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Valay Parikh, Vijay Swarup, Jacob Hantla, Venkat Vuddanda, Tawseef Dar, Bharath Yarlagadda, Luigi Di Biase, Amin Al-Ahmad, Andrea Natale, Dhanunjaya Lakkireddy
BACKGROUND: Esophageal thermal injury is a feared complication of radiofrequency ablation for atrial fibrillation (AF). Rise in luminal esophageal temperature (LET) limits the ability to deliver radiofrequency energy on the posterior wall of the left atrium. OBJECTIVE: The purpose of this study was to evaluate the feasibility, safety, and efficacy of a mechanical esophageal deviation (ED) tool during AF ablation. METHODS: We evaluated 687 patients who underwent radiofrequency ablation for AF...
April 18, 2018: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Hideharu Okamatsu, Ken Okumura
Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF...
December 25, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
Sanghamitra Mohanty, Prasant Mohanty, Veronica Natale, Chintan Trivedi, Carola Gianni, J David Burkhardt, Javier E Sanchez, Rodney Horton, G Joseph Gallinghouse, Richard Hongo, Salwa Beheiry, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale
AIMS: This study investigated the impact of weight loss in longstanding persistent (LSPAF) patients undergoing catheter ablation (CA). METHODS: Ninety consecutive obese LSPAF patients were approached; 58 volunteered to try weight loss interventions for up to 1 year (group 1), while 32 patients declined weight loss interventions and were included as a control (group 2). Both groups remained on antiarrhythmic drugs. If they continued to experience AF, CA was performed...
February 2018: Journal of Cardiovascular Electrophysiology
Konstantinos Vlachos, Michael Efremidis, Konstantinos P Letsas, George Bazoukis, Ruairidh Martin, Maria Kalafateli, Louiza Lioni, Stamatis Georgopoulos, Athanasios Saplaouras, Theodore Efremidis, Tong Liu, Kosmas Valkanas, Nikolaos Karamichalakis, Dimitrios Asvestas, Antonios Sideris
INTRODUCTION: We aimed to evaluate the extent of atrial fibrosis in paroxysmal atrial fibrillation (AF) and the correlation with ablation outcomes after pulmonary vein antral isolation (PVΑI) using a mapping system with high-resolution and high-spatial sampling. METHODS AND RESULTS: We prospectively enrolled 80 consecutive patients (45 males, median age 60.26 years) with symptomatic paroxysmal AF who were scheduled for PVAI. Prior to PVAI, high-density bipolar voltage mapping (median number of 2,485 points) was carried out during sinus rhythm in all patients...
December 2017: Journal of Cardiovascular Electrophysiology
Changjian Lin, Steen Pehrson, Peter Karl Jacobsen, Xu Chen
BACKGROUND: There have been advancements of sophisticated mapping systems used for ablation procedures over the last decade. Utilization of these novel mapping systems in combination with remote magnetic navigation (RMN) needs to be established. We investigated the new EnSite Precision mapping system (St. Jude Medical, Inc., St. Paul, MN, USA), which collects magnetic data for checking navigation field stability and is built on an open platform, allowing physicians to choose diagnostic and ablation catheters...
December 2017: Journal of Cardiovascular Electrophysiology
Satoru Hida, Masao Takemoto, Akihiro Masumoto, Takahiro Mito, Kazuhiro Nagaoka, Hiroshi Kumeda, Yuki Kawano, Ryota Aoki, Honsa Kang, Atsushi Tanaka, Atsutoshi Matsuo, Kiyoshi Hironaga, Teiji Okazaki, Kiyonobu Yoshitake, Kei-Ichiro Tayama, Ken-Ichi Kosuga
BACKGROUND: Pulmonary vein antrum isolation (PVAI) under sedation has proven to be a useful strategy for catheter ablation of atrial fibrillation (AF). METHODS: To evaluate the clinical benefits of respiratory management using supraglottic airways (SGAs) under deep sedation while monitoring the bispectral (BIS) index during the PVAI and the durations from admission to the catheterization room to starting the radiofrequency energy delivery (Time α), and from starting the radiofrequency energy delivery to completion of the PVAI (Time β), X-ray time, frequency of dislocations of the three-dimensional maps (D3DM), procedure-related complications, and proportion of an AF-free rate 15 months after the PVAI (PAFFR) in patients who received deep sedation without SGAs (Group A: n=48) and those with SGAs (Group B: n=51) were evaluated...
