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Atrial Fibrillation Ablation (atrial + fibrillation_ablation)
Long-Term Outcome of Atrial Fibrillation Ablation: Impact and Predictors of Very Late RecurrenceJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2010
ANITA WOKHLU M.D.
Long-Term Outcome of AF Ablation. Introduction: Ablation eliminates atrial fibrillation (AF) in studies with 1 year follow-up, but very late recurrences may compromise long-term efficacy. In a large cohort, we sought to describe the determinants of delayed recurrence after AF ablation. Methods and Results: Seven hundred and seventy-four patients with AF (428 paroxysmal [PAF, 55%] and 346 persistent or longstanding persistent [PersAF, 45%]) underwent wide area circumferential ablation (WACA, 62%) or pulmonary vein isolation (38%). Over 3.0 ± 1.9 years, there were 135 recurrences in PAF patients and 142 in PersAF patients. AF elimination was achieved in 61% of patients with PersAF at 2 years after last ablation and in 71% of patients with PAF (P = 0.04). This finding was related to a higher initial rate of very late recurrence in PersAF. From 1.0 to 2.5 years, the recurrence increased by 20% (from 37% to 57%) in PersAF patients versus only 12% (from 27% to 39%) in PAF patients. Independent predictors of overall recurrence included diabetes (HR 1.9 [1.3,2.9], P = 0.002) and PersAF (HR 1.6 [1.2,2.0], P < 0.001). Independent predictors of very late recurrence included PersAF (HR 1.7 [1.1,2.7], P = 0.018) and WACA (HR 1.8 [1.1,2.7], P = 0.018), while diabetes came close to significance. In PAF patients, left atrial size >45 mm was identified as an AF-type specific predictor (HR 2.4 [1.3,4.7], P = 0.009), whereas in PersAF patients, no unique predictors were identified. Conclusion: Late recurrences reduced the long-term efficacy of AF ablation, particularly in patients with PersAF and underlying cardiovascular diseases. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1071-1078) [source]
Cryoballoon Approach for Atrial Fibrillation Ablation: Free from Complications?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2010
YOUNG-HOON KIM M.D.
No abstract is available for this article. [source]
Impact of Systematic Isolation of Superior Vena Cava in Addition to Pulmonary Vein Antrum Isolation on the Outcome of Paroxysmal, Persistent, and Permanent Atrial Fibrillation Ablation: Results from a Randomized StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010
ANDREA CORRADO M.D.
Impact of the Systematic Isolation of the Superior Vena Cava.,Background: Pulmonary veins (PVs) have been shown to represent the most frequent sites of ectopic beats initiating paroxysmal atrial fibrillation (AF). However, additional non-PV triggers, arising from different areas, have been reported as well. One of the most common non-PV sites described is the superior vena cava. Aims: The purpose of the study was to investigate the impact resulting from the systematic isolation of the superior vena cava (SVCI) in addition to pulmonary vein antrum isolation (PVAI) on the outcome of paroxysmal, persistent, and permanent AF ablation. Methods: A total of 320 consecutive patients who had been referred to our center in order to undergo a first attempt of AF ablation were randomized into 2 groups. Group I (160 patients) underwent PVAI only; Group II (160 patients) underwent PVAI and SVCI. Results: AF was paroxysmal in 134 (46%), persistent in 75 (23%), and permanent in 111 (31%) of said patients. SVCI was performed on 134 of the 160 patients (84%) in Group II. SVC isolation was not performed on the remaining 26 patients either because of phrenic nerve capture or the lack of SVC potentials. Comparison of the outcome data between the 2 groups, after a follow-up of 12 months, revealed a significant difference in total procedural success solely with patients manifesting paroxysmal atrial fibrillation (56/73 [77%] Group I vs. 55/61 [90%] Group II; P = 0.04; OR 2.78). Conclusions: In our study, the strategy of the empiric SVCI in addition to PVAI has improved the outcome of AF ablation solely in patients manifesting paroxysmal AF. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1,5, January 2010) [source]
Reduced Fluoroscopy During Atrial Fibrillation Ablation: Benefits of Robotic Guided NavigationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010
DANIEL STEVEN M.D.
