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Atrial fibrillation substrate

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https://www.readbyqxmd.com/read/28541417/family-history-of-atrial-fibrillation-as-a-predictor-of-atrial-substrate-and-arrhythmia-recurrence-in-patients-undergoing-atrial-fibrillation-catheter-ablation
#1
Sunil Kapur, Saurabh Kumar, Roy M John, William G Stevenson, Usha B Tedrow, Bruce A Koplan, Laurence M Epstein, Calum A MacRae, Gregory F Michaud
Aims: A commonly held notion is that patients with a family history of atrial fibrillation (AF) have worse atrial substrate and higher rates of arrhythmia recurrence following ablation. We sought to examine differences in atrial substrate and catheter ablation outcomes in patients with a 1st degree family member with paroxysmal or persistent AF (PeAF) compared to those without. Methods and results: A total of 256 consecutive patients undergoing their 1st ablation for AF (123 paroxysmal, 133 persistent) with >1 year follow up were included...
May 24, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28525549/the-change-in-circulating-galectin-3-predicts-absence-of-atrial-fibrillation-after-thoracoscopic-surgical-ablation
#2
Wouter R Berger, Benoît Jagu, Nicoline W E van den Berg, Dean R P P Chan Pin Yin, Jan P van Straalen, Onno J de Boer, Antoine H G Driessen, Jolien Neefs, Sébastien P J Krul, WimJan P van Boven, Allard C van der Wal, Joris R de Groot
Aims: Galectin-3 (Gal-3) is an important mediator of cardiac fibrosis, particularly in heart failure. Increased Gal-3 concentration (Gal-3), associated with increased risk of developing atrial fibrillation (AF), may reflect atrial fibrotic remodelling underlying AF progression. We aimed to investigate whether the change in serum Gal-3 reflects alterations of the arrhythmogenic atrial substrate following thoracoscopic AF surgery, and predicts absence of AF. Methods and results: Consecutive patients undergoing thoracoscopic AF surgery were included...
May 19, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28501100/comparison-of-direct-current-synchronized-cardioversion-to-ibutilide-guided-catheter-ablation-for-long-term-sinus-rhythm-maintenance-after-isolated-pulmonary-vein-isolation-of-persistent-atrial-fibrillation
#3
Maojing Wang, Qing Zhao, Wei Ding, Shanglang Cai
Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup)...
March 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28496934/catheter-ablation-for-persistent-and-long-standing-persistent-atrial-fibrillation
#4
REVIEW
Martin Fiala
Persistent and long-standing persistent atrial fibrillation evolves from complex arrhythmogenic substrate and sources. Multiple studies have shown improved freedom from arrhythmia recurrences if sinus rhythm had been restored during the index ablation; however, such harder procedural endpoint requires laborious stepwise approach almost invariably pursuing non-pulmonary-vein sources. Longer-term conversion of persistent atrial fibrillation into sinus rhythm is associated with significant improvement in major indices of hemodynamic and functional status; these indices also represent major predictors of cardiovascular mortality...
October 2016: Journal of Atrial Fibrillation
https://www.readbyqxmd.com/read/28496076/-early-results-of-complex-fractionated-atrial-electrogram-mapping-guided-atrial-fibrillation-surgery
#5
Kazuaki Fukahara, Mari Sakai, Shigeki Yokoyama, Toshio Doi, Naoki Yoshimura
OBJECTIVE: Although the Cox-maze operation is the standard surgical procedure for permanent atrial fibrillation(AF), conversion to sinus rhythm is limited by patient characteristics, including the duration of AF, atrial size, and voltage of fibrillation waves. A surgical strategy based on structural alteration of the electrical substrates of AF is required to achieve better outcomes of AF surgery. Complex fractionated atrial electrogram (CFAE) plays an important role in the electrical substrate of AF...
