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https://www.readbyqxmd.com/read/27909521/recurrent-atrial-fibrillation-after-catheter-ablation-considerations-for-repeat-ablation-and-strategies-to-optimize-success
#1
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
#2
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
#3
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
#4
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
#5
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 a 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 two 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
#6
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
https://www.readbyqxmd.com/read/27784738/pulmonary-vein-antral-isolation-and-nonpulmonary-vein-trigger-ablation-are-sufficient-to-achieve-favorable-long-term-outcomes-including-transformation-to-paroxysmal-arrhythmias-in-patients-with-persistent-and-long-standing-persistent-atrial-fibrillation
#7
Jackson J Liang, Melissa A Elafros, Daniele Muser, Rajeev K Pathak, Pasquale Santangeli, Erica S Zado, David S Frankel, Gregory E Supple, Robert D Schaller, Rajat Deo, Fermin C Garcia, David Lin, Mathew D Hutchinson, Michael P Riley, David J Callans, Francis E Marchlinski, Sanjay Dixit
BACKGROUND: Transformation from persistent to paroxysmal atrial fibrillation (AF) after ablation suggests modification of the underlying substrate. We examined the nature of initial arrhythmia recurrence in patients with nonparoxysmal AF undergoing antral pulmonary vein isolation and nonpulmonary vein trigger ablation and correlated recurrence type with long-term ablation efficacy after the last procedure. METHODS AND RESULTS: Three hundred and seventeen consecutive patients with persistent (n=200) and long-standing persistent (n=117) AF undergoing first ablation were included...
November 2016: Circulation. Arrhythmia and Electrophysiology
https://www.readbyqxmd.com/read/27773652/refractoriness-in-human-atria-time-and-voltage-dependence-of-sodium-channel-availability
#8
Lasse Skibsbye, Thomas Jespersen, Torsten Christ, Mary M Maleckar, Jonas van den Brink, Pasi Tavi, Jussi T Koivumäki
BACKGROUND: Refractoriness of cardiac cells limits maximum frequency of electrical activity and protects the heart from tonic contractions. Short refractory periods support major arrhythmogenic substrates and augmentation of refractoriness is therefore seen as a main mechanism of antiarrhythmic drugs. Cardiomyocyte excitability depends on availability of sodium channels, which involves both time- and voltage-dependent recovery from inactivation. This study therefore aims to characterise how sodium channel inactivation affects refractoriness in human atria...
October 20, 2016: Journal of Molecular and Cellular Cardiology
https://www.readbyqxmd.com/read/27766704/treatment-of-recurrent-non-paroxysmal-atrial-fibrillation-using-focal-impulse-and-rotor-mapping-firm-guided-rotor-ablation-early-recurrence-and-long-term-outcomes
#9
Stefan Georg Spitzer, László Károlyi, Carola Rämmler, Frank Scharfe, Thomas Weinmann, Mirko Zieschank, Anke Langbein
INTRODUCTION: A patient-tailored ablation approach focused on the elimination of both pulmonary vein triggers as well as substrate drivers may result in favourable outcomes with recurrent persistent AF patients. OBJECTIVE: We evaluated the long-term outcomes of rotor ablation combined with conventional pulmonary vein isolation (PVI) in patients with recurrent non-paroxysmal AF. METHODS: 58 consecutive patients underwent FIRM-guided rotor ablation followed by conventional PVI for the treatment of recurrent non-paroxysmal AF...
October 21, 2016: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/27764185/atrial-substrate-modification-in-atrial-fibrillation-targeting-gp-or-cfae-evidence-from-meta-analysis-of-clinical-trials
#10
Mu Qin, Xu Liu, Shao-Hui Wu, Xiao-Dong Zhang
Several clinically relevant outcomes post atrial substrate modification in patients with atrial fibrillation (AF) have not been systematically analyzed among published studies on adjunctive cardiac ganglionated plexi (GP) or complex fractionated atrial electograms (CFAE) ablation vs. pulmonary vein isolation (PVI) alone. Out of 176 reports identified, the present meta-analysis included 14 randomized and non-randomized controlled trials (1613 patients) meeting inclusion criteria. Addition of GP ablation to PVI significantly increased freedom from atrial tachyarrhythmia in short- (OR: 1...