Reduced Fluoroscopy in PVI Using RN.,Background: Recently, a nonmagnetic robotic navigation system (RN, Hansen-SenseiÔ) has been introduced for remote catheter manipulation. Objective: To investigate the influence of RN combined with intuitive 3-dimensional mapping on the fluoroscopy exposure to operator and patient during pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) in a prospective randomized trial. Methods: Sixty patients were randomly assigned to undergo PVI either using a RN guided (group 1; n = 30, 20 male, 62 ± 7.7 years) or conventional ablation approach (group 2; n = 30, 14 male, 61 ± 7.6 years). A 3-dimensional mapping system (NavXÔ) was used in both groups. Results: Electrical disconnection of the ipsilateral pulmonary veins (PVs) was achieved in all patients. Use of RN significantly lowered the overall fluoroscopy time (9 ± 3.4 vs 22 ± 6.5 minutes; P < 0.001) and reduced the operator's fluoroscopy exposure (7 ± 2.1 vs 22 ± 6.5 minutes; P < 0.001). The difference in fluoroscopy duration between both groups was most pronounced during the ablation part of the procedure (3 ± 2.4 vs 17 ± 6.3 minutes; P < 0.001). The overall procedure duration tended to be prolonged using RN without reaching statistical significance (156 ± 44.4 vs 134 ± 12 minutes, P = 0.099). No difference regarding outcome was found during a midterm follow-up of 6 months (AF freedom group 1 = 73% vs 77% in group 2 [P = 0.345]). Conclusion: The use of RN for PVI seems to be effective and significantly reduces overall fluoroscopy time and operator's fluoroscopy exposure without affecting mid-term outcome after 6-month follow-up. (J Cardiovasc Electrophysiol, Vol. 21, pp. 6,12, January 2010) [source]
Experience with the Hansen Robotic System for Atrial Fibrillation Ablation,Lessons Learned and Techniques Modified: Hansen in the Real WorldJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2009
OUSSAMA M. WAZNI M.D.
Introduction: The Hansen robotic system has only recently been used in the United States for catheter ablation procedures in humans. Atrial fibrillation (AF) ablation may be performed utilizing this system. We report our management of complications with early experience of this system. Methods and Results: All 71 patients in whom the system was utilized were included. In all patients, a 2-operator technique was to be employed; one operator manipulates the ablation catheter via the robot and the other manipulates the circular mapping and intracardiac echocardiogram catheters. There was no procedure-related mortality. All vascular complications occurred in the first 25 procedures performed. There were 6 intraoperative procedural-related complications. These included significant vascular complications (n = 4), one of whom required iliac vein stenting, and 2 cardiac tamponade (one related to a pop-phenomenon),successfully treated by pericardiocentesis. Early complications (n = 3) were 1 tamponade several hours post-procedure, 1 vascular complication, and 1 pericarditis. Late complications included 5 patients with severe pulmonary vein stenosis (all in first 27 patients) and 1 patient with gastroparesis. All complications were successfully managed without persistent morbidity and occurred earlier in our experience. This led to specific alterations in our vascular access and ablation techniques. These include the use of a longer 14 Fr sheath, through which the robotic sheath is more safely advanced. The choice of ablation catheter and titration of power, particularly when the catheter has a perpendicular orientation to the atrial wall, is also important. Conclusions: The suggested modifications may make the system easier to use with the potential to reduce complications. [source]
Complex Fractionated Electrogram Distribution and Temporal Stability in Patients Undergoing Atrial Fibrillation AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2008
JEAN-FRANÇOIS ROUX M.D.
Background: Targeting of complex fractionated electrograms (CFEs) has been described as an approach for catheter ablation of atrial fibrillation (AF); however, the distribution and temporal stability of CFE regions remain poorly defined. Methods: In patients with persistent AF referred for ablation, we performed two consecutive left atrial (LA) CFE maps prior to AF ablation. Bipolar electrograms were acquired during AF, and the mean AF cycle length and electrogram voltage were automatically determined at each point. Sites with mean CL ,120 ms were considered CFE positive. The two maps were then compared qualitatively and quantitatively. Results: A total of 15 patients (93% male, age 56.1 ± 9.0 years) undergoing AF ablation were studied. The two maps were separated in time by 31 ± 10 minutes. There was no significant difference in the number of CFE-positive regions (12.3 ± 5.2 vs 11.3 ± 4.7; P = 0.06) between the maps. While CFEs were widely distributed within the LA, the PV/left atrial junction (73%) and left atrial appendage (77%) were most often CFE positive. The presence of CFEs at each region was concordant 78% of the time. There was a significant correlation between the two maps (r = 0.35 ± 0.21, range 0.1,0.84; P < 0.001) with a percent difference of 17.5 ± 9.4%. Conclusions: During persistent AF, most CFE regions are found in the vicinity of the PVs. There is a significant correlation between two CFE maps constructed 31 minutes apart, with 78% concordance of CFE sites. [source]
Periprocedural Anticoagulation for Atrial Fibrillation AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2008
