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Atrial fibrillation substrate

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https://www.readbyqxmd.com/read/28062142/aldosterone-pathway-blockade-to-prevent-atrial-fibrillation-a-systematic-review-and-meta-analysis
#1
J Neefs, N W E van den Berg, J Limpens, W R Berger, S M Boekholdt, P Sanders, J R de Groot
BACKGROUND: Despite advances in therapeutic interventions AF remains a progressive and symptomatic disease. Therefore, novel therapeutic interventions targeting the underlying arrhythmogenic substrate for AF is needed. Atrial fibrosis is an important component of the arrhythmogenic substrate of AF and may be initiated by aldosterone binding to the mineralocorticoid receptor. We hypothesized that aldosterone pathway blockade with mineralocorticoid receptor antagonists (MRA) reduces atrial fibrosis, and thus AF...
December 23, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28057773/inverse-remodelling-of-k2p3-1-k-channel-expression-and-action-potential-duration-in-left-ventricular-dysfunction-and-atrial-fibrillation-implications-for-patient-specific-antiarrhythmic-drug-therapy
#2
Constanze Schmidt, Felix Wiedmann, Xiao-Bo Zhou, Jordi Heijman, Niels Voigt, Antonius Ratte, Siegfried Lang, Stefan M Kallenberger, Chiara Campana, Alexander Weymann, Raffaele De Simone, Gabor Szabo, Arjang Ruhparwar, Klaus Kallenbach, Matthias Karck, Joachim R Ehrlich, István Baczkó, Martin Borggrefe, Ursula Ravens, Dobromir Dobrev, Hugo A Katus, Dierk Thomas
AIMS: Atrial fibrillation (AF) prevalence increases with advanced stages of left ventricular (LV) dysfunction. Remote proarrhythmic effects of ventricular dysfunction on atrial electrophysiology remain incompletely understood. We hypothesized that repolarizing K2P3.1 K(+ )channels, previously implicated in AF pathophysiology, may contribute to shaping the atrial action potential (AP), forming a specific electrical substrate with LV dysfunction that might represent a target for personalized antiarrhythmic therapy...
January 4, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28054729/comparison-of-the-efficacy-of-empiric-thoracic-vein-isolation-for-the-treatment-of-paroxysmal-and-persistent-atrial-fibrillation-in-patients-without-structural-heart-disease
#3
Koichiro Ejima, Ryuta Henmi, Yuji Iwanami, Daigo Yagishita, Morio Shoda, Nobuhisa Hagiwara
INTRODUCTION: The guidelines suggest that an adjuvant substrate modification in addition to pulmonary vein isolation (PVI) may be needed for persistent atrial fibrillation (PerAF) assuming that catheter ablation is less successful for PerAF than paroxysmal AF (PAF). To revisit the above assumption, we compared the outcome of the same catheter ablation strategy between PAF and PerAF. METHODS AND RESULTS: Two-hundred and thirty-three consecutive patients (mean age 60±10 years, 53 PerAF and 8 long-lasting PerAF) without structural heart disease underwent catheter ablation of AF by the same strategy using an empiric thoracic vein isolation (a wide circumferential PVI plus empiric superior vena cava isolation) as a major part of the strategy without any adjuvant substrate modification...
January 5, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28054377/left-atrial-substrate-modification-targeting-low-voltage-areas-for-catheter-ablation-of-atrial-fibrillation-a-systematic-review-and-meta-analysis
#4
REVIEW
Alessandro Blandino, Francesca Bianchi, Stefano Grossi, Giuseppe Biondi-Zoccai, Maria Rosa Conte, Luca Gaido, Fiorenzo Gaita, Marco Scaglione, Francesco Rametta
BACKGROUND: This meta-analysis aims to assess the impact of a voltage-guided substrate modification by targeting low-voltage area (LVA) in addition to pulmonary vein isolation (PVI) in patients undergoing catheter ablation for atrial fibrillation (AF). METHODS: MEDLINE/PubMed, Cochrane Library and references reporting AF ablation and 'voltage* OR substrate* OR fibrosis OR fibrotic area* were screened and studies included if matching inclusion and exclusion criteria...
