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af ablation

Dennis W den Uijl, Nuno Cabanelas, Eva M Benito, Rosa Figueras, Francisco Alarcón, Roger Borràs, Susanna Prat, Eduard Guasch, Rosario Perea, Marta Sitges, Josep Brugada, Antonio Berruezo, Lluís Mont
INTRODUCTION: To investigate the relation between left atrial (LA) volume, sphericity and fibrotic content derived from contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) and their impact on the outcome of catheter ablation for atrial fibrillation (AF). METHODS AND RESULTS: In 83 patients undergoing catheter ablation for AF, CE-CMR was used to assess LA volume, sphericity and fibrosis. There was a significant correlation between LA volume and sphericity (R = 0...
March 12, 2018: Journal of Cardiovascular Electrophysiology
Patrycja Pruszkowska, Radosław Lenarczyk, Jakub Gumprecht, Ewa Jedrzejczyk-Patej, Michał Mazurek, Oskar Kowalski, Adam Sokal, Tomasz Podolecki, Stanisław Morawski, Witold Streb, Katarzyna Mitręga, Zbigniew Kalarus
BACKGROUND: Pulmonary vein isolation with cryobaloon catheter ablation (CCB) is an effective method oftreatment in patients with atrial fibrillation (AF) but in patients with heart failure (HF) therole of CCB remains unknown. AIMS: To assess feasibility, effectiveness and safety of CCB in patients with HF and cardiac electronic devices (CIED), the impact of the procedure on symptoms and echocardiographic parameters. METHODS: Thirty consecutive HF patients with left ventricular ejection fraction (EF)≤40% and CIED, referred for CCB of AF were included...
March 12, 2018: Kardiologia Polska
Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hiroki Niikura, Keijiro Nakamura, Raisuke Iijima, Hidehiko Hara, Makoto Suzuki, Mahito Noro, Masao Moroi, Kaoru Sugi, Masato Nakamura
A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected...
March 12, 2018: International Heart Journal
Michael H Hoskins, Anshul M Patel, David B DeLurgio
The epidemic of atrial fibrillation (AF) requires a comprehensive management strategy that uses the full force of available data and technology, including anticoagulation, ablative therapy, and left atrial appendage occlusion. Patient-centered care with an emphasis on shared decision-making is particularly relevant to the authors' understanding of the complexity of AF and has helped them tailor therapy in this ever-growing patient population.
April 2018: Interventional Cardiology Clinics
Guy Rozen, Jeena Vaid, Seyed Mohammadreza Hosseini, M Ihsan Kaadan, Allon Rafael, Attila Roka, Yukkee C Poh, Ming-Zher Poh, Edwin Kevin Heist, Jeremy Neil Ruskin
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, associated with significant morbidity, increased mortality, and rising health-care costs. Simple and available tools for the accurate detection of arrhythmia recurrence in patients after electrical cardioversion (CV) or ablation procedures for AF can help to guide therapeutic decisions. We conducted a prospective, single-center study to evaluate the accuracy of Cardiio Rhythm Mobile Application (CRMA) for AF detection. Patients >18 years of age who were scheduled for elective CV for AF were enrolled in the study...
February 13, 2018: American Journal of Cardiology
Aleksandr Voskoboinik, Paul B Sparks, Joseph B Morton, Geoffrey Lee, Stephen A Joseph, Joshua J Hawson, Peter M Kistler, Jonathan M Kalman
BACKGROUND: Despite technological advances, studies continue to report high complication rates for atrial fibrillation (AF) ablation. We sought to review complication rates for AF ablation at a high-volume centre over a 14-year period and identify predictors of complications. METHODS: We reviewed prospectively collected data from 2750 consecutive AF ablation procedures at our institution using radiofrequency energy (RF) between January 2004 and May 2017. All cases were performed under general anaesthetic with transoesophageal echocardiography (TEE), 3D-mapping and an irrigated ablation catheter...
February 3, 2018: Heart, Lung & Circulation
S Chris Malaisrie, Patrick M McCarthy, Jane Kruse, Roland Matsouaka, Adin-Cristian Andrei, Maria V Grau-Sepulveda, Daniel J Friedman, James L Cox, J Matthew Brennan
BACKGROUND: This study compares early and late outcomes in patients undergoing coronary artery bypass grafting with and without preoperative atrial fibrillation in a contemporary, nationally representative Medicare cohort. METHODS: In the Medicare-Linked Society of Thoracic Surgeons database, 361,138 patients underwent isolated coronary artery bypass from 2006 to 2013, of whom 37,220 (10.3%) had preoperative atrial fibrillation; 13,161 (35.4%) were treated with surgical ablation and were excluded...
