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Atrial fibrillation; AF Ablation

Marie-Isabel Murray, Ahran Arnold, Murad Younis, Swaroop Varghese, Andreas Michael Zeiher
OBJECTIVE: The aim of this study was to evaluate the clinical efficacy and safety outcomes of the treatment with cryoballoon (CB) compared to the treatment with traditional irrigated radiofrequency ablation (RF) for pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (pAF) and refractory to antiarrhythmic drug therapy (AAD). DESIGN: We conducted a systemic review to find and include more than two randomized controlled trials (RCTs) with at least 20 patients in each of the CB and RF groups...
March 21, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Kei Takayama, Hitoshi Hachiya, Yoshito Iesaka, Kenzo Hirao, Mitsuaki Isobe
Early recurrence (ER) of atrial fibrillation (AF) is common after ablation of longstanding persistent AF. However, optimal timing for repeat ablation has yet to be established.Two-hundred-four patients (mean age 62 ± 9 years) with longstanding persistent AF underwent catheter ablation including pulmonary vein (PV) isolation and substrate modification. ER defined as AF recurrence within 60 days, occurred in 115 patients (56.4%) 9 ± 1 days after the procedure. Analysis showed optimal blanking period to be 15 days...
March 20, 2018: International Heart Journal
Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the Executive Summary of the second update to the original Practical Guide, published in 2013. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF), and have emerged as the preferred choice, particularly in patients newly started on anticoagulation. Both physicians and patients are becoming more accustomed to the use of these drugs in clinical practice. However, many unresolved questions on how to optimally use these agents in specific clinical situations remain...
March 19, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jan Steffel, Peter Verhamme, Tatjana S Potpara, Pierre Albaladejo, Matthias Antz, Lien Desteghe, Karl Georg Haeusler, Jonas Oldgren, Holger Reinecke, Vanessa Roldan-Schilling, Nigel Rowell, Peter Sinnaeve, Ronan Collins, A John Camm, Hein Heidbüchel
The current manuscript is the second update of the original Practical Guide, published in 2013 [Heidbuchel et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15:625-651; Heidbuchel et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17:1467-1507]. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with atrial fibrillation (AF) and have emerged as the preferred choice, particularly in patients newly started on anticoagulation...
March 17, 2018: European Heart Journal
Muhammad R Afzal, Omar Kahaly, Raul Weiss, Mahmoud Houmsse, Emile G Daoud, John D Hummel
BACKGROUND: Successful pulmonary vein isolation (PVI) is the most reliable predictor of success after ablation in patients with atrial fibrillation (AF). Adenosine triphosphate (ATP) unmasks the dormant conduction and can be used to improve the effectiveness of PVI. The impact of ATP guided PVI on clinical outcomes is discordant in various randomized controlled trials (RCTs). OBJECTIVES: To delineate the incremental benefit of ATP during PVI in patients with AF through a meta-analysis...
March 21, 2018: Expert Review of Cardiovascular Therapy
Sallu Jabati, Jawed Fareed, Jeffrey Liles, Abigail Otto, Debra Hoppensteadt, Jack Bontekoe, Trung Phan, Amanda Walborn, Mushabbar Syed
The purpose of this study was to determine whether there are any differences in the levels of inflammatory, thrombotic, and collagen turnover biomarkers between individuals with atrial fibrillation (AF) and healthy volunteers. Circulating plasma levels of plasminogen activator inhibitor 1 (PAI-1), CD40-ligand (CD40-L), nucleosomes (which are indicators of cell death), C-reactive protein (CRP), procollagen III N-terminal propeptide (PIIINP), procollagen III C-terminal propeptide (PIIICP), procollagen I N-terminal propeptide, tissue plasminogen activator, and von Willebrand factor were analyzed as potential biomarkers of AF...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Berardo Sarubbi, Gaetano Rea, Giuseppe Santoro, Enrico Melillo, Giancarlo Scognamiglio, Maria Giovannna Russo
One of the major complications of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) is pulmonary vein stenosis (PVS). The natural history of PVS, especially when it involves more than one vein, leads to severe and irreversible pulmonary hypertension with end-stage right heart failure that can require, in extreme cases, even heart-lung transplantation. We report the case of a young patient who underwent RFCA for a single lasting episode of AF and developed PVS years later. He was treated with ballon venoplasty followed by stent implantation in left pulmonary vein because of PVS relief...
March 9, 2018: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
Henry Chubb, Rashed Karim, Sébastien Roujol, Marta Nuñez-Garcia, Steven E Williams, John Whitaker, James Harrison, Constantine Butakoff, Oscar Camara, Amedeo Chiribiri, Tobias Schaeffter, Matthew Wright, Mark O'Neill, Reza Razavi
BACKGROUND: Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. METHODS: Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS...