January 5, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28053220/application-of-static-modeling-in-the-prediction-of-in-vivo-drug-drug-interactions-between-rivaroxaban-and-anti-arrhythmic-agents-based-on-in-vitro-inhibition-studies
#5
Eleanor Jing Yi Cheong, Janice Jia Ni Goh, Yanjun Hong, Gopalakrishnan Venkatesan, Yuanjie Liu, Gigi Ngar Chee Chiu, Pipin Kojodjojo, Eric Chun Yong Chan
Rivaroxaban, a direct Factor Xa inhibitor, is indicated for stroke prevention in non-valvular atrial fibrillation (AF). Studies have revealed that the clearance of rivaroxaban is largely attributed to CYP3A4, CYP2J2 metabolism and P-gp efflux pathways. Amiodarone and dronedarone are anti-arrhythmic agents employed in AF management. Amiodarone, dronedarone and their major metabolites, N-desethylamiodarone (NDEA) and N-desbutyldronedarone (NDBD) demonstrate inhibitory effects on CYP3A4 and CYP2J2 with FDA recommended probe substrates...
January 4, 2017: Drug Metabolism and Disposition: the Biological Fate of Chemicals
https://www.readbyqxmd.com/read/28039281/association-of-rate-dependent-conduction-block-between-eccentric-coronary-sinus-to-left-atrial-connections-with-inducible-atrial-fibrillation-and-flutter
#6
Dong Huang, Joseph E Marine, Jing-Bo Li, Tarek Zghaib, Esra Gucuk Ipek, Sunil Sinha, David D Spragg, Hiroshi Ashikaga, Ronald D Berger, Hugh Calkins, Saman Nazarian
BACKGROUND: We sought to describe the prevalence and variability of coronary sinus (CS) and left atrial (LA) myocardium connections, their susceptibility to rate-dependent conduction block, and association with atrial fibrillation (AF) and flutter induction. METHODS AND RESULTS: The study cohort included 30 consecutive AF patients (age 63.3±10.5 years, 63% male). Multipolar catheters were positioned in the CS, high right atrium (HRA), and LA parallel to and near the CS...
January 2017: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/28011831/atrial-fibrillation-septal-pacing-translation-of-modelling-results
#7
Adrian Luca, Todd Kallmyer, Nathalie Virag
AIMS: Atrial fibrillation (AF) septal pacing consists of rapid pacing from a ring of electrodes around the atrial septum, leading to local capture of both atria during AF. The present model-based study evaluated the impact of the number of stimulation electrodes in the septal ring on AF capture for different types of sustained AF dynamics. METHODS AND RESULTS: Using a biophysical model of AF based on CT scans from an AF patient, models with different AF substrates (Cholinergic AF and Meandering Wavelets) were created by varying the atrial membrane kinetics...
December 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27995637/active-atrial-function-and-atrial-scar-burden-after-multiple-catheter-ablations-of-persistent-atrial-fibrillation
#8
Jana M Nührich, Anne C Geisler, Daniel Steven, Boris A Hoffmann, Benjamin Schäffer, Gunnar Lund, Christian Stehning, Ulf K Radunski, Arian Sultan, Michael Schwarzl, Gerhard Adam, Stephan Willems, Kai Muellerleile
BACKGROUND: Extensive and repeated substrate modification (SM) is frequently performed as an ablation strategy in persistent atrial fibrillation (persAF). The effect of these extended ablation strategies on atrial function has not been investigated sufficiently so far. The purpose was to assess atrial function by cardiac magnetic resonance (CMR) and its association with left atrial (LA) scar burden by electroanatomical voltage-mapping after multiple persAF ablation procedures. METHODS: We included 16 persAF-patients who had ≥ 2 SM procedures and a control group (CG) of 21 persAF-patients without prior ablation...
December 20, 2016: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/27984585/atrial-heterogeneity-generates-re-entrant-substrate-during-atrial-fibrillation-and-anti-arrhythmic-drug-action-mechanistic-insights-from-canine-atrial-models
#9
Marta Varela, Michael A Colman, Jules C Hancox, Oleg V Aslanidi
Anti-arrhythmic drug therapy is a frontline treatment for atrial fibrillation (AF), but its success rates are highly variable. This is due to incomplete understanding of the mechanisms of action of specific drugs on the atrial substrate at different stages of AF progression. We aimed to elucidate the role of cellular, tissue and organ level atrial heterogeneities in the generation of a re-entrant substrate during AF progression, and their modulation by the acute action of selected anti-arrhythmic drugs. To explore the complex cell-to-organ mechanisms, a detailed biophysical models of the entire 3D canine atria was developed...
