scholarly journals The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Xiao-yu Liu ◽  
Hai-feng Shi ◽  
Jie Zheng ◽  
Ku-lin Li ◽  
Xiao-xi Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Magnetic Navigation ◽  
Remote Magnetic Navigation ◽  
X Ray ◽  
Group A ◽  
Group B ◽  
The Impact

Objective. The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods. A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results. During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P<0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P<0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P<0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions. AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.

Abstract 17296: Arrhythmia Recurrence and Subsequent Heart Failure Hospitalization in Atrial Fibrillation Patients Undergoing Catheter Ablation: A Landmark Analysis From the Kansai Plus Atrial Fibrillation (KPAF) Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobuaki Tanaka ◽  
KOICHI INOUE ◽  
Atsushi Kobori ◽  
Kazuaki Kaitani ◽  
Takeshi Morimoto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Large Scale ◽  
Multicenter Observational Study ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Af Recurrence

Background: Heart failure (HF) is the leading cause of death in patients with atrial fibrillation (AF). Radiofrequency catheter ablation (RFCA) of AF is effective for maintaining sinus rhythm though its impact on heart failure still remains controversial. Purpose: We sought to elucidate whether AF recurrence following RFCA was associated with subsequent HF hospitalizations. Methods: We conducted a large-scale, prospective, multicenter, observational study. A total of 4931 consecutive patients who underwent an initial RFCA for AF with longer than 1-year of follow-up in 26 centers were enrolled (average age, 64±10 years; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years. The primary endpoint was an HF hospitalization more than 1-year after the index RFCA. We compared the patients without AF recurrences (group A) to those with AF recurrences within 1-year post RFCA (group B). Results: The 1-year cumulative incidence of AF recurrences after a single procedure was 30.7% (group A=3418, group B=1513 patients). Group B had a lower body mass index (group A vs. group B,24.1±3.6 vs. 23.8±3.4 kg/m 2 , p=0.014), longer history of AF (1.9 vs. 3.1 years, p<0.0001), higher prevalence of non-paroxysmal AF (32.1% vs. 33.9%, p<0.0001), and valvular heart disease (5.9% vs. 7.8%, p=0.013). They also had a lower ejection fraction (63.7±9.4% vs. 62.8±9.6%, p=0.0043) and larger left atrial dimeter (39.7±6.6 vs. 40.6±7.0 mm, p<0.0001) on echocardiography. Hospitalizations for HF were observed in 57 patients (1.14%) more than 1-year after the RFCA and were significantly higher in group B than group A (group A vs. group B, 0.91% vs 1.72%, log-rank p=0.019). Conclusions: Among AF patients receiving RFCA, those with AF recurrences were at a greater risk of subsequent heart failure hospitalizations than those without AF recurrences. Recognition that AF recurrence following RFCA is a risk factor for a subsequent HF-related hospitalization is appropriate in clinical practice.

scholarly journals The impact of catheter ablation of atrial fibrillation on the left atrial volume and function: study using three-dimensional echocardiography

2019 ◽  
Vol 57 (1) ◽  
pp. 87-95
Author(s):  
Jongmin Hwang ◽  
Hyoung-Seob Park ◽  
Seongwook Han ◽  
Seung-Woon Jun ◽  
Na-Young Kang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Three Dimensional ◽  
Left Atrial Volume ◽  
Volumetric Assessment ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography ◽  
And Function ◽  
The Impact

Abstract Purpose The exact correlation between the baseline left atrial (LA) volume (LAV) and atrial fibrillation (AF) radiofrequency catheter ablation (RFCA) outcomes and changes to the LA after AF RFCA has not yet been fully understood. We sought to evaluate the serial changes in the LAV and LA function after RFCA using 3D echocardiography. Methods Consecutive patients who received RFCA of paroxysmal (PAF) or persistent AF (PeAF) at our center between January 2013 and March 2016 were included. Real-time 3D apical full-volume images were acquired, and a 3D volumetric assessment was performed using an automated three-beat averaging method. The LAV index (LAVI) was calculated and the LA ejection fraction (LAEF) was calculated as [LAVmax − LAVmin]/LAVmax. Results Ninety-nine total patients were enrolled, and the mean age was 58.0 ± 8.2 years and 75 (74.7%) were male. There were 59 (59.6%) PAF patients and the remaining 40 (40.4%) had PeAF. AF recurred in 5 of 59 (8.5%) PAF and in 10 of 40 (25%) PeAF patients. The LAVImax increased on 1 day, decreased at 3 months, and then increased again at 1 year but was lower than that at baseline. The LAEF changes were similar to the volume changes but were more prominent in PeAF than PAF patients. The baseline 3D LAVImax was an independent predictor of AF recurrence after RFCA and the cut-off value was 44.13 ml/m2. Conclusion In our study, even after 3 months of scar formation due to ablation, structural remodeling of the LA continued. The changes were more prominent in the non-recurrent, PeAF patients.

