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Atrial fibrillation substrate

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https://www.readbyqxmd.com/read/29244075/the-athlete-s-heart-is-a-proarrhythmic-heart-and-what-that-means-for-clinical-decision-making
#1
Hein Heidbuchel
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. The athlete's heart, a heart that adapts so magically to cope with the demands of exercise, harbours many structural and functional changes that by themselves predispose to arrhythmia development, at the atrial, nodal and ventricular levels...
December 13, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29229215/atrial-fibrillation-neurogenic-or-myogenic
#2
REVIEW
Alina Scridon, Răzvan Constantin Şerban, Philippe Chevalier
A 55-year-old hypertensive patient presents atrial fibrillation after vasovagal syncope. Non-invasive cardiac workup is normal. Without antiarrhythmic therapy, the patient has no recurrence for the next 3years, then presents with a stroke. Echocardiography eventually reveals left atrial dilation. This sequence of events illustrates the well-known links between age, arterial hypertension, atrial fibrillation, atrial neuromyopathy and stroke. A frequently neglected common denominator in this equation is impaired sympathovagal balance...
December 8, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29208256/combined-cryoballoon-and-radiofrequency-ablation-versus-radiofrequency-ablation-alone-for-long-standing-persistent-atrial-fibrillation
#3
Tümer Erdem Guler, Tolga Aksu, Kivanc Yalin, Sukriye Ebru Golcuk, Ferit Onur Mutluer, Serdar Bozyel
BACKGROUND: To achieve sinus rhythm, ablation of long-standing persistent atrial fibrillation (LSPAF) usually requires substrate modification in addition to pulmonary vein isolation (PVI). In the present article, we aimed to compare clinical and substrate modification effects of 2 distinct PVI strategies during stepwise ablation in patients with LSPAF: (1) Combined approach: cryoballoon (CB) for PVI and radiofrequency (RF) ablation for substrate modification and (2) RF-only approach: RF ablation for both PVI and substrate modification...
December 2017: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/29187667/strategy-and-outcome-of-catheter-ablation-for-persistent-atrial-fibrillation%C3%A3-impact-of-progress-in-the-mapping-and-ablation-technologies
#4
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...
November 30, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29177475/individually-tailored-vs-standardized-substrate-modification-during-radiofrequency-catheter-ablation-for-atrial-fibrillation-a-randomized-study
#5
Simon Kircher, Arash Arya, David Altmann, Sascha Rolf, Andreas Bollmann, Philipp Sommer, Nikolaos Dagres, Sergio Richter, Ole-A Breithardt, Borislav Dinov, Daniela Husser, Charlotte Eitel, Thomas Gaspar, Christopher Piorkowski, Gerhard Hindricks
Aims: This randomized single-centre study sought to compare the efficacy and safety of pulmonary vein isolation (PVI) plus voltage-guided ablation vs. PVI with or without linear ablation depending on the type of atrial fibrillation (AF). Methods and results: Overall, 124 ablation-naive patients with paroxysmal or persistent AF were randomized to PVI with (persistent AF) or without (paroxysmal AF) additional linear ablation (control group) vs. PVI plus ablation of low-voltage areas (LVAs) irrespective of AF type...
November 21, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29174247/atrial-electrical-abnormality-in-patients-with-brugada-syndrome-assessed-by-signal-averaged-electrocardiography
#6
Yasutsugu Nagamoto, Yuto Fujii, Yuichi Morita, Yusuke Ueda, Yasuko Miyake, Kenichi Yamane, Mai Fujiwara, Shinji Mito, Yuichiro Watari, Hiromichi Tamekiyo, Tomokazu Okimoto, Yuji Muraoka, Yasuhiko Hayashi
BACKGROUND: Ventricular fibrillation and atrial fibrillation are well-known arrhythmias in patients with Brugada syndrome. This study evaluated the characteristics of the atrial arrhythmogenic substrate using the signal-averaged electrogram (SAECG) in patients with Brugada syndrome. METHODS: SAECGs were performed during normal sinus rhythm in 23 normal volunteers (control group), 21 patients with paroxysmal atrial fibrillation (PAF; PAF group), and 21 with Brugada syndrome (Brugada group)...