December 2016: PLoS Computational Biology
https://www.readbyqxmd.com/read/27979373/electrophysiological-abnormalities-in-patients-with-paroxysmal-atrial-fibrillation-in-the-absence-of-overt-structural-heart-disease
#10
José David Arroja, Haran Burri, Chan Il Park, Philippe Giraudet, Marc Zimmermann
PURPOSE: The aim of the present study was to define the atrial electrical substrate in patients with paroxysmal atrial fibrillation (AF) occurring in the absence of overt structural heart disease and to assess if electrophysiological parameters could predict AF recurrence after radiofrequency ablation in this population. METHODS AND RESULTS: 45 consecutive patients (39 male, age 59 ± 10 years) with paroxysmal AF and without overt structural heart disease, referred for radiofrequency catheter ablation, were prospectively enrolled...
September 2016: Indian Pacing and Electrophysiology Journal
https://www.readbyqxmd.com/read/27966276/autonomic-tone-activity-before-the-onset-of-atrial-fibrillation
#11
Cristina Gallo, Pier Paolo Bocchino, Massimo Magnano, Luca Gaido, Domenica Zema, Alberto Battaglia, Matteo Anselmino, Fiorenzo Gaita
INTRODUCTION: The autonomic nervous system has been proven to play a major role in the onset of atrial fibrillation (AF), along with a predisposing substrate and a specific trigger event usually consisting of a premature supraventricular ectopic beat (SVEB). By means of heart rate variability (HRV) analysis, we investigated the activity of the autonomic nervous system before SVEBs non-triggering and triggering AF. METHODS AND RESULTS: We evaluated 28 patients with at least one episode of sustained AF (> 30 seconds) recorded during 24-hour Holter monitorings...
December 14, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27957770/substrate-ablation-for-treatment-of-atrial-fibrillation-back-to-basics
#12
EDITORIAL
Jeffrey J Goldberger
No abstract text is available yet for this article.
December 13, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27943042/association-between-left-atrial-appendage-emptying-velocity-n-terminal-plasma-brain-natriuretic-peptide-levels-and-recurrence-of-atrial-fibrillation-after-catheter-ablation
#13
Xin-Xin Ma, Yue-Li Zhang, Bing Hu, Wen-Jun Jiang, Man Wang, Dong-Yan Zheng, Meng-Ruo Zhu, Xiao-Pei Xue
PURPOSE: Multiple studies have shown the efficacy and potentially curative effect of catheter ablation (CA). However, CA is always accompanied by a considerable recurrence rate for atrial fibrillation (AF). We hypothesized that pre-procedure assessments of baseline left atrial appendage emptying flow velocity (LAAFV) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels would help identify abnormal atrial substrate and offer preliminary evidence regarding susceptibility to AF recurrence in patients with paroxysmal or persistent AF, respectively...
December 12, 2016: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/27940935/left-atrial-fibrosis-quantification-by-late-gadolinium-enhanced-magnetic-resonance-a-new-method-to-standardize-the-thresholds-for-reproducibility
#14
Eva M Benito, Alicia Carlosena-Remirez, Eduard Guasch, Susana Prat-González, Rosario J Perea, Rosa Figueras, Roger Borràs, David Andreu, Elena Arbelo, J Maria Tolosana, Felipe Bisbal, Josep Brugada, Antonio Berruezo, Lluis Mont
AIMS: Identification of left atrial (LA) fibrosis through late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) remains controversial due to the heterogeneity and lack of reproducibility of proposed methods. Our aim is to describe a normalized, reproducible, standardized method to evaluate LA fibrosis through LGE-CMR. METHODS AND RESULTS: Electrocardiogram- and respiratory-gated 3-Tesla LGE-CMR was performed in 10 healthy young volunteers and 30 patients with atrial fibrillation (AF): 10 with paroxysmal AF, 10 with persistent AF, and 10 with a previous AF ablation procedure...
December 8, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27909521/recurrent-atrial-fibrillation-after-catheter-ablation-considerations-for-repeat-ablation-and-strategies-to-optimize-success
#15
REVIEW
Andrew E Darby Md Fhrs
Recurrent AF after catheter ablation occurs in at least 20 to 40% of patients. Repeat ablation is primarily considered for those with symptomatic AF recurrences (often drug-refactory) occurring at least 3 months or more post-ablation. Pulmonary vein reconnection is almost universally encountered, and repeat isolation of electrically connected pulmonary veins should be the primary ablation strategy. Beyond repeat PVI and possible ablation of non-PV triggers, there is little to no evidence that additional substrate modification improves outcomes...
