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Left atrial appendage isolation

Nishant Verma, Bradley P Knight
No abstract text is available yet for this article.
December 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Yun Gi Kim, Jaemin Shim, Suk-Kyu Oh, Kwang-No Lee, Jong-Il Choi, Young-Hoon Kim
BACKGROUND: Electrical isolation of the left atrial appendage (LAA) is associated with a lower rate of atrial fibrillation (AF) recurrence in patients undergoing radiofrequency catheter ablation. However, LAA isolation can significantly impair LAA contractility. OBJECTIVE: This study was performed to evaluate whether electrical isolation of the LAA is associated with an increased risk of ischemic stroke or transient ischemic attack (TIA). METHODS: Consecutive patients with AF undergoing radiofrequency catheter ablation at Korea University Medical Center Anam Hospital were analyzed...
December 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Takahiko Nagase, Stefano Bordignon, Laura Perrotta, Fabrizio Bologna, Nikolaos Tsianakas, Shaojie Chen, Athanasios Konstantinou, Julian K R Chun, Boris Schmidt
BACKGROUND: It remains unclear whether left atrial low-voltage area (LALVA) affects atrial tachyarrhythmia recurrence after laser balloon pulmonary vein isolation (PVI) for atrial fibrillation (AF). We prospectively evaluated the outcome of laser balloon PVI in patients with and without LALVA (≤ 0.5 mV) together with surface/intracardiac electrophysiological criteria. METHODS: One hundred consecutive paroxysmal/persistent AF patients underwent laser balloon PVI...
November 20, 2018: Pacing and Clinical Electrophysiology: PACE
Nitish Badhwar, Ghannam Al-Dosari, Jonathan Dukes, Randall J Lee
Two patients with long-standing atrial fibrillation (AF) refractory to medical management and with prior pulmonary vein isolation underwent a new hybrid epicardial/endocardial subxyphoid approach for AF ablation and left atrial appendage (LAA) ligation. Pulmonary vein and LA posterior wall isolation, as well as LAA exclusion were achieved in both patients. There were no procedural complications. Both patients remain in sinus rhythm. Both patients are off antiarrhythmic medications.
June 2018: Journal of Atrial Fibrillation
Sri Sundaram, William Choe, J Ryan Jordan, Charles Boorman, Nate Mullins, Austin Davies, Austin Stucky, Sunil Nath
Background: This study describes the use of lesion index (LSI) as a direct measure to assess the adequacy of ablation lesion formation with force-sensing catheters in ablation of paroxysmal atrial fibrillation (PAF). LSI is calculated by the formula:LSI = CF (g) ×Current (mA) ×Time (sec). Methods: Fifty consecutive patients with PAF underwent pulmonary vein (PV) isolation using a catheter dragging technique and targeting different LSI values in different anatomical areas...
June 2018: Journal of Atrial Fibrillation
Antonio Madaffari, Anett Große, Elisabetta Conci, J Christoph Geller
Left atrial appendage (LAA) may be the source for initiation and maintenance of atrial fibrillation (AF). This report shows restoration of sinus rhythm in the atria during radiofrequency wide-area LAA electrical isolation, whereas AF persists in the LAA.
November 5, 2018: Pacing and Clinical Electrophysiology: PACE
Luigi Di Biase, Andrea Natale, Jorge Romero
Understanding the anatomy, physiology, and arrhythmogenic and thrombogenic roles of the left atrial appendage (LAA) has become very important. The potential deleterious effects of this chamber in patients with atrial fibrillation have led to the development of specific treatments for this structure. It has been established that the LAA is the area where the vast majority of thrombi in nonvalvular atrial fibrillation are formed and that some LAA morphologies may actually facilitate thrombi formation and risk stratification for thromboembolic events in patients with low CHA2 DS2 -VASc scores...
