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Stefan Georg Spitzer, László Károlyi, Carola Rämmler, Frank Scharfe, Thomas Weinmann, Mirko Zieschank, Anke Langbein
INTRODUCTION: A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favourable outcomes with recurrent persistent AF patients. OBJECTIVE: We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent non-paroxysmal AF. METHODS: 58 consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent non-paroxysmal AF...
October 21, 2016: Journal of Cardiovascular Electrophysiology
Mu Qin, Xu Liu, Shao-Hui Wu, Xiao-Dong Zhang
Several clinically relevant outcomes post atrial substrate modification in patients with atrial fibrillation (AF) have not been systematically analyzed among published studies on adjunctive cardiac ganglionated plexi (GP) or complex fractionated atrial electograms (CFAE) ablation vs. pulmonary vein isolation (PVI) alone. Out of 176 reports identified, the present meta-analysis included 14 randomized and non-randomized controlled trials (1613 patients) meeting inclusion criteria. Addition of GP ablation to PVI significantly increased freedom from atrial tachyarrhythmia in short- (OR: 1...
2016: PloS One
Sandeep Prabhu, Vincent Mackin, Alex Ja McLellan, Tuong Phan, Desmond McGlade, Liang-Han Ling, Kah Y Peck, Alexandr Voskoboinik, Bupesh Pathik, Chrishan J Nalliah, Geoff R Wong, Sonia M Azzopardi, Geoffrey Lee, Justin Mariani, Andrew J Taylor, Jonathan M Kalman, Peter M Kistler
INTRODUCTION: The significance of adenosine induced dormant pulmonary vein (PV) conduction in AF ablation remains controversial. The optimal dose of adenosine to determine dormant PV conduction is yet to be systematically explored. METHODS AND RESULTS: Consecutive patients undergoing index AF ablation received 3 adenosine doses (12mg, 18mg, 24mg) in a randomized blinded order, immediately after PVI. Electrophysiological (PR prolongation, AV block (AVB) and PV reconnection) and hemodynamic (BP) parameters were measured...
October 19, 2016: Journal of Cardiovascular Electrophysiology
Girish M Nair, Roshan Raut, Karan Bami, Pablo B Nery, Calum J Redpath, Mouhannad M Sadek, Martin S Green, David H Birnie
PURPOSE OF REVIEW: Pulmonary vein reconnection leading to recurrence of atrial arrhythmias after pulmonary vein isolation (PVI) for atrial fibrillation remains a significant challenge. A number of adjunctive measures during PVI have been used to attempt to reduce pulmonary vein reconnection and recurrence of atrial arrhythmias. We performed a systematic review of the literature and meta-analysis of studies evaluating the efficacy of adjunctive measures used during PVI in reducing recurrent atrial arrhythmias...
October 15, 2016: Current Opinion in Cardiology
Jeremiah Wasserlauf, Bradley P Knight, Zhi Li, Adin-Cristian Andrei, Rishi Arora, Alexandru B Chicos, Jeffrey J Goldberger, Susan S Kim, Albert C Lin, Nishant Verma, Martha M Bohn, Rod S Passman
BACKGROUND: Cryoballoon ablation (CBA) for paroxysmal atrial fibrillation (pAF) can be performed under general anesthesia (GA) or moderate sedation (MS). Our objective was to compare the effectiveness, safety, procedure duration, and time spent in the electrophysiology (EP) laboratory for CBA performed under GA and MS. METHODS: . Patients undergoing a first CBA for pAF were identified. Patients received either GA administered by an anesthesiologist or MS with midazolam and fentanyl administered by EP laboratory staff...
October 17, 2016: Pacing and Clinical Electrophysiology: PACE
Sharan Prakash Sharma, Rajbir S Sangha, Khagendra Dahal, Parasuram Krishnamoorthy
BACKGROUND: It is not clear whether additional empiric superior vena cava isolation (SVCI) to pulmonary vein isolation (PVI) results in low recurrences of atrial fibrillation. We aimed to perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated role of empiric SVCI in atrial fibrillation ablation. METHODS: We searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for RCTs (inception April 15, 2016 without language restrictions) and performed meta-analysis using random effects model...