The Impact of Left Atrial Size on Long-Term Outcome of Catheter Ablation of Chronic Atrial Fibrillation

2009 ◽  
Vol 20 (11) ◽  
pp. 1211-1216 ◽  
Author(s):  
LI-WEI LO ◽  
YENN-JIANG LIN ◽  
HSUAN-MING TSAO ◽  
SHIH-LIN CHANG ◽  
AMEYA R. UDYAVAR ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Chronic Atrial Fibrillation ◽  
Left Atrial Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Atrial Size ◽  
The Impact

scholarly journals Management and clinical outcome of patients with atrial fibrillation stratified by the 4S-AF scheme for structured characterization of atrial fibrillation: data from CODE-AF registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S.R Lee ◽  
K.M Park ◽  
B Joung ◽  
E.K Choi ◽  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Rhythm Control ◽  
Prevention Strategies ◽  
Group A ◽  
Group B

Abstract Background Recently, 4S-AF scheme consisting of four essential domains requiring for integrated management of atrial fibrillation (AF), including stroke prevention, symptom severity, severity of AF burden, and substrate for AF, has been proposed for the structured characterization of AF. Purpose To classify patients with AF applying 4S-AF scheme, evaluate how rhythm control and stroke prevention strategies were applied according to the 4S-AF scheme, and analyze the association between 4S-AF scheme score and the risk of clinical outcome, composite of stroke and admission for heart failure in patients with AF. Methods Using the data from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry from June 2015 to October 2020, we identified patients with AF who had information about 4S. The 4S-AF scheme score was calculated by stroke risk (truly low risk patients = 0; otherwise = 1), symptom severity (no symptom = 1; presence of symptom = 1), severity of AF burden (paroxysmal = 0, persistent = 1, and long-persistent to permanent = 2), substrate for AF (add 1 if &gt;75 years; no comorbidity=1, 1 comorbidity = 1, 2 or more comorbidities = 2; left atrial anteroposterior diameter &lt;40mm = 0, 40 to &lt;50mm = 1, and ≥50mm = 2). Treatment strategies, including rhythm control and anticoagulation, were analyzed according to the 4S-AF scheme score. The risk for a composite of stroke and admission for heart failure was evaluated according to the 4S-AF scheme score during follow-up. Results Among 8199 patients with AF, the 4S-AF scheme scores of 0, 1, 2, 3, 4, 5, and ≥6 were 2.5%, 5.6%, 9%, 17.1%, 20.1%, 17.6%, and 28%, respectively. Patients with higher scores were tended to be older, had higher CHA2DS2-VASc score, included less proportion of paroxysmal AF, and showed larger left atrial size (Table). According to 4S-AF scheme, physicians preferred to apply a rhythm control strategy through both performing catheter ablation and prescribing antiarrhythmic agents in patients with lower 4S-AF scheme score (Figure). Oral anticoagulation rates were higher in patients with higher 4S-AF scheme score owing to higher CHA2DS2-VASc scores of these patients (Figure). The incidence rates of composite clinical outcomes were increased with increasing in 4S-AF scheme score (Figure). When grouping 4S-AF scheme score 0 and 1 as group A, 2 to 4 as group B, 5 as group C, and 6 as group D, group B, C, and D were associated with a higher risk of the composite clinical outcomes by 3.4, 7.9 and 11.5-fold compared to group A, respectively (Figure). Conclusions The 4S-AF scheme score was well-associated with the risk of stroke and admission for heart failure in patients with AF. Although the 4S-AF scheme might be already reflected in clinical practice when physicians determined the rhythm control and stroke prevention strategies for their AF patients, more systematic approach should be utilized for better clinical outcomes in patients with AF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by a research grant from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI15C1200, HC19C0130).

Abstract T MP60: Impact of Aortic Arch Atheroma for Stroke Recurrence in Patients With or Without Atrial Fibrillation

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Shigeru Fujimoto ◽  
Masato Osaki ◽  
Masaya Kumamoto ◽  
Makoto Kanazawa ◽  
Naoki Tagawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Arch ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact

Background & Purpose: In patients with embolic stroke of undetermined source, aortic arch atheroma evaluated using transesophageal echocardiography (TEE) is a possible embolic source. We investigated the impact of embolic sources including aortic arch atheroma for a stroke recurrences and death. Methods: Among the consecutive 1545 acute stroke patients, 542 patients who were admitted within 24 hours after the symptom onset, with ischemic lesions in the cortex or cerebellum on the diffusion-weighted image, NIH stroke scale of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. All 542 patients underwent TEE to search for embolic sources. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for average period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% patients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recurrence-free survival among the four groups (p=0.0076, log-rank test). Stroke recurrence was more frequent in group B than group C patients especially in the early phase from the onset. On COX proportional-hazards model analysis and diabetes mellitus (HR 1.73, p=0.0264) and aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146) were significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch atheroma can independently be associated with stroke recurrences and death, furthermore, a combination of aortic arch atheroma and cardiogenic embolic sources showed more frequent events than each of them alone.

P962Circumferential pulmonary vein ablation in combination with a linear lesion at the left atrial roof for catheter ablation of persistent atrial fibrillation (8.5-year follow-up)

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kettering