March 19, 2018: Journal of Cardiovascular Magnetic Resonance
Signe S Risom, Johanne Lind, Pamela J McCabe, Selina Kikkenborg Berg
Purpose: The CopenHeartRFA trial was designed and conducted to explore the effects of rehabilitation on patients treated with ablation for atrial fibrillation (AF). It included a cardiac rehabilitation program consisting of physical exercise and psychoeducational consultations over 6 months. As part of the evaluation of the CopenHeartRFA trial, both quantitative and qualitative data were collected. The intervention was delivered by a multidisciplinary team. Aim: This study aimed to understand the experience of patients treated for AF with ablation who participated in the CopenHeartRFA cardiac rehabilitation program...
2018: Journal of Multidisciplinary Healthcare
Guangli Yin, Ruiqin Xie, Ling You, Hongning Yin, Yucui Sun, Jinglan Wu, Yansha Zhao, Xue Geng, Yanan Zhang
BACKGROUND: The conversion of atrial fibrillation (AF) to sinus rhythm is associated with transient dysfunction of the left atrium (LA). This study aimed to investigate the time course of LA function and inflammation after radiofrequency (RF) ablation for paroxysmal AF. METHODS: Fifty-three patients with paroxysmal AF undergoing RF ablation were recruited. White blood cells were counted and high-sensitivity C-reactive protein (hs-CRP), fibrinogen, and D-dimer levels were measured...
March 15, 2018: Journal of the Chinese Medical Association: JCMA
Tomonori Watanabe, Shinsuke Miyazaki, Takatsugu Kajiyama, Sadamitsu Ichijo, Takamitsu Takagi, Miyako Igarashi, Hiroaki Nakamura, Hiroshi Taniguchi, Hitoshi Hachiya, Yoshito Iesaka
Persistent iatrogenic atrial septal defects (iASDs) can be observed after intervention requiring a left atria (LA) access, including pulmonary vein isolation (PVI) of atrial fibrillation (AF). We investigated the incidence of iASDs post-second-generation cryoballoon ablation and the pre-procedural predictors. Eighty-three paroxysmal AF patients underwent PVI using second-generation cryoballoons. The LA was accessed with single 15-Fr steerable sheaths following a radiofrequency transseptal puncture, and the iASD was evaluated with transthoracic echocardiography (TTE), a median of 9...
March 17, 2018: Heart and Vessels
Chen Chen, Xinbin Zhou, Min Zhu, Shenjie Chen, Jie Chen, Hongwen Cai, Jin Dai, Xiaoming Xu, Wei Mao
PURPOSE: The superiority of catheter ablation (CA) for persistent (and long-standing persistent) atrial fibrillation (AF) is currently not well defined. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the clinical outcomes of CA compared with medical therapy in persistent AF patients. METHODS: We systematically searched PubMed, EMBASE, the Cochrane Library, and for RCTs comparing CA with medical therapy in patients with persistent AF...
March 16, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Kang An, Hang Yin, Ju Mei, Jiaquan Zhu, Min Tang
OBJECTIVES: We retrospectively analysed data from non-valvular atrial fibrillation (AF) patients who underwent minimally invasive surgical AF ablation at our centre. Our purpose was to explore the atrial endocardial expression of von Willebrand factor (vWF) and thrombomodulin (TM) and their association with rhythm results after the procedure. METHODS: From January 2014 to May 2015, 60 patients underwent minimally invasive surgical AF ablation at our centre. Left atrial appendage samples were obtained during the procedure and immunohistochemistry for endocardial markers including vWF and TM was performed and semi-quantitatively graded...
March 14, 2018: Interactive Cardiovascular and Thoracic Surgery
Lisette Wintgens, Aleksandr Romanov, Karen Phillips, Gabriel Ballesteros, Martin Swaans, Richard Folkeringa, Ignacio Garcia-Bolao, Evgeny Pokushalov, Lucas Boersma
Aims: Long-term freedom from atrial fibrillation (AF) after catheter ablation (CA) and consequently the potential for stroke reduction remain unpredictable. Percutaneous left atrial appendage closure (LAAC) is an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. This study aims to evaluate long-term clinical results of combined CA and LAAC in one single procedure. Methods and results: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective compilation of independent prospective general LAAC registries at the individual centres...