October 14, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Melanie A Gunawardene, Boris A Hoffmann, Benjamin Schaeffer, Da-Un Chung, Julia Moser, Ruken Oezge Akbulak, Mario Jularic, Christian Eickholt, Jana Nuehrich, Christian Meyer, Stephan Willems
INTRODUCTION: Comparative data of early recurrence rates of atrial fibrillation (ERAF) following second-generation cryoballoon (CB-G2) and radiofrequency current (RFC) ablation for pulmonary vein isolation (PVI) in paroxysmal AF (PAF) are rare. We randomized PAF patients into either PVI with CB-G2 (group 1) or PVI with a combined RFC-approach applying contact force (CF) with the endpoint of unexcitability (group 2) to investigate ERAF. METHODS: In group 1 (n = 30), CB-G2-PVI was performed...
October 14, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Ariel Brandwein, Kavita Patel, Myriam Kline, Peter Silver, Sandeep Gangadharan
OBJECTIVES: Patients with obstructive airway disease have varying degrees of pulsus paradoxus that correlate with illness severity. Pulsus paradoxus can be measured using plethysmography. We investigated whether plethysmograph (pleth) variability on admission to the pediatric emergency department (ED) could predict patient disposition. We hypothesized that patients with a larger pleth variability would have a higher likelihood of being admitted to a general pediatrics unit or the intensive care unit (ICU)...
October 6, 2016: Pediatric Emergency Care
Yi-He Chen, Hui Lin, Cheng-Long Xie, Jian-Wen Hou, Yi-Gang Li
AIMS: Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). METHODS AND RESULTS: We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Christian Pfluecke, Lina Plichta, Daniel Tarnowski, Mathias Forkmann, Stefan Ulbrich, Silvio Quick, Felix M Heidrich, Stephan Wiedemann, Marian Christoph, David M Poitz, Carsten Wunderlich, Ruth H Strasser, Karim Ibrahim
Atrial fibrillation (AF) is known to cause platelet activation. AF and its degree of thrombogenesis could be associated with monocyte-platelet aggregates (MPAs). We investigated on whether the content of MPAs or other platelet activation markers is associated with the recurrence of AF after pulmonary vein isolation (PVI). A total of 73 patients with symptomatic AF underwent PVI. After 6 months, all patients were evaluated for episodes of AF recurrence. At the same time, flow-cytometric quantification analyses were performed to determine the content of MPAs...
October 13, 2016: Platelets
Yasunori Kanzaki, Yasuya Inden, Monami Ando, Yosuke Kamikubo, Tadahiro Ito, Yoshiaki Mizutani, Hiroyuki Kato, Aya Fujii, Satoshi Yanagisawa, Makoto Hirai, Toyoaki Murohara
BACKGROUNDS: Although several prognostic factors of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) have been investigated, the accurate prediction of AF recurrence remains difficult. We propose an ECG index, the P-wave force (PWF), which is the product of the amplitude of the negative terminal phase of the P-wave in the V1 electrode and the filtered P-wave duration (FPD), obtained by a signal-averaged P-wave analysis. This study was conducted to evaluate the impact of the PWF on the recurrence of AF after PVI...
October 10, 2016: Pacing and Clinical Electrophysiology: PACE
Ru-Hong Jiang, Gen-Sheng Hu, Qiang Liu, Xia Sheng, Ya-Xun Sun, L U Yu, Pei Zhang, Zu-Wen Zhang, Shi-Quan Chen, Yang Ye, Jun Zhu, Guo-Sheng Fu, Chen-Yang Jiang
BACKGROUND: The mechanisms underlying atrial fibrillation (AF) initiation and pulmonary vein isolation (PVI) effectiveness remain unclear. Ganglionated plexus (GPs) have been implicated in AF initiation and maintenance. In this study, we evaluated the impact of GP ablation in patients with PV firing after PVI. METHODS: Patients with drug-refractory paroxysmal AF undergoing radiofrequency catheter ablation therapy with PVI were screened. Amongst 840 cases over a 3...
October 10, 2016: Pacing and Clinical Electrophysiology: PACE
Márcio Galindo Kiuchi, Shaojie Chen, Gustavo Ramalho E Silva, Luis Marcelo Rodrigues Paz, Tetsuaki Kiuchi, Ary Getulio de Paula Filho, Gladyston Luiz Lima Souto
BACKGROUND: Atrial fibrillation (AF) frequently complicates chronic kidney disease (CKD). AF treatment is challenging and requires complete pulmonary vein isolation (PVI). Recently, renal sympathetic denervation (RSD) has been reported to reduce AF recurrence when performed alongside PVI. METHODS: A prospective therapeutic study of patients with controlled hypertension and paroxysmal AF was undertaken. Renal function was evaluated using estimated glomerular filtration rate...
