Prominent atrial fibrosis and its correlation with dilated atrium atrial tachyarrhythmia and long after classic Fontan surgery

Introduction: Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. Methods: Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). Results: Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. Conclusion: Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.

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Impact of the Fontan Operation on Organ Systems

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x19666190211165124 ◽

2019 ◽

Vol 19 (3) ◽

pp. 205-214

Author(s):

Miriam Michel ◽

Manuela Zlamy ◽

Andreas Entenmann ◽

Karin Pichler ◽

Sabine Scholl-Bürgi ◽

...

Keyword(s):

Systematic Study ◽

Fontan Operation ◽

Gastrointestinal System ◽

Adjunct Treatment ◽

Organ Systems ◽

Fontan Surgery ◽

Fontan Patients

: In patients having undergone the Fontan operation, besides the well discussed changes in the cardiac, pulmonary and gastrointestinal system, alterations of further organ systems including the hematologic, immunologic, endocrinological and metabolic are reported. As a medical adjunct to Fontan surgery, the systematic study of the central role of the liver as a metabolizing and synthesizing organ should allow for a better understanding of the pathomechanism underlying the typical problems in Fontan patients, and in this context, the profiling of endocrinological and metabolic patterns might offer a tool for the optimization of Fontan follow-up, targeted monitoring and specific adjunct treatment.

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Airway emergency during general anesthesia in a child with plastic bronchitis following Fontan surgery: a case report

JA Clinical Reports ◽

10.1186/s40981-020-0311-5 ◽

2020 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Hirofumi Nakamoto ◽

Satoru Kayama ◽

Mae Harada ◽

Takahiro Honjo ◽

Kinuko Kubota ◽

...

Keyword(s):

Case Report ◽

General Anesthesia ◽

Plastic Bronchitis ◽

Airway Emergency ◽

Fontan Surgery

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Outcome of contact force-guided radiofrequency catheter ablation or second generation cryoballoon ablation for paroxysmal atrial fibrillation: propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0571 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Ukita ◽

A Kawamura ◽

H Nakamura ◽

K Yasumoto ◽

M Tsuda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Propensity Score ◽

Contact Force ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Second Generation ◽

Late Recurrence ◽

Cryoballoon Ablation ◽

Atrial Tachyarrhythmia

Abstract Background Little has been reported on the outcome of contact force (CF)-guided radiofrequency catheter ablation (RFCA) and second generation cryoballoon ablation (CBA). Purpose The purpose of this study was to compare the outcome of CF-guided RFCA and second generation CBA for paroxysmal atrial fibrillation (PAF). Methods We enrolled the consecutive 364 patients with PAF who underwent initial ablation between September 2014 and July 2018 in our hospital. We compared the late recurrence of atrial tachyarrhythmia more than three months after ablation between RFCA group and CBA group. All RFCA procedures were performed using CF-sensing catheter and all CBA procedures were performed using second generation CB. Results There were significant differences in background characteristics: chronic kidney disease, serum brain natriuretic peptide level, and left ventricular ejection fraction. After propensity score matched analysis (Table), atrial tachyarrhythmia free survival was significantly higher in CBA group than in RFCA group (Figure). Conclusions Second generation CBA showed a significantly lower late recurrence rate compared to CF-guided RFCA. Kaplan-Meier Curve Funding Acknowledgement Type of funding source: None

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Clinical outcome of non-use of touch-up focal ablation catheters strategy during cryoballoon atrial fibrillation ablation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0565 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Matsunaga ◽

Y Egami ◽

M Yano ◽

M Yamato ◽

R Shutta ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Pulmonary Veins ◽

Conventional Group ◽

Atrial Tachyarrhythmia ◽

Free Survival ◽

Af Ablation ◽

Frequent Use ◽

Class 1 ◽

Focal Ablation

Abstract Background It has been reported that frequent use of touch-up focal ablation catheters was related to worse outcomes after cryoballoon (CB) atrial fibrillation (AF) ablation. It is unknown whether non-use of touch-up focal ablation catheters strategy affects the outcome of AF ablation. Therefore, this study aimed to assess whether non-use of touch-up focal ablation catheters strategy improve clinical outcome after AF ablation using CB. Methods A total of 151 consecutive patients who received CB ablation from February 2017 to August 2019 were enrolled. Non-use of a touch-up focal ablation catheters strategy was started from February 2018. Patients were divided into 2 groups according to the type of strategy. In the non-touch-up group, pulmonary veins were isolated without touch-up focal ablation catheters as much as possible and in conventional group, touch-up focal ablation catheters were used as required. The 1-year atrial tachyarrhythmia free survival without class 1 or 3 antiarrhythmic drugs after a 90-day blanking period was assessed between the 2 groups. Results The conventional group consisted of 76 patients and the non-touch-up group consisted of 75 patients. Baseline characteristics were comparable between 2 groups. Touch-up focal ablation catheters were used more in the conventional group (11 patients, 14%) than non-touch-up group (0 patients, 0%) (p<0.001). Pulmonary isolation was achieved in all patients of both groups. Atrial tachyarrhythmia recurrence occurred more frequently in the non-touch-up group (15/75 patients, 20%) than conventional group (7/76 patients, 9%) (p=0.045). Conclusion Non-use of a touch-up focal ablation catheters strategy may be related to worse outcome after CB AF ablation. Funding Acknowledgement Type of funding source: None

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