March 13, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Dominik Linz, R Doug McEvoy, Martin R Cowie, Virend K Somers, Stanley Nattel, Patrick Lévy, Jonathan M Kalman, Prashanthan Sanders
Importance: Obstructive sleep apnea (OSA) is the most common clinically significant breathing abnormality during sleep. It is highly prevalent among patients with atrial fibrillation (AF), and it promotes arrhythmogenesis and impairs treatment efficacy. Observations: The prevalence of OSA ranges from 3% to 49% in population-based studies and from 21% to 74% in patients with AF. Diagnosis and treatment of OSA in patients with AF requires a close interdisciplinary collaboration between electrophysiologists, cardiologists, and sleep specialists...
March 14, 2018: JAMA Cardiology
Hein Heidbuchel, Nikolaos Dagres, Matthias Antz, Karl-Heinz Kuck, Patrice Lazure, Suzanne Murray, Céline Carrera, Gerhard Hindricks, Alec Vahanian
Aims: Guideline-adherent treatment is associated with improved prognosis in atrial fibrillation (AF) patients but is insufficiently implemented in clinical practice. The European Society of Cardiology (ESC) performed a multinational educational needs assessment study among cardiologists, general practitioners/family physicians (GPs/FPs), and neurologists in order to evaluate knowledge and skills of physicians and system factors related to AF care delivery. Methods and results: A total of 561 physicians (294 cardiologists, 131 neurologists, and 136 GPs/FPs) from six European countries participated...
March 12, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Fabian Moser, Andreas Rieger, Christian Pönisch, Hans Kottkamp
INTRODUCTION: Box isolation of fibrotic areas (BIFA) is a promising ablation approach for atrial fibrillation (AF) patients. However, complete isolation of fibrotic anteroseptal left atrial area, where Bachmann's bundle is blending into the left atrial myocardium, is very specific and complex. METHODS AND RESULTS: In 34 AF patients with anteroseptal fibrosis, circumferential BIFA was performed in addition to pulmonary vein isolation. In 8/34 patients, complete isolation of the fibrotic area was achieved with BIFA alone...
March 14, 2018: Journal of Cardiovascular Electrophysiology
Michał Orczykowski, Karolina Borowiec, Elzbieta Biernacka, Robert Bodalski, Piotr Urbanek, Pawel Derejko, Katarzyna Kodziszewska, Olgierd Wozniak, Aneta Fronczak, Kamil Marcinkiewicz, Krystyna Guzek, Agnieszka Fil, Grzegorz Warminski, Piotr Hoffman, Maria Bilinska, Lukasz Szumowski
BACKGROUND: After the surgical correction of Tetralogy of Fallot (TOF), surgical scars and natural obstacles form pathways capable of supporting an atrial tachyarrhythmia (AT). Radiofrequency ablation is effective, although the few studies to date on this topic had relatively short follow-up periods. AIM: The aims of the study were to evaluate the acute and long-term effects of RF ablation of AT and examine the characteristics of arrhythmia recurrence. METHODS: Tetralogy of Fallot patients (N 16, age 44...
March 14, 2018: Kardiologia Polska
Yang Liu, Xiao-Hui Niu, Xiaomeng Yin, Yue-Jian Liu, Chao Han, Jie Yang, Xin Huang, Xiaohong Yu, Lianjun Gao, Yan-Zong Yang, Yun-Long Xia, Hui-Hua Li
BACKGROUND: In atrial fibrillation (AF), a more extensively fibrotic left atrium (LA) provides a substrate for arrhythmias and increases risk of relapse following ablation. Fibrocytes are bone marrow-derived circulating mesenchymal progenitors that have been identified in the atrium of patients with AF who have valvular diseases. The present study investigates the associations between circulating fibrocytes and LA fibrosis or the prevalence of recurrence after ablation in patients with persistent AF...
March 13, 2018: Journal of the American Heart Association
Carlo Pappone, Giuseppe Ciconte, Gabriele Vicedomini, Jan O Mangual, Wenwen Li, Manuel Conti, Luigi Giannelli, Felicia Lipartiti, Luke McSpadden, Kyungmoo Ryu, Marco Guazzi, Lorenzo Menicanti, Vincenzo Santinelli
BACKGROUND: Clinical outcomes after ablation of persistent atrial fibrillation remain suboptimal. Identification of AF drivers using a novel integrated mapping technique may be crucial to ameliorate the clinical outcome. METHODS AND RESULTS: Persistent AF patients were prospectively enrolled to undergo high-density electrophysiological mapping to identify repetitive-regular activities (RRas) before modified circumferential pulmonary vein (PV) ablation. They have been randomly assigned (1:1 ratio) to ablation of RRa followed by modified circumferential PV ablation (mapping group; n=41) or modified circumferential PV ablation alone (control group; n=40)...
March 2018: Circulation. Arrhythmia and Electrophysiology
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