August 2017: Journal of Arrhythmia
Rune Borregaard, Henrik Kjærulf Jensen, Bawer Jalal Tofig, Samuel Alberg Thrysøe, Christian Gerdes, Jens Cosedis Nielsen, Peter Lukac
OBJECTIVE: To investigate the effect of the operator knowing the real-time contact force (CF) on the efficacy of pulmonary vein antrum isolation (PVAI). METHODS: Fifty patients with paroxysmal atrial fibrillation (AF) or short lasting persistent AF were randomized to CF guided PVAI (n = 25) or conventional PVAI (n = 25). In the CF guided group, CF between 10 and 40 g was aimed at. Efficacy of PVAI was measured as reduction in AF burden (AFB) and time to AF recurrence detected by implantable cardiac monitor (ICM), inserted three months before PVAI...
June 2017: Scandinavian Cardiovascular Journal: SCJ
John P Bois, James Glockner, Phillip M Young, Thomas A Foley, Seth Sheldon, Darrell B Newman, Grace Lin, Douglas L Packer, Peter A Brady
BACKGROUND: Atrial fibrillation (AF) is the most common sustained atrial arrhythmia. One potential target for ablation is left atrial (LA) scar (LAS) regions that may be the substrate for re-entry within the atria, thereby sustaining AF. Identification of LAS through LA delayed gadolinium enhancement (LADE) with MRI has been proposed. OBJECTIVES: We sought to evaluate LADE in patients referred for catheter ablation of AF. METHODS: Prospective analysis was conducted of consecutive patients who underwent pulmonary vein antrum isolation (PVAI) ablation for AF at a single institution...
2017: Open Heart
Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Chintan Trivedi, Eli Hamilton Morris, Carola Gianni, Pasquale Santangeli, Rong Bai, Javier E Sanchez, Patrick Hranitzky, G Joseph Gallinghouse, Amin Al-Ahmad, Rodney P Horton, Richard Hongo, Salwa Beheiry, Claude S Elayi, Dhanunjaya Lakkireddy, Yaruva Madhu Reddy, Juan F Viles Gonzalez, J David Burkhardt, Andrea Natale
Aims: Left atrial (LA) scarring, a consequence of cardiac fibrosis is a powerful predictor of procedure-outcome in atrial fibrillation (AF) patients undergoing catheter ablation. We sought to compare the long-term outcome in patients with paroxysmal AF (PAF) and severe LA scarring identified by 3D mapping, undergoing pulmonary vein isolation (PVAI) only or PVAI and the entire scar areas (scar homogenization) or PVAI+ ablation of the non-PV triggers. Methods and results: Totally, 177 consecutive patients with PAF and severe LA scarring were included...
November 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Adel F Mina, Nicholas L Warnecke
Background: Pulmonary Vein Antral isolation (PVAI) is currently the standard of care for both paroxysmal and persistent atrial fibrillation ablation. Reconnection to the pulmonary vein is the most common cause of recurrence of atrial fibrillation. Achieving the endpoint of bidirectional block (BDB) for cavotricuspid isthmus dependant flutter has improved our outcomes for atrial flutter ablation. With this we tried to achieve long delays in the pulmonary veins antral lines prior to complete isolation comparable to those delays found in patient with bidirectional block of atrial flutter lines...
August 2016: Journal of Atrial Fibrillation
Cas Teunissen, Nick Clappers, Wil Kassenberg, Rutger J Hassink, Jeroen F van der Heijden, Peter Loh
Aims: Adenosine testing can reveal dormant pulmonary vein (PV) conduction after PV antrum isolation (PVAI). However, the optimal timing for adenosine administration is unknown. We hypothesized that adenosine testing immediately after PVAI reliably reveals PV reconnection and thereby eliminates the need for an observation period. Methods and results: Fifty patients underwent PVAI. Immediately after isolation of a PV pair, adenosine was administered. Both PV pairs were separately tested...