2016: PloS One
https://www.readbyqxmd.com/read/27756468/the-electrophysiologic-effects-of-acute-mitral-regurgitation-in-a-canine-model
#11
Christopher P Lawrance, Matthew C Henn, Jacob R Miller, Michael A Kopek, Andrew J Zhang, Richard B Schuessler, Ralph J Damiano
BACKGROUND: Atrial fibrillation (AF) occurs in 30% of patients with mitral regurgitation referred for surgical intervention. However, the underlying mechanisms in this population are poorly understood. This study examined the effects of acute left atrial volume overload on atrial electrophysiology and the inducibility of AF. METHODS: Ten canines underwent insertion of an atrioventricular shunt between the left ventricle and left atrium. Shunt and aortic flows were calculated, and the shunt was titrated to a shunt fraction to 40% to 50% of cardiac output...
October 15, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27747025/atrial-fibrillation-review-of-current-treatment-strategies
#12
Joshua Xu, Jessica G Y Luc, Kevin Phan
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF...
September 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/27738066/does-the-extent-of-left-atrial-arrhythmogenic-substrate-depend-on-the-electroanatomical-mapping-technique-impact-of-pulmonary-vein-mapping-catheter-vs-ablation-catheter
#13
Martin Huemer, Daniel Qaiyumi, Philipp Attanasio, Abdul Parwani, Burkert Pieske, Florian Blaschke, Leif-Hendrik Boldt, Wilhelm Haverkamp, Alexander Wutzler
AIMS: In persistent atrial fibrillation (AF), left atrial low-voltage areas and complex fractionated atrial electrograms (CFAEs) have been thoroughly discussed as critical substrate points for AF perpetuation. Thus, in patients undergoing pulmonary vein isolation, these sites are often considered additional ablation targets. Currently, mapping techniques for these substrate indicators are still under discussion. The aim of this study was to evaluate the impact of different mapping catheters on the detection of low-voltage areas and CFAE...
October 12, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27694326/percutaneous-pulmonary-valve-implantation-alters-electrophysiologic-substrate
#14
Hoang H Nguyen, Shabana Shahanavaz, George F Van Hare, David T Balzer, Ramzi Nicolas, Jennifer N Avari Silva
BACKGROUND: Percutaneous pulmonary valve implantation (PPVI) is first-line therapy for some congenital heart disease patients with right ventricular outflow tract dysfunction. The hemodynamics improvements after PPVI are well documented, but little is known about its effects on the electrophysiologic substrate. The objective of this study is to assess the short- and medium-term electrophysiologic substrate changes and elucidate postprocedure arrhythmias. METHODS AND RESULTS: A retrospective chart review of patients undergoing PPVI from May 2010 to April 2015 was performed...
September 30, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27693594/obstructive-sleep-apnea-and-cardiac-arrhythmogenesis-mechanistic-insights
#15
Anna M May, David R Van Wagoner, Reena Mehra
A surge of data has reproducibly identified strong associations of obstructive sleep apnea (OSA) with cardiac arrhythmias. As an extension of epidemiologic and clinic-based findings, experimental investigations have made strides in advancing our understanding of the putative OSA and cardiac arrhythmogenesis mechanistic underpinnings. While most studies have focused on the links between OSA and atrial fibrillation (AF), relationships with ventricular arrhythmias have also been characterized. Key findings implicate OSA-related autonomic nervous system fluctuations typified by enhanced parasympathetic activation during and sympathetic surges subsequent to respiratory events which contribute to augmented arrhythmic propensity...