M. EYMAN MORTADA M.D.
Background: Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined. Objective: We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation. Methods: A total of 207 patients underwent ablation for AF. Transesophageal echocardiography (TEE) guided transseptal puncture and ruled out clot in the LA. After first puncture, the sheath was flushed with heparin (5,000 Units/mL). After second puncture, a bolus of 80 units/kg of heparin was given, followed by an infusion to maintain activated clotting time (ACT) around 300,350 seconds. Warfarin was stopped and aspirin was started (325 mg/day) 3 days preprocedure. Warfarin was restarted on the day of the procedure. Both medications were continued for 6 weeks postablation. Warfarin was continued for 6 months in patients with prior history of persistent or recurrent AF. Thirty-seven patients who showed smoke in the LA on TEE were given low molecular weight heparin postprocedure until international normalized ratio (INR) was therapeutic. Results: Thirty-two patients had persistent and 175 had paroxysmal AF; 87 were cardioverted during ablation. Two patients had transient ischemic attack (TIA) on the sixth and eighth days, respectively, following ablation, with complete recovery. Both had subtherapeutic INRs. Conclusion: In patients without demonstrable clot or smoke in the LA, starting aspirin 3 days prior and warfarin immediately post-radiofrequency ablation, without low molecular weight heparin, with meticulous anticoagulation during the procedure, appears to be a safe mode of anticoagulation. [source]
Atrial Anatomy and Imaging in Atrial Fibrillation AblationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2006
ANDREW D. McGAVIGAN M.B.Ch.B., M.D.
Catheter ablation of atrial fibrillation (AF) can be a technically challenging procedure, requiring detailed knowledge of the anatomy of the atria and thoracic veins to achieve successful cure of AF with a low complication rate. In this article, we review the anatomy relevant to AF ablation: the intraatrial septum, the pulmonary veins and left atrial antral region, the left atrial vestibule, the right atrium and related veins, and the esophagus. We focus on normal variations of anatomy and the role of the available imaging modalities in facilitating safe and effective ablation of this common and complex arrhythmia. [source]
With Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Ablation, One Size Does Not Fit AllJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2002
David E. Haines M.D.
Is Atrial Fibrillation Ablation a Futile Effort in Patients Who Have Markedly Enlarged Left Atria?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 5 2010
ANDREA M. RUSSO M.D.
First page of article [source]
Acute and Chronic Pulmonary Vein Reconnection after Atrial Fibrillation Ablation: A Prospective Characterization of Anatomical SitesPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2008
KIM RAJAPPAN M.D.
Background:Arrhythmia recurrence after atrial fibrillation (AF) ablation is often associated with pulmonary vein reconnection (PVR). We prospectively examined anatomical sites of both acute and chronic PVR. Methods:One hundred and fifty AF patients underwent PV wide encirclement and sites where immediate electrical isolation (EI) occurred were tagged using electroanatomic mapping/CT integration (CartomergeÔ, Biosense Webster, Diamond Bar, CA, USA). After 30 minutes PVs were checked and acute PVR sites marked at reisolation. Chronic PVR sites were marked at the time of repeat procedures. Results:On the left, immediate EI sites were predominantly on the intervenous ridge (IVR) and PV-left atrial appendage (PV-LAA) ridge. On the right they were at the roof, IVR, and floor of the PVs. Ninety-eight of one hundred and fifty patients had PVs checked after >30 minutes. Thirty-two of ninety-eight had acute PVR. This was mostly on the IVR and PV-LAA ridge on the left (88%), and on the roof and IVR on the right (78%). At repeat procedure, 38/39 patients had chronic PVR, predominantly on the IVR (61%) and PV-LAA ridge (21%) on the left, and on the roof, IVR, and floor of the right PVs (79%). There was minimal acute or chronic PVR posteriorly. Acutely PVR occurred close to the immediate EI site 60% of the time, but only 30% of the time chronically. Conclusion:Acute and chronic PVR sites have a preferential distribution. This may be determined by anatomical and technical factors. Knowledge of immediate EI sites may be beneficial acutely, but with chronic PVR a careful survey is required. These findings may help target ablation, improving safety and success. [source]
Protracted CRP Elevation after Atrial Fibrillation AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008
JAMES M. McCABE M.D.