October 30, 2018: Circulation
Petra Kleinbongard, Nilguen Gedik, Mücella Kirca, Leanda Stoian, Ulrich Frey, Afsaneh Zandi, Matthias Thielmann, Heinz Jakob, Jürgen Peters, Markus Kamler, Gerd Heusch
Background Remote ischemic preconditioning ( RIPC ) by repeated brief cycles of limb ischemia/reperfusion attenuates myocardial ischemia/reperfusion injury. We aimed to identify a functional parameter reflecting the RIPC -induced protection in human. Therefore, we measured mitochondrial function in right atrial tissue and contractile function of isolated right atrial trabeculae before and during hypoxia/reoxygenation from patients undergoing coronary artery bypass grafting with RIPC or placebo, respectively...
August 7, 2018: Journal of the American Heart Association
Ahmet Adiyaman, Thomas J Buist, Rypko J Beukema, Jaap Jan J Smit, Peter Paul H M Delnoy, Martin E W Hemels, Hauw T Sie, Anand R Ramdat Misier, Arif Elvan
BACKGROUND: Current guidelines recommend both percutaneous catheter ablation (CA) and surgical ablation in the treatment of atrial fibrillation, with different levels of evidence. No direct comparison has been made between minimally invasive thoracoscopic pulmonary vein isolation with left atrial appendage ligation (surgical MIPI) versus percutaneous CA comprising of pulmonary vein isolation as primary treatment of atrial fibrillation. We, therefore, conducted a randomized controlled trial comparing the safety and efficacy of these 2 treatment modalities...
October 2018: Circulation. Arrhythmia and Electrophysiology
Ahmed AlTurki, Thao Huynh, Ahmed Dawas, Hussain AlTurki, Jacqueline Joza, Jeff S Healey, Vidal Essebag
A significant proportion of patients' experience recurrence of atrial fibrillation (AF) despite pulmonary venous isolation (PVI), especially those with persistent AF. Isolation of the left atrial appendage (LAA) may reduce AF recurrence. The aim of this study was to assess the efficacy of LAA isolation in addition to PVI compared with PVI alone. We conducted a comprehensive search of electronic databases, up to April 21st, 2017, for all studies comparing the effect LAA electrical isolation or ligation in addition to PVI, as opposed to PVI alone, on the recurrence of atrial fibrillation after catheter ablation...
October 2018: Journal of Arrhythmia
Satoshi Miyazawa, Seiji Fukamizu, Iwanari Kawamura, Rintaro Hojo
A 79-year-old woman with a history of pulmonary vein isolation for persistent atrial fibrillation was admitted for recurrence of atrial tachycardia, with a tachycardia cycle length of 236 milliseconds. The ultra-high-resolution mapping system revealed that tachycardia circuit detouring the epicardium at the anterior wall scar and breaking through to the endocardium below the left atrial appendage. Radiofrequency energy was applied to this site, which successfully terminated the tachycardia. This case suggests that epicardial conduction could occur even at the left atrial anterior wall and identifies a variation in epicardial conduction around the left atrium, which could be a tachycardia circuit...
October 4, 2018: Journal of Cardiovascular Electrophysiology
D A Lerman, M Diaz, B Peault
Introduction: Focussing on the potential role of cardiovascular cell therapy, we investigated the spatial relationship between pericytes (cells with cardiac repair capabilities that ensheath blood vessels) and endogenous cardiac progenitors within stem cells' niches. We explored possible changes in their co-localisation in developing human hearts from foetal to adult stage and following ischaemia. Methods: Foetal and adult human heart specimens, obtained under ethical consent (University of Edinburgh ethics committee), were used for immunohistochemistry, cell isolation, culture and differentiation...
August 28, 2018: European Heart Journal
Helena Domínguez, Christoffer Valdorff Madsen, Oliver Nøhr Hjorth Westh, Peter Appel Pallesen, Christian Lildal Carrranza, Akhmadjon Irmukhamedov, Jesper Park-Hansen
PURPOSE OF REVIEW: Stroke is the most feared complication of atrial fibrillation. To prevent stroke, left atrial appendage exclusion has been targeted, as it is the prevalent site for formation of heart thrombi during atrial fibrillation. We review the historic development of methods for exclusion of the left atrial appendage and the evidence to support its amputation during routine cardiac surgery. RECENT FINDINGS: Evidence is not yet sufficient to routinely recommend left atrial exclusion during heart surgery, despite a high prevalence of postoperative atrial fibrillation...