May 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28484965/the-protective-role-of-small-heat-shock-proteins-in-cardiac-diseases-key-role-in-atrial-fibrillation
#6
Xu Hu, Denise M S Van Marion, Marit Wiersma, Deli Zhang, Bianca J J M Brundel
Atrial fibrillation (AF) is the most common tachyarrhythmia which is associated with increased morbidity and mortality. AF usually progresses from a self-terminating paroxysmal to persistent disease. It has been recognized that AF progression is driven by structural remodeling of cardiomyocytes, which results in electrical and contractile dysfunction of the atria. We recently showed that structural remodeling is rooted in derailment of proteostasis, i.e., homeostasis of protein production, function, and degradation...
May 8, 2017: Cell Stress & Chaperones
https://www.readbyqxmd.com/read/28475580/neural-substrate-of-posterior-left-atrium-a-novel-modulation-for-inducibility-and-remodeling-of-atrial-fibrillation-in-canine
#7
Mu Qin, Li Li, Xu Liu, Tao Liu, Shao Bo Shi
BACKGROUND: The neural mechanism of posterior left atrium (PLA) for genesis of atrial fibrillation has not been completely elucidated. We sought to assess the contribution of PLA denervation on atrial fibrillation (AF) inducibility and atrial remodeling. METHODS AND RESULTS: After left thoracotomy in anesthetized dogs (n = 32), electrode catheters were attached to the PLA, left atrial roof, left pulmonary vein and left atrial appendage. Experiment 1 (n = 16): Vagal stimulation (VS group, n = 8) led to more pronounced ERP shortening in PLA than in other sites (CTL:71±7 ms vs VS: 52±6 ms, P<0...
2017: PloS One
https://www.readbyqxmd.com/read/28457239/ebstein-anomaly
#8
REVIEW
Elizabeth D Sherwin, Dominic J Abrams
Ebstein anomaly is a rare form of congenital heart disease with a uniquely high prevalence of arrhythmias. The most prevalent arrhythmia mechanisms are intrinsic to the underlying embryologic defects and may manifest at any stage. Current electrophysiological and surgical strategies are well equipped to address these arrhythmia mechanisms, yet despite available technology and a robust understanding of the mechanisms, these cases remain challenging. Surgical techniques that render arrhythmia substrates unreachable mandate comprehensive presurgical electrophysiological assessment and potential ablation...
June 2017: Cardiac Electrophysiology Clinics
https://www.readbyqxmd.com/read/28450367/atrial-fibrillation-epidemiology-pathophysiology-and-clinical-outcomes
#9
REVIEW
Laila Staerk, Jason A Sherer, Darae Ko, Emelia J Benjamin, Robert H Helm
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions...
April 28, 2017: Circulation Research
https://www.readbyqxmd.com/read/28443594/diastolic-electrocardiographic-parameters-predict-implantable-device-detected-asymptomatic-atrial-fibrillation
#10
Ahmet İlker Tekkeşin, Yalçın Velibey, Ceyhan Türkkan, Ahmet Taha Alper, Yasin Çakıllı, Tolga Sinan Güvenç, Ozan Tanık, Adnan Kaya, Özlem Yıldırımtürk, Nazmiye Özbilgin, Özge Güzelburç, Ahmet Öz, Regayip Zehir, Kadir Gürkan
BACKGROUND: Atrial fibrillation (AF) is the most common clinically significant arrhythmia. It is now established that atrial high rate episodes (AHRE) correlate highly with AF. AIMS: Present study aimed to investigate the relation between diastolic electrocardiographic parameters and subclinical AF detected by cardiac implantable electronic devices. STUDY DESIGN: This study was cross-sectional study that included a total of 203 patients who had a DDDR pacemaker due to sinus node dysfunction...
April 6, 2017: Balkan Medical Journal
https://www.readbyqxmd.com/read/28438722/propagation-of-meandering-rotors-surrounded-by-areas-of-high-dominant-frequency-in-persistent-atrial-fibrillation
#11
João Salinet, Fernando S Schlindwein, Peter Stafford, Tiago P Almeida, Xin Li, Frederique J Vanheusden, María S Guillem, G André Ng
BACKGROUND: Identification of arrhythmogenic regions remains a challenge in persistent atrial fibrillation (persAF). Frequency and phase analysis allows identification of potential ablation targets. OBJECTIVE: This study aimed to investigate the spatiotemporal association between dominant frequency (DF) and reentrant phase activation areas. METHODS: A total of 8 persAF patients undergoing first-time catheter ablation procedure were enrolled...