November 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/29141846/atrial-substrate-modification-for-atrial-fibrillation-striving-to-get-smarter
#7
EDITORIAL
Prabhat Kumar, J Paul Mounsey
No abstract text is available yet for this article.
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29141843/stable-sr-electrophysiological-substrate-ablation-in-the-left-atrium-during-sinus-rhythm-for-the-treatment-of-nonparoxysmal-atrial-fibrillation-a-prospective-multicenter-randomized-clinical-trial
#8
RANDOMIZED CONTROLLED TRIAL
Bing Yang, Chenyang Jiang, Yazhou Lin, Gang Yang, Huimin Chu, Heng Cai, Fengmin Lu, Xianzhang Zhan, Jian Xu, Xinhua Wang, Chi-Keong Ching, Balbir Singh, Young-Hoon Kim, Minglong Chen
BACKGROUND: Circumferential pulmonary vein isolation (CPVI) alone or combined with adjuvant substrate modifications is unsatisfactory for atrial fibrillation (AF) control in nonparoxysmal AF patients. Ablation targeting the fibrotic areas after CPVI (STABLE-SR [Electrophysiological Substrate Ablation in the Left Atrium During Sinus Rhythm]) is a newly evolved substrate modification strategy. METHODS AND RESULTS: In this multicenter, randomized clinical trial, 229 symptomatic nonparoxysmal AF patients were 1:1 randomized to STABLE-SR group (n=114) or conventional STEPWISE group (n=115)...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29133380/atrial-substrate-and-triggers-of-paroxysmal-atrial-fibrillation-in-patients-with-obstructive-sleep-apnea
#9
MULTICENTER STUDY
Elad Anter, Luigi Di Biase, Fernando M Contreras-Valdes, Carola Gianni, Sanghamitra Mohanty, Cory M Tschabrunn, Juan F Viles-Gonzalez, Eran Leshem, Alfred E Buxton, Guy Kulbak, Rim N Halaby, Peter J Zimetbaum, Jonathan W Waks, Robert J Thomas, Andrea Natale, Mark E Josephson
BACKGROUND: Obstructive sleep apnea (OSA) is associated with atrial remodeling, atrial fibrillation (AF), and increased incidence of arrhythmia recurrence after pulmonary vein (PV) isolation. We aimed to characterize the atrial substrate, including AF triggers in patients with paroxysmal AF and OSA. METHODS AND RESULTS: In 86 patients with paroxysmal AF (43 with ≥moderate OSA [apnea-hypopnea index ≥15] and 43 without OSA [apnea-hypopnea index <5]), right atrial and left atrial voltage distribution, conduction velocities, and electrogram characteristics were analyzed during atrial pacing...
November 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29128866/association-of-atrial-fibrillation-clinical-phenotypes-with-treatment-patterns-and-outcomes-a-multicenter-registry-study
#10
Taku Inohara, Peter Shrader, Karen Pieper, Rosalia G Blanco, Laine Thomas, Daniel E Singer, James V Freeman, Larry A Allen, Gregg C Fonarow, Bernard Gersh, Michael D Ezekowitz, Peter R Kowey, James A Reiffel, Gerald V Naccarelli, Paul S Chan, Benjamin A Steinberg, Eric D Peterson, Jonathan P Piccini
Importance: Atrial fibrillation (AF) is usually classified on the basis of the disease subtype. However, this characterization does not capture the full heterogeneity of AF, and a data-driven cluster analysis reveals different possible classifications of patients. Objective: To characterize patients with AF based on a cluster analysis and to evaluate the association between these phenotypes, treatment, and clinical outcomes. Design, Setting, and Participants: This cluster analysis used data from an observational cohort that included 9749 patients with AF who had been admitted to 174 US sites participating in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry...
November 12, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29104737/cardiac-magnetic-resonance-imaging-which-information-is-useful-for-the-arrhythmologist
#11
REVIEW
Elia De Maria, Annachiara Aldrovandi, Ambra Borghi, Letizia Modonesi, Stefano Cappelli
Cardiac magnetic resonance (CMR) is a non-invasive, non-ionizing, diagnostic technique that uses magnetic fields, radio waves and field gradients to generate images with high spatial and temporal resolution. After administration of contrast media (e.g., gadolinium chelate), it is also possible to acquire late images, which make possible the identification and quantification of myocardial areas with scar/fibrosis (late gadolinium enhancement, LGE). CMR is currently a useful instrument in clinical cardiovascular practice for the assessment of several pathological conditions, including ischemic and non-ischemic cardiomyopathies and congenital heart disease...
