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Journal of the American College of... Mar 2022
Topics: Atrial Fibrillation; Heart Atria; Heart Valve Diseases; Humans; Ventricular Remodeling
PubMed: 35272800
DOI: 10.1016/j.jacc.2021.12.028 -
Arrhythmia & Electrophysiology Review Jul 2021Conduction system pacing (CSP) comprises His bundle pacing and left bundle branch area pacing and is rapidly gaining widespread adoption. Effective CSP not only depends... (Review)
Review
Conduction system pacing (CSP) comprises His bundle pacing and left bundle branch area pacing and is rapidly gaining widespread adoption. Effective CSP not only depends on successful system implantation but also on proper device programming. Current implantable impulse generators are not specifically designed for CSP. Either single chamber, dual chamber or CRT devices can be used for CSP depending on the underlying heart rhythm (sinus rhythm or permanent atrial arrhythmia) and the aim of pacing. Different programming issues may arise depending on the device configuration. This article aims to provide an update on practical considerations for His bundle and left bundle branch area pacing programming and follow-up.
PubMed: 34401180
DOI: 10.15420/aer.2021.16 -
Cardiac Electrophysiology Clinics Dec 2019Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic... (Review)
Review
Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic ablation. Electroanatomic mapping is the cornerstone of substrate-based strategies; ablation can be directed within a delineated scar region defined by low voltage. Bipolar voltage mapping has inherent limitations. Specific electrogram characteristics may improve the specificity of localizing the most arrhythmogenic regions within the substrate. Deceleration zones during sinus rhythm are niduses for reentry and can be identified by isochronal late activation mapping, which is a functional analysis of substrate propagation with local annotation to electrogram offset.
Topics: Body Surface Potential Mapping; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Humans; Tachycardia, Ventricular
PubMed: 31706472
DOI: 10.1016/j.ccep.2019.08.009 -
Circulation. Cardiovascular Imaging Jun 2023Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was... (Clinical Trial)
Clinical Trial
BACKGROUND
Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation).
METHODS
All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder.
RESULTS
Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m. Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; <0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; =0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; <0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 (<0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 (<0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence.
CONCLUSIONS
Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT02755688.
Topics: Aged; Female; Humans; Male; Middle Aged; Atrial Fibrillation; Atrial Function, Left; Catheter Ablation; Echocardiography; Heart Atria; Recurrence; Treatment Outcome
PubMed: 37288553
DOI: 10.1161/CIRCIMAGING.123.015352 -
Arrhythmia & Electrophysiology Review Jun 2020Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely... (Review)
Review
Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.
PubMed: 32637114
DOI: 10.15420/aer.2019.06 -
European Heart Journal Oct 2022A strategy of systematic, early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF). It is not known how this... (Clinical Trial)
Clinical Trial
AIMS
A strategy of systematic, early rhythm control (ERC) improves cardiovascular outcomes in patients with atrial fibrillation (AF). It is not known how this outcome-reducing effect is mediated.
METHODS AND RESULTS
Using the Early treatment of Atrial Fibrillation for Stroke prevention Trial (EAST-AFNET 4) data set, potential mediators of the effect of ERC were identified in the total study population at 12-month follow up and further interrogated by use of a four-way decomposition of the treatment effect in an exponential model predicting future primary outcome events. Fourteen potential mediators of ERC were identified at the 12-month visit. Of these, sinus rhythm at 12 months explained 81% of the treatment effect of ERC compared with usual care during the remainder of follow up (4.1 years). In patients not in sinus rhythm at 12 months, ERC did not reduce future cardiovascular outcomes (hazard ratio 0.94, 95% confidence interval 0.65-1.67). Inclusion of AF recurrence in the model only explained 31% of the treatment effect, and inclusion of systolic blood pressure at 12 months only 10%. There was no difference in outcomes in patients who underwent AF ablation compared with those who did not undergo AF ablation.
