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Arrhythmia ablation

Chin-Yu Lin, Yenn-Jiang Lin, Sanjiv M Narayan, Tina Baykaner, Men-Tzung Lo, Fa-Po Chung, Yun-Yu Chen, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Jo-Nan Liao, Ta-Chuan Tuan, Tze-Fan Chao, Abigail Louise D Te, Ling Kuo, Jennifer Jeanne B Vicera, Ting-Yung Chang, Simon Salim, Kuo-Liong Chien, Shih-Ann Chen
INTRODUCTION: Adjunctive driver-guided ablation in addition to pulmonary vein isolation has been proposed as a strategy to improve procedural success and outcomes for various populations with atrial fibrillation (AF). This study firstly aimed to evaluate the different mapping techniques for driver/rotor identification and secondly to evaluate the benefit of driver/rotor guided ablation in patients with paroxysmal and persistent AF. METHODS: We searched the electronic database in PubMed using the keywords "atrial fibrillation", "rotor", "rotational driver", "atrial fibrillation source", and "drivers" for both randomized controlled trials and observational controlled trials...
December 10, 2018: Pacing and Clinical Electrophysiology: PACE
Yasuhiro Shirai, Pasquale Santangeli, Jackson J Liang, Fermin C Garcia, Gregory E Supple, David S Frankel, Michael P Riley, David Lin, Robert D Schaller, Sanjay Dixit, David J Callans, Erica S Zado, Francis E Marchlinski
Aims: Catheter ablation of outflow tract ventricular arrhythmias (OTVAs) with the earliest activation within the coronary venous system (CVS) can be challenging. When ablation from the CVS is not feasible or ineffective, an approach from anatomically adjacent site(s) can be considered. We report the outcomes of an anatomical approach for OTVAs linked to the CVS. Methods and results: We retrospectively analysed 665 OTVA patients. Of these, 65 (9.8%) had the earliest activation within the CVS...
December 10, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Martin Manninger, Jakob Ebner, David Zweiker, Raphael Sieghartsleitner, Bernadette Mastnak, Egbert Bisping, Peter Lercher, Rita Riedlbauer, Brigitte Rotman, Helmut Brussee, Daniel Scherr
BACKGROUND: Catheter ablation of atrial fibrillation (AF) is an established second line therapy for patients with symptomatic paroxysmal AF (PAF) and may be considered as a first line therapy in selected patients who are highly symptomatic, considering patient choice, benefit, and risk, according to recent guidelines. Our study investigated whether a first line vs. second line ablation approach may result in improved sinus rhythm maintenance after ablation. METHODS: A total of 153 patients undergoing pulmonary vein isolation for PAF were included in the study (age 55±12 years, 29% female)...
2018: PloS One
Yuanqing Yao, Jun Qian, Shunkang Rong, Yuwen Huang, Bo Xiong, Gang Yang, Dengqing Zhang, Shimin Deng, Jie Tan, Que Zhu, Changming Deng, Dichuan Liu, Haitao Ran, Zhigang Wang, Jing Huang
Stellate ganglion (SG) modification has been investigated for arrhythmia treatment. In this study, transesophageal SG imaging and intervention were explored using a homemade 30F integrated focused ultrasonic catheter in healthy mongrel canines in vivo. Anatomic details of SGs were ultrasonically imaged and evaluated. SG had a heterogeneous echoic structure and characteristic profiles sketched by hyper-echoic outlines in an ultrasonogram. Left SGs in the experimental group were successfully ablated through the esophagus under ultrasonic guidance provided by the catheter itself...
December 5, 2018: Ultrasound in Medicine & Biology
Glenmore Lasam, Joshua B Oaks
A case of a 51-year-old female with history of hypertension and a significant family history of premature coronary artery disease presented to the hospital after cardiac arrest. She successfully completed a targeted temperature management therapy with full neurologic recovery. Her hospital course was complicated by several bouts of ventricular fibrillation (VF) arrest which was rescued by timely defibrillation, high quality cardiorespiratory resuscitation, and administration of antiarrhythmic medications and inotropic agents...
