P1421Assessment of intraatrial conduction during staged catheter ablation of persistent AF

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Kovalev ◽  
A G Filatov ◽  
S A Kovalev ◽  
L A Bockeria
Keyword(s):  
Catheter Ablation ◽  
Posterior Wall ◽  
Refractory Periods ◽  
Second Stage ◽  
Atrial Functions ◽  
Staged Treatment ◽  
Interatrial Conduction

Abstract Goal. To evaluate the electrophysiological changes in the LA myocardium between the stages of sequential RFA of persistent AF. Materials and methods. From 2015 to 2018 43 patients (27 men and 16 women) underwent sequential ablation (second intervention in a period of 3 to 6 months) of persistent AF. The routine isolation was performed in the first stage. During the second stage additional lesions were performed in the areas of the restored conduction and posterior wall isolation. All patients underwent a routine EP before each stage with measurements of the atrial myocardial refractory periods, as well as intraatrial conduction. Results. The EP parameters before the first and second stages had significantly changed: refractory periods in the areas of previously performed RFA had increased from 184 (166; 208) ms to 212 (174; 249) ms, respectively, p <0.001, the dispersion of refractivity decreased from 34 (18; 48) ms to 21 (16; 29) ms, p = 0.017. According to ECG, the duration of intraatrial conduction also decreased by 34 (24; 51) ms, p = 0.034. Conclusion. Electrophysiological markers of intra- and interatrial conduction show a tendency to reverse modeling of atrial functions in patients passing through the staged treatment of persistent AF.

scholarly journals Benefits of early intervention with catheter ablation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Intervention ◽  
Catheter Ablation ◽  
Success Rate ◽  
Therapeutic Option ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Early Group ◽  
Late Group

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: >12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p<0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Abstract 16766: Intraprocedural Ablation and Fluid Status Management in Heart Failure Patients Undergoing Catheter Ablation for Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sahitya Allam ◽  
Evan Harmon ◽  
Sula Mazimba ◽  
James M Mangrum ◽  
Ilana Kutinsky ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Tertiary Care ◽  
Fluid Management ◽  
Management Strategies ◽  
Clinical Trial Data ◽  
Posterior Wall ◽  
Fluid Status ◽  
Volume Output

Background: Recent randomized clinical trial data has supported catheter ablation (CA) of atrial fibrillation (AF) in patients with heart failure (HF). Ablation and fluid management strategies could impact periprocedural outcomes especially in HF patients. Methods: We conducted a single-center retrospective analysis of 200 consecutive patients with and without HF undergoing CA at a tertiary care academic center from July 2017 through June 2018. HF was defined as any EF < 40%, prior inpatient admission for HF exacerbation, or ambulatory management of HF confirmed by independent chart review. Diuretic regimens were reported as furosemide equivalent. Results: Among 200 patients, 65 (32.5%) had HF and 135 (67.5%) did not. HF patients had longer mean procedure times (299.8 ± 96 min vs 268.4 ± 96 min, p = 0.03) and were more likely to require mitral isthmus (p < 0.001), posterior wall isolation (p = 0.002), and cavotriscupid isthmus (p = 0.004) ablations. There were no differences between the HF vs. non-HF groups’ intraprocedural volume intake, intraprocedural volume output, net fluid status, or intraprocedural diuretic dose (Table 1). HF patients received higher doses of IV (41.5 ± 43.0 mg vs 23.6 ± 11.8 mg, p = 0.007) and PO (43.2 ± 16.7 mg vs 26.7 ± 10.0 mg, p < 0.001) postprocedural diuretic. There were no differences in the rates of major in-hospital complications (Table 1). In a multivariable regression analysis adjusted for procedural covariates, there were higher proportions of posterior wall isolation (p = 0.01) as well as postprocedural PO (p = 0.01) and IV diuretic (p = 0.002) administration in the HF cohort. Conclusion: Intraprocedural volume and diuretic management was similar between HF and non-HF patients undergoing CA of AF, though HF patients tended to receive more aggressive diuresis post procedurally with no difference in complications. Table 1. Intra- and post-procedural management and outcomes in HF vs non-HF patients undergoing CA for AF

Durability of posterior wall isolation after catheter ablation among patients with recurrent atrial fibrillation

Heart Rhythm ◽  
2020 ◽  
Vol 17 (10) ◽  
pp. 1740-1744 ◽  
Author(s):  
Timothy M. Markman ◽  
Matthew C. Hyman ◽  
Ramanan Kumareswaran ◽  
Jeffrey S. Arkles ◽  
Pasquale Santangeli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Posterior Wall ◽  
Recurrent Atrial Fibrillation

Morton's Interdigital Neuroma: A Comprehensive Treatment Protocol

1995 ◽  
Vol 16 (12) ◽  
pp. 760-763 ◽  
Author(s):  
Gordon L. Bennett ◽  
Charles E. Graham ◽  
Donald M. Mauldin
Keyword(s):  
Treatment Program ◽  
Treatment Protocol ◽  
Signs And Symptoms ◽  
Surgical Excision ◽  
Metatarsal Head ◽  
Comprehensive Treatment ◽  
Second Stage ◽  
Third Stage ◽  
Local Anesthetic Injection ◽  
Staged Treatment

