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Atrial fibrillation; AF Ablation

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https://www.readbyqxmd.com/read/28449532/the-future-of-hybrid-ablation-an-emerging-need-for-an-anticoagulation-protocol-for-thoracoscopic-ablation
#1
EDITORIAL
Pavel Osmancik, Petr Budera
The midterm efficacy of hybrid ablation of atrial fibrillation (AF) reported in recent papers is about 70% in terms of sinus rhythm maintenance without antiarrhythmic drugs. Bearing in mind that the majority of patients enrolled are patients with persistent and long-standing persistent AF, the reported efficacies seem to be very good. Despite the high efficacies, safety remains a critical issue in hybrid, and especially thoracoscopic ablations. The frequency of complications during thoracoscopic ablations is more than 10% in the majority of reports...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28449531/ablation-of-atrial-fibrillation-single-shot-techniques-poised-to-dominate-rhythm-control-strategies-the-future-is-here
#2
EDITORIAL
Antonis S Manolis
Over the recent years, the advent of single-shot techniques, such as circular catheter and cryoballoon ablation, has ushered in a new era in the catheter ablation approach and rhythm control strategies of patients with atrial fibrillation (AF). These techniques make it easier to navigate the heart and have the potential to decrease the threshold for, expand the access to, and increase patient and physician acceptance of rhythm-control therapies, that may lead to reduction of the AF disease burden and its socioeconomic impact...
March 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28447320/should-ablation-be-first-line-therapy-for-patients-with-paroxysmal-af
#3
REVIEW
Sergio Conti, Atul Verma
Atrial fibrillation is the most common cardiac arrhythmia and the number of patients is expected to continuously increase in the next years. Catheter ablation is an effective, safe, and well-established treatment for patient with symptomatic and drug-resistant paroxysmal atrial fibrillation (PAF). Over the last decade, there was an increasing body of evidence demonstrating superiority of catheter ablation over antiarrhythmic drugs (AADs) in maintaining sinus rhythm. However, randomized clinical trials have not been conclusive to consider catheter ablation as a first-line therapy for PAF...
May 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28444307/left-atrial-volume-predicts-atrial-fibrillation-recurrence-after-radiofrequency-ablation-a-meta-analysis
#4
Augustine Njoku, Munish Kannabhiran, Rishi Arora, Pratap Reddy, Rakesh Gopinathannair, Dhanunjaya Lakkireddy, Paari Dominic
Aims: Left atrial (LA) diameter is a predictor of atrial fibrillation (AF) recurrence following radiofrequency catheter ablation (RFA). However, LA volume (LAV) is more accurate in assessing LA size. Studies evaluating LAV as a predictor of AF recurrence are contradictory; therefore, we performed a meta-analysis to assess whether LAV is an independent predictor of AF recurrence following RFA. Methods and results: All studies reporting LAV/LAV index (LAVi) as a predictor of AF recurrence following RFA were included...
April 21, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28444228/improved-outcome-and-cost-effectiveness-in-ablation-of-persistent-atrial-fibrillation-under-general-anaesthetic
#5
Claire A Martin, James P Curtain, Parag R Gajendragadkar, David A Begley, Simon P Fynn, Andrew A Grace, Patrick M Heck, Kiran Salaunkey, Munmohan S Virdee, Sharad Agarwal
Aims: Outcome of persistent atrial fibrillation (AF) ablation remains suboptimal. Techniques employed to reduce arrhythmia recurrence rate are more likely to be embraced if cost-effectiveness can be demonstrated. A single-centre observational study assessed whether use of general anaesthesia (GA) in persistent AF ablation improved outcome and was cost-effective. Methods and results: Two hundred and ninety two patients undergoing first ablation procedures for persistent AF under conscious sedation or GA were followed...
April 21, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28439618/-radiofrequency-current-or-cryoballoon-for-ablation-of-atrial-fibrillation-hot-or-cold
#6
B Reissmann, K-H Kuck, A Metzner
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. The aim of therapy in symptomatic patients is the establishment of a stable sinus rhythm (SR). Catheter ablation with isolation of the pulmonary veins is the essential component of all forms of ablation therapy and provides the most effective treatment option. The most frequently used technologies for pulmonary vein isolation (PVI) are radiofrequency current (RFC)-based and cryoballoon (CB)-guided ablation. Irrespective of the simplification of PVI, CB ablation is characterized by a short learning curve and short procedural times and demonstrated non-inferiority with respect to safety and efficacy when directly compared to RFC ablation for the treatment of patients with paroxysmal AF; however, the clinical outcome in patients with persistent AF is often insufficient when performing pulmonary vein isolation (PVI) alone for stabilization of SR...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28439617/-stroke-prophylaxis-in-atrial-fibrillation-when-how-and-for-whom
#7
T Maurer, C Sohns
In patients suffering from atrial fibrillation (AF), modern antithrombotic therapy and anticoagulation strategies should be individualized based on shared decision making including patient preferences and the absolute and relative risks of stroke and bleeding. Estimation of the individual risk for stroke is still based on the CHA2DS2-VASc score. Based on the most recent guidelines for the management of AF, oral anticoagulation therapy should be considered for men with a CHA2DS2-VASc score ≥1 and women with a score ≥2, balancing the expected stroke reduction, risk of bleeding and patient preference...
