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Atrial fibrillation; AF Ablation

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
Kaylin T Nguyen, Rachel A Gladstone, Jonathan W Dukes, Babak Nazer, Eric Vittinghoff, Nitish Badhwar, Vasanth Vedantham, Edward P Gerstenfeld, Byron K Lee, Randall J Lee, Zian H Tseng, Jeffrey E Olgin, Melvin M Scheinman, Gregory M Marcus
INTRODUCTION: Atrial refractoriness may be an important determinant of atrial fibrillation (AF) risk, but its measurement is not clinically accessible. Because the QT interval predicts incident AF and the atrium and ventricle share repolarizing ion currents, we investigated the association between an individual's QT interval and atrial effective refractory period (AERP). METHODS: In paroxysmal AF patients presenting for catheter ablation, the QT interval was measured from the surface 12-lead ECG...
October 18, 2016: Pacing and Clinical Electrophysiology: PACE
P Gal, T J Buist, J J J Smit, A Adiyaman, A R Ramdat Misier, P P H M Delnoy, A Elvan
INTRODUCTION: Pulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation. METHODS: 50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLD(TM), Medtronic Inc...
October 17, 2016: Netherlands Heart Journal
Ning Ma, Xiao-Yan Wu, Chang-Sheng Ma, Nian Liu, Rong Bai, Xin Du, Yan-Fei Ruan, Jian-Zeng Dong
Catheter ablation has been recommended as a treatment option for paroxysmal atrial fibrillation (PAF) patients complicated with type 2 diabetes mellitus (T2DM). PAF patients with T2DM have a higher recurrence rate after catheter ablation. Prolongation of corrected QT (QTc) interval has been linked to poor outcomes in T2DM patients. Whether the abnormal QTc interval is associated with the ablation outcome in the PAF patients with T2DM remains unknown. In this study, 134 PAF patients with T2DM undergoing primary catheter ablation were retrospectively enrolled...
October 2016: Journal of Huazhong University of Science and Technology. Medical Sciences
Ru-Xing Wang, Hon-Chi Lee, Jia-Ping Li, David O Hodge, Yong-Mei Cha, Paul A Friedman, Thomas M Munger, Komandoor Srivathsan, Behzad B Pavri, Win-Kuang Shen
BACKGROUND: Although sudden death (SD) is a rare complication after atrioventricular junction (AVJ) ablation and permanent pacemaker implantation, the risk factors leading to this SD remain unknown. The purpose of this study was to investigate SD and its risk factors after ablate-and-pace strategy for rate control in atrial fibrillation (AF) patients during long-term follow-up. HYPOTHESIS: METHODS: From January 2005 to December 2009, we enrolled into this study 517 AF patients with AVJ ablation and right ventricular pacemaker implantation...
October 17, 2016: Clinical 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
Joshua Xu, Jessica G Y Luc, Kevin Phan
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF...
September 2016: Journal of Thoracic Disease
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
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
Sotirios Nedios, Emmanuel Koutalas, Philipp Sommer, Arash Arya, Sascha Rolf, Daniela Husser, Andreas Bollmann, Gerhard Hindricks, Ole-Alexander Breithardt
AIMS: The association between anatomical left atrial (LA) remodelling and ventricular diastolic dysfunction (DD) in atrial fibrillation (AF) patients is not well studied. We aimed to examine the effect of DD on anatomic LA remodelling and their relation with ablation outcomes. METHODS AND RESULTS: In 104 patients (58 ± 10 years, 69% male) referred for AF ablation, LA volume (LAV) was determined by computed tomography. A cutting plane, between the pulmonary vein (PV) ostia and the appendage and parallel to the posterior wall, divided LAV into anterior- (LA-A) and posterior-LA parts...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Henrik Vadmann, Anders Gorst-Rasmussen, Søren Pihlkjær Hjortshøj, Sam Riahi, Gregory Y H Lip, Torben Bjerregaard Larsen
AIMS: The aim of this study was to investigate whether there is a similar mortality and thrombo-embolic risk, after an atrial ablation procedure, compared with an atrial fibrillation (AF) procedure. METHODS AND RESULTS: Using data from nationwide Danish health registries, we identified patients aged 18-75 years undergoing a first-time atrial flutter or an AF ablation procedure in the period 2000-13. Cox proportional hazards regression was used to calculate hazard ratios (HRs) after 5 years of follow-up, adjusting for concomitant risk factors...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Malte Kuniss, Harald Greiß, Dmitri Pajitnev, Ersan Akkaya, Nikolas Deubner, Andreas Hain, Lars Bodammer, Alexander Berkowitsch, Gian-Battista Chierchia, Christian W Hamm, Thomas Neumann