September 29, 2018: Curēus
Yenn-Jiang Lin, Chin-Yu Lin, Shih-Ann Chen
PURPOSE OF REVIEW: Percutaneous catheter ablation is an effective treatment for atrial fibrillation. However, catheter ablation for the treatment of persistent atrial fibrillation or long-standing persistent atrial fibrillation is associated with unsatisfying success rates. This review aims to summarize the recent literature on the progress of catheter ablation among patients with persistent atrial fibrillation RECENT FINDINGS: In this review, we outline the potential future therapeutic techniques of catheter ablation of persistent atrial fibrillation...
January 2019: Current Opinion in Cardiology
Xiaomei Yu, Wenbo He, Jing Xie, Bo He, Da Luo, Xiaoying Wang, Hong Jiang, Zhibing Lu
INTRODUCTION: Our recent study found that selective ablation of the distal part of the ligament of Marshall (LOMLSPV ) could suppress ventricular arrhythmias (VAs) during acute myocardial infarction (AMI). This study was to investigate the possible underlying mechanisms. METHODS: Dogs were randomly subjected into the sham operated group (SO, n=6), AMI group (AMI, n=8) and the group undergoing LOMLSPV ablation ahead of AMI (LOMD+AMI, n=8). Incidence of VAs, serum levels of malondialdehyde (MDA) and superoxide diamutas (SOD), expression of connexin (Cx43), Bcl-2, Bax, Caspase-3, tumor necrosis factor (TNF)-α, IL-6 and high mobility group box (HMGB)1 were compared...
December 5, 2018: Journal of Cardiovascular Electrophysiology
Joshua D Moss, Adam Oesterle, Michael Raiman, Erin E Flatley, Andrew D Beaser, Valluvan Jeevanandam, Liviu Klein, Takeyoshi Ota, Georg Wieselthaler, Nir Uriel, Roderick Tung
INTRODUCTION: Ventricular arrhythmias (VA) after left ventricular assist device (LVAD) placement are associated with increased morbidity and mortality. We sought to assess epicardial voltage characteristics at the time of LVAD implantation and investigate relationships between scar burden and post-implant VA. METHODS AND RESULTS: Consecutive patients underwent open-chest epicardial electroanatomic mapping immediately prior to LVAD implantation. Areas of low voltage and sites with local abnormal potentials were identified...
December 5, 2018: Journal of Cardiovascular Electrophysiology
Stacy Westerman, Nanette Wenger
Atrial fibrillation is the most common sustained cardiac arrhythmia. The scope and impact of atrial fibrillation is wide; it can affect cardiac function, functional status, and quality of life, and it confers a stroke risk. There are sex differences in atrial fibrillation across the scope of the disease process, from epidemiology and causative mechanisms to management and outcomes. The approach to management of atrial fibrillation differs between women and men, and there are sex differences in response to medical therapy and catheter ablation...
December 4, 2018: Current Cardiology Reviews
Mihail G Chelu, Jordan B King, Eugene G Kholmovski, Junjie Ma, Pim Gal, Qussay Marashly, Mossab A AlJuaid, Gagandeep Kaur, Michelle A Silver, Kara A Johnson, Promporn Suksaranjit, Brent D Wilson, Frederick T Han, Arif Elvan, Nassir F Marrouche
Background Late gadolinium enhancement magnetic resonance imaging is an effective tool for assessment of atrial fibrosis. The degree of left atrial fibrosis is a good predictor of atrial fibrillation ( AF ) ablation success at 1 year, but the association between left atrial fibrosis and long-term ablation success has not been studied. Methods and Results Late gadolinium enhancement magnetic resonance images of sufficient quality to quantify atrial fibrosis were obtained before the first AF ablation in 308 consecutive patients...
