Role of the CHADS2 Score in the Evaluation of Thromboembolic Risk in Patients With Atrial Fibrillation Undergoing Transesophageal Echocardiography Before Pulmonary Vein Isolation

2010 ◽  
Vol 2010 ◽  
pp. 547-549
Author(s):  
M.R. Gold
Keyword(s):  
Atrial Fibrillation ◽  
Transesophageal Echocardiography ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Chads2 Score ◽  
Thromboembolic Risk

scholarly journals The Role of Adenosine in Pulmonary Vein Isolation: A Critical Review

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Paolo D. Dallaglio ◽  
Timothy R. Betts ◽  
Matthew Ginks ◽  
Yaver Bashir ◽  
Ignasi Anguera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Waiting Time ◽  
Critical Review ◽  
Recurrence Rates ◽  
The Impact ◽  
Af Recurrence

The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI), which can be achieved in more than 95% of patients at the end of the procedure. However, AF recurrence rates remain high and are related to recovery of PV conduction. Adenosine testing is used to unmask dormant pulmonary vein conduction (DC). The aim of this study is to review the available literature addressing the role of adenosine testing and determine the impact of ablation at sites of PV reconnection on freedom from AF. Adenosine infusion, by restoring the excitability threshold, unmasks reversible injury that could lead to recovery of PV conduction. The studies included in this review suggest that adenosine is useful to unmask nontransmural lesions at risk of reconnection and that further ablation at sites of DC is associated with improvement in freedom from AF. Nevertheless it has been demonstrated that adenosine is not able to predict all veins at risk of later reconnection, which means that veins without DC are not necessarily at low risk. The role of the waiting period in the setting of adenosine testing has also been analyzed, suggesting that in the acute phase adenosine use should be accompanied by enough waiting time.

The important role of complete pulmonary vein isolation in catheter ablation of permanent atrial fibrillation

Heart Rhythm ◽  
2005 ◽  
Vol 2 (5) ◽  
pp. S195 ◽  
Author(s):  
Feifan Ouyang ◽  
Sabine Ernst ◽  
Matthias Antz ◽  
Dietmar Bänsch ◽  
Julian Chun ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Permanent Atrial Fibrillation

The Role of Adenosine Following Pulmonary Vein Isolation in Patients Undergoing Catheter Ablation for Atrial Fibrillation: A Systematic Review

2013 ◽  
Vol 24 (7) ◽  
pp. 742-751 ◽  
Author(s):  
ALEX J.A. MCLELLAN ◽  
SAURABH KUMAR ◽  
CATHERINE SMITH ◽  
JOSEPH B. MORTON ◽  
JONATHAN M. KALMAN ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation

scholarly journals The role of ablation index-guided pulmonary vein isolation in high-sensitivity TrThe role of ablation index-guided pulmonary vein isolation in high-sensitivoponin I and atrial fibrillation recurrence

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D De Campos ◽  
L Puga ◽  
P Sousa ◽  
N Antonio ◽  
L Elvas
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
High Sensitivity ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ablation Index

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Ablation Index (AI) software has been associated with better freedom from atrial arrhythmias after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF). There is conflicting data regarding the relationship between high sensitivity cardiac Troponin I (Hs-cTnI) and arrhythmia recurrence. The objective was to evaluate the impact of AI on Hs-cTnI level and on ablation effectiveness quotient (AEQ) and to assess if these markers are predictors of arrhythmia recurrence.  Methods Prospective observational study of consecutive patients referred for PVI for paroxysmal AF ablation from October 2017 to June 2018 according to a pre-specified AI protocol. Procedural endpoints and 2-year follow-up outcomes were assessed and compared to a retrospective cohort of conventional PVI contact-force-guided group .  Results A total of 56 patients were included: 29 patients the AI group and 27 patients in the control group. The mean age was 60.5 ± 10.3 years, 48% males. Left ventricular ejection fraction (60 ± 6 % AI vs 61 ± 5 % control, P = 0.07) and left atrium diameter (43 ± 7 mm AI vs 44 ± 6 mm control, P = 0.58) were comparable between groups. First-pass isolation was shown to be higher in the AI group (79% AI vs 44%, p= 0.01). Mean number of radiofrequency applications was lower in the AI group (93 ± 24 vs 111 ± 30, P = 0.02). Average contact-force was similar between groups (17.6 ± 4.1 g vs 22.6 ± 10.7 g, P =0.166). Patients that performed PVI guided by the AI had lower Hs-cTnI (1815 ± 1146 ng/L vs 3274 ± 1696 ng/L, p < 0.001) and lower AEQ (1.01 ± 0.7 ng/L/s vs 1.51 ± 0.7 ng/L/s, P = 0.011) compared to patients in the control group. During a mean follow-up of 26 ± 11 months, AF recurrence was documented in 10.3% of patients in the AI group and 22.2% in the control group (P = 0.223). Neither Hs-cTnI nor AEQ levels were predictors of arrhythmia recurrence.  Conclusions These data suggest that AI-guided catheter ablation is associated with reduced levels of of Hs-cTnI and AEQ. Neither Hs-cTnI and AEQ should be used to predict arrhythmia recurrence. Abstract Figure.

scholarly journals Prospective Randomized Clinical Trial of Wide Area Circumferential Pulmonary Vein Ablation versus Segmental Pulmonary Vein Ablation for Pulmonary Vein Isolation as a Treatment for Short-Duration Paroxysmal Atrial Fibrillation

2021 ◽  
Author(s):  
Sapan Bhuta ◽  
Gustaf Sverin ◽  
Hiro Kawata ◽  
Malek Bashti ◽  
Jessica Hunter ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Wide Area ◽  
Pulmonary Vein Ablation ◽  
Total Procedure Time

Background: Previous studies suggest that wide area circumferential pulmonary vein ablation (WACA) is more effective than segmental pulmonary vein ablation (SPVA) for pulmonary vein isolation (PVI) for treatment of atrial fibrillation. Whether this is true in patients (pts) with very short duration paroxysmal atrial fibrillation (PAF) is unknown. Objective: To compare WACA to SPVA in pts with PAF lasting <48 hours. Methods: One hundred pts with PAF <48 hours were randomized to either WACA vs SPVA (45 and 53 pts respectively, with 2 withdrawals), and followed up for 24 months with 14-day ECGs every 6 months. Results: Among 97 pts at an average of 22.1±4.8 months followup, 26 (57.8%) remained free of any atrial arrhythmias after WACA versus 29 (55.86%) after SPVA (p=0.64). Sixteen pts (35.6%) had recurrent PAF after WACA versus 20 pts (38.5%) after SPVA (p=0.79). Seven pts (15.6%) had atrial flutter after WACA versus 5 pts (9.64%) after SPVA (p=0.376) and 1 pt (2.2%) had atrial tachycardia after WACA vs 1 pt (1.9%) after SPVA (p=0.918). Total procedure time was lower for SPVA vs WACA (242.9 vs 271.1 minutes, p= 0.047), and fluoroscopy time similar for WACA vs SPVA (50.8 vs 53.4 minutes, p=0.555). Conclusions: As an initial ablation approach in pts with PAF <48 hours, SPVA was similarly effective to WACA with respect to arrhythmia recurrence, supporting the central role of the pulmonary veins for maintaining AF in these pts. Future therapies using alternative ablation energies may incorporate these insights to reduce risk to gastroesophageal structures.

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