Ultrasound-guided versus conventional femoral venipuncture for catheter ablation of atrial fibrillation: a multicentre randomized efficacy and safety trial (ULTRA-FAST trial)

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

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Efficacy and safety of catheter ablation combined with left atrial appendage occlusion for nonvalvular atrial fibrillation: A systematic review and meta‐analysis

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13845 ◽

2019 ◽

Vol 43 (1) ◽

pp. 123-132

Author(s):

Ying Jiang ◽

Fanghui Li ◽

Dongze Li ◽

Yisong Cheng ◽

Yu Jia ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Catheter Ablation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Meta Analysis ◽

Atrial Appendage ◽

Efficacy And Safety ◽

Nonvalvular Atrial Fibrillation ◽

Left Atrial Appendage Occlusion

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Comparing efficacy and safety in catheter ablation strategies for atrial fibrillation: protocol of a network meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2020-041819 ◽

2020 ◽

Vol 10 (11) ◽

pp. e041819

Author(s):

Emmanouil Charitakis ◽

Lars O Karlsson ◽

Kostantinos Rizas ◽

Henrik Almroth ◽

Anders Hassel Jönsson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Bibliographic Databases ◽

Controlled Trials ◽

Separate Analysis ◽

Efficacy And Safety ◽

Randomised Controlled

IntroductionAtrial fibrillation (AF) is the most common sustained arrhythmia. Catheter ablation (CA) of AF is an increasingly offered therapeutic approach, primary to relieve AF-related symptoms. Despite the development of new ablation approaches, there is no consensus regarding the most efficient ablation strategy. The objective of this network meta-analysis (NMA) is to compare the efficacy and safety of all different CA approaches for the treatment of patients with paroxysmal (PAF) and non-PAF (non-PAF).Methods and analysisWe will perform a systematic search to identify randomised controlled trials of different CA approaches for the treatment of PAF and non-PAF, through the final search date of 1 March 2020. Information sources will include major bibliographic databases (MEDLINE, Web of Science and CENTRAL) and clinical trial registries. Our primary outcomes will be the efficacy (recurrence-free survival) and safety of different CA approaches for the treatment of AF. Secondary outcomes will be all-cause mortality and procedural time. An NMA will be performed to determine the relative effects of different catheter ablation approaches (such as pulmonary vein isolation alone or in combination with ablation lines, ablation of complex fractionated atrial electrograms, etc). In PAF, a separate analysis will be performed including different energy sources (such as radiofrequency, cryogenic and laser energy). Risk of bias assessment and sensitivity analyses will be conducted to assess the robustness of the findings to potential bias.Ethics and disseminationNo ethical approval will be needed because data are collected from previous studies. The results will be presented through peer-review journals and conference presentation.PROSPERO registration numberCRD42020169494.

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Advantages of the integration of ICE and 3D electroanatomical mapping and ultrasound-guided femoral venipuncture in catheter ablation of atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00835-6 ◽

2020 ◽

Author(s):

Carmelo La Greca ◽

Arianna Cirasa ◽

Davide Di Modica ◽

Alberico Sorgato ◽

Umberto Simoncelli ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Electroanatomical Mapping ◽

Ultrasound Guided

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Efficacy and Safety of Periprocedural Dabigatran in Patients Undergoing Catheter Ablation of Atrial Fibrillation

Circulation Journal ◽

10.1253/circj.cj-12-0498 ◽

2012 ◽

Vol 76 (10) ◽

pp. 2337-2342 ◽

Cited By ~ 68

Author(s):

Kenichi Kaseno ◽

Shigeto Naito ◽

Kohki Nakamura ◽

Tamotsu Sakamoto ◽

Takehito Sasaki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Efficacy And Safety

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Network meta-analysis of efficacy and safety of competitive oral anticoagulants in patients undergoing radiofrequency catheter ablation of atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-016-0126-5 ◽

2016 ◽

Vol 46 (3) ◽

pp. 213-224 ◽

Cited By ~ 3

Author(s):

Pei-Jun Li ◽

Jun Xiao ◽

Qing Yang ◽

Yuan Feng ◽

Ting Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Efficacy And Safety

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The impact of age on the efficacy and safety of catheter ablation for long-standing persistent atrial fibrillation

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.03.025 ◽

2013 ◽

Vol 168 (3) ◽

pp. 2693-2698 ◽

Cited By ~ 10

Author(s):

Xiao-Dong Zhang ◽

Jun Gu ◽

Wei-Feng Jiang ◽

Liang Zhao ◽

Yuan-Long Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Persistent Atrial Fibrillation ◽

Efficacy And Safety ◽

The Impact

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

Siriraj Medical Journal ◽

10.33192/smj.2021.16 ◽

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.

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