December 4, 2018: Journal of the American Heart Association
Stephane Arques
Atrial fibrillation is the most common cardiac rhythm disorder observed in clinical practice. It carries high morbidity and mortality rates, primarily related to heart failure, stroke and death. Validation of noninvasive markers in the diagnosis of heart failure with preserved ejection fraction and risk stratification is relevant in this clinical setting. The spectral tissue Dopplerderived E/e' ratio is a simple and reproducible index, which has been validated in noninvasive assessment of left ventricular diastolic pressures, regardless of rhythm...
August 2018: Journal of Atrial Fibrillation
Luigi Di Biase, Jorge Romero, Erica S Zado, Juan Carlos Diaz, Carola Gianni, Patrick M Hranitzki, Javier E Sanchez, Sanghamitra Mohanty, Amin Al-Ahmad, Prasant Mohanty, Chintan Trivedi, Domenico Della Rocca, Pasquale Santangeli, J David Burkhardt, Fermin C Garcia, Francis E Marchlinski, Andrea Natale
BACKGROUND: The optimal site of ablation of idiopathic left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs) is challenging as activation mapping can reveal similar activation times suggesting an intramural origin. OBJECTIVE: We sought to assess whether in patients with intramural VAs and with multiple early activation sites (AS), sequential ablation of all the early AS could improve acute and long term outcomes. METHODS: A total of 116 patients undergoing ablation for symptomatic LVOT VAs were enrolled in this study...
November 29, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Riccardo Proietti, David Birnie, Paul D Ziegler, George A Wells, Atul Verma
Background Recent evidence shows an association between the level of physical activity and cardiovascular mortality and morbidity in patients with atrial fibrillation ( AF ). We sought to assess the impact of AF daily burden on the activity level of the patient who underwent pulmonary vein isolation. Methods and Results Patients enrolled in the DISCERN AF (Discerning Symptomatic and Asymptomatic Episodes Pre and Post Radiofrequency Ablation of Atrial Fibrillation) study all had insertable cardiac monitors, which provided the daily burden of atrial tachycardia and atrial fibrillation ( AT / AF ) and a corresponding activity level...
December 4, 2018: Journal of the American Heart Association
Mehrdad Emami, Joseph B Morton, Kim H Chan, Kurt C Roberts-Thomson
Ventricular arrhythmias are one of the leading causes of death in patients with a prior myocardial infarction. Implantable cardioverter-defibrillators (ICDs) are very effective in the prevention of sudden cardiac death but the risk of recurrence remains an issue since defibrillation does not alter the underlying substrate. Recurrent ICD shocks are distressing and are associated with an increase in mortality. Catheter ablation is an effective treatment for recurrent ventricular tachycardia in these patients, particularly when antiarrhythmic therapy produces side effects or is ineffective...
October 15, 2018: Heart, Lung & Circulation
Shinwan Kany, Ardan M Saguner
Usefulness of Electroanatomical Mapping in Rhythmology Abstract. Atrial fibrillation is the most common arrhythmia and its prevalence is rising. Therapeutic options include drug treatment and interventional catheter ablation via pulmonary vein isolation (PVI). This procedure was associated with long fluoroscopy times which carried risks for patients and physicians. Electroanatomical mapping (EAM) is a tool to visualize anatomy, voltage and activation of the heart chambers. Current EAM systems used in clinical practice include CARTO®, EnSite NavX® and Rhythmia®...
