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Arrhythmia ablation

Jason G Andrade, Jean Champagne, Marc W Deyell, Vidal Essebag, Sandra Lauck, Carlos Morillo, John Sapp, Alan Skanes, Patricia Theoret-Patrick, George A Wells, Atul Verma
BACKGROUND: The ideal management of patients with newly diagnosed symptomatic atrial fibrillation (AF) remains unknown. Current practice guidelines recommend a trial of antiarrhythmic drugs (AAD) prior to considering an invasive ablation procedure. However, earlier ablation offers an opportunity to halt the progressive patho-anatomical changes associated with AF, as well as impart other important clinical benefits. OBJECTIVE: The aim of this study is to determine the optimal initial management strategy for patients with newly diagnosed, symptomatic atrial fibrillation...
October 17, 2018: American Heart Journal
Amneet Sandhu, Joseph L Schuller, Wendy S Tzou, Alexis Z Tumolo, William H Sauer, Duy T Nguyen
A 62-year-old man was referred to our institution for high-density, symptomatic PVCs with resultant decrease in LV function having failed prior ablation attempts. Successful, durable ablation of the patient's mid-myocardial PVC arising from the LV summit region was achieved through the proximal great cardiac vein with ablation depth augmented by use of half-normal saline irrigant. Though standard ablation of ventricular arrhythmias using normal saline irrigation from the coronary venous system has been well-reported, this may be of limited value in addressing mid-myocardial sites of origin...
October 20, 2018: Pacing and Clinical Electrophysiology: PACE
Lilei Yu, Benjamin S Scherlag, Kenneth Dormer, Isaac Rutel, Bing Huang, Xiaoya Zhou, Aneetta E Kuriakose, Kytai K Nguyen, Sunny Po
OBJECTIVES: This study sought to develop a novel targeted delivery therapy to ablate the major atrial ganglionated plexi (GP) using magnetic nanoparticles carrying a CaCl2 payload. BACKGROUND: Prior studies indicated the role of hyperactivity of the cardiac autonomic nervous system in the genesis of atrial fibrillation. METHODS: Twenty-eight male mongrel dogs underwent a bilateral thoracotomy. CaCl2 -encapsulated magnetic nanoparticles (Ca-MNP) included magnetite in a sphere of biocompatible, biodegradable poly(lactic-co-glycolic acid)...
October 2018: JACC. Clinical Electrophysiology
Benjamin M Moore, Robert Anderson, Ashley M Nisbet, Manish Kalla, Karin du Plessis, Yves d'Udekem, Andrew Bullock, Rachael L Cordina, Leeanne Grigg, David S Celermajer, Jonathan Kalman, Mark A McGuire
OBJECTIVES: This study sought to describe atrial arrhythmia mechanisms, acute outcomes, and long-term arrhythmia burdens following catheter ablation in adult atriopulmonary (AP) Fontan patients. BACKGROUND: Atrial arrhythmias are a significant cause of morbidity and mortality in the AP Fontan population. METHODS: Sixty consecutive atrial arrhythmia ablations were reviewed in 42 AP Fontan patients (31 ± 8 years of age), performed between 1998 and 2017...
October 2018: JACC. Clinical Electrophysiology
Pablo Ávila, Francis Bessière, Blandine Mondésert, Sylvia Abadir, Annie Dore, François-Pierre Mongeon, Marc Dubuc, Paul Khairy
OBJECTIVES: The purpose of this study was to assess the safety and efficacy of cryoablation for perinodal substrates in patients with congenital heart disease (CHD) and a displaced atrioventricular (AV) conduction system or an AV conduction system location that was difficult to predict. BACKGROUND: Catheter ablation for perinodal arrhythmias in patients with CHD may incur higher risks due to unconventional or difficult to predict locations of the AV conduction system...
October 2018: JACC. Clinical Electrophysiology
Jeremy P Moore, Kevin M Shannon, Roberto G Gallotti, Christopher J McLeod, Anca Chiriac, Edward P Walsh, Narayanswami Sreeram, Akash R Patel, Natasja M De Groot, Johannes von Alvensleben, Seshadri Balaji, David S Frankel, Christina Y Miyake, James C Perry, Kalyanam Shivkumar
OBJECTIVES: The purpose of this study was to determine the ventricular arrhythmia (VA) substrates in patients with unoperated and post-surgical Ebstein's Anomaly (EA). BACKGROUND: EA is associated with variable atrialization of the right ventricle and a propensity for VA and sudden death. There are scant data on catheter ablation for VA in this population. METHODS: This was a retrospective study involving 11 congenital heart disease centers...
