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European Heart Journal Sep 2014Catheter ablation of atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. There is considerable evidence available from several... (Review)
Review
Catheter ablation of atrial fibrillation (AF) is now an important therapeutic modality for patients with AF. There is considerable evidence available from several prospective randomized trials demonstrating that catheter ablation of AF is superior to antiarrhythmic drug therapy in controlling AF and that AF ablation improves quality of life substantially. This is especially true for patients with paroxysmal AF without other severe comorbidities. Catheter ablation is indicated for treatment of patients with symptomatic AF in whom one or more attempts at class 1 or 3 antiarrhythmic drug therapy have failed. Although current guidelines state that is appropriate to perform catheter ablation as a first-line therapy in selected patients, in our clinical practice this is rare. This reflects a number of important realities concerning the field of AF ablation. Catheter ablation of AF is a challenging and complex procedure, which is not free of the risk of potentially life-threatening complications, such as an atrio-oesophageal fistula, stroke, and cardiac tamponade. Although these major complications are rare and their rate is falling, they must be considered by both patients and physicians. The progress made and the new developments on the horizon in the field of AF catheter ablation are remarkable. When radiofrequency catheter ablation was first introduced in the late 1980s, few would have predicted that catheter ablation of AF would emerge as the most commonly performed ablation procedure in most major hospitals.
Topics: Atrial Fibrillation; Catheter Ablation; Equipment Design; Forecasting; Humans; Practice Guidelines as Topic; Treatment Outcome
PubMed: 25053659
DOI: 10.1093/eurheartj/ehu291 -
Journal of the American Heart... Jul 2023Background Despite the high burden of atrial fibrillation in cardiac amyloidosis (CA), the safety of catheter ablation therapy in CA is not well established. We sought...
Background Despite the high burden of atrial fibrillation in cardiac amyloidosis (CA), the safety of catheter ablation therapy in CA is not well established. We sought to examine short-term safety outcomes following atrial fibrillation ablation in patients with CA compared with matched patients with dilated cardiomyopathy (DCM). Methods and Results Using data from the National Inpatient Sample, we identified all hospitalizations for atrial fibrillation ablation from the fourth quarter of 2015 through 2019. Admissions for CA and DCM were matched in a 1:5 ratio using propensity scores based on the following sociodemographics: age, sex, race or ethnicity, payor, median income, comorbidities, and hospital characteristics. We compared in-hospital outcomes between both cardiomyopathies. We identified 1395 unweighted hospitalizations (representing 6750 national hospitalizations) for atrial fibrillation ablation, out of which 45 (3.2%) were admissions for CA. Compared with DCM, patients with CA were older (72.9 versus 65.1 years), had a higher burden of prior stroke (20.0% versus 8.6%) and chronic kidney disease (53.3% versus 33.6%), and were less likely to have a prior implantable cardioverter-defibrillator (4.4% versus 23.0%). We successfully matched 42 CAs to 210 DCM hospitalizations. After matching, there was no difference in total complications (14.3% versus 10.5%, =0.60), length-of-stay (3.1 versus 2.1 days, =0.23), home disposition (97.6% versus 96.2%, =0.65), and total charges ($137 250 versus $133 910, =0.24). Conclusions In this nationally representative study of atrial fibrillation catheter ablation in CA, short-term safety outcomes and complication rates were similar to a propensity score-matched cohort of DCM. Further studies exploring long-term safety outcomes are needed.
Topics: Humans; Atrial Fibrillation; Treatment Outcome; Cardiomyopathies; Cardiomyopathy, Dilated; Catheter Ablation; Amyloidosis
PubMed: 37449569
DOI: 10.1161/JAHA.122.029339 -
Open Heart May 2020Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The... (Review)
Review
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
Topics: Action Potentials; Atrial Fibrillation; Catheter Ablation; Electrophysiologic Techniques, Cardiac; Heart Rate; Humans; Pulmonary Veins; Recurrence; Risk Factors; Treatment Outcome
PubMed: 32393656
DOI: 10.1136/openhrt-2019-001207 -
European Heart Journal Mar 2019Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish...
