-
Clinical Medicine (London, England) Sep 2023Atrial fibrillation (AF) is the most common cardiac arrhythmia and imposes a significant healthcare burden. The landscape of AF has changed considerably over the past... (Review)
Review
Atrial fibrillation (AF) is the most common cardiac arrhythmia and imposes a significant healthcare burden. The landscape of AF has changed considerably over the past few years, with the advent of novel diagnostic approaches, advances in therapies and changing recommendations on best practice from the latest major trials. In this article, we review our evolving understanding of the natural history of AF and explore the contemporary landscape of its diagnosis and management.
Topics: Humans; Atrial Fibrillation; Catheter Ablation
PubMed: 37775166
DOI: 10.7861/clinmed.2023-23.5.Cardio2 -
Journal of the American College of... Sep 2023Atrial fibrillation is the most common atrial arrhythmia and accounts for a significant burden of cardiovascular disease globally. With advances in implanted and... (Review)
Review
Atrial fibrillation is the most common atrial arrhythmia and accounts for a significant burden of cardiovascular disease globally. With advances in implanted and wearable cardiac monitoring technology, it is now possible to readily and accurately quantify an individual's time spent in atrial fibrillation. This review summarizes the relationship between atrial fibrillation burden and adverse cardiovascular and cerebrovascular outcomes and discusses the role of catheter ablation to mitigate the morbidity and mortality associated with greater burden of atrial fibrillation.
Topics: Humans; Atrial Fibrillation; Catheter Ablation; Wearable Electronic Devices
PubMed: 37648353
DOI: 10.1016/j.jacc.2023.06.029 -
JAMA Sep 2023The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
The impact of atrial fibrillation (AF) catheter ablation on mental health outcomes is not well understood.
OBJECTIVE
To determine whether AF catheter ablation is associated with greater improvements in markers of psychological distress compared with medical therapy alone.
DESIGN, SETTING, AND PARTICIPANTS
The Randomized Evaluation of the Impact of Catheter Ablation on Psychological Distress in Atrial Fibrillation (REMEDIAL) study was a randomized trial of symptomatic participants conducted in 2 AF centers in Australia between June 2018 and March 2021.
INTERVENTIONS
Participants were randomized to receive AF catheter ablation (n = 52) or medical therapy (n = 48).
MAIN OUTCOMES AND MEASURES
The primary outcome was Hospital Anxiety and Depression Scale (HADS) score at 12 months. Secondary outcomes included follow-up assessments of prevalence of severe psychological distress (HADS score >15), anxiety HADS score, depression HADS score, and Beck Depression Inventory-II (BDI-II) score. Arrhythmia recurrence and AF burden data were also analyzed.
RESULTS
A total of 100 participants were randomized (mean age, 59 [12] years; 31 [32%] women; 54% with paroxysmal AF). Successful pulmonary vein isolation was achieved in all participants in the ablation group. The combined HADS score was lower in the ablation group vs the medical group at 6 months (8.2 [5.4] vs 11.9 [7.2]; P = .006) and at 12 months (7.6 [5.3] vs 11.8 [8.6]; between-group difference, -4.17 [95% CI, -7.04 to -1.31]; P = .005). Similarly, the prevalence of severe psychological distress was lower in the ablation group vs the medical therapy group at 6 months (14.2% vs 34%; P = .02) and at 12 months (10.2% vs 31.9%; P = .01), as was the anxiety HADS score at 6 months (4.7 [3.2] vs 6.4 [3.9]; P = .02) and 12 months (4.5 [3.3] vs 6.6 [4.8]; P = .02); the depression HADS score at 3 months (3.7 [2.6] vs 5.2 [4.0]; P = .047), 6 months (3.4 [2.7] vs 5.5 [3.9]; P = .004), and 12 months (3.1 [2.6] vs 5.2 [3.9]; P = .004); and the BDI-II score at 6 months (7.2 [6.1] vs 11.5 [9.0]; P = .01) and 12 months (6.6 [7.2] vs 10.9 [8.2]; P = .01). The median (IQR) AF burden in the ablation group was lower than in the medical therapy group (0% [0%-3.22%] vs 15.5% [1.0%-45.9%]; P < .001).
