Sinus Rhythm Atrial Fibrillation (AF) Catheter RF-Ablation Guided by “AF-Nests” Spectral Mapping

Abstract Aims Restoring sinus rhythm (SR) by ablation alone is an endpoint used in radiofrequency (RF) ablation for long-standing persistent atrial fibrillation (AF) but not with cryotherapy. The simultaneous use of two cryotherapy catheters can improve ablation efficiency; we compared this with RF ablation in chronic persistent AF aiming for termination to SR by ablation alone. Methods and results Consecutive patients undergoing their first ablation for persistent AF of >6 months duration were screened. A total of 100 participants were randomized 1:1 to multi-catheter cryotherapy or RF. For cryotherapy, a 28-mm Arctic Front Advance was used in tandem with focal cryoablation catheters. Open-irrigated, non-force sensing catheters were used in the RF group with a 3D mapping system. Pulmonary vein (PV) isolation and non-PV triggers were targeted. Participants were followed up at 6 and 12 months, then yearly. Acute PVI was achieved in all cases. More patients in the multi-catheter cryotherapy group were restored to SR by ablation alone, with a shorter procedure duration. Sinus rhythm continued to the last available follow-up in 16/49 patients (33%) in the multi-catheter at 3.0 ± 1.6 years post-ablation and in 12/50 patients (24%) in the RF group at 4.0 ± 1.2 years post-ablation. The yearly rate of arrhythmia recurrence was similar. Conclusion Multi-catheter cryotherapy can restore SR by ablation alone in more cases and more quickly than RF ablation. Long-term success is difficult to achieve by either methods and is similar with both.

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Evaluation of the Effect of Pulmonary Vein Isolation Treatment With Left Atrial Catheter Ablation Method on Atrial Conduction Times in Patients With Paroxysmal Atrial Fibrillation

10.21203/rs.3.rs-167274/v1 ◽

2021 ◽

Author(s):

Ibrahim Donmez ◽

Fatma Hizal Erdem ◽

Tolga Memioğlu ◽

Emrah Acar

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Left Atrial ◽

Tissue Doppler ◽

Conduction Delay ◽

Conduction Time ◽

Rf Ablation ◽

Interatrial Conduction

Abstract PurposeAtrial fibrillation (AF) causes structural, electrical, and cellular remodeling in the atrium. Evaluation of intra- and interatrial conduction time, which is measured by tissue doppler echocardiography, indicates structural and electrical remodeling in the atrium. In the meta-analysis of the studies investigating rhythm control treatment strategy in paroxysmal atrial fibrillation; radiofrequency (RF) ablation has been shown to be superior over antiarrhythmics in ensuring and protecting sinus rhythm. The aim of this study was to evaluate the effect of pulmonary vein isolation applied with RF ablation therapy on intra- and interatrial conduction time and to investigate the structural and electrically remodeling after treatment.MethodsFifty-two patients with symptomatic PAF despite at least one antiarrhythmic drug and without structural heart disease were included in the study. Two patients were excluded because of complications developed during and after the operation. Fifty patients (28 female; mean age: 51.68 ± 11.731; mean left atrial diameter: 36.79 ± 4.318) who underwent CARTO® 3D pulmonary vein isolation applied with the RF ablation system were followed-up. Intra- and the inter-atrial electromechanical delay was measured in all patients by tissue doppler echocardiography before and three months after RF ablation. ResultsAll intra- and interatrial conduction times were significantly decreased 3 months after RF ablation procedure (PA lateral p = 0.022; PA septum p = 0.002; PA tricuspid p = 0.019, interatrial conduction delay p= 0,012, intra-atrial conduction delay p = 0.029).ConclusionThe results of our study suggest that providing stable sinus rhythm by the elimination of the AF triggering mechanisms with RF ablation of pulmonary vein isolation may slow down, stop or even improve structural remodeling at substrate level secondary to AF even in patients who did not yet develop atrial fibrosis and permanent structural changes.