July 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Michael Efremidis, Konstantinos P Letsas, Louiza Lioni, Konstantinos Vlachos, Stamatis Georgopoulos, Athanasios Saplaouras, Eleni Geladari, George Giannopoulos, Tong Liu, Spyridon Deftereos, Antonios Sideris
OBJECTIVES: The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction and whether such conduction should be eliminated still remain controversial. This randomized study aimed to investigate whether adenosine-guided ablation of the reconnection gaps improves the long-term outcomes of pulmonary vein antral isolation (PVAI) for paroxysmal atrial fibrillation (AF). METHODS AND RESULTS: Consecutive patients with paroxysmal AF were randomly assigned to undergo (n = 80, group 1) or not (n = 81, group 2) adenosine testing following PVAI...
August 1, 2016: Journal of Cardiovascular Electrophysiology
Sanghamitra Mohanty, Carola Gianni, Prasant Mohanty, Philipp Halbfass, Tamara Metz, Chintan Trivedi, Thomas Deneke, Gery Tomassoni, Rong Bai, Amin Al-Ahmad, Shane Bailey, John David Burkhardt, G Joseph Gallinghouse, Rodney Horton, Patrick M Hranitzky, Javier E Sanchez, Luigi Di Biase, Andrea Natale
BACKGROUND: Nonrandomized studies have reported focal impulse and rotor modulation (FIRM)-guided ablation to be superior to pulmonary vein antrum isolation (PVAI) for persistent atrial fibrillation and long-standing persistent atrial fibrillation. OBJECTIVES: This study sought to compare efficacy of FIRM ablation with or without PVAI versus PVAI plus non-PV trigger ablation in randomized persistent atrial fibrillation and long-standing persistent atrial fibrillation patients...
July 19, 2016: Journal of the American College of Cardiology
Mohamed Bassiouny, Walid Saliba, Ayman Hussein, John Rickard, Mariam Diab, Wahaj Aman, Thomas Dresing, Thomas Callahan, Mandeep Bhargava, David O Martin, Mingyuan Shao, Bryan Baranowski, Khaldoun Tarakji, Patrick J Tchou, Ali Hakim, Mohamed Kanj, Bruce Lindsay, Oussama Wazni
BACKGROUND: Achieving long-term successful outcomes with ablation of persistent atrial fibrillation (AF) remains a clinical and procedural challenge. We aimed to assess 2 ablation strategies for persistent AF: pulmonary vein antral isolation (PVAI) in sinus rhythm after direct current cardioversion versus PVAI and ablation targeting complex-fractionated atrial electrograms while in AF. METHODS AND RESULTS: Between June 2009 and July 2013, patients with continuous persistent AF for ≥3 months were prospectively randomized to either direct current cardioversion before PVAI and posterior wall/septum ablation while in sinus rhythm (group 1), versus same ablation in group 1 in addition to complex-fractionated atrial electrogram ablation while in AF (group 2)...
February 2016: Circulation. Arrhythmia and Electrophysiology
Cas Teunissen, Wil Kassenberg, Jeroen F van der Heijden, Rutger J Hassink, Vincent J H M van Driel, Nicolaas P A Zuithoff, Pieter A Doevendans, Peter Loh
AIMS: Pulmonary vein antrum isolation (PVAI) is the cornerstone of atrial fibrillation (AF) ablation. There is an ongoing discussion on whether and when to add substrate modification to PVAI. This study evaluates (1) long-term efficacy of PVAI as a primary ablation strategy in all patients independently from AF type and (2) predictors of arrhythmia recurrence. METHODS AND RESULTS: A total of 509 consecutive patients (mean age 57 years, 38.9% non-paroxysmal AF) with AF underwent PVAI...
