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https://www.readbyqxmd.com/read/28800192/efficacy-and-safety-of-driver-guided-catheter-ablation-for-atrial-fibrillation-a-systematic-review-and-meta-analysis
#1
F Daniel Ramirez, David H Birnie, Girish M Nair, Agnieszka Szczotka, Calum J Redpath, Mouhannad M Sadek, Pablo B Nery
INTRODUCTION: Targeting localized drivers (electrical rotors or focal impulses) during catheter ablation for atrial fibrillation (AF) has been proposed as a strategy to improve procedural success. However, the strength and quality of the evidence to support this approach is unclear. METHODS AND RESULTS: Clinical studies reporting efficacy or safety outcomes of driver-guided ablation for AF were identified in Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Pubmed, and conference abstracts from major scientific meetings...
August 11, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28800169/global-multi-electrode-contact-mapping-plus-ablation-with-a-single-catheter-preclinical-and-preliminary-experience-in-humans-with-atrial-fibrillation
#2
Hans Kottkamp, Fabian Moser, Andreas Rieger, Doreen Schreiber, Christian Pönisch, Monica Trofin
INTRODUCTION: One question for the technological advancement of catheter ablation of atrial fibrillation (AF) is whether a creative new concept can combine and even improve the diagnostic mapping options of single-tip and basket catheters with the simplicity of the use of balloon catheters for ablation. Herein, we describe the first in-human experience with a single catheter offering such a complete solution. METHODS AND RESULTS: A new catheter (Globe®) with a distal multi-electrode array consisting of 16 ribs with 122 gold-plated electrodes was used...
August 11, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28795289/beyond-pulmonary-vein-isolation-the-role-of-additional-sites-in-catheter-ablation-of-atrial-fibrillation
#3
REVIEW
Li-Wei Lo, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Shih-Ann Chen
PURPOSE OF REVIEW: Pulmonary vein (PV) isolation is the cornerstone of atrial fibrillation (AF) ablation. However, the long-term procedural outcome remains suboptimal and there is a frequent need for repeat ablation procedure, especially in patients with non-paroxysmal AF. The review article summarizes the rationales, recent evidences, and strategies of ablation of extra-PV sites and its clinical outcomes. RECENT FINDINGS: It is a consensus that durable PV isolations are a definite therapy in patients with paroxysmal AF...
August 9, 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28790104/first-in-man-analysis-of-the-relationship-between-electrical-rotors-from-noninvasive-panoramic-mapping-and-atrial-fibrosis-from-magnetic-resonance-imaging-in-patients-with-persistent-atrial-fibrillation
#4
Christian Sohns, Christine Lemes, Andreas Metzner, Thomas Fink, Mikhail Chmelevsky, Tilman Maurer, Margarita Budanova, Vladislav Solntsev, Walther H W Schulze, Wieland Staab, Shibu Mathew, Christian Heeger, Bruno Reißmann, Eugene Kholmovski, Dietmar Kivelitz, Feifan Ouyang, Karl-Heinz Kuck
BACKGROUND: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging can be used to evaluate characteristics of atrial fibrosis. The novel noninvasive epicardial and endocardial electrophysiology system (NEEES) allows for the identification of sources with rotor activity. This study describes a new technique to examine the relationship between rotors and LGE signal intensity in patients with persistent atrial fibrillation (PERS) scheduled for ablation. METHODS AND RESULTS: Ten consecutive patients underwent pulmonary vein isolation for persistent atrial fibrillation...
August 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28733070/spatial-relationship-of-sites-for-atrial-fibrillation-drivers-and-atrial-tachycardia-in-patients-with-both-arrhythmias
#5
Tina Baykaner, Junaid A B Zaman, Albert J Rogers, Rachita Navara, Mahmood AlHusseini, Ryan T Borne, Shirley Park, Paul J Wang, David E Krummen, William H Sauer, Sanjiv M Narayan
INTRODUCTION: Atrial fibrillation (AF) often converts to and from atrial tachycardia (AT), but it is undefined if these rhythms are mechanistically related in such patients. We tested the hypothesis that critical sites for AT may be related to regional AF sources in patients with both rhythms, by mapping their locations and response to ablation on transitions to and from AF. METHODS: From 219 patients undergoing spatial mapping of AF prior to ablation at 3 centers, we enrolled 26 patients in whom AF converted to AT by ablation (n=19) or spontaneously (n=7; left atrial size 42±6cm, 38% persistent AF)...