April 24, 2017: Herz
https://www.readbyqxmd.com/read/28438723/long-term-outcomes-of-minimally-invasive-surgical-ablation-for-atrial-fibrillation-a-single-center-experience
#8
Aditya Saini, Yuhning L Hu, Vigneshwar Kasirajan, Frederick T Han, Muhammad Z Khan, Luke Wolfe, Sampath Gunda, Jayanthi N Koneru, Kenneth A Ellenbogen
BACKGROUND: Minimally invasive surgical AF ablation delivers RF energy via a thoracoscopic approach to perform pulmonary vein isolation and LA ganglionic plexi ablation. Data on long term outcomes of MISAA is lacking. OBJECTIVE: We report 5 year follow-up data from a prospective cohort of patients who underwent MISAA at a single center. METHODS: One hundred nine consecutive patients (60 paroxysmal, 49 persistent, mean age 62.7±9.3 years) underwent MISAA with left atrial appendage exclusion by a single surgeon between 2006 and 2012...
April 21, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28438722/propagation-of-meandering-rotors-surrounded-by-high-dominant-frequency-areas-in-persistent-atrial-fibrillation
#9
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 aims to investigate the spatiotemporal association between dominant frequency (DF) and re-entrant phase activation areas. METHODS: Eight persAF patients undergoing first-time catheter ablation procedure were enrolled. A non-contact array catheter was deployed into the left atrium (LA) and 2048 AF electrograms (AEG) were acquired for 15 seconds following ventricular far-field cancellation...
April 21, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28436566/atrial-fibrillation-originating-from-superior-vena-cava-with-atrial-flutter-electrocardiogram-pattern
#10
Hung-Kai Huang, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Yen-Chang Huang, Chung-Hsing Lin, Chao-Shun Chan, Hung-Yu Chang, Chin-Yu Lin, Yao-Ting Chang, Ching-Hui Huang, Shih-Ann Chen
BACKGROUNDS: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). METHODS AND RESULTS: Seventy-six patients with AF originating from SVC underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2)...
April 24, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28434446/revisiting-pulmonary-vein-isolation-alone-for-persistent-atrial-fibrillation-a-systematic-review-and-meta-analysis
#11
Aleksandr Voskoboinik, Jeremy T Moskovitch, Nadav Harel, Prashanthan Sanders, Peter M Kistler, Jonathan M Kalman
BACKGROUND: Early studies demonstrated relatively low success rates for pulmonary vein isolation (PVI) alone in patients with persistent atrial fibrillation (PeAF). However, the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF. OBJECTIVE: The purpose of this study was to systematically review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF...
May 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
#12
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/28433223/risk-of-intraatrial-thrombi-after-thoracoscopic-ablation-in-absence-of-heparin-and-appendage-closure
#13
Petr Budera, Pavel Osmancik, Dalibor Herman, David Talavera, Robert Petr, Zbynek Straka
BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion...
April 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28432503/high-voltage-zones-within-the-pulmonary-vein-antra-major-determinants-of-acute-pulmonary-vein-reconnections-after-atrial-fibrillation-ablation
#14
Koichi Nagashima, Ichiro Watanabe, Yasuo Okumura, Kazuki Iso, Keiko Takahashi, Ryuta Watanabe, Masaru Arai, Sayaka Kurokawa, Toshiko Nakai, Kimie Ohkubo, Shunichi Yoda, Atsushi Hirayama
PURPOSE: Recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI) is mainly due to PV reconnections. Patient-specific tissue characteristics that may contribute remain unidentified. This study aimed to assess the relationship between the bipolar electrogram voltage amplitudes recorded from the PV-left atrial (LA) junction and acute PV reconnection sites. METHODS: Three-dimensional LA voltage maps created before an extensive encircling PVI in 47 AF patients (31 men; mean age 62 ± 11 years) were examined for an association between the EGM voltage amplitude recorded from the PV-LA junction and acute post-PVI PV reconnections (spontaneous PV reconnections and/or ATP-provoked dormant PV conduction)...