April 22, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28436566/atrial-fibrillation-originating-from-superior-vena-cava-with-atrial-flutter-electrocardiogram-pattern
#12
Hung-Kai Huang, Shih-Lin Chang, Yenn-Jiang Lin, Li-Wei Lo, Yu-Feng Hu, Fa-Po Chung, Yen-Chang Huang, Chung-Hsing Lin, Chao-Shun Chan, Hung-Yu Chang, Chin-Yu Lin, Yao-Ting Chang, Ching-Hui Huang, Shih-Ann Chen
BACKGROUNDS: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). METHODS AND RESULTS: Seventy-six patients with AF originating from SVC underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2)...
April 24, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28434446/revisiting-pulmonary-vein-isolation-alone-for-persistent-atrial-fibrillation-a-systematic-review-and-meta-analysis
#13
Aleksandr Voskoboinik, Jeremy T Moskovitch, Nadav Harel, Prashanthan Sanders, Peter M Kistler, Jonathan M Kalman
BACKGROUND: Early studies demonstrated relatively low success rates for pulmonary vein isolation (PVI) alone in patients with persistent atrial fibrillation (PeAF). However, the advent of new technologies and the observation that additional substrate ablation does not improve outcomes have created a new focus on PVI alone for treatment of PeAF. OBJECTIVE: The purpose of this study was to systematically review the recent medical literature to determine current medium-term outcomes when a PVI-only approach is used for PeAF...
May 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28429499/atrial-fibrillation-patients-with-isolated-pulmonary-veins-is-sinus-rhythm-achievable
#14
Judit Szilágyi, Gregory M Marcus, Nitish Badhwar, Byron K Lee, Randall J Lee, Vasanth Vedantham, Zian H Tseng, Tomos Walters, Melvin Scheinman, Jeffrey Olgin, Edward P Gerstenfeld
BACKGROUND: The cornerstone of atrial fibrillation (AF) ablation is isolation of the pulmonary veins (PVs). Patients with recurrent AF undergoing repeat ablation usually have PV reconnection (PVr). The ablation strategy and outcome of patients undergoing repeat ablation who have persistent isolation of all PVs (PVi) at the time of repeat ablation is unknown. METHODS AND RESULTS: We studied consecutive patients with recurrent AF undergoing repeat ablation and compared patients with PVi to those with PVr...
April 21, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28387462/identification-and-electrophysiological-characterization-of-early-left-atrial-structural-remodeling-as-a-predictor-for-atrial-fibrillation-recurrence-after-pulmonary-vein-isolation
#15
Atsuhiko Yagishita, Dina Sparano, Ivan Cakulev, J Rod Gimbel, Timothy Phelan, Hossam Mustafa, Samer De Oliveira, Judith Mackall, Mauricio Arruda
BACKGROUND: Voltage-guided substrate ablation following pulmonary vein isolation (PVI) improves atrial fibrillation (AF) ablation outcomes. However, by setting upper voltage cutoff of 0.5 mV during sinus rhythm (SR) to guided substrate ablation using electroanatomic voltage mapping (EAVM), mildly affected low voltage area (maLVA) may be undetected. We sought to determine the optimal bipolar voltage cutoff to identify maLVA, its electrogram complexity, and the implication on ablation outcome...
April 7, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28369767/multiple-targets-for-flecainide-action-implications-for-cardiac-arrhythmogenesis
#16
REVIEW
Samantha C Salvage, Karthik H Chandrasekharan, Kamalan Jeevaratnam, Angela F Dulhunty, Andrew J Thompson, Antony P Jackson, Christopher L-H Huang
Flecainide suppresses cardiac tachyarrhythmias including paroxysmal atrial fibrillation, supraventricular tachycardia and arrhythmic long QT syndromes (LQTS), as well as the Ca(2+) -mediated, catecholaminergic polymorphic ventricular tachycardia (CPVT). However, flecainide can also exert pro-arrhythmic effects most notably following myocardial infarction and when used to diagnose Brugada syndrome (BrS). These divergent actions result from its physiological and pharmacological actions at multiple, interacting levels of cellular organization...
