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Atrial fibrillation substrate

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https://www.readbyqxmd.com/read/28651348/an-e-e-ratio-on-echocardiography-predicts-the-existence-of-left-atrial-low-voltage-areas-and-poor-outcomes-after-catheter-ablation-for-atrial-fibrillation
#1
Masaharu Masuda, Masashi Fujita, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Takashi Kanda, Akihiro Sunaga, Takuya Tsujimura, Yasuhiro Matsuda, Takuya Ohashi, Masaaki Uematsu
Aims: An elevated left atrial pressure has been reported to play an important role in the development of atrial remodelling in atrial fibrillation (AF) patients. The study aimed at elucidating the association between the diastolic early transmitral flow velocity/mitral annular velocity (E/e', a non-invasive surrogate of left atrial pressure) and left atrial low-voltage-area existence, and the prognostic impact of the E/e' on procedural outcomes in patients undergoing AF ablation. Methods and results: Total of 215 consecutive patients were divided into 3 groups based on the estimated left atrial pressure: normal (E/e' < 8...
June 22, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28645473/efficacy-and-safety-of-rivaroxaban-versus-warfarin-in-patients-taking-nondihydropyridine-calcium-channel-blockers-for-atrial-fibrillation-from-the-rocket-af-trial
#2
Jeffrey B Washam, Anne S Hellkamp, Yuliya Lokhnygina, Jonathan P Piccini, Scott D Berkowitz, Christopher C Nessel, Richard C Becker, Günter Breithardt, Keith A A Fox, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Daniel E Singer, Manesh R Patel
Non-dihydropyridine calcium channel blockers (non-DHP CCBs) possess combined P-glycoprotein and moderate CYP3A4 inhibition, which may lead to increased exposure of medications that are substrates for these metabolic pathways, such as rivaroxaban. We evaluated the use and outcomes of non-DHP CCBs in patients with atrial fibrillation (AF) in Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)...
May 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28639747/the-effect-of-activation-rate-on-left-atrial-bipolar-voltage-in-patients-with-paroxysmal-atrial-fibrillation
#3
Steven E Williams, Nick Linton, Louisa O'Neill, James Harrison, John Whitaker, Rahul Mukherjee, Christopher A Rinaldi, Jaswinder Gill, Steven Niederer, Matthew Wright, Mark O'Neill
INTRODUCTION: Bipolar voltage is used during electroanatomic mapping to define abnormal myocardium, but the effect of activation rate on bipolar voltage is not known. We hypothesized that bipolar voltage may change in response to activation rate. By examining corresponding unipole signals we sought to determine the mechanisms of such changes. METHODS AND RESULTS: LA extrastimulus mapping was performed during CS pacing in 10 patients undergoing 1(st) time paroxysmal atrial fibrillation ablation...
June 22, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28626989/electrical-isolation-of-the-left-atrial-appendage-by-maze-like-catheter-substrate-modification-a-reproducible-strategy-for-pulmonary-vein-isolation-non-responders
#4
Stefano Bordignon, Laura Perrotta, Daniela Dugo, Fabrizio Bologna, Takahiko Nagase, Alexander Fuernkranz, Kr Julian Chun, Boris Schmidt
INTRODUCTION: The ablation strategy for atrial fibrillation (AF) despite pulmonary vein isolation (PVI) is controversial. Left atrial appendage isolation (LAAI) may contribute to improve outcome. We describe an ablation approach ("Maze-like"-LAAI) that (1) modifies the underlying LA substrate by linear ablation (2) eliminates the LAA as a putative AF trigger site and (3) incorporates an unambiguous procedural endpoint. The role of LAA closure (LAAC) after LAAI was investigated. METHODS: Patients with atrial tachyarrhythmias non-responsive to PVI underwent a LAAI ablation procedure...
June 19, 2017: Journal of Cardiovascular Electrophysiology
https://www.readbyqxmd.com/read/28610723/pathophysiology-of-paroxysmal-and-persistent-atrial-fibrillation-rotors-foci-and-fibrosis
#5
REVIEW
Dennis H Lau, Dominik Linz, Ulrich Schotten, Rajiv Mahajan, Prashanthan Sanders, Jonathan M Kalman
Recent advances in our understanding of the mechanisms underlying atrial fibrillation (AF) have further underscored the complex pathophysiological basis of the arrhythmia. It has become apparent that the current clinical classification of AF does not reflect the severity of the underlying atrial disease. Atrial fibrosis has been identified as the key structural change in different substrates that are responsible for the perpetuation of AF. Three-dimensional electroanatomical mapping and late gadolinium-enhanced magnetic resonance imaging are novel modalities that can be used to facilitate identification and quantitation of atrial fibrosis for improved delineation of the AF substrate...
May 24, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28607613/complex-fractionated-atrial-electrograms-high-dominant-frequency-regions-and-left-atrial-voltages-during-sinus-rhythm-and-atrial-fibrillation
#6
Naoko Sasaki, Ichiro Watanabe, Yasuo Okumura, Koichi Nagashima, Rikitake Kogawa, Kazumasa Sonoda, Kazuki Iso, Keiko Takahashi, Masaru Arai, Ryuta Watanabe, Sayaka Kurokawa, Kimie Ohkubo, Toshiko Nakai, Atsushi Hirayama, Mizuki Nikaido
BACKGROUND: Ablation targeting complex fractionated atrial electrograms (CFAEs) or high dominant frequency (DF) sites is generally effective for persistent atrial fibrillation (AF). CFAEs and/or high DF sites may exist in low-voltage regions, which theoretically represent abnormal substrates. However, whether CFAEs or high DF sites reflect low voltage substrates during sinus rhythm (SR) is unknown. METHODS: Sixteen patients with AF (8 with paroxysmal AF; 8, persistent AF) underwent high-density mapping of the left atrium (LA) with a 3-dimensional electroanatomic mapping system before ablation...