February 9, 2018: Journal of Thoracic and Cardiovascular Surgery
Tarek Zghaib, Ali Keramati, Jonathan Chrispin, Dong Huang, Muhammad A Balouch, Luisa Ciuffo, Ronald D Berger, Joseph E Marine, Hiroshi Ashikaga, Hugh Calkins, Saman Nazarian, David D Spragg
Background: Bipolar voltage mapping, as part of atrial fibrillation (AF) ablation, is traditionally performed in a point-by-point (PBP) approach using single-tip ablation catheters. Alternative techniques for fibrosis-delineation include fast-anatomical mapping (FAM) with multi-electrode circular catheters, and late gadolinium-enhanced magnetic-resonance imaging (LGE-MRI). The correlation between PBP, FAM, and LGE-MRI fibrosis assessment is unknown. Objective: In this study, we examined AF substrate using different modalities (PBP, FAM, and LGE-MRI mapping) in patients presenting for an AF ablation...
January 2018: JACC. Clinical Electrophysiology
Khola Tahir, Andy Kiser, Thomas Caranasos, J Paul Mounsey, Anil Gehi
WHO SHOULD UNDERGO HYBRID AF ABLATION?: Patients with symptomatic persistent or long-standing persistent atrial fibrillation refractory to pharmacological or routine catheter ablation can be considered for hybrid epicardial-endocardial AF ablation. Although it seems clear that patient selection should be important when considering hybrid AF ablation for optimal results, unfortunately, available data on the outcomes of hybrid epicardial-endocardial ablation is limited. Hybrid ablation is rarely compared to stand-alone catheter ablation, the surgical approach (access site, lesion set, ablation tool) is inconsistent, and the patient population studied is often suitable for a catheter ablation approach (paroxysmal AF, minimal structural heart disease)...
March 8, 2018: Current Treatment Options in Cardiovascular Medicine
Jackson J Liang, Melissa A Elafros, Michael T Mullen, Daniele Muser, Tatsuya Hayashi, Andres Enriquez, Rajeev K Pathak, Erica S Zado, Pasquale Santangeli, Jeffrey S Arkles, Robert D Schaller, Gregory E Supple, David S Frankel, Fermin C Garcia, Rajat Deo, David Lin, Michael P Riley, Saman Nazarian, Sanjay Dixit, Francis E Marchlinski, David J Callans
INTRODUCTION: Whether successful catheter ablation for atrial fibrillation (AF) reduces risk of cerebrovascular events (CVEs) remains controversial and whether oral anticoagulation therapy (OAT) can be safely discontinued in patients rendered free of AF recurrences remains unknown. We evaluated OAT use patterns and examined long-term rates of CVEs (stroke/TIA) and major bleeding episodes (MBEs) in patients with nonparoxysmal AF treated with catheter ablation. METHODS AND RESULTS: Four hundred patients with nonparoxysmal AF (200 persistent, 200 longstanding persistent; mean age 60...
March 7, 2018: Journal of Cardiovascular Electrophysiology
João Mesquita, Diogo Cavaco, António Miguel Ferreira, Francisco Moscoso Costa, Pedro Carmo, Francisco Morgado, Miguel Mendes, Pedro Adragão
BACKGROUND: Pulmonary vein isolation (PVI) is the cornerstone of AF ablation, but its long-term clinical outcomes, predictors of relapse, and optimal pharmacological treatment remain controversial. OBJECTIVE: The objectives of this paper were to (1) assess very long-term AF recurrence, (2) identify predictors of relapse, and (3) evaluate the impact of continued antiarrhythmic drug (AAD) treatment after ablation. METHODS: Multicenter observational registry including all consecutive patients with drug-resistant AF who underwent a first PVI between 2006 and 2008 (n = 253 (age 55 years (IQR 48-63)), 80% males, 64% with paroxysmal AF...
March 6, 2018: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Yemei He, Baixue Zhang, Fang Zhu, Zheyu Hu, Jia Zhong, Wenhui Zhu
AIMS: Paroxysmal atrial fibrillation (PAF) commonly recurs after radiofrequency catheter ablation (RFCA). This study aimed to assess left atrial appendage (LAA) volume and function by transesophageal echocardiography (TEE) and to explore its value in predicting PAF recurrence after RFCA. METHODS: Eighty patients with PAF were recruited. The left atrial (LA) and LAA volume and function were measured by transthoracic echocardiography (TTE) and TEE before ablation...
March 6, 2018: Echocardiography
Alessandro Capucci, Laura Cipolletta, Federico Guerra, Irene Giannini
The main aim of current research on the field of atrial fibrillation (AF) treatment is to find new antiarrhythmic drugs with less side effects. Areas covered: Dronedarone and vernakalant showed promising result in term of efficacy and safety in selected patients. Ranolazine and colchicine are obtaining a role as a potential antiarrhythmic drug. Ivabradine is used in experimental studies for the rate control of AF. Moreover, new compounds (vanoxerine, moxonidine, budiodarone) are still under investigation. Monoclonal antibodies or selective antagonist of potassium channel are under investigation for long term maintenance of sinus rhythm...