October 26, 2017: World Journal of Cardiology
https://www.readbyqxmd.com/read/29100747/box-isolation-of-fibrotic-areas-a-substrate-modification-approach-in-atrial-fibrillation-patients
#12
REVIEW
Fabian Moser, Doreen Schreiber, Andreas Rieger, Monica Trofin, Christian Pönisch, Hans Kottkamp
In the last years, atrial fibrosis was shown to be an independent predictor of procedural failure in patients with paroxysmal and persistent atrial fibrillation. Ablation strategies have been developed to improve the outcome of catheter ablation by targeting detected areas of fibrosis, based either on endocardial voltage mapping or cardiac magnetic resonance. Box isolation of fibrotic areas (BIFA) is a new and promising patient-tailored ablation strategy for atrial fibrillation patients targeting substantial fibrotic areas by circumferential isolation of left atrial fibrosis...
October 31, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29018165/catheter-ablation-of-the-superolateral-mitral-isthmus-line-a-novel-approach-to-reduce-the-need-for-epicardial-ablation
#13
Tilman Maurer, Andreas Metzner, S Yen Ho, Peter Wohlmuth, Bruno Reißmann, Christian Heeger, Christine Lemes, Kentaro Hayashi, Ardan M Saguner, Johannes Riedl, Christian Sohns, Shibu Mathew, Karl-Heinz Kuck, Erik Wissner, Feifan Ouyang
BACKGROUND: The mitral isthmus is a critical part of perimitral reentrant tachycardia, as well as an important substrate of persistent atrial fibrillation. Deployment of an endocardial mitral isthmus line (MIL) with the end point of bidirectional block may be challenging and often requires additional epicardial ablation within the coronary sinus. METHODS AND RESULTS: The study population comprised 114 patients with perimitral flutter who underwent de novo ablation of an MIL...
October 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/29016756/the-electrocardiogram-as-a-predictor-of-successful-pharmacological-cardioversion-and-progression-of-atrial-fibrillation
#14
Stef Zeemering, Theo A R Lankveld, Pietro Bonizzi, Ione Limantoro, Sebastiaan C A M Bekkers, Harry J G M Crijns, Ulrich Schotten
Aims: Non-invasive characterization of atrial fibrillation (AF) substrate complexity based on the electrocardiogram (ECG) may improve outcome prediction in patients receiving rhythm control therapies for AF. Multiple parameters to assess AF complexity and predict treatment outcome have been suggested. A comparative study of the predictive performance of complexity parameters on response to therapy and progression of AF in a large patient population is needed to standardize non-invasive analysis of AF...
July 26, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29016724/triggered-intracellular-calcium-waves-in-dog-and-human-left-atrial-myocytes-from-normal-and-failing-hearts
#15
Gary L Aistrup, Rishi Arora, Søren Grubb, Shin Yoo, Benjamin Toren, Manvinder Kumar, Aaron Kunamalla, William Marszalec, Tej Motiwala, Shannon Tai, Sean Yamakawa, Satya Yerrabolu, Francisco J Alvarado, Hector H Valdivia, Jonathan M Cordeiro, Yohannes Shiferaw, John Andrew Wasserstrom
Aims: Abnormal intracellular Ca2+ cycling contributes to triggered activity and arrhythmias in the heart. We investigated the properties and underlying mechanisms for systolic triggered Ca2+ waves in left atria from normal and failing dog hearts. Methods and results: Intracellular Ca2+ cycling was studied using confocal microscopy during rapid pacing of atrial myocytes (36 °C) isolated from normal and failing canine hearts (ventricular tachypacing model). In normal atrial myocytes (NAMs), Ca2+ waves developed during rapid pacing at rates ≥ 3...