June 2017: Journal of Arrhythmia
https://www.readbyqxmd.com/read/28601532/genetics-of-atrial-fibrillation-state-of-the-art-in-2017
#7
REVIEW
Diane Fatkin, Celine F Santiago, Inken G Huttner, Steven A Lubitz, Patrick T Ellinor
Genetic variation is an important determinant of atrial fibrillation (AF) susceptibility. Numerous rare variants in protein-coding sequences of genes have been associated with AF in families and in early-onset cases, and chromosomal loci harbouring common risk variants have been mapped in AF cohorts. Many of these loci are in non-coding regions of the human genome and are thought to contain regulatory sequences that modulate gene expression. Disease genes implicated to date have predominantly encoded cardiac ion channels, with predicted mutation effects on the atrial action potential duration...
May 11, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/28597249/differential-regulation-of-protein-phosphatase-1-pp1-isoforms-in-human-heart-failure-and-atrial-fibrillation
#8
Stefanie Meyer-Roxlau, Simon Lämmle, Annett Opitz, Stephan Künzel, Julius P Joos, Stefan Neef, Karolina Sekeres, Samuel Sossalla, Friedrich Schöndube, Konstantin Alexiou, Lars S Maier, Dobromir Dobrev, Kaomei Guan, Silvio Weber, Ali El-Armouche
Protein phosphatase 1 (PP1) is a key regulator of important cardiac signaling pathways. Dysregulation of PP1 has been heavily implicated in cardiac dysfunctions. Accordingly, pharmacological targeting of PP1 activity is considered for therapeutic intervention in human cardiomyopathies. Recent evidence from animal models implicated previously unrecognized, isoform-specific activities of PP1 in the healthy and diseased heart. Therefore, this study examined the expression of the distinct PP1 isoforms PP1α, β, and γ in human heart failure (HF) and atrial fibrillation (AF) and addressed the consequences of β-adrenoceptor blocker (beta-blocker) therapy for HF patients with reduced ejection fraction on PP1 isoform expression...
July 2017: Basic Research in Cardiology
https://www.readbyqxmd.com/read/28596994/recurrent-post-ablation-paroxysmal-atrial-fibrillation-shares-substrates-with-persistent-atrial-fibrillation-an-11-center-study
#9
Junaid A B Zaman, Tina Baykaner, Paul Clopton, Vijay Swarup, Robert C Kowal, James P Daubert, John D Day, John Hummel, Amir A Schricker, David E Krummen, Moussa Mansour, Gery F Tomassoni, Kevin R Wheelan, Mohan Vishwanathan, Shirley Park, Paul J Wang, Sanjiv M Narayan, John M Miller
INTRODUCTION: The role of atrial fibrillation (AF) substrates is unclear in patients with paroxysmal AF (PAF) that recurs after pulmonary vein isolation (PVI). We hypothesized that patients with recurrent post-ablation (redo) PAF despite PVI have electrical substrates marked by rotors and focal sources, and structural substrates that resemble persistent AF more than patients with (de novo) PAF at first ablation. METHODS: In 175 patients at 11 centers, we compared AF substrates in both atria using 64 pole-basket catheters and phase mapping, and indices of anatomical remodeling between patients with de novo or redo PAF and first ablation for persistent AF...
April 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/28594430/substrate-characteristics-and-ablation-outcome-of-left-atrial-tachycardia-in-rheumatic-mitral-valve-disease
#10
Hongwu Chen, Bing Yang, Weizhu Ju, Fengxiang Zhang, Gang Yang, Kai Gu, Mingfang Li, Hailei Liu, Zidun Wang, Kejiang Cao, Minglong Chen
BACKGROUND: Right atrial tachycardia (AT) is common arrhythmia post-surgical valve replacement in patients with rheumatic heart disease (RHD). However, the substrate and the mechanism of left AT in such patients and the ablation efficacy is less known. METHODS AND RESULTS: Twenty-seven RHD patients with AT were enrolled in this study, nine of them (33%) had Left AT. Five and four patients had left AT during the first and second procedure, respectively. A spontaneous scar in the left posterior wall was identified in all patients, and obvious anterior scar in three patients...
June 8, 2017: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/28593399/mri-use-for-atrial-tissue-characterization-in-arrhythmias-and-for-ep-procedure-guidance
#11
Ehud J Schmidt, Henry R Halperin
We review the utilization of magnetic resonance imaging methods for classifying atrial tissue properties that act as a substrate for common cardiac arrhythmias, such as atrial fibrillation. We then review state-of-the-art methods for mapping this substrate as a predicate for treatment, as well as methods used to ablate the electrical pathways that cause arrhythmia and restore patients to sinus rhythm.
June 7, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28582578/proteomics-of-the-epicardial-fat-secretome-and-its-role-in-post-operative-atrial-fibrillation
#12
Alessandro Viviano, Xiaoke Yin, Anna Zampetaki, Marika Fava, Mark Gallagher, Manuel Mayr, Marjan Jahangiri
Aims: Post-operative atrial fibrillation (POAF) is a predictor of morbidity and mortality after cardiac surgery. Latent predisposing factors may reside in the epicardial adipose tissue (EAT) due to its anatomical position and high protein production rate. In order to explore a possible mechanistic link, we characterized proteins secreted by the EAT preceding the onset of POAF. Methods and results: Epicardial adipose tissue samples were collected from 76 consecutive patients with no history of AF undergoing coronary artery bypass surgery, 50 samples for proteomic analysis and 26 for gene expression studies, further divided according to development of POAF...
June 5, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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...
July 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
#19
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
#20
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
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