AIMS
Catheter ablation is considered the treatment of choice for many tachyarrhythmias, but convincing 'real-world' data on efficacy and safety are lacking. Using Swedish national registry data, the ablation spectrum, procedural characteristics, as well as ablation efficacy and reported adverse events are reported.
METHODS AND RESULTS
Consecutive patients (≥18 years of age) undergoing catheter ablation in Sweden between 01 January 2006 and 31 December 2015 were included in the study. Follow-up (repeat ablation and vital status) was collected through 31 December 2016. A total of 26 642 patients (57 ± 15 years, 62% men), undergoing a total of 34 428 ablation procedures were included in the study. In total, 4034 accessory pathway/Wolff-Parkinson-White syndrome (12%), 7358 AV-nodal re-entrant tachycardia (21%), 1813 atrial tachycardia (5.2%), 5481 typical atrial flutter (16%), 11 916 atrial fibrillation (AF, 35%), 2415 AV-nodal (7.0%), 581 premature ventricular contraction (PVC, 1.7%), and 964 ventricular tachycardia (VT) ablations (2.8%) were performed. Median follow-up time was 4.7 years (interquartile range 2.7-7.0). The spectrum of treated arrhythmias changed over time, with a gradual increase in AF, VT, and PVC ablation (P < 0.001). Decreasing procedural times and utilization of fluoroscopy with time, were seen for all arrhythmia types. The rates of repeat ablation differed between ablation types, with the highest repeat ablation seen in AF (41% within 3 years). The rate of reported adverse events was low (n = 595, 1.7%). Death in the immediate period following ablation was rare (n = 116, 0.34%).
CONCLUSION
Catheter ablations have shifted towards more complex procedures over the past decade. Fluoroscopy time has markedly decreased and the efficacy of catheter ablation seems to improve for AF.
Topics: Adult; Aged; Arrhythmias, Cardiac; Catheter Ablation; Cohort Studies; Female; Humans; Male; Middle Aged; Reoperation; Sweden; Treatment Outcome
PubMed: 30452631
DOI: 10.1093/eurheartj/ehy709 -
JACC. Clinical Electrophysiology Oct 2022
Topics: Humans; Tachycardia, Ventricular; Catheter Ablation; Arrhythmias, Cardiac; Neuroimaging
PubMed: 36266000
DOI: 10.1016/j.jacep.2022.08.007 -
Journal of the American College of... Feb 2023Hybrid ablation is a novel therapy in the invasive management of patients with atrial fibrillation (AF) which combines minimally invasive surgical and percutaneous... (Review)
Review
Hybrid ablation is a novel therapy in the invasive management of patients with atrial fibrillation (AF) which combines minimally invasive surgical and percutaneous catheter-based techniques. The evidence is mainly based on observational studies from experienced centers, with success rates of approximately 70% and risks that are 2.0-fold to 3.6-fold higher than catheter-based ablation. Hybrid ablation is offered typically to patients with persistent or longstanding persistent AF which, by design, requires 2 procedures (epicardial surgical and endocardial catheter-based ablation). One randomized trial demonstrated that hybrid ablation was more effective than catheter-based ablation, but with higher complication rates. The incidence of the most serious complications has decreased in contemporary studies of hybrid ablation. At present, hybrid ablation should be performed by experienced centers on selected patients with persistent or longstanding persistent AF. Additional randomized trials are needed to define the risks, benefits, and cost effectiveness of hybrid ablation to identify its most appropriate application in clinical practice.
Topics: Humans; Atrial Fibrillation; Treatment Outcome; Minimally Invasive Surgical Procedures; Catheter Ablation
PubMed: 36754519
DOI: 10.1016/j.jacc.2022.11.039 -
Scientific Reports Mar 2022The complexity of the MRI protocol is one of the factors limiting the clinical adoption of MR temperature mapping for real-time monitoring of cardiac ablation procedures...