March 6, 2018: Expert Opinion on Emerging Drugs
Albert C Lin, Bradley P Knight
Interventional catheter ablation approaches to the rhythm control of atrial fibrillation (AF) have advanced significantly in the past decade. The foundation of the catheter ablation in AF is electrical isolation of the pulmonary veins (PVI). However, PVI only in more advanced stages of AF (persistent AF) has only modest to poor success rates prompting a search for alternative and adjunctive procedures to improve the outcomes of ablation in persistent AF. The left atrial appendage (LAA) is well understood to be a primary source of emboli in AF but less well known be a trigger or driver for AF...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Prabhpreet Singh, Amit Noheria
Invasive electrophysiology (EP) mapping and catheter ablation has increasingly become the standard of care for many cardiac arrhythmias like supraventricular tachycardias, atrial fibrillation, premature ventricular complexes (PVC), and monomorphic ventricular tachycardia. In this review, we discuss the recent progress made in the mapping and ablation of ventricular fibrillation (VF). Ventricular activation during VF is apparently disorganized, making mapping and interpretation difficult. Prolonged mapping during VF would require mechanical circulatory support as VF causes complete hemodynamic collapse...
March 6, 2018: Current Treatment Options in Cardiovascular Medicine
Masaharu Masuda, Masashi Fujita, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takashi Kanda, Takuya Tsujimura, Yasuhiro Matsuda, Shota Okuno, Takuya Ohashi, Aki Tsuji, Toshiaki Mano
BACKGROUND: Association between the presence of left atrial low-voltage areas and atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) has been shown mainly in persistent AF patients. We sought to compare the AF recurrence rate in paroxysmal AF patients with and without left atrial low-voltage areas. METHODS: This prospective observational study included 147 consecutive patients undergoing initial ablation for paroxysmal AF. Voltage mapping was performed after PVI during sinus rhythm, and low-voltage areas were defined as regions where bipolar peak-to-peak voltage was <0...
April 15, 2018: International Journal of Cardiology
Baptiste Maille, Moloy Das, Ahmed Hussein, Matthew Shaw, Vivek Chaturvedi, Maureen Morgan, Christina Ronayne, Richard L Snowdon, Dhiraj Gupta
INTRODUCTION: The ConfiDENSE™ module (Carto3 v4) allows rapid annotation of endocardial electrograms acquired by multi-electrode (ME) mapping. However, its accuracy in assessing atrial voltages is unknown. METHODS AND RESULTS: Two ConfiDENSE™ left atrial voltage maps were created during continuous pacing in 20 patients undergoing catheter ablation for persistent AF using a ME lasso catheter and a Contact Force (CF) sensing ablation catheter. The automated Tissue Proximity indicator (TPI) filter was then applied to the ME map to yield a TPI map...
March 5, 2018: Journal of Cardiovascular Electrophysiology
Laura Martinez-Mateu, Lucia Romero, Ana Ferrer-Albero, Rafael Sebastian, José F Rodríguez Matas, José Jalife, Omer Berenfeld, Javier Saiz
Anatomically based procedures to ablate atrial fibrillation (AF) are often successful in terminating paroxysmal AF. However, the ability to terminate persistent AF remains disappointing. New mechanistic approaches use multiple-electrode basket catheter mapping to localize and target AF drivers in the form of rotors but significant concerns remain about their accuracy. We aimed to evaluate how electrode-endocardium distance, far-field sources and inter-electrode distance affect the accuracy of localizing rotors...
March 5, 2018: PLoS Computational Biology
Hong Yu, Qi Li, Chan Chen, Tao Li, Ji-Yue Xiong, Zhen Qin, Ming Luo, Zhao-Xia Tan, Ting Liu, Hui Yu, Xiao-Rong Yin, Hai Yu, Rong-Hua Zhou
BACKGROUND: This study aimed to evaluate the effect of intralipid postconditioning (ILPC) on myocardial damage in patients undergoing valve replacement surgery with concomitant radiofrequency ablation (RFA) for atrial fibrillation (AF). METHODS: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing valve replacement surgery with concomitant RFA. Sixty-nine patients were randomly assigned to ILPC group (n = 34) or control group (n = 35): ILPC group received an intravenous infusion of 20% intralipid (2 mL/kg) just 10 minutes before aortic cross-unclamping, and control group received an equivalent volume of normal saline...
January 2018: Medicine (Baltimore)
Edward J Ciaccio, Nicholas S Peters, Hasan Garan
BACKGROUND: The mechanisms involved in onset, maintenance, and termination of atrial fibrillation are not well understood. A biophysical model could be useful to determine how the events unfold. METHOD: A two-dimensional cellular automaton consisting of 576 × 576 grid nodes was implemented to demonstrate the types of electrical activity that may occur in compromised atrial substrate. Electrical activation between nodes was made anisotropic (2:1), and the refractory period (RP) was adjusted from 74 to 192 ms in the spatial domain...
February 24, 2018: Computers in Biology and Medicine
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