One hundred fifteen patients with signs and symptoms of Mortons' interdigital neuroma were studied in an attempt to evaluate the efficacy of a staged treatment program. The first stage consisted of patient education, footwear modifications, and metatarsal head relief. The second stage consisted of a steroid/local anesthetic injection into the affected interspace. The third stage was surgical excision of the inflamed interdigital nerve. Overall, 97 of 115 patients (85%) believed that they had improved with the treatment program. Twenty-four patients (21%) eventually required surgical excision of the nerve and 23 of 24 patients (96%) had satisfactory results. The results of the staged treatment protocol were very satisfactory and patient satisfaction was high.

scholarly journals 12-Month Single-Procedure Outcomes after Atrial Fibrillation Catheter Ablation in Phramongkutklao Hospital: A Single Center 10-Year Experience

2021 ◽  
Vol 72 (2) ◽  
pp. 114-120
Author(s):  
Sarawuth Limprasert
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Posterior Wall ◽  
Efficacy And Safety ◽  
Related Complication ◽  
Single Procedure ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack ◽  
First Time

Objective: This study aimed to report the efficacy and safety of 1-year outcome for single-procedure radiofrequency catheter ablation (RFCA) at Phramongkutklao Hospital. Methods: Review of medical records was carried out on consecutive patients with symptomatic atrial fibrillation (AF) who had undergone first-time RFCA in Phramongkutklao Hospital between January 2009 and December 2018. The efficacy and safety of outcomes after 1 year of RFCA were collected, analyzed, and validated using descriptive data. Results: 61 patients underwent RFCA for the first time. 77.05% were male, with a mean age of 58.31 ± 10.83 years. Paroxysmal AF presented in 65.57%. 49.18% had hypertension, 9.84% had a history of ischemic stroke or transient ischemic attack, 6.56% had diabetes, 6.56% had coronary artery disease, and 4.92% had heart failure. 96.72% of RFCA procedures were performed under local anesthesia and conscious sedation. Pulmonary vein isolation was performed in all patients. Roofline, mitral isthmus line, and posterior wall isolation were created in 27.87%, 13.11%, and 3.28%, respectively. Additional complex fractionated atrial electrograms (CFAEs) were targeted in 19.67%. After 12 months, 45.45% remained in sinus rhythm, with only one patient experiencing a procedure-related complication with cardiac tamponade. Conclusion: The 1-year results of single-procedure RFCA for treating AF at our center, while not highly successful in our first decade, were comparable to other series. Notably, there was a relatively low rate of complications.

scholarly journals 471 Arrhythmia-free survival in early-persistent atrial fibrillation patients undergoing radiofrequency catheter ablation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Michele Magnocavallo ◽  
Domenico Giovanni Della Rocca ◽  
Carlo Lavalle ◽  
Cristina Chimenti ◽  
Gianni Carola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Survival Data ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Free Survival ◽  
One Year

Abstract Aims Despite advances in success rate of paroxysmal atrial fibrillation (PAF) ablation, outcomes of radiofrequency catheter ablation (RFCA) in patients with persistent AF are highly variable. Early persistent AF (EPsAF) is defined as AF that is sustained beyond 7 days but is less than 3 months in duration. Arrhythmia-free survival data after RFCA in this specific population are still limited. We sought to report the outcomes of RFCA in the subgroup of patients with EPsAF, compared to those with PAF and with ‘late’ persistent AF (LPsAF) lasting between 3 and 12 months. Methods and results Data from 1143 consecutive AF patients receiving their first RFCA were prospectively collected. Patients with EPsAF (n = 190) were compared with PAF (n = 531) and LPsAF (n = 422) patients. All patients received pulmonary vein antrum isolation + posterior wall and sustained non-pulmonary vein (PV) trigger ablation. Non-sustained non-PV triggers were ablated based on operator discretion. Non-PV triggers were defined as sites of firing leading to sustained (&gt;30 s) or non-sustained arrhythmias (&lt;30 s, including premature atrial contractions ≥10 beats/min) with earliest activation outside the PVs. Mean age of the population was 64 ± 11 years. Female patients were more in PAF group (39%) compared to EPsAF (26%) and LPsAF (28%) (P &lt; 0.001). There was no difference in other clinical characteristics among populations. Non-PV triggers were detected more in EPsAF [127 (66.8%)], and LPsAF [296 (70.1%)] patients compared to PAF [185 (34.8%)] (P &lt; 0.001).One-year arrhythmia-free survival rate after a single procedure was 75.0% (398), 74.2% (141), and 64.5% (272) in PAF, EPsAF, and LPsAF, respectively. Success rate was significantly higher in PAF {[HR: 0.67 (0.53, 0.84), P = 0.001] and EPsAF [HR: 0.67 (0.49, 0.93)], P = 0.015} compared to LPsAF. Conclusions In patients with EPsAF, RFCA may result in significantly better freedom from atrial arrhythmias, compared to LPsAF. In this cohort, ablation might be reasonable as first line approach to improve outcomes and prevent AF progression.

Sign in / Sign up

Export Citation Format

Share Document