April 3, 2017: British Journal of Pharmacology
https://www.readbyqxmd.com/read/28343787/relationship-between-rotors-and-complex-fractionated-electrograms-in-atrial-fibrillation-using-a-novel-computational-analysis
#17
Pedro Adragão, Pedro Carmo, Diogo Cavaco, João Carmo, António Ferreira, Francisco Moscoso Costa, Maria Salomé Carvalho, João Mesquita, Rita Quaresma, Francisco Belo Morgado, Miguel Mendes
INTRODUCTION: Rotors and complex fractionated atrial electrograms (CFAEs) have been suggested as possible therapeutic targets in ablation of atrial fibrillation (AF). The aim of this study was to assess the relationship between rotors and CFAEs in patients with AF. METHODS: We studied 18 patients with AF (mean age 69±8 years, 33% female) who underwent rotor ablation and pulmonary vein isolation. Endocardial mapping was performed with a basket catheter to identify the presence, number and location of rotors and CFAEs...
April 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28340160/safety-of-fluoroscopy-guided-transseptal-approach-for-ablation-of-left-sided-arrhythmias
#18
Zviad Matoshvili, Hamid Bastani, Tara Bourke, Frieder Braunschweig, Nikola Drca, Kristjan Gudmundsson, Per Insulander, Anette Jemtrén, Göran Kennebäck, Ott Saluveer, Jonas Schwieler, Jari Tapanainen, Christer Wredlert, Mats Jensen-Urstad
Aims: The transseptal approach is used for left atrial access during the ablation of atrial fibrillation (AF) and other left-sided arrhythmia substrates. Transseptal puncture (TP) is commonly performed with fluoroscopic guidance, contrast injection, and pressure monitoring. In many centres, additional techniques [intracardiac echocardiography (ICE), transoesophageal echocardiography (TEE), radiofrequency needle] are used to facilitate TP but its use adds costs. In this retrospective study, we studied the safety and complication rate when TP was routinely done with fluoroscopic guidance, contrast injection, and pressure monitoring using ICE or TEE only in selected cases...
March 10, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28339601/characterization-and-consistency-of-interactions-of-triggers-and-substrate-at-the-onset-of-paroxysmal-atrial-fibrillation
#19
David G Jones, Vias Markides, Anthony W C Chow, Richard J Schilling, Prapa Kanagaratnam, Tom Wong, D Wyn Davies, Nicholas S Peters
Aims: Initiating mechanisms of atrial fibrillation (AF) remain poorly understood, involving complex interaction between triggers and the atrial substrate. This study sought to classify the transitional phenomena, hypothesizing that there is consistency within and between patients in trigger-substrate interaction during transition to AF. Methods and results: Non-contact left atrial (LA) mapping was performed in 17 patients undergoing ablation for paroxysmal AF. All had spontaneous ectopy...
January 25, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28337705/the-effects-of-polyunsaturated-fatty-acids-and-antioxidant-vitamins-on-atrial-oxidative-stress-nitrotyrosine-residues-and-connexins-following-extracorporeal-circulation-in-patients-undergoing-cardiac-surgery
#20
Felipe Petersen, Ramón Rodrigo, Manfred Richter, Sawa Kostin
Cardiac surgery with extracorporeal circulation is characterized by different degrees of myocardial ischemia/reperfusion, which is often associated with postoperative atrial fibrillation (POAF). We have previously shown that a novel preventive therapy based on the reinforcement of the antioxidant system using omega-3 fatty acids plus antioxidant vitamin supplementation applied to patients undergoing cardiac surgery reduces POAF occurrence. We hypothesized that oxidative stress and nitrosative stress are involved in the development of an arrhythmogenic substrate by their effect on connexins (Cx40, Cx43 and Cx45) abundance and distribution pattern...
March 23, 2017: Molecular and Cellular Biochemistry
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