July 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28729643/superhydrophobic-drag-reduction-spherical-bearing-fabricated-by-laser-ablation-and-pei-regulated-zno-nanowire-growth
#6
Rui Weng, Haifeng Zhang, Yanjing Tuo, Yang Wang, Xiaowei Liu
The resistance of the bearing is a significant factor affecting the performance of the ball-disk rotor gyroscope. The micro and nano combined surface with low surface energy material modifications can be hydrophobic. This can reduce the drag when the bearing is lubricated by deionized water. Laser ablation method is utilized to form micron-scaled structures on the surface of the stainless steel rotor ball. And the nanostructures are formed by PEI (Polyetherimide) regulated ZnO nanowires growth. After low surface energy material modification, the water contact angle of processed surface was 163° and the sliding angle was less than 4°...
July 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28697936/radiofrequency-catheter-ablation-for-atrial-fibrillation-approaches-and-outcomes
#7
REVIEW
Manish Kalla, Prashanthan Sanders, Jonathan M Kalman, Geoffrey Lee
Catheter ablation is now at the forefront of the management of symptomatic atrial fibrillation (AF). Its role in paroxysmal AF is well defined with considerable data supporting its role. Catheter ablation in persistent AF has been less effective and the subject of considerable debate. Mechanistic studies have demonstrated the critical role of pulmonary vein physiology in paroxysmal AF, whereas the mechanisms that sustain persistent AF are not well understood. Additional substrate ablation in persistent AF has not improved long-term outcomes and the use of novel mapping technologies to assess rotor activity remains controversial...
June 13, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28678805/ablation-as-targeted-perturbation-to-rewire-communication-network-of-persistent-atrial-fibrillation
#8
Susumu Tao, Samuel F Way, Joshua Garland, Jonathan Chrispin, Luisa A Ciuffo, Muhammad A Balouch, Saman Nazarian, David D Spragg, Joseph E Marine, Ronald D Berger, Hugh Calkins, Hiroshi Ashikaga
Persistent atrial fibrillation (AF) can be viewed as disintegrated patterns of information transmission by action potential across the communication network consisting of nodes linked by functional connectivity. To test the hypothesis that ablation of persistent AF is associated with improvement in both local and global connectivity within the communication networks, we analyzed multi-electrode basket catheter electrograms of 22 consecutive patients (63.5 ± 9.7 years, 78% male) during persistent AF before and after the focal impulse and rotor modulation-guided ablation...
2017: PloS One
https://www.readbyqxmd.com/read/28670858/rotors-exhibit-greater-surface-ecg-variation-during-ventricular-fibrillation-than-focal-sources-due-to-wavebreak-secondary-rotors-and-meander
#9
Gordon Ho, Christopher T Villongco, Omid Yousefian, Aaron Bradshaw, Andrew Nguyen, Yonatan Faiwiszewski, Justin Hayase, Wouter-Jan Rappel, Andrew D McCulloch, David E Krummen
INTRODUCTION: Ventricular fibrillation is a common life-threatening arrhythmia. The ECG of VF appears chaotic but may allow identification of sustaining mechanisms to guide therapy. HYPOTHESIS: We hypothesized that rotors and focal sources manifest distinct features on the ECG, and computational modeling may identify mechanisms of such features. METHODS: VF induction was attempted in 31 patients referred for ventricular arrhythmia ablation...
July 3, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28596994/recurrent-post-ablation-paroxysmal-atrial-fibrillation-shares-substrates-with-persistent-atrial-fibrillation-an-11-center-study
#10
Junaid A B Zaman, Tina Baykaner, Paul Clopton, Vijay Swarup, Robert C Kowal, James P Daubert, John D Day, John Hummel, Amir A Schricker, David E Krummen, Moussa Mansour, Gery F Tomassoni, Kevin R Wheelan, Mohan Vishwanathan, Shirley Park, Paul J Wang, Sanjiv M Narayan, John M Miller
INTRODUCTION: The role of atrial fibrillation (AF) substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources, and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. METHODS: In 175 patients at 11 centers, we compared AF substrates in both atria using 64 pole-basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF...