Background: Atrial fibrillation (AF) has been linked to an inflammatory process detected through various biomarkers, including C-Reactive Protein (CRP). Early recurrence of AF within the first 3 months after curative AF ablation is not felt to reflect success or failure of the procedure. We hypothesized that this early recurrence is due to an inflammatory response to the ablation itself. We therefore sought to evaluate levels of CRP after AF ablation. Methods: We prospectively enrolled subjects undergoing AF ablation. A control group of patients undergoing ablation for supraventricular tachycardia (SVT) was also enrolled. Each patient had CRP drawn on the day of the procedure (prior to ablation) and during their first follow-up (median 49 days, interquartile range [IQR] 37,93) and second follow-up (median 147 days, IQR 141,257) clinic visits. Patient interviews were performed and medical histories reviewed for evidence of recurrent AF prior to the first follow-up. Results: CRP levels significantly increased from baseline to first follow-up in the AF ablation group (P = 0.0017). CRP did not significantly change after SVT ablation (P = 0.92). Seventeen (45%) of the AF subjects exhibited recurrence of AF prior to first follow-up. After adjusting for multiple potential confounders, AF ablation patients with recurrent AF prior to their first follow-up had a statistically significant greater odds of having an increase in CRP (OR 21, 95% CI 1.1,417, P = 0.045). Conclusions: AF ablation generates an inflammatory response that persists for several weeks. This inflammation may explain early recurrence of AF after curative ablation. [source]
Atypical Electrocardiographic Features of Cavotricuspid Isthmus-Dependent Atrial Flutter Occurring during Left Atrial Fibrillation AblationANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2010
Janice Y. Chyou M.D.
Background: Patients who have undergone percutaneous catheter ablation for atrial fibrillation (AF) may develop cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), which can occur either spontaneously during left atrial (LA) ablation for AF or by induction from sinus rhythm during the procedure. The electrocardiographic (ECG) characteristics of CTI-dependent AFL occurring during LA ablation have not been described. The purpose of this study was to describe the ECG features of CTI-dependent AFL occurring during percutaneous LA catheter ablation for AF. Methods and Results: Of 223 patients presenting for first AF ablation at our institution between May 2004 and February 2008, 20 patients (9%) developed CTI-dependent AFL during LA ablation for AF. CTI-dependent AFL developed spontaneously in 4 patients (20%) and was induced in 16 patients (80%). Among these 20 patients, 3 (15%) had typical ECG patterns and 17 (85%) had atypical ECG patterns. Flutter waves in the inferior leads were biphasic in 10 patients (50%), downward in 3 patients (15%), positive in 3 patients (15%), and not fitting the above classifications in 4 patients (20%). There was no statistically significant association between AFL pattern and LA size, left ventricular ejection fraction, total ablation time, duration of prior AF, or type of prior AF. Conclusion: A majority of patients with CTI-dependent AFL occurring during LA ablation have atypical ECG patterns. Biphasic flutter waves in the inferior leads are common ECG features, occurring in one-half of patients. Right atrial CTI-dependent AFL should be suspected even if the ECG appearance is atypical. Ann Noninvasive Electrocardiol 2010;15(3):200,208 [source]
Surgical Ablation of Atrial Fibrillation: The Columbia Presbyterian ExperienceJOURNAL OF CARDIAC SURGERY, Issue 5 2006
Veli K. Topkara M.D.