April 21, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28431512/hemoglobin-a1c-and-risk-of-left-atrial-thrombus-and-spontaneous-echo-contrast-in-non-valvular-atrial-fibrillation-patients
#15
Rong-Ren Kuang, Fang-Zhou Liu, Yun-Peng Li, Wei-Dong Lin, Hua-Sheng Liang, Ai-Hua Chen
OBJECTIVES: To evaluate the relationship between hemoglobin A1c (HbA1c) and risk of left atrial thrombus/spontaneous echo contrast (LAT/SEC) in non-valvular atrial fibrillation (AF) patients. METHODS: In this retrospective study, 1158 consecutive non-valvular AF patients undergoing transesophageal echocardiography prior to radiofrequency catheter ablation or electric cardioversion were enrolled. Baseline characteristics were collected and analyzed. RESULTS: There were 87 (7...
April 21, 2017: European Journal of Medical Research
https://www.readbyqxmd.com/read/28431066/limited-left-atrial-surgical-ablation-effectively-treats-atrial-fibrillation-but-decreases-left-atrial-function
#16
Marieke G Compier, Laurens F Tops, Jerry Braun, Katja Zeppenfeld, Robert J Klautz, Martin J Schalij, Serge A Trines
Aims: Limited left atrial (LA) surgical ablation with bipolar radiofrequency is considered to be an effective procedure for treatment of atrial fibrillation (AF). We studied whether limited LA surgical ablation concomitant to cardiac surgery is able to maintain LA function. Methods and Results: Thirty-six consecutive patients (age 66 ± 12 years, 53% male, 78% persistent AF) scheduled for valve surgery and/or coronary revascularization and concomitant LA surgical ablation were included...
April 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28431050/role-of-adenosine-guided-pulmonary-vein-isolation-in-patients-undergoing-catheter-ablation-for-atrial-fibrillation-a-meta-analysis
#17
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...
April 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28429499/atrial-fibrillation-patients-with-isolated-pulmonary-veins-is-sinus-rhythm-achievable
#18
Judit Szilágyi, Gregory M Marcus, Nitish Badhwar, Byron K Lee, Randall J Lee, Vasanth Vedantham, Zian H Tseng, Tomos Walters, Melvin Scheinman, Jeffrey Olgin, Edward P Gerstenfeld
BACKGROUND: The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. METHODS AND RESULTS: We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr...
April 21, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28427852/circumferential-pulmonary-vein-isolation-with-second-generation-multipolar-catheter-in-patients-with-paroxysmal-or-persistent-atrial-fibrillation-procedural-and-one-year-follow-up-results
#19
Stefan G Spitzer, Patrick Leitz, Anke Langbein, Laszlo Karolyi, Frank Scharfe, Thomas Weinmann, Carola Rämmler, Christian Pott, Gerold Mönnig, Lars Eckardt
BACKGROUND: There is a lack of procedural and follow-up data on pulmonary vein isolation (PVI) with the second-generation pulmonary vein ablation catheter® (PVAC Gold) in patients with atrial fibrillation (AF). This study provides data on PVI procedures and 1-year follow-up results with PVAC Gold in patients with AF treated in clinical practice. METHODS AND RESULTS: Three hundred and eighty four patients with documented symptomatic paroxysmal (n=198) or persistent (n=186) AF were included in a non-randomized prospectively designed database...
April 12, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28427735/comparison-of-frequency-and-characteristics-of-patients-with-atrial-fibrillation-having-ablation-with-versus-without-coronary-narrowing-%C3%A2-50-by-angiography
#20
Toshiro Tomomatsu, Itsuro Morishima, Kenji Okumura, Hideyuki Tsuboi, Yasuhiro Morita, Kensuke Takagi, Ruka Yoshida, Hiroaki Nagai, Yoshihiro Ikai, Naoki Shibata, Kazuhito Tsuzuki, Takahito Sone, Toyoaki Murohara
Atrial fibrillation (AF) shares background comorbidities with coronary artery disease (CAD), including hypertension and diabetes mellitus. The aim of the study is to evaluate the prevalence, risk factors, and prognostic significance of CAD among patients who underwent catheter ablation for AF. In 544 consecutive registered patients who underwent catheter ablation for AF (CHADS2 score 1.2 ± 1.1, paroxysmal AF 57%), quantitative coronary angiography was used to detect CAD, defined as luminal narrowing of ≥50% in diameter...
March 16, 2017: American Journal of Cardiology
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