CONCLUSION AND RELEVANCE
In this trial of participants with symptomatic AF, improvement in psychological symptoms of anxiety and depression was observed with catheter ablation, but not medical therapy.
TRIAL REGISTRATION
ANZCTR Identifier: ACTRN12618000062224.
Topics: Female; Humans; Male; Middle Aged; Anxiety; Anxiety Disorders; Atrial Fibrillation; Catheter Ablation; Psychological Distress; Anti-Arrhythmia Agents; Aged; Depression
PubMed: 37698564
DOI: 10.1001/jama.2023.14685 -
JACC. Clinical Electrophysiology Aug 2023Because of its safety, "single-shot" pulsed field ablation (PFA) catheters have been developed for pulmonary vein isolation (PVI). However, most atrial fibrillation (AF)...
BACKGROUND
Because of its safety, "single-shot" pulsed field ablation (PFA) catheters have been developed for pulmonary vein isolation (PVI). However, most atrial fibrillation (AF) ablation procedures are performed with focal catheters to permit flexibility of lesion sets beyond PVI.
OBJECTIVES
This study sought to determine the safety and efficacy of a focal ablation catheter able to toggle between radiofrequency ablation (RFA) or PFA to treat paroxysmal or persistent AF.
METHODS
In a first-in-human study, a focal 9-mm lattice tip catheter was used for PFA posteriorly and either irrigated RFA (RF/PF) or PFA (PF/PF) anteriorly. Protocol-driven remapping was at ∼3 months postablation. The remapping data prompted PFA waveform evolution: PULSE1 (n = 76), PULSE2 (n = 47), and the optimized PULSE3 (n = 55).
RESULTS
The study included 178 patients (paroxysmal/persistent AF = 70/108). Linear lesions, either PFA or RFA, included 78 mitral, 121 cavotricuspid isthmus, and 130 left atrial roof lines. All lesion sets (100%) were acutely successful. Invasive remapping of 122 patients revealed improvement of PVI durability with waveform evolution: PULSE1: 51%; PULSE2: 87%; and PULSE3: 97%. After 348 ± 652 days of follow-up, the 1-year Kaplan-Meier estimates for freedom from atrial arrhythmias were 78.3% ± 5.0% and 77.9% ± 4.1% for paroxysmal and persistent AF, respectively, and 84.8% ± 4.9% for the subset of persistent AF patients receiving the PULSE3 waveform. There was 1 primary adverse event-inflammatory pericardial effusion not requiring intervention.
CONCLUSIONS
AF ablation with a focal RF/PF catheter allows efficient procedures, chronic lesion durability, and good freedom from atrial arrhythmias-for both paroxysmal and persistent AF. (Safety and Performance Assessment of the Sphere-9 Catheter and the Affera Mapping and RF/PF Ablation System to Treat Atrial Fibrillation; NCT04141007 and NCT04194307).
Topics: Humans; Atrial Fibrillation; Catheters; Catheter Ablation; Pulmonary Veins; Ablation Techniques
PubMed: 37227340
DOI: 10.1016/j.jacep.2023.04.002 -
European Heart Journal Sep 2023This study aimed to histologically validate atrial structural remodelling associated with atrial fibrillation.
BACKGROUND AND AIMS
This study aimed to histologically validate atrial structural remodelling associated with atrial fibrillation.