CONCLUSION
The effectiveness of early rhythm control is mediated by the presence of sinus rhythm at 12 months in the EAST-AFNET 4 trial. Clinicians implementing ERC should aim for rapid and sustained restoration of sinus rhythm in patients with recently diagnosed AF and cardiovascular comorbidities.
Topics: Humans; Atrial Fibrillation; Catheter Ablation; Secondary Prevention; Stroke; Treatment Outcome
PubMed: 36036648
DOI: 10.1093/eurheartj/ehac471 -
The Medical Clinics of North America Sep 2019Atrial fibrillation (AF) is the most common arrhythmia and its management may be organized into risk stratification and/or treatment of heart failure, stroke prevention,... (Review)
Review
Atrial fibrillation (AF) is the most common arrhythmia and its management may be organized into risk stratification and/or treatment of heart failure, stroke prevention, and symptom control. At the core of symptom control, treatment is tailored to either allow AF continue with controlled heart rates, so-called rate control, versus restoring and maintaining sinus rhythm or rhythm control. Rate control strategies mainly use rate-modulating medications, whereas rhythm control treatment includes therapy aimed at restoring sinus rhythm, including pharmacologic and direct current cardioversion, as well as maintenance of sinus rhythm, including antiarrhythmic medications and ablation therapy.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Clinical Trials as Topic; Disease Management; Humans; Radiofrequency Ablation; Risk Assessment
PubMed: 31378329
DOI: 10.1016/j.mcna.2019.04.004 -
Current Cardiology Reports Oct 2022Heart failure (HF) and atrial fibrillation (AF) frequently co-exist, with the prevalence of AF increasing in patients with more advanced HF symptoms. When present, AF... (Review)
Review
PURPOSE OF REVIEW
Heart failure (HF) and atrial fibrillation (AF) frequently co-exist, with the prevalence of AF increasing in patients with more advanced HF symptoms. When present, AF increases morbidity and mortality in patients with HF. The purpose of this review is to examine emerging evidence addressing the value of restoration and maintenance of sinus rhythm in patients with HF.
RECENT FINDINGS
Earlier trials comparing a rhythm control strategy with antiarrhythmic drugs have failed to demonstrate benefit in patients with HF and reduced ejection fraction. More recent trials, including the recently published RAFT-AF, utilizing catheter ablation for rhythm control, have shown greater promise, possibly due to reduced medication-related side effects and higher efficacy in maintaining sinus rhythm. A strategy of sinus rhythm maintenance with catheter ablation appears to improve mortality, reduce HF events and improve quality of life in patients with AF and HF.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Catheter Ablation; Heart Failure; Humans; Quality of Life; Treatment Outcome
PubMed: 35870075
DOI: 10.1007/s11886-022-01743-z -
International Heart Journal Nov 2020The risk of thromboembolic events is significantly increased among patients with heart failure, even in those without atrial fibrillation. However, it is still unclear... (Review)
Review
The risk of thromboembolic events is significantly increased among patients with heart failure, even in those without atrial fibrillation. However, it is still unclear whether patients with heart failure and sinus rhythm can benefit from prophylactic anticoagulant therapy.This was a retrospective review of the pathophysiological mechanisms, epidemiological studies, and clinical trials on anticoagulation in patients with heart failure and sinus rhythm.Some subgroup analyses of clinical trials found that prophylactic anticoagulant therapy could reduce the incidence of stroke in patients with heart failure and sinus rhythm, and the risk of bleeding was significantly increased. Regarding the incidence of primary endpoint outcomes, all results from clinical trials were negative.Prophylactic anticoagulation did not improve the clinical outcome in patients with heart failure and sinus rhythm.
Topics: Anticoagulants; Factor Xa Inhibitors; Heart Failure; Hemorrhage; Humans; Stroke; Thromboembolism
PubMed: 33191346
DOI: 10.1536/ihj.20-248