September 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
John W Nance, Irfan M Khurram, Saman Nazarian, Jane DeWire, Hugh Calkins, Stefan L Zimmerman
Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate patients with atrial fibrillation (AF) before pulmonary vein antral isolation (PVAI). The purpose of this study was to assess the incidence and pattern of left ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR before PVAI and compare the clinical and demographic differences of patients with and without LV LGE. Clinical and demographic data on 62 patients (mean age 61 ± 7.9, 69% male) undergoing CMR before PVAI for AF were collected...
September 2015: Medicine (Baltimore)
Shinsuke Miyazaki, Hiroshi Taniguchi, Hiroaki Nakamura, Takamitsu Takagi, Jin Iwasawa, Hitoshi Hachiya, Yoshito Iesaka
BACKGROUND: Early recurrence of atrial fibrillation (ERAF) is common after pulmonary vein antrum isolation (PVAI); however, the definition, study population, and lesion set are not uniform in prior studies. We examined ERAF for paroxysmal AF while complying with the definition in the latest guidelines. METHODS AND RESULTS: We included 471 patients undergoing empirical PVAI for paroxysmal AF. ERAF was observed in 180 patients (38.2%) including 49, 16, and 115 within 3, 4-7 days, and 8-90 days, respectively, after the index procedure...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Yonghui Zhao, Luigi Di Biase, Chintan Trivedi, Sanghamitra Mohanty, Rong Bai, Prasant Mohanty, Carola Gianni, Pasquale Santangeli, Rodney Horton, Javier Sanchez, G Joseph Gallinghouse, Jason Zagrodzky, Richard Hongo, Salwa Beheiry, Dhanunjaya Lakkireddy, Madhu Reddy, Patrick Hranitzky, Amin Al-Ahmad, Claude Elayi, J David Burkhardt, Andrea Natale
BACKGROUND: Whether ablation of non-pulmonary vein (PV) triggers after pulmonary vein antrum isolation (PVAI) improves the long-term procedure outcome in patients with paroxysmal atrial fibrillation (PAF) and left ventricular systolic dysfunction is unknown. OBJECTIVE: We sought to evaluate whether a more extensive ablation procedure improves outcomes at follow-up. METHODS: Consecutive patients with PAF refractory to antiarrhythmic drugs presenting for PVAI were prospectively studied...
January 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Rong Bai, Luigi Di Biase, Prasant Mohanty, Chintan Trivedi, Antonio Dello Russo, Sakis Themistoclakis, Michela Casella, Pietro Santarelli, Gaetano Fassini, Pasquale Santangeli, Sanghamitra Mohanty, Antonio Rossillo, Gemma Pelargonio, Rodney Horton, Javier Sanchez, Joseph Gallinghouse, J David Burkhardt, Chang-Sheng Ma, Claudio Tondo, Andrea Natale
BACKGROUND: It is unclear whether isolation of the left atrial posterior wall (LAPW) offers additional benefits over pulmonary vein antrum isolation (PVAI) alone in patients with persistent atrial fibrillation (AF). OBJECTIVE: We sought to determine the impact of PVAI and LAPW isolation (PVAI+LAPW) versus PVAI alone on the outcome of ablation of persistent AF. METHODS: During the first procedure, PVAI was performed in 20 patients (group 1), whereas in 32 patients (group 2), PVAI was extended to the left atrial (LA) septum and coronary sinus (CS), and isolation of the LAPW was targeted (ePVAI+LAPW)...
January 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
Jackson J Liang, Melissa A Elafros, William W Chik, Pasquale Santangeli, Erica S Zado, David S Frankel, Gregory E Supple, Robert D Schaller, David Lin, Mathew D Hutchinson, Michael P Riley, David J Callans, Francis E Marchlinski, Sanjay Dixit
BACKGROUND: Early recurrence of atrial arrhythmia (ERAA) is common after atrial fibrillation (AF) ablation and is associated with long-term recurrence. However, the association between timing or frequency of ERAA and long-term ablation success remains unclear. OBJECTIVE: We aimed to examine whether timing or frequency of ERAA after pulmonary vein antral isolation (PVAI) affects long-term ablation success. METHODS: Three hundred AF patients (100 paroxysmal, 100 persistent, 100 long-standing persistent; mean age 59...
December 2015: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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