The Role of Posterior Wall Isolation in Catheter Ablation of Persistent Atrial Fibrillation

2021 ◽  
Author(s):  
John‐Ross D. Clarke ◽  
Jonathan P. Piccini ◽  
Daniel J. Friedman
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall

scholarly journals Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

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 (>30 s) or non-sustained arrhythmias (<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 < 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 < 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.

scholarly journals Is Catheter Ablation Better Than Antiarrhythmic Drugs for the Treatment of Atrial Fibrillation?

2020 ◽  
Vol 29 (02) ◽  
pp. 131-140
Author(s):  
Balaji Natarajan ◽  
Srishti Nayak ◽  
Ramdas G. Pai
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Poor Quality ◽  
Treatment Side Effects ◽  
Randomized Controlled Studies ◽  
Antiarrhythmic Medications ◽  
Better Than

AbstractLong-standing atrial fibrillation is associated with significant morbidity including stroke and development of heart failure. Patients also report poor quality of life as a result of debilitating symptoms or treatment side effects from antiarrhythmic medications. Radio frequency or cryothermal mediated catheter ablation has a central role in the management of symptomatic patients with paroxysmal or persistent atrial fibrillation. Circumferential pulmonary vein isolation is vital to the success of this therapy and other ancillary techniques have been described, especially for persistent atrial fibrillation. Several randomized controlled studies have been reported over the last two decades studying important clinical outcomes in patients with atrial fibrillation. In this article, we aim to provide a review of the major studies that have helped define the role of catheter ablation in the management of symptomatic atrial fibrillation in patients with both diseased and structurally normal hearts.

Abstract 17454: The Effect of Catheter Ablation on Coronary Sinus Cycle Length in Persistent Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ghaith Zaatari ◽  
Jorge Bohorquez ◽  
Raul Mitrani ◽  
Jason Ng ◽  
Justin Ng ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Coronary Sinus ◽  
Cycle Length ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Quality Signals ◽  
Before And After ◽  
Ventricular Activation ◽  
Ablation Success

Background: While pulmonary vein isolation (PVI) for treatment of persistent atrial fibrillation (PeAF) is successful in approximately 50%, acute termination of PeAF is rarely observed. Prolongation of cycle length (CL) by 10% is often utilized as an indicator of successful catheter ablation (CA). Objective: To evaluate coronary sinus (CS) cycle length (CL) before and after CA for PeAF. Methods: CA for PeAF was performed in 31 patients (24males, age 63±9 yrs, CHA2DS2-VASc 2.3±1.7, LVEF 49±10%) with PVI, with 4 (13%) also having posterior wall isolation. A multielectrode catheter was placed in the CS and maintained throughout the procedure. CS electrograms were recorded for 10 seconds prior to CA and after completion of CA. No patient reverted to sinus rhythm during CA. CS CL was determined using customized software for activation detection and verified visually, excluding ventricular activation and low quality signals (n=3). The shortest CL among the recording electrodes was used for analysis. Results: CS CL pre- and post-CA were 182.4±23.0 and 191.6± 29.9 ms (p= 0.04) with change from baseline of 5.4±12.7%. The figure shows the histogram for change in CS CL from baseline. Only 7/28 (25%) of patients had CS CL prolongation >10%. Of ten patients who were free of AF off anti-arrhythmic drugs at 1 year, CS CL increased 4.0±6.1%; 2/10 had CS CL prolongation >10%. Of 6 patients with recurrent AF, CS CL increased 13.8±20.7%; 4/6 had CS CL prolongation >10%. Conclusion: Our data demonstrate that CS CL prolongation >10% is not a useful marker of outcomes in patients undergoing catheter ablation for PeAF. This highlights the need to identify other indicators of acute ablation success.

scholarly journals Long-standing Persistent Atrial Fibrillation Ablation: the Role of the Inter- and Intra-atrial Bundles

2020 ◽  
Vol 33 (2) ◽  
pp. 73-81
Author(s):  
Russell Mitchell ◽  
Cesar Augusto Bonilla Isaza
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Conduction System ◽  
Atrial Fibrillation Ablation ◽  
Anatomical Location

Catheter ablation has become the mainstream treatment of atrial fibrillation, but still remains a challenge in those patient with persistent and long standing persistent atrial fibrillation. In addition of isolation of the pulmonary veins, any other areas that can trigger or perpetuate atrial fibrillation need to be isolated. Current technologies may allow to effectively deliver permanently lasting lesions, and therefore improve clinical outcomes after ablation. The specialized conduction system including the Bachmann and septopulmonary bundles, are important substrate targets for the management of atrial fibrillation. The anatomical location of these fibers, and the corresponding approach for ablation are described in this case.

Sign in / Sign up

Export Citation Format

Share Document