April 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/28523369/-new-strategies-and-technologies-for-ablation-of-atrial-fibrillation-where-do-we-go
#11
A Metzner, J Riedl, K-H Kuck
Catheter-based ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation is the established cornerstone of all ablation strategies. However, the rate of electrical reconduction of previously isolated pulmonary veins is high and associated with recurrence of AF. Novel and innovative mapping and ablation systems are being developed or are under clinical evaluation aiming for higher durability of pulmonary vein isolation. Additional ablation strategies for patients with recurrence of AF despite persistent isolation of the pulmonary veins are under evaluation...
May 18, 2017: Herz
https://www.readbyqxmd.com/read/28500479/-catheter-ablation-of-persistent-atrial-fibrillation-where-do-we-go
#12
C Lemeš, K-H Kuck, S Mathew
Despite the very promising initial results of clinical studies, catheter ablation of persistent atrial fibrillation (AF) remains a challenge in modern electrophysiology. On the basis of the hypothesized pathophysiological mechanisms, a variety of ablation strategies have been developed over the course of time. The current ablation strategies range from pulmonary vein isolation (PVI) alone as first-line therapy, through ablation of multiple linear lesions, ablation of complex fractionated atrial electrograms (CFAE), rotor ablation, isolation of fibrotic and scar tissue up to isolation of the left atrial appendage (LAA); however, it is unclear even to the present day whether these complex and time-consuming strategies actually improve the success rate of ablation therapy...
May 12, 2017: Herz
https://www.readbyqxmd.com/read/28471019/type-and-rate-of-atrial-fibrillation-termination-due-to-rotational-activity-ablation-combined-with-pulmonary-vein-isolation
#13
Zsuzsanna Kis, Dominic A Theuns, Rohit Bhagwandien, Sip Wijchers, Sing-Chien Yap, Tamas Szili-Torok
BACKGROUND: There remains controversy about the optimal ablation technique and termination rate of atrial fibrillation (AF) during catheter ablation in patients with persistent AF. The aim of this study was to determine the rate and timing of AF termination during combined pulmonary vein isolation (PVI) and focal impulse and rotor modulation (FIRM)-guided ablation of rotational activity (RoAc). METHODS: This single-center, prospective cohort study enrolled 38 consecutive patients (63% male, mean age 63 ± 11 years) with persistent AF (mean left atrial size: 46 ± 7 mm), who underwent FIRM mapping and ablation of the identified RoAcs followed by PVI...
May 4, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28438722/propagation-of-meandering-rotors-surrounded-by-areas-of-high-dominant-frequency-in-persistent-atrial-fibrillation
#14
João Salinet, Fernando S Schlindwein, Peter Stafford, Tiago P Almeida, Xin Li, Frederique J Vanheusden, María S Guillem, G André Ng
BACKGROUND: Identification of arrhythmogenic regions remains a challenge in persistent atrial fibrillation (persAF). Frequency and phase analysis allows identification of potential ablation targets. OBJECTIVE: This study aimed to investigate the spatiotemporal association between dominant frequency (DF) and reentrant phase activation areas. METHODS: A total of 8 persAF patients undergoing first-time catheter ablation procedure were enrolled...
April 22, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28433558/spatial-relationship-of-organized-rotational-and-focal-sources-in-human-atrial-fibrillation-to-autonomic-ganglionated-plexi
#15
Tina Baykaner, Theodoros A Zografos, Junaid A B Zaman, Ioannis Pantos, Mahmood Alhusseini, Rachita Navara, David E Krummen, Sanjiv M Narayan, Demosthenes G Katritsis
BACKGROUND: One approach to improve ablation for atrial fibrillation (AF) is to focus on physiological targets including focal or rotational sources or ganglionic plexi (GP). However, the spatial relationship between these potential mechanisms has never been studied. We tested the hypothesis that rotors and focal sources for AF may co-localize with ganglionated plexi (GP). METHODS: We prospectively identified locations of AF rotors and focal sources, and correlated these to GP sites in 97 consecutive patients (age 59...
