Arnaud Denis
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Ashok Shah
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Sana Amraoui
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Meleze Hocini
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Michel Haissaguerre
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalen Bordeaux II, Bordeaux, France
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Anselmino M, Ferraris F, Cerrato N, Barbero U, Scaglione M, Gaita F. Left persistent superior vena cava and paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2014; 15:647-52. [DOI: 10.2459/jcm.0000000000000144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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41
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Pezawas T, Ristl R, Bilinski M, Schukro C, Schmidinger H. Single, remote-magnetic catheter approach for pulmonary vein isolation in patients with paroxysmal and non-paroxysmal atrial fibrillation. Int J Cardiol 2014; 174:18-24. [DOI: 10.1016/j.ijcard.2014.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/31/2014] [Accepted: 03/09/2014] [Indexed: 12/19/2022]
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Arbelo E, Brugada J, Hindricks G, Maggioni AP, Tavazzi L, Vardas P, Laroche C, Anselme F, Inama G, Jais P, Kalarus Z, Kautzner J, Lewalter T, Mairesse GH, Perez-Villacastin J, Riahi S, Taborsky M, Theodorakis G, Trines SA, Brugada J, Arbelo E, Hindriks G, Maggioni AP, Morgan J, Tavazzi L, Vardas P, Alonso A, Ferrari R, Komajda M, Tavazzi L, Wood D, Vardas P, Brugada J, Mairesse G, Taborsky M, Kautzner J, Lewalter T, Riahi S, Jais P, Anselme F, Theodorakis G, Inama G, Trines S, Kalarus Z, Villacastin JP, Maggioni AP, Manini M, Gracia G, Laroche C, Missiamenou V, Taylor C, Konte M, Fiorucci E, Lefrancq EF, Glémot M, McNeill PA, Bois T, Heidbüchel H, Nuyens D, Boland J, Dinraths V, Herzet JM, Hoffer E, Malmendier D, Massoz M, Pourbaix S, Ballant E, Blommaert D, Deceuninck O, Dormal F, Xhaet O, De Potter T, Geelen P, Derycker K, Duytschaever M, Tavernier R, Vandekerckhove Y, Vankats D, Bulava A, Hanis J, Sitek D, Blahova M, Cihak R, Hanyasova L, Jansova H, Peichl P, Tanzerova M, Wichterle D, Duda J, Haman L, Parizek P, Coling L, Neuzil P, Petru J, Sediva L, Skoda J, Chovancik J, Fiala M, Neuwirth R, Karlsdottir A, Pehrson S, Gerdes C, Jensen H, Lukac P, Nielsen JC, Hansen J, Johannessen A, Hansen PS, Pedersen A, Heath F, Hjortshoj S, Thogersen A, Da Costa A, Martel I, Romeyer-Bouchard C, Sadki N, Schmid A, Haissaguerre M, Hocini M, Knecht S, Sacher F, Ait Said M, Cauchemez B, Ledoux F, Thomas O, Cebron JP, Decarsin N, Gras D, Hervouet S, Durand C, Durand-Dubief A, Poty H, Babuty D, Pierre B, Albenque JP, Boveda S, Combes N, Mas R, Hermida JS, Kubala M, Godin B, Savouré A, Soublin Y, Defaye P, Jacon P, Brigadeau F, Corbut S, Flament-Balzola F, Kacet S, Klug D, Lacroix D, Copie X, Gilles L, Hocine Z, Paziaud O, Piot O, Crocq C, Kaballu G, Le Moal V, Lotton P, Mabo P, Pavin D, Andronache M, De Chillou C, Magnin-Poull I, Deharo JC, Durand C, Franceschi F, Peyrouse E, Prevot S, Etchegoin M, Extramiana F, Leenhardt A, Messali A, Heine T, Schneider A, Winter N, Brachmann J, Ritscher G, Schertel-Gruenler B, Simon H, Sinha AM, Turschner O, Wystrach A, Stemberg M, Kuck KH, Metzner A, Tilz R, Wissner E, Heitmann K, Willems S, Andresen D, Mueller S, Volkmer M, Schmidt B, Kostopoulou A, Livanis E, Voudris V, Efremidis M, Letsas K, Tsikrikas S, Christoforatou E, Ioannidis P, Katsivas A, Kourouklis S, Andrikopoulos G, Rassias I, Tzeis S, Dakos G, Paraskevaidis S, Stavropoulos G, Theofilogiannakos E, Vassilikos V, Bongiorni M, Zucchelli G, Raviele A, Themistoclakis S, Pratola C, Tritto M, Della Bella P, Mazzone P, Moltrasio M, Tondo C, Calo L, De Luca L, Guarracini F, Lioy E, Dozza L, Frigoli E, Giannelli L, Pappone C, Saviano M, Schiavina G, Vicedomini G, De Ponti R, Doni LA, Marazzi R, Salerno-Uriarte J, Tamborini C, Anselmino M, Ferraris F, Gaita F, Bertaglia E, Brandolino G, Zoppo F, De Groot N, Janse P, Jordaens L, Pison L, Roos C, Van Gelder I, Manusama R, Meijer A, Van der Voort P, Trines S, Compier MG, Kazmierczak J, Kornacewicz-Jach Z, Wielusinski M, Baran J, Kulakowski P, Dzidowski M, Fuglewicz A, Nowak K, Pruszkowska-Skrzep P, Wozniak A, Nowak S, Trusz-Gluza M, Almendral J, Atienza F, Castellanos E, De Diego C, Ortiz M, Moreno Planas J, Perez Castellano N, Benezet J, Farre Muncharaz J, Rubio Campal J, Hernandez Madrid A, Matia R, Arana E, Pedrote A, Cozar R, Peinado R, Valverde I, Arbelo E, Berruezo A, Calvo N, Guiu E, Husseini S, Mont Girbau L. The Atrial Fibrillation Ablation Pilot Study: an European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association. Eur Heart J 2014; 35:1466-78. [DOI: 10.1093/eurheartj/ehu001] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elena Arbelo
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Department of Cardiology, Thorax Institute, Hospital Clínic de Barcelona, C/ Villarroel 170, 6° - Escala 3, 08036, University of Barcelona, Barcelona, Spain
| | | | - Aldo P. Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Luigi Tavazzi
- GVM Care and Research, E.S. Health Science Foundation, Maria Cecilia Hospital, Cotignola, Italy
| | - Panos Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia – Antipolis, France
| | - Frédéric Anselme
- Service De Cardiologie, Hôpital Charles Nicolle, Rouen Cedex, France
| | | | - Pierre Jais
- Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France
| | - Zbigniew Kalarus
- Department of Cardiology, Silesian Academy of Medicine, Zabrze, Poland