November 1, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28964164/sensitivity-of-reentrant-driver-localization-to-electrophysiological-parameter-variability-in-image-based-computational-models-of-persistent-atrial-fibrillation-sustained-by-a-fibrotic-substrate
#16
Dongdong Deng, Michael J Murphy, Joe B Hakim, William H Franceschi, Sohail Zahid, Farhad Pashakhanloo, Natalia A Trayanova, Patrick M Boyle
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, causing morbidity and mortality in millions worldwide. The atria of patients with persistent AF (PsAF) are characterized by the presence of extensive and distributed atrial fibrosis, which facilitates the formation of persistent reentrant drivers (RDs, i.e., spiral waves), which promote fibrillatory activity. Targeted catheter ablation of RD-harboring tissues has shown promise as a clinical treatment for PsAF, but the outcomes remain sub-par...
September 2017: Chaos
https://www.readbyqxmd.com/read/28962160/effect-of-eicosapentaenoic-acid-and-pitavastatin-on-electrophysiology-and-anticoagulant-gene-expression-in-mice-with-rapid-atrial-pacing
#17
Maoqing Tong, Jiewen Wang, Yunxin Ji, Xiaomin Chen, Jieru Wang, Shuangshuang Wang, Liemin Ruan, Hanbin Cui, Ying Zhou, Qingyu Zhang, Eiichi Watanabe
Atrial remodeling is considered to be any persistent change in atrial structure or function, and is responsible for the development and perpetuation of atrial fibrillation (AF). Oxidative stress and intracellular pH regulation may also be linked to AF; however it remains unclear whether eicosapentaenoic acid (EPA) or statins have beneficial therapeutic effects. The aim of the present study was to investigate the effects of EPA and pitavastatin on the electrophysiology of and gene expressions in mice with rapidly-paced atria...
September 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28946993/beat-to-beat-p-wave-morphology-as-a-predictor-of-paroxysmal-atrial-fibrillation
#18
Dimitrios Filos, Ioanna Chouvarda, Dimitris Tachmatzidis, Vassilios Vassilikos, Nicos Maglaveras
BACKGROUND AND OBJECTIVES: Atrial Fibrillation (AF) is the most common cardiac arrhythmia. The initiation and the perpetuation of AF is linked with phenomena of atrial remodeling, referring to the modification of the electrical and structural characteristics of the atrium. P-wave morphology analysis can reveal information regarding the propagation of the electrical activity on the atrial substrate. The purpose of this study is to investigate patterns on the P-wave morphology that may occur in patients with Paroxysmal AF (PAF) and which can be the basis for distinguishing between PAF and healthy subjects...
November 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/28943552/aortic-aneurysm-associated-disseminated-intravascular-coagulation-dic-that-responded-well-to-a-switch-from-warfarin-to-rivaroxaban
#19
Yasuko Kadohira, Shinya Yamada, Erika Matsuura, Tomoe Hayashi, Eriko Morishita, Shinji Nakao, Hidesaku Asakura
We describe a case in which uncontrolled chronic disseminated intravascular coagulation (DIC) caused by an aortic aneurysm that was exacerbated by chemotherapy for lung cancer, showed dramatic improvement when warfarin, which was being administered for atrial fibrillation, was replaced by rivaroxaban, a direct oral anticoagulant (DOAC). The present case is interesting because a DOAC was effective in treating DIC due to an aortic aneurysm, whereas warfarin, another oral anticoagulant, was ineffective. In controlling DIC, it is important to inhibit activated coagulation factors such as thrombin and activated factor X, rather than the coagulation factors, which act as substrates...
September 25, 2017: Internal Medicine
https://www.readbyqxmd.com/read/28939092/spanish-catheter-ablation-registry-16th-official-report-of-the-spanish-society-of-cardiology-working-group-on-electrophysiology-and-arrhythmias-2016
#20
Adolfo Fontenla, Javier García-Fernández, José Luis Ibáñez
INTRODUCTION AND OBJECTIVES: This report describes the findings of the 2016 Spanish Catheter Ablation Registry. METHODS: Data were retrospectively collected by means of a standardized questionnaire completed by each of the participating centers. RESULTS: Data were collected from 83 centers. A total of 13 482 ablation procedures were performed (the highest historically reported in this registry), with a mean of 162.4 ± 116 and a median of 136 procedures per center...
November 2017: Revista Española de Cardiología
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