April 19, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28369344/first-endocardial-rotor-ablation-using-a-64-pole-basket-catheter-in-a-patient-with-a-left-atrial-appendage-closure-device
#16
Barbara Bellmann, Mario Kasner, Ulf Landmesser, Andreas Rillig
No abstract text is available yet for this article.
March 21, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28364320/repetitive-atrial-activation-during-ongoing-atrial-fibrillation-comparison-using-different-mapping-algorithms-preliminary-findings
#17
Philipp Halbfass, Patrick Müller, Karin Nentwich, Kai Sonne, Karsten Hamm, Sebastian Barth, Franziska Fochler, Andreas Mügge, Thomas Deneke
PURPOSE: Targeting repetitive sources identified during atrial fibrillation (focal impulse and rotor modulation, FIRM) has been used as an ablation strategy using specific mapping tools. Aim of this study was to evaluate FIRM mapped rotors with a new multipolar mapping algorithm. METHODS: Patients with persistent atrial fibrillation undergoing FIRM ablation were included. Mapping of left atrial rotors was performed with a 64-pole basket catheter in conjunction with a specialized phase mapping algorithm...
March 31, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28343787/relationship-between-rotors-and-complex-fractionated-electrograms-in-atrial-fibrillation-using-a-novel-computational-analysis
#18
Pedro Adragão, Pedro Carmo, Diogo Cavaco, João Carmo, António Ferreira, Francisco Moscoso Costa, Maria Salomé Carvalho, João Mesquita, Rita Quaresma, Francisco Belo Morgado, Miguel Mendes
INTRODUCTION: Rotors and complex fractionated atrial electrograms (CFAEs) have been suggested as possible therapeutic targets in ablation of atrial fibrillation (AF). The aim of this study was to assess the relationship between rotors and CFAEs in patients with AF. METHODS: We studied 18 patients with AF (mean age 69±8 years, 33% female) who underwent rotor ablation and pulmonary vein isolation. Endocardial mapping was performed with a basket catheter to identify the presence, number and location of rotors and CFAEs...
April 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28339546/multicentre-safety-of-adding-focal-impulse-and-rotor-modulation-firm-to-conventional-ablation-for-atrial-fibrillation
#19
David E Krummen, Tina Baykaner, Amir A Schricker, Christopher A B Kowalewski, Vijay Swarup, John M Miller, Gery F Tomassoni, Shirley Park, Mohan N Viswanathan, Paul J Wang, Sanjiv M Narayan
Aims: Focal Impulse and Rotor Modulation (FIRM) uses 64-electrode basket catheters to identify atrial fibrillation (AF)-sustaining sites for ablation, with promising results in many studies. Accordingly, new basket designs are being tested by several groups. We set out to determine the procedural safety of adding basket mapping and map-guided ablation to conventional pulmonary vein isolation (PVI). Methods and results: We collected 30 day procedural safety data in five US centres for consecutive patients undergoing FIRM plus PVI (FIRM-PVI) compared with contemporaneous controls undergoing PVI without FIRM...
May 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28285456/is-vf-an-ablatable-rhythm
#20
REVIEW
Ghassen Cheniti, Meleze Hocini, Ruairidh Martin, Frederic Sacher, Remi Dubois, Michel Haissaguerre, Pierre Jais
Ventricular fibrillation (VF) has traditionally been considered to be a disorganized arrhythmia not amenable to catheter ablation. However, a better understanding of the VF pathophysiology has allowed identification of targets for ablation. Ablation targeting the premature ventricular complexes which trigger VF was proven to be associated with high success rates and long-term freedom from VF recurrence. Recent mapping data has identified rotors, focal breakthroughs, and figure of eight re-entries as main drivers maintaining human VF...
February 2017: Current Treatment Options in Cardiovascular Medicine
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