August 31, 2018: Current Cardiology Reports
James R Stewart
No abstract text is available yet for this article.
November 2018: Annals of Thoracic Surgery
Malcolm C Finlay, Charles A Mosse, Richard J Colchester, Sacha Noimark, Edward Z Zhang, Sebastien Ourselin, Paul C Beard, Richard J Schilling, Ivan P Parkin, Ioannis Papakonstantinou, Adrien E Desjardins
High-frequency ultrasound imaging can provide exquisite visualizations of tissue to guide minimally invasive procedures. Here, we demonstrate that an all-optical ultrasound transducer, through which light guided by optical fibers is used to generate and receive ultrasound, is suitable for real-time invasive medical imaging in vivo . Broad-bandwidth ultrasound generation was achieved through the photoacoustic excitation of a multiwalled carbon nanotube-polydimethylsiloxane composite coating on the distal end of a 300-μm multi-mode optical fiber by a pulsed laser...
December 2017: Light, Science & Applications
N Ma, J Mei, R X Lu, Z L Jiang, M Tang, F B Ding
Objective: To evaluate the efficacy of Mei mini maze procedure for treating atrial fibrillation (AF) patients with previously failed catheter ablation. Methods: Between August 2010 and May 2016, 48 AF (8 proximal AF, 15 persistent AF and 25 long-standing persistent AF) patients (29 males, 19 females, mean age: (62.5±7.3) years old) with previously 1-3 failed catheter ablation results were treated with Mei mini maze procedure in our department. Under thoracoscopic assistance, the procedure was performed through three ports on left chest wall, pulmonary vein isolation and ablations of the roof and posterior wall of left atrium was made by bipolar radiofrequency ablation...
August 24, 2018: Zhonghua Xin Xue Guan Bing za Zhi
Toshiya Ohtsuka, Takahiro Nonaka, Motoyuki Hisagi, Mikio Ninomiya
BACKGROUND: We evaluated the safety and rhythm control effectiveness in en bloc isolation of the left pulmonary vein (PV) and appendage conducted as part of the thoracoscopic procedure for bilateral PV isolation, non-PV ablation, and appendage closure for atrial fibrillation (AF). METHODS: Procedural safety was evaluated by reviewing the surgical records. Rhythm control was examined in accordance with the Heart Rhythm Society guidelines at postoperative months 1, 3, 6, and 12, and yearly thereafter...
November 2018: Annals of Thoracic Surgery
Georgios Giannopoulos, Vasileios Kekeris, Dimitrios Vrachatis, Charalampos Kossyvakis, Charalampos Ntavelas, Georgios Tsitsinakis, Athanasios Koutivas, Christos Tolis, Christos Angelidis, Spyridon Deftereos
BACKGROUND: Left atrial appendage (LAA) functional modification in the context of pulmonary vein isolation has been a focus point of research and LAA emptying flow velocity (LAAEFV) is considered to reflect LAA contractility, stunning, and fibrosis. OBJECTIVE: In the present study, we sought to prospectively evaluate short-term LAAEFV changes after radiofrequency (RF) or cryoballoon ablation in paroxysmal AF. METHODS: This was a prospective substudy of the Effect of Cryoballoon and RF Ablation on Left Atrial Function (CryoLAEF) study (ClinicalTrials...
September 2018: Pacing and Clinical Electrophysiology: PACE
Heiko Lehrmann, Amir S Jadidi, Jan Minners, Juan Chen, Björn Müller-Edenborn, Reinhold Weber, Olaf Dössel, Thomas Arentz, Axel Loewe
OBJECTIVES: This study hypothesized that P-wave morphology and timing under left atrial appendage (LAA) pacing change characteristically immediately upon anterior mitral line (AML) block. BACKGROUND: Perimitral flutter commonly occurs following ablation of atrial fibrillation and can be cured by an AML. However, confirmation of bidirectional block can be challenging, especially in severely fibrotic atria. METHODS: The study analyzed 129 consecutive patients (66 ± 8 years, 64% men) who developed perimitral flutter after atrial fibrillation ablation...
July 2018: JACC. Clinical Electrophysiology
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