October 2018: JACC. Clinical Electrophysiology
Guohua Fu, Bin He, Binhao Wang, Jing Liu, Yibo Yu, Xianfeng Du, Mingjun Feng, Fang Gao, He Jin, Renyuan Fang, Huimin Chu
BACKGROUND: Transmural lesions (TLs) are the crucial point for radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients. Previous studies have reported that complete positive unipolar electrogram (UP-EGM) after ablation is associated with transmural lesions. However, UP-EGM patterns may differ in different regions of continuous circular lesions (CCLs) around the pulmonary vein ostia after ablation. We aimed to analyze the different UP-EGM patterns in different CCL regions after ablation and the effectiveness of UP-EGM guided RFCA in paroxysmal atrial fibrillation (PAF)...
October 17, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Svetlana Ivanovna Sazonova, Julia Nikolaevna Ilushenkova, Roman Efimovich Batalov, Anna Mihaylovna Gusakova, Julia Vladimirovna Saranchina, Julia Viktorovna Rogovskaya, Sergey Valentinovich Popov
Background: Atrial fibrillation (AF) is one of the widest spread forms of arrhythmia, which is associated with the increased mortality and thromboembolic complications. To date, the involvement of renin-angiotensin-aldosterone system and immunomediators of inflammation into the mechanisms of development and maintenance of isolated AF is not clear. Specificity of their changes with respect to the latent myocarditis at AF is not proved. Methods: In 96 patients with persistent isolated atrial fibrillation (IsAF), scheduled for radiofrequency ablation and endomyocardial biopsy (EMB), and in 20 healthy volunteers (HVT), levels of plasma tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10, fatty acid-binding protein (FABP), neopterin, C-reactive protein (CRP) were determined by ELISA, level of aldosterone and the renin activity were determined by radioimmunoassay...
October 2018: Journal of Arrhythmia
Mark J Shen, Bradley P Knight
PURPOSE OF REVIEW: This article uses three commonly encountered clinical scenarios to highlight the value of high-density mapping in the electrophysiology laboratory for the identification of the circuits and substrates during catheter ablation of complex arrhythmias. RECENT FINDINGS: High-density mapping gathered with a multielectrode catheter, with its smaller individual electrode size and closer interelectrode spacing, helps during ablation procedures in a number of ways...
October 15, 2018: Current Opinion in Cardiology
Wei Li, Jian Sun, Ying Yu, Zhi-Quan Wang, Peng-Pai Zhang, Kai Guo, Man-Tian Chen, Yi-Gang Li
BACKGROUND: Post cardiac injury syndrome (PCIS) is a troublesome but not uncommon complication following catheter ablation of arrhythmias. We aimed to study the clinical features of ablation-associated PCIS. METHODS: For this purpose, we conducted a computerised literature search that identified 19 published cases, and we additionally included another 2 new cases from our centres. Twenty-one cases of PCIS following ablation were analysed. RESULTS: Among the 21 cases, PCIS most commonly occurred after atrial flutter/fibrillation (AFL/AF) ablation (71...
October 7, 2018: Heart, Lung & Circulation
Adam Lee, Tomos E Walters, Edward P Gerstenfeld, Haris M Haqqani
Frequent ventricular ectopy is a common clinical presentation in patients suffering idiopathic ventricular outflow tract arrhythmias. These are focal arrhythmias that generally occur in patients without structural heart disease and share a predilection for characteristic anatomic sites of origin. Mechanistically, they are generally due to cyclic adenosine monophosphate (cAMP)-mediated triggered activity. As a result, there is typically an exercise or catecholamine related mode of induction and often a sensitivity to suppression with adenosine...
October 4, 2018: Heart, Lung & Circulation
Yosuke Ishii
Fundamental procedure of arrhythmia surgery is to bock conduction of macro-reentry or focal activation. Traditional "cut and sew" technique is effective to make a conduction block without any special devices although it is time consuming and there is some bleeding risk. Surgical ablation devices are easily able to make a conduction block during surgery. It could undergo the minimally invasive cardiovascular surgery (MICS) -maze procedure through the right mini thoracotomy. It is most important to make complete conduction block because incomplete ablation causes residual conduction, resulting in recurrence of atrial fibrillation or atrial tachycardia...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Hitoshi Mori, Syota Muraji, Naokata Sumitomo, Ritsushi Kato, Tomohiko Imamura, Akiko Komori, Noriyuki Iwashita, Toshiki Kobayashi, Kazuo Matsumoto
BACKGROUND: A new mapping system (Rhythmia) using a 64 mini-electrode small basket array (Orion) was developed and enables rapid high-density mapping in a short time. However, there are few reports about the usefulness of this system in pediatric cases. OBJECTIVE: The aim of this study was to investigate the safety and accuracy of the Rhythmia system and Orion catheter in the pediatric field. METHODS: Catheter ablation using the Rhythmia system and Orion catheter was performed in 23 patients less than 20 years-old whose body weight was more than 20 kg without a past medical history of cardiac disease...