June 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909504/long-term-evolution-of-patients-treated-for-paroxysmal-atrial-fibrillation-with-first-and-second-generation-cryoballoon-catheter-ablation-with-a-prospective-protocol-guided-by-complete-bidirectional-left-atrium-pulmonary-veins-disconnection-after-adenosine
#16
Jesus M Paylos Md PhD, Aracelis Morales Md, Luis Azcona Md, Marisol Paradela Md, Raquel Yagüe Md, Fernando Gómez-Guijarro Md, Lourdes Lacal Md, Clara Ferrero Rn, Octavio Rodríguez Md
INTRODUCTION: Cryoballoon ablation (CB) has proven effective for treating patients with paroxysmal atrial fibrillation (PAF). We analyzed our seven year follow-up of patients, treated for PAF with first (CB1) and second generation (CB2), with demonstration of LA-PV disconnection with bidirectional block (BB) after adenosine (AD). METHODS: Since November 2008 to May 2015, 128 patients, 97 male (58±7 years), without heart disease, highly symptomatic, refractory to antiarrhythmic drugs (AAD) were treated, and follow-up (1411 ±727 days)...
April 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27909489/advanced-mapping-systems-to-guide-atrial-fibrillation-ablation-electrical-information-that-matters
#17
REVIEW
Sotirios Nedios Md, Philipp Sommer Md, Andreas Bollmann Md PhD, Gerhard Hindricks Md
Catheter ablation is an established and widespread treatment for atrial fibrillation (AF). Contemporary electroanatomical mapping systems (EAMs) have been developed to facilitate mapping processes but remain limited by spatiotemporal and processing restrictions. Advanced mapping systems emerged from the need to better understand and ablate complex AF substrate, by improving the acquisition and illustration of electrophysiological information. In this review, we present you the recently advanced mapping systems for AF ablation in comparison to the established contemporary EAMs...
April 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/27875475/scar-based-catheter-ablation-for-persistent-atrial-fibrillation
#18
Pablo B Nery, Rebecca Thornhill, Girish M Nair, Elena Pena, Calum J Redpath
PURPOSE OF REVIEW: Percutaneous catheter ablation can be an effective treatment for paroxysmal atrial fibrillation. However, catheter ablation for the treatment of persistent atrial fibrillation or long-standing persistent atrial fibrillation is associated with success rates of 45-50% at 1 year. To address the challenge of ablating patients with persistent atrial fibrillation, several approaches have been proposed. Atrial scar-based catheter ablation is a promising strategy for ablation of persistent atrial fibrillation...
January 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27862561/long-term-outcome-of-left-atrial-voltage-guided-substrate-ablation-during-atrial-fibrillation-a-novel-adjunctive-ablation-strategy
#19
Atsuhiko Yagishita, J Rod Gimbel, Samer DE Oliveira, Harish Manyam, Dina Sparano, Ivan Cakulev, Judith Mackall, Mauricio Arruda
INTRODUCTION: Left atrium (LA) low voltage area (LVA) on 3-D electroanatomic bipolar voltage mapping (EAVM), as a surrogate for scar, is associated with poor AF ablation outcome. We evaluated the long-term outcome of an LVA-guided atrial fibrillation (AF) substrate modification strategy as an adjunct to pulmonary vein isolation (PVI). METHODS AND RESULTS: Two hundred and one consecutive patients with AF (82% persistent/Non-PAF, age 65 years), who underwent EAVM during AF prior to PVI, were divided into 2 groups according to the presence or absence of LVA outside the PV antra, defined as bipolar voltage of <0...
November 12, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27788847/left-atrial-appendage-isolation-in-patients%C3%A2-with-longstanding-persistent-af%C3%A2-undergoing-catheter-ablation-belief-trial
#20
Luigi Di Biase, J David Burkhardt, Prasant Mohanty, Sanghamitra Mohanty, Javier E Sanchez, Chintan Trivedi, Mahmut Güneş, Yalçın Gökoğlan, Carola Gianni, Rodney P Horton, Sakis Themistoclakis, G Joseph Gallinghouse, Shane Bailey, Jason D Zagrodzky, Richard H Hongo, Salwa Beheiry, Pasquale Santangeli, Michela Casella, Antonio Dello Russo, Amin Al-Ahmad, Patrick Hranitzky, Dhanunjaya Lakkireddy, Claudio Tondo, Andrea Natale
BACKGROUND: Longstanding persistent (LSP) atrial fibrillation (AF) is the most challenging type of AF. In addition to pulmonary vein isolation, substrate modification and triggers ablation have been reported to improve freedom from AF in patients with LSPAF. OBJECTIVES: This study sought to assess whether the empirical electrical isolation of the left atrial appendage (LAA) could improve success at follow-up. METHODS: This was an open-label, randomized study assessing the effectiveness of empirical electrical left atrial appendage isolation for the treatment of LSPAF...
November 1, 2016: Journal of the American College of Cardiology
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