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | - Sam Riahi
- AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Milos Taborsky
- Internal Cardiology Department, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | | | - Serge A. Trines
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Vandecasteele T, Vandevelde K, Doom M, Van Mulken E, Simoens P, Cornillie P. The Pulmonary Veins of the Pig as an Anatomical Model for the Development of a New Treatment for Atrial Fibrillation. Anat Histol Embryol 2013; 44:1-12. [DOI: 10.1111/ahe.12099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- T. Vandecasteele
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - K. Vandevelde
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - M. Doom
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - E. Van Mulken
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Simoens
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
| | - P. Cornillie
- Department of Morphology; Faculty of Veterinary Medicine; Ghent University; Salisburylaan 133 9820 Merelbeke Belgium
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Montserrat S, Gabrielli L, Borras R, Poyatos S, Berruezo A, Bijnens B, Brugada J, Mont L, Sitges M. Left atrial size and function by three-dimensional echocardiography to predict arrhythmia recurrence after first and repeated ablation of atrial fibrillation. Eur Heart J Cardiovasc Imaging 2013; 15:515-22. [DOI: 10.1093/ehjci/jet194] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Corradi D, Callegari S, Gelsomino S, Lorusso R, Macchi E. Morphology and pathophysiology of target anatomical sites for ablation procedures in patients with atrial fibrillation. Int J Cardiol 2013; 168:1769-78. [DOI: 10.1016/j.ijcard.2013.06.141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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Dewire J, Calkins H. Update on atrial fibrillation catheter ablation technologies and techniques. Nat Rev Cardiol 2013; 10:599-612. [DOI: 10.1038/nrcardio.2013.121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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National survey of catheter ablation for atrial fibrillation: The Japanese catheter ablation registry of atrial fibrillation (J-CARAF). J Arrhythm 2013. [DOI: 10.1016/j.joa.2012.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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48
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Kumar S, Walters TE, Halloran K, Morton JB, Hepworth G, Wong CX, Kistler PM, Sanders P, Kalman JM. Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia. ACTA ACUST UNITED AC 2013; 15:1702-9. [DOI: 10.1093/europace/eut162] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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49
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Mathew S, Metzner A, Ouyang F, Kuck KH, Tilz RR. [Catheter ablation of paroxysmal atrial fibrillation. Optimal approach and result]. Herzschrittmacherther Elektrophysiol 2013; 24:7-14. [PMID: 23588966 DOI: 10.1007/s00399-013-0244-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/29/2013] [Indexed: 11/28/2022]
Abstract
The gold standard in ablation of paroxysmal atrial fibrillation (PAF) is radiofrequency (RF) based point by point pulmonary vein isolation (PVI). In the majority of patients with PAF (80 %) PVI can restore stable SR even during long-term follow-up of up to 5 years. However multiple procedures are often required. Cryo-balloon based PVI is an established technique. Safety and efficacy are comparable to RF ablation. Due to the high success rates in patients with PAF and the progression rate to persistent atrial fibrillation (AF) an early intervention is recommended as implemented in the latest guidelines for AF treatment.
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Affiliation(s)
- Shibu Mathew
- II. Medizinische Klinik, Klinik für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, Hamburg, Germany.
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50
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Spragg D. Left Atrial Fibrosis: Role in Atrial Fibrillation Pathophysiology and Treatment Outcomes. J Atr Fibrillation 2013; 5:810. [PMID: 28496835 DOI: 10.4022/jafib.810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/01/2013] [Accepted: 03/02/2013] [Indexed: 01/07/2023]
Abstract
The mechanisms of atrial fibrillation are complex, and have been the subject of intensive study for over fifty years. There is likely a complex interplay between triggers and substrate that mediates the initiation and maintenance of AF. Increasingly, atrial fibrosis has been recognized as a key component of that substrate, playing a critical role in conduction abnormalities in the left atrium that appear necessary to maintaining AF. In the last several years, our abilities to quantify left atrial fibrosis - both through catheter- and MRI-based techniques - has shed important light on the underlying mechanisms of AF, and on therapeutic strategies to treat AF. Whether our increased appreciation of the role of atrial fibrosis in AF translates into improved efficacy of catheter ablation or anti-arrhythmic therapy, though, remains to be seen. The aim of this review is to summarize clinical investigations of atrial fibrosis as a factor in the development and treatment of atrial fibrillation.
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Affiliation(s)
- David Spragg
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
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