October 4, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Tomofumi Nakamura, Kaoru Okishige, Toshiro Kanazawa, Mitsumi Yamashita, Naohiko Kawaguchi, Nobutaka Kato, Hideshi Aoyagi, Yasuteru Yamauchi, Tetsuo Sasano, Kenzo Hirao
AIMS: Pulmonary vein (PV) isolation (PVI) utilizing a cryoballoon (CB) has become one of the standard therapeutic options for atrial fibrillation (AF). However, it connotes a potential risk of cerebral ischaemic events (CIEs). This study aimed to clarify the prevalence of CIEs after PVI using second-generation CBs assessed by magnetic resonance imaging (MRI) of the brain. METHODS: This prospective observational study consisted of 160 patients that underwent PVI with second-generation CBs for drug-refractory AF...
October 4, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Sheldon M Singh, Andre d'Avila, Young-Hoon Kim, Arash Aryana, J Michael Mangrum, Gregory F Michaud, Srinivas R Dukkipati, Conor D Barrett, E Kevin Heist, Michael K Parides, Kevin E Thorpe, Vivek Y Reddy
AIMS: Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group...
October 4, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Samantha R Warnakulasuriya, Simon J Davies, R Jonathan T Wilson, David R A Yates
STUDY OBJECTIVE: This study aims to investigate if there is equivalence in volumes of fluid administered when intravenous fluid therapy is guided by Pleth Variability Index (PVI) compared to the established technology of esophageal Doppler in low-risk patients undergoing major colorectal surgery. DESIGN: Randomized controlled trial. SETTING: Operating room. PATIENTS: Forty low-risk patients undergoing elective colorectal surgery...
November 2016: Journal of Clinical Anesthesia
Makoto Sato, Takayuki Kunisawa, Atsushi Kurosawa, Tomoki Sasakawa
STUDY OBJECTIVE: Hypertension or hypotension in patients receiving continuous infusions of dexmedetomidine (DEX) is often due to changes in vascular resistance caused by α2 receptor stimulation. We investigated whether baseline perfusion index (PI) and pleth variability index (PVI), derived from pulse oximetry readings, could predict DEX-induced changes in the hemodynamic status in spontaneously breathing patients. DESIGN: Observational study. SETTING: Operating room...
November 2016: Journal of Clinical Anesthesia
Daniel Addison, Hoshang Farhad, Ravi V Shah, Thomas Mayrhofer, Siddique A Abbasi, Roy M John, Gregory F Michaud, Michael Jerosch-Herold, Udo Hoffmann, William G Stevenson, Raymond Y Kwong, Tomas G Neilan
BACKGROUND: The factors that predict recovery of left ventricular (LV) systolic dysfunction among patients with atrial fibrillation (AF) are not completely understood. Late gadolinium enhancement (LGE) of the LV has been reported among patients with AF, and we aimed to test whether the presence LGE was associated with subsequent recovery of LV systolic function among patients with AF and LV dysfunction. METHODS AND RESULTS: From a registry of 720 consecutive patients undergoing a cardiac magnetic resonance study prior to pulmonary vein isolation (PVI), patients with LV systolic dysfunction (ejection fraction [EF] <50%) were identified...
2016: Journal of the American Heart Association
Petra Maagh, Gunnar Plehn, Arnd Christoph, Ahmet Oernek, Axel Meissner
Background: Atrial fibrillation (AF) represents a turning point in hypertrophic cardiomyopathy (HCM). Pulmonary Vein Isolation (PVI) with Radiofrequency Catheter Ablation (RFCA) is accepted to be successful in restoring sinus rhythm (SR) in HCM patients. The efficacy of cryoballoon (CB) therapy in HCM patients has not been studied so far. Methods: 166 patients with AF underwent PVI with CB technology in our single center between 1/2012 and 12/2015. To evaluate the efficacy of the CB therapy in HCM patients, we compared their clinical outcome with those in "Non-HCM" AF patients in a 3 and 6 months follow-up...
2016: International Journal of Medical Sciences
Tadashi Hashida, Koichiro Yoshioka, Shigetaka Kanda, Daisuke Fujibayashi, Mari Amino, Yuji Ikari
Pulmonary vein isolation (PVI) with radio-frequency catheter ablation (RFCA) is effective therapy for the patients with paroxysmal atrial fibrillation (pAF). However, it is not easy to predict relapse of pAF. Approximately 70% pAF patients were maintained sinus rhythm for 1 year after PVI in Japan. In this study, all of the cases were underwent chest computed tomography (CT) to check for the morphology and positional relationship of the left atrium. We detected relapse cases that exhibited spur formation in the thoracic vertebrae...
2016: Tokai Journal of Experimental and Clinical Medicine
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