October 8, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Dierk Thomas, Torsten Christ, Larissa Fabritz, Andreas Goette, Matthias Hammwöhner, Jordi Heijman, Jens Kockskämper, Dominik Linz, Katja E Odening, Patrick A Schweizer, Reza Wakili, Niels Voigt
Cardiac arrhythmias remain a common challenge and are associated with significant morbidity and mortality. Effective and safe rhythm control strategies are a primary, yet unmet need in everyday clinical practice. Despite significant pharmacological and technological advances, including catheter ablation and device-based therapies, the development of more effective alternatives is of significant interest to increase quality of life and to reduce symptom burden, hospitalizations and mortality. The mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches...
October 10, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Michael Efremidis, Konstantinos P Letsas, Stamatis Georgopoulos, Nikolaos Karamichalakis, Konstantinos Vlachos, Louiza Lioni, George Bazoukis, Athanasios Saplaouras, Antigoni Sakellaropoulou, Angelos Michael Kolokathis, Aikaterini Rokiza, Aikaterini Anagnostou, Kosmas Valkanas, Antonios Sideris
BACKGROUND: Data regarding long-term outcomes of atrial fibrillation (AF) catheter ablation are limited. This study evaluated the safety, long-term efficacy and predictors of recurrence after a single left atrial ablation procedure in patients with paroxysmal (PAF) and non-paroxysmal AF (NPAF). METHODS: Data from 520 patients (354 males, mean age 57.08 ± 11.33 years) with PAF (n = 356, 68.5%) or NPAF (n = 164, 31.5%) who underwent a single radiofrequency ablation procedure were analysed...
October 10, 2018: Acta Cardiologica
Robert D Anderson, Saurabh Kumar, Jonathan M Kalman, Prashanthan Sanders, Frederic Sacher, Meleze Hocini, Pierre Jais, Michel Haisaguerre, Geoffrey Lee
Ventricular fibrillation (VF) is a common and life-threatening arrhythmia resulting in sudden cardiac death (SCD). Due to the inherent challenges of mapping VF in humans, the underlying mechanisms that initiate and sustain this common arrhythmia are still poorly understood. In high-risk patients and survivors of SCD, implantable cardioverter defibrillators (ICD) play a central role in treating VF episodes, however, ICDs do not prevent VF recurrences and patients remain at risk of electrical storm and multiple shocks that are often refractory to escalation of medical therapy...
September 29, 2018: Heart, Lung & Circulation
Jin Kyung Hwang, Dong Seop Jeong, Hye Bin Gwag, Kyoung-Min Park, Joonghyun Ahn, Keumhee Carriere, Seung-Jung Park, June Soo Kim, Young Keun On
The treatment effect of the hybrid procedure, consisting of a thoracoscopic ablation followed by an endocardial radiofrequency catheter ablation (RFCA), is unclear. A total of 117 ablation-naïve patients who underwent either the staged hybrid procedure (n = 72) or RFCA alone (n = 105) for drug-refractory, non-valvular persistent or long-standing persistent atrial fibrillation (AF) were enrolled. The primary outcome is occurrence of total atrial arrhythmia, defined as a composite of AF, sustained atrial tachycardia (AT), and atypical atrial flutter (AFL) after index procedure...
2018: PloS One
Naga Venkata Pothineni, Krishna Kancharla, Ajoe J Katoor, Ghanshyam Shanta, Hakan Paydak, Suraj Kapa, Abhishek Deshmukh
INTRODUCTION: Catheter ablation has emerged as the preferred modality of treatment for many cardiac arrhythmias. Anatomical sites of ablation are often located in close proximity to coronary arteries. However, the incidence of catheter ablation related coronary injury has not been well studied. We sought to systematically evaluate all cases of catheter ablation related coronary injuries. METHODS AND RESULTS: A PUBMED search was conducted from inception until May 1, 2017 using the key words 'coronary artery' and 'ablation...
October 4, 2018: Journal of Cardiovascular Electrophysiology
Andrew Silverman, Sonia Taneja, Liliya Benchetrit, Peter Makusha, Robert L McNamara, Alexander B Pine
A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Yukie Sunata, Hideki Mori, Yuichiro Hirai, Yoko Kubosawa, Shigeo Banno, Satoshi Kinoshita, Yoshihiro Nakazato, Toshihiro Nishizawa, Masahiro Kikuchi, Toshio Uraoka
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and cryoballoon ablation was developed as a new treatment modality for symptomatic AF. Gastroparesis is rarely reported as a transient complication of ablation, and its frequency and risk are not clear. We experienced a rare case of gastroparesis after cryoballoon ablation followed by medication-induced recovery within 6 months.
May 2018: Case Reports in Gastroenterology
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