The complexity of the MRI protocol is one of the factors limiting the clinical adoption of MR temperature mapping for real-time monitoring of cardiac ablation procedures and a push-button solution would ease its use. Continuous gradient echo golden angle radial acquisition combined with intra-scan motion correction and undersampled temperature determination could be a robust and more user-friendly alternative than the ultrafast GRE-EPI sequence which suffers from sensitivity to magnetic field susceptibility artifacts and requires ECG-gating. The goal of this proof-of-concept work is to establish the temperature uncertainty as well as the spatial and temporal resolutions achievable in an Agar-gel phantom and in vivo using this method. GRE radial golden angle acquisitions were used to monitor RF ablations in a phantom and in vivo in two sheep hearts with different slice orientations. In each case, 2D rigid motion correction based on catheter micro-coil signal, tracking its motion, was performed and its impact on the temperature imaging was assessed. The temperature uncertainty was determined for three spatial resolutions (1 × 1 × 3 mm, 2 × 2 × 3 mm, and 3 × 3 × 3 mm) and three temporal resolutions (0.48, 0.72, and 0.97 s) with undersampling acceleration factors ranging from 2 to 17. The combination of radial golden angle GRE acquisition, simultaneous catheter tracking, intra-scan 2D motion correction, and undersampled thermometry enabled temperature monitoring in the myocardium in vivo during RF ablations with high temporal (< 1 s) and high spatial resolution. The temperature uncertainty ranged from 0.2 ± 0.1 to 1.8 ± 0.2 °C for the various temporal and spatial resolutions and, on average, remained superior to the uncertainty of an EPI acquisition while still allowing clinical monitoring of the RF ablation process. The proposed method is a robust and promising alternative to EPI acquisition to monitor in vivo RF cardiac ablations. Further studies remain required to improve the temperature uncertainty and establish its clinical applicability.
Topics: Animals; Catheter Ablation; Catheters; Heart; Magnetic Resonance Imaging; Phantoms, Imaging; Sheep; Thermometry
PubMed: 35256627
DOI: 10.1038/s41598-022-06927-9 -
Revista Portuguesa de Cardiologia :... Nov 2017Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation and is effective for preventing arrhythmias recurrences, especially in patients with... (Review)
Review
Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation and is effective for preventing arrhythmias recurrences, especially in patients with paroxysmal atrial fibrillation. During the last years, cryoballoon ablation has emerged as an unquestionable alternative approach to radiofrequency ablation. Many non-randomized and randomized trials have proven undoubtedly that cryoballoon ablation displays similar efficacy and overall safety profile, when compared to radiofrequency ablation for the treatment of patients with drug-refractory paroxysmal atrial fibrillation. These results have been obtained in all types of pulmonary veins anatomical subsets, which confirms that there is no need to select patients according to the latter. The value of cryoablation in the setting of short persistent atrial fibrillation still needs more evidence. Importantly, cryoballoon ablation seems to be less operator-dependent and more reproducible than radiofrequency for the isolation of pulmonary veins.
Topics: Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Treatment Outcome
PubMed: 29108897
DOI: 10.1016/j.repc.2017.09.008 -
European Journal of Cardio-thoracic... Sep 2022
Topics: Atrial Fibrillation; Catheter Ablation; Humans; Maze Procedure; Pulmonary Veins
PubMed: 36066427
DOI: 10.1093/ejcts/ezac446 -
Revista Portuguesa de Cardiologia :... Nov 2017Ablation of atrial fibrillation (AF) is one of most complex procedures in electrophysiology. Many technical improvements have been incorporated lately in order to... (Review)
Review
Ablation of atrial fibrillation (AF) is one of most complex procedures in electrophysiology. Many technical improvements have been incorporated lately in order to improve clinical results and reducing risks. Currently, cardiac tamponade, stroke, PV stenosis, phrenic palsy and atrial esophageal fistula are still recognized as the major risks of AF ablation, although their managements have been much better established. The aim of this article is to review recent data in how to avoid, to identify and to treat such complications.
Topics: Atrial Fibrillation; Cardiac Surgical Procedures; Catheter Ablation; Humans; Postoperative Complications
PubMed: 29126890
DOI: 10.1016/j.repc.2017.09.005