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P1021Low incidence of atrial tachycardia following ablation of low voltage areas in sinus rhythm for persistent atrial fibrillation

EP Europace ◽

10.1093/europace/euaa162.026 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Lepillier ◽

X Copie ◽

W Escande ◽

M Niro ◽

O Paziaud ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Atrial Tachycardia ◽

Low Voltage ◽

Pulmonary Veins ◽

Left Atrial Volume ◽

Persistent Atrial Fibrillation ◽

Anterior Wall ◽

Rf Ablation ◽

Efficient Strategy

Abstract . Background: Dedicated ablation strategies for persistent atrial fibrillation (AF) have shown a limited success rate with frequent atrial tachycardia (AT) occurrence. Recent studies suggest that atrial arrhythmogenic sites are related to tissular heterogeneities and increased fibrosis can be identified as reduced bipolar voltage areas. . Purpose: Targeting low voltage areas (LVA) in addition to PVI may represent an efficient strategy for the ablation of persistent AF, and may limit the risk of AT recurrence. . Methods: We prospectively included consecutive patients with symptomatic persistent AF. The ablation strategy consisted of the following steps: circumferential pulmonary vein isolation (CPVI), Sinus rhythm restoration by electrical cardioversion, voltage map performed in sinus rhythm. Complementary RFA was guided by low voltage areas (0.2-0.4 mV). Success was defined as freedom from AF/ atrial flutter or atrial arrhythmia at 12 months or more. . Results: 101 patients (mean age: 62.5 +/- 10.4 years, men 73%) were included with persistent AF or long standing AF (7%). Procedure time was: 154 ± 25 min and fluoroscopy time: 184 ± 90 sec. Time of RFA was 44.7 +/- 12 min. Mean LA volume was 182 +/- 38 mL. LVA were found in 50 patients (49.5%). The distribution of these areas was: 30 anterior wall 29.7%), 21 septum (20.7%), 19 roof (18.8%), 5 inferior (4.9%), 11 left appendage (10.8%), 6 posterior (5.9%), 3 mitral isthmus (3%). RF ablation was realized for all LVA and homogenisation was attempt. After a single procedure at a mean FU of 12 months, 72.3% of patients were free of symptomatic AF. 27 patients had recurrence of atrial AF: 7 permanent, 15 persistent and 5 paroxysmal AF. Predictive factors of recurrence of AF were: long standing persistent AF, large left atrial volume (> 205 mL), shorts AF cycle length (< 168 ms) and reduce LEVF (< 45%). Atrial tachycardia occurred in 5 patients (4,9%). Mechanisms of AT were: typical cavo-tricuspid flutter in one patient, peri-mitral flutter in 2 patients, and atrial focal tachycardia (close to pulmonary veins) in 2 patients. . Conclusion: These results suggest that PVI with complementary RF ablation guided on low voltage areas is an efficient strategy for symptomatic persistent AF, and reduce the recurrence of AT following this ablation strategy.

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Atrial Fibrillation (AF) catheter RF-ablation guided by “AF-nests” spectral mapping

Heart Rhythm ◽

10.1016/j.hrthm.2005.02.485 ◽

2005 ◽

Vol 2 (5) ◽

pp. S155 ◽

Cited By ~ 1

Author(s):

Jose C. Pachon M ◽

Enrique I. Pachon M ◽

Tasso J. Lobo ◽

Juan C. Pachon M ◽

M. Zelia C. Pachon ◽

...

Keyword(s):

Atrial Fibrillation ◽

Rf Ablation ◽

Spectral Mapping

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Cox-maze III Procedure for Atrial Fibrillation during Valve Surgery: A Single Institution Experience

10.21203/rs.2.24078/v2 ◽

2020 ◽

Author(s):

Changtian Wang ◽

Lei Zhang ◽

Tao Qin ◽

Zhi-long Xi ◽

Lei Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pacemaker Implantation ◽

Valve Surgery ◽

Valve Disease ◽

Heart Valve Disease ◽

Rf Ablation ◽

Efficacy And Safety ◽

Single Institution ◽

The Mean

Abstract Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF. Methods: A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. In this trial, we used a monopolar radiofrequency (RF) ablation in addition to cut and sew technique to treat AF.Results: 66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2±8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4±32.9 and 115.6±22.8 minutes respectively. The first 24hours drainage was 488.6±293.3ml. The postoperative hospital stay was 14.8±8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5%, 1.5%, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7%, 93.1%, 94.7%, 93.3% and 89.5% at 1, 3, 6, 12, and 24 months respectively.Conclusions: The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.

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