November 2018: Praxis
Ana Paula Susin Osório, Luciana Eder Martins Barros Simoni, Antonio Lessa Gaudie Ley, Grasiele Bess de Oliveira, Roberto Tofani Santanna, Marcelo Haertel Miglioranza, Gustavo Glotz de Lima, Vidal Essebag, Tiago Luiz Luz Leiria
BACKGROUND: The potential for thromboembolism in atrial flutter (AFL) is different from atrial fibrillation. AFL cycle length (AFL-CL) may be related to reduced left atrial appendage (LAA) function. Very rapid AFL-CL can lead to mechanical and electrophysiological disorders that contribute to lower LAA emptying velocity (LAEV). The aim of this study is to relate atrial flutter cycle length with LAEV and its role in thrombogenesis. METHODS: Cross-sectional study of patients with atrial flutter AFL who underwent transoesophageal echocardiography (TEE) before catheter ablation or electric cardioversion...
October 9, 2018: Journal of Electrocardiology
Caroline H Roney, Steven E Williams, Hubert Cochet, Rahul K Mukherjee, Louisa O'Neill, Iain Sim, John Whitaker, Orod Razeghi, George J Klein, Edward J Vigmond, Mark O'Neill, Steven A Niederer
Aims: Treatments for persistent atrial fibrillation (AF) offer limited efficacy. One potential strategy aims to return the right atrium (RA) to sinus rhythm (SR) by ablating interatrial connections (IAC) to isolate the atria, but there is limited clinical data to evaluate this ablation approach. We aimed to use simulation to evaluate and predict patient-specific suitability for ablation of IAC to treat AF. Methods and results: Persistent AF was simulated in 12 patient-specific geometries, incorporating electrophysiological heterogeneity and fibres, with IAC at Bachmann's bundle, the coronary sinus, and fossa ovalis...
November 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Joe B Hakim, Michael J Murphy, Natalia A Trayanova, Patrick M Boyle
Aims: Efforts to improve ablation success rates in persistent atrial fibrillation (AF) patients by targeting re-entrant driver (RD) sites have been hindered by weak mechanistic understanding regarding emergent RDs localization following initial fibrotic substrate modification. This study aimed to systematically assess arrhythmia dynamics after virtual ablation of RD sites in computational models. Methods and results: Simulations were conducted in 12 patient-specific atrial models reconstructed from pre-procedure late gadolinium-enhanced magnetic resonance imaging scans...
November 1, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Fumi Yamagami, Kazuko Tajiri, Kosuke Doki, Masayuki Hattori, Junya Honda, Satoshi Aita, Tomohiko Harunari, Hiro Yamasaki, Nobuyuki Murakoshi, Yukio Sekiguchi, Masato Homma, Naohiko Takahashi, Kazutaka Aonuma, Akihiko Nogami, Masaki Ieda
Renal dysfunction results in the accumulation of various uremic toxins, including indoxyl sulphate (IS), and is a major risk factor for atrial fibrillation (AF). Experimental studies have demonstrated that IS exacerbates atrial remodelling via oxidative stress, inflammation, and fibrosis. However, its clinical impact on AF-promoting cardiac remodelling has not been described. Therefore, the purpose of this study was to clarify the relationship between basal IS levels and the 1-year outcomes after catheter ablation for the treatment of AF...
November 22, 2018: Scientific Reports
Serge Boveda, Andreas Metzner, Dinh Q Nguyen, K R Julian Chun, Konrad Goehl, Georg Noelker, Jean-Claude Deharo, George Andrikopoulos, Tillman Dahme, Nicolas Lellouche, Pascal Defaye
OBJECTIVES: The CRYO4PERSISTENT AF (Cryoballoon Ablation for Early Persistent Atrial Fibrillation) trial aims to report long-term outcomes after a single pulmonary vein isolation (PVI)-only ablation procedure using the second-generation cryoballoon in persistent atrial fibrillation (PerAF) patients. BACKGROUND: Pulmonary vein isolation is recognized as the cornerstone of atrial fibrillation (AF) ablation, including ablation of PerAF. METHODS: The CRYO4PERSISTENT AF trial (NCT02213731) is a prospective, multicenter, single-arm trial designed to assess single-procedure outcomes of PVI using the cryoballoon...
November 2018: JACC. Clinical Electrophysiology
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