However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach. Methods: This study involves patients undergoing surgical atrial fibrillation ablation (SAFA) at a single institution from 1999 to 2005. Type of concomitant procedures, preoperative clinical characteristics, and chronicity of AF were evaluated in overall patient population. Parameters including surgical approach, lesion pattern, and energy source used were collected intraoperatively. Clinical outcomes examined were postoperative rhythm success, stroke, early mortality, and long-term survival. Results: Three hundred thirty-nine patients were identified. Three hundred twenty-eight (96.8%) patients had associated cardiac disease and underwent concomitant procedures; 75.8% of patients had persistent AF. Energy sources used were microwave (49.8%), radiofrequency (42.2%), and laser (8.0%). In 41.9% of cases a pulmonary vein encircling lesion was the only lesion created. Combination lesion sets were performed in the remaining cases. Rhythm success rates at 3, 6, 12, and 24 months were 74.1%, 68.2%, 74.5%, and 71.1%, respectively. Patients who underwent surgical removal of left atrial appendage by means of stapling or simple excision had no early postoperative stroke. Early mortality was 4.9%. Postoperative survival rates at 1, 3, and 5 years were 89.6%, 83.1%, and 78.0%. Conclusions: Surgical ablation of atrial fibrillation is a safe and effective procedure in restoring sinus rhythm with excellent postoperative survival rates. Further advancements in the field will eventually result in minimally invasive procedures with higher success rates. [source]
Intracardiac Ultrasound Detection of Thrombus on Transseptal Sheath: Incidence, Treatment, and PreventionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 6 2005
KATANEH MALEKI M.D.
Background: Transseptal (TS) catheterization is used for left atrial (LA) ablation procedures and a major risk is thromboembolism. The purpose of this study was to assess (1) the value of intracardiac ultrasound (ICUS) monitoring during LA ablation procedures, and (2) a new technique to reduce the risk of thrombus formation. Methods and Results: One hundred and eighty consecutive patients underwent TS catheterization under ICUS guidance with two sheaths for atrial fibrillation ablation and one for other LA procedures. Group I included the initial 90 patients in whom TS sheaths were flushed with a standard 2 U/cc concentration of heparin; group II consisted of the next 90 patients in whom sheaths were flushed with 1,000 U/cc concentration. All patients received bolus and infusion of heparin to maintain ACT between 250,300 seconds. ICUS was monitored throughout. In group I, echodense material at the tip of the sheath consistent with thrombus was observed on ICUS in 8 of 90 patients (9%) within 5,15 minutes of entering the LA. In group II, only 1 of 90 patient (1%) demonstrated thrombus (P < 0.001). There were no significant clinical differences in group I patients with and without thrombus. In all nine patients, the clot was removed with vigorous aspiration. No patients suffered a neurological event. Conclusion: Thrombus formation on TS sheath, detected by ICUS, may be more common than expected despite adequate anticoagulation. Using a higher concentration of heparin for the TS system before deployment reduced the risk. The thrombus was retrieved with aspiration without the need to abort the procedure. [source]
Significant Left Atrial Appendage Activation Delay Complicating Aggressive Septal Ablation during Catheter Ablation of Persistent Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2010
CHEN-XI JIANG M.D.
Background:,This study aims to describe significant left atrial appendage activation following ablation of persistent atrial fibrillation, and explore its relationship with aggressive septal ablation. Methods and Results:,Significant left atrial appendage activation delay was found in 23 out of 201 patients undergoing persistent atrial fibrillation ablation. Of them, 14 were found in their index procedures, of whom septal line ablation was performed in nine (odds ratio 15.2, 95% confidence interval 4.6,50.8, P < 0.001). Another nine were found during their redo procedures (including two with biatrial activation dissociation), all of whom received extensive left septal complex fractionated electrograms ablation in their prior procedures (P = 0.002). Electrocardiograph showed split P wave with the latter component merged into the QRS wave. Activation mapping demonstrated the earliest breakthrough of the left atrium changed to coronary sinus in 18 (85.7%) patients. After 1 month, the mitral A wave velocity was 18.2 ± 17.0 cm/s, and decreased significantly as compared with preablation (20.2 ± 19.1 vs 58.2 ± 17.9 cm/s, P = 0.037) in patients undergoing redo procedures. Fourteen (60.9%) remained arrhythmia-free during follow-up for 10.6 ± 6.2 months. Conclusion:,Septal line ablation and extensive septal complex fractionated electrograms ablation are correlated with significant left atrial activation delay or even biatrial activation dissociation, and should be performed with prudent consideration. (PACE 2010; 33:652,660) [source]