METHODS AND RESULTS
Patients undergoing atrial fibrillation ablation and endomyocardial atrial biopsy were included (n = 230; 67 ± 12 years old; 69 women). Electroanatomic mapping was performed during right atrial pacing. Voltage at the biopsy site (Vbiopsy), global left atrial voltage (VGLA), and the proportion of points with fractionated electrograms defined as ≥5 deflections in each electrogram (%Fractionated EGM) were evaluated. SCZtotal was calculated as the total width of slow conduction zones, defined as regions with a conduction velocity of <30 cm/s. Histological factors potentially associated with electroanatomic characteristics were evaluated using multiple linear regression analyses. Ultrastructural features and immune cell infiltration were evaluated by electron microscopy and immunohistochemical staining in 33 and 60 patients, respectively. Fibrosis, intercellular space, myofibrillar loss, and myocardial nuclear density were significantly associated with Vbiopsy (P = .014, P < .001, P < .001, and P = .002, respectively) and VGLA (P = .010, P < .001, P = .001, and P < .001, respectively). The intercellular space was associated with the %Fractionated EGM (P = .001). Fibrosis, intercellular space, and myofibrillar loss were associated with SCZtotal (P = .028, P < .001, and P = .015, respectively). Electron microscopy confirmed plasma components and immature collagen fibrils in the increased intercellular space and myofilament lysis in cardiomyocytes, depending on myofibrillar loss. Among the histological factors, the severity of myofibrillar loss was associated with an increase in macrophage infiltration.
CONCLUSION
Histological correlates of atrial structural remodelling were fibrosis, increased intercellular space, myofibrillar loss, and decreased nuclear density. Each histological component was defined using electron microscopy and immunohistochemistry studies.
Topics: Humans; Female; Middle Aged; Aged; Atrial Fibrillation; Electrophysiologic Techniques, Cardiac; Heart Atria; Heart Rate; Fibrosis; Atrial Remodeling; Catheter Ablation
PubMed: 37350738
DOI: 10.1093/eurheartj/ehad396 -
Anatolian Journal of Cardiology Dec 2023
Topics: Humans; Atrial Fibrillation; COVID-19; Treatment Outcome; Catheter Ablation
PubMed: 38031671
DOI: 10.14744/AnatolJCardiol.2023.12 -
Annals of Cardiothoracic Surgery Jan 2024In this state-of-the art review on hybrid atrial fibrillation (AF) ablation, we briefly focus on the pathophysiology of AF, the rationale for the hybrid approach, its... (Review)
Review
In this state-of-the art review on hybrid atrial fibrillation (AF) ablation, we briefly focus on the pathophysiology of AF, the rationale for the hybrid approach, its technical aspects and the efficacy and safety outcomes after hybrid AF ablation, both from meta-analyses and randomized control trial data. Also, we performed a systematic search to provide a provisional overview of real-world hybrid AF ablation efficacy and safety outcomes. Furthermore, we give an insight into the 'Maastricht approach', an approach that allows us to tailor the ablation procedure to the individual patient. Finally, we reflect on future perspectives with the objective to continue improving our thoracoscopic hybrid AF ablation approach. Based on the review of the available literature, we believe it is fair to state that thoracoscopic hybrid AF ablation is a valid alternative to catheter ablation for the treatment of patients with more persistent forms of AF.
PubMed: 38380145
DOI: 10.21037/acs-2023-afm-0129 -
Ugeskrift For Laeger Jan 2024Paediatric patients with ventricular pre-excitation/asymptomatic WPW syndrome have a higher risk of atrial fibrillation degenerating into ventricular fibrillation and... (Review)
Review
Paediatric patients with ventricular pre-excitation/asymptomatic WPW syndrome have a higher risk of atrial fibrillation degenerating into ventricular fibrillation and sudden cardiac death (SCD). In more than half of these patients this can be the first symptom presenting. Hence, it is important to conduct a risk stratification for SCD in asymptomatic patients with pre-excitation/delta wave in the ECGs. In this review, invasive risk stratification by electrophysiologic testing and ablation is recommended when possible. Catheter ablation is reported to have a high rate of success and low risk of complications.
Topics: Child; Humans; Atrial Fibrillation; Catheter Ablation; Death, Sudden, Cardiac; Electrocardiography; Risk; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome
PubMed: 38305265
DOI: 10.61409/V08230550