AIMS: Although the generation of linear lesions by ablation improves success rates in patients with persistent atrial fibrillation (AF), the procedure has been considered unsuitable for cryoablation balloon catheter technologies. We developed a technique for linear ablations, using second-generation cryoballoon technology. METHODS AND RESULTS: This was a single-arm, prospective study in 76 patients with persistent AF treated consecutively at our centre. Cryoablation was performed using a 28 mm second-generation cryoballoon...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Martin Huemer, Daniel Qaiyumi, Philipp Attanasio, Abdul Parwani, Burkert Pieske, Florian Blaschke, Leif-Hendrik Boldt, Wilhelm Haverkamp, Alexander Wutzler
AIMS: In persistent atrial fibrillation (AF), left atrial low-voltage areas and complex fractionated atrial electrograms (CFAEs) have been thoroughly discussed as critical substrate points for AF perpetuation. Thus, in patients undergoing pulmonary vein isolation, these sites are often considered additional ablation targets. Currently, mapping techniques for these substrate indicators are still under discussion. The aim of this study was to evaluate the impact of different mapping catheters on the detection of low-voltage areas and CFAE...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Lin Wang, Madhavi Kadiyala, Elana Koss, Abhimanyu Yarramaneni, Kathleen Rapelje, Stephanie Kampfer, Nathaniel Reichek, David Hoch, Vinay Jayam, Joseph Levine, Jie J Cao
BACKGROUND: We investigated CT angiography (CTA) in assessment of left atrial appendage (LAA) stasis and thrombus in pre-procedural evaluation for atrial fibrillation (AF) ablation in a large community cohort. METHODS AND RESULTS: We reviewed CTA and transesophageal echocardiographic images obtained in 861 consecutive patients with a history of AF undergoing same-day CTA and transesophageal echocardiogram (TEE) before AF ablation at a single hospital (2006-2013)...
October 12, 2016: Pacing and Clinical Electrophysiology: PACE
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
Andrea Radinovic, Patrizio Mazzone, Giovanni Landoni, Eustachio Agricola, Damiano Regazzoli, Paolo Della Bella
BACKGROUND: Left atrial catheterization through transseptal puncture is frequently performed in cardiac catheterization procedures. Appropriate transseptal puncture is critical to achieve procedural success. AIMS: The aim of the study is to evaluate the feasibility of selective transseptal punctures, using a modified radiofrequency (RF) transseptal needle and transesophageal echocardiography (TEE), in different types of procedures that require specific sites of left atrial catheterization...
October 2016: Annals of Cardiac Anaesthesia
Liang Zhao, Kai Xu, Weifeng Jiang, Li Zhou, Yuanlong Wang, Xiaodong Zhang, Shaohui Wu, Daoliang Zhang, Xu Liu
OBJECTIVE: The long-term outcomes of catheter ablation of atrial fibrillation (AF) developing post-cardiac valve replacement (VR) remain undefined. METHODS AND RESULTS: Eighty-nine post-VR patients with AF (44% longstanding persistent AF, LSP-AF) were enrolled. Cumulative success rate of circumferential pulmonary vein ablation (CPVA for paroxysmal AF) and bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs for persistent and LSP-AF) as index and repeat procedural endpoints reached 57% (mean, 1...
October 1, 2016: International Journal of Cardiology
Giuseppe Stabile, Matteo Anselmino, Ezio Soldati, Ermengildo De Ruvo, Francesco Solimene, Assunta Iuliano, Luigi Sciarra, Maria Grazia Bongiorni, Leonardo Calò, Fiorenzo Gaita
PURPOSE: Left atrial volume (LA) and pulmonary vein (PV) anatomy may potentially relate to technical challenges in achieving stable and effective catheter position in case of atrial fibrillation (AF) ablation by means of "one-shot" catheters. The aim of this study was to investigate whether LA volume and PV anatomy, evaluated by computed tomography (CT) or magnetic resonance (MR) prior to ablation, predict acute and midterm outcome of AF ablation by nMARQ™. METHODS: We included 75 patients (mean age 58 ± 11 years, 67 % male) with symptomatic paroxysmal AF...
October 6, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
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