September 29, 2016: Chest
https://www.readbyqxmd.com/read/27692603/spanish-catheter-ablation-registry-15th-official-report-of-the-spanish-society-of-cardiology-working-group-on-electrophysiology-and-arrhythmias-2015
#16
Alonso Pedrote, Adolfo Fontenla, Javier García-Fernández
INTRODUCTION AND OBJECTIVES: This report presents the findings of the 2015 Spanish Catheter Ablation Registry. METHODS: For data collection, each center was allowed to choose freely between 2 systems: retrospective, requiring the completion of a standardized questionnaire, and prospective, involving reporting to a central database. RESULTS: Data were collected from 82 centers. A total of 12 863 ablation procedures were performed, for a mean of 157±119 and a median of 138 procedures per center...
September 28, 2016: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27688260/echocardiographic-associates-of-atrial-fibrillation-in-end-stage-renal-disease
#17
Liselotte C R Hensen, Victoria Delgado, Suzanne E van Wijngaarden, Melissa Leung, Mihaly K de Bie, Maurits S Buiten, Martin J Schalij, Jos J Van de Kerkhof, Ton J Rabelink, Joris I Rotmans, J Wouter Jukema, Jeroen J Bax
BACKGROUND: The prevalence of atrial fibrillation (AF) in end-stage renal disease (ESRD) patients is relatively high. The present study evaluated the association between left atrial (LA) remodelling, including an increased size and myocardial fibrosis, and slow LA conduction and the occurrence of AF. METHODS: In 171 ESRD patients enrolled in the Implantable Cardioverter Defibrillators in Dialysis patients (ICD2) trial, the LA dimensions, LA conduction delay [as reflected by the time difference between P-wave onset on surface electrocardiogram and A'-wave on tissue Doppler imaging (PA-TDI)] and LA function were compared between patients who exhibited AF versus patients without AF...
September 29, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27670628/regional-distribution-of-t-tubule-density-in-left-and-right-atria-in-dogs
#18
Rishi Arora, Gary L Aistrup, Stephen Supple, Caleb Frank, Jasleen Singh, Shannon Tai, Anne Zhao, Laura Chicos, William Marszalec, Ang Guo, Long-Sheng Song, J Andrew Wasserstrom
BACKGROUND: The peculiarities of transverse tubule (T-tubule) morphology and distribution in the atrium-and how they contribute to excitation-contraction coupling-are just beginning to be understood. OBJECTIVES: The objectives of this study were to determine T-tubule density in the intact, live right and left atria in a large animal and to determine intraregional differences in T-tubule organization within each atrium. METHODS: Using confocal microscopy, T-tubules were imaged in both atria in intact, Langendorf-perfused normal dog hearts loaded with di-4-ANEPPS...
September 23, 2016: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/27663175/regulating-the-regulator-insights-into-the-cardiac-protein-phosphatase-1-interactome
#19
David Y Chiang, Albert J R Heck, Dobromir Dobrev, Xander H T Wehrens
Reversible phosphorylation of proteins is a delicate yet dynamic balancing act between kinases and phosphatases, the disturbance of which underlies numerous disease processes. While our understanding of protein kinases has grown tremendously over the past decades, relatively little is known regarding protein phosphatases. This may be because protein kinases are great in number and relatively specific in function, and thereby amenable to be studied in isolation, whereas protein phosphatases are much less abundant and more nonspecific in their function...
September 20, 2016: Journal of Molecular and Cellular Cardiology
https://www.readbyqxmd.com/read/27646314/applications-of-advanced-imaging-in-cardiac-electrophysiology
#20
REVIEW
Mrinal Yadava, Michael D Shapiro
Imaging modalities such as computed tomography, magnetic resonance, positron emission tomography, and single-photon emission computed tomography are an indispensable component of cardiac arrhythmia management. Over the last two decades, developments in imaging techniques have facilitated safer and more effective cardiac ablation and device implantation procedures. Pre-procedural assessment of arrhythmogenic substrate and integration with electroanatomic data has significantly impacted the management of atrial fibrillation and ventricular tachycardia...
November 2016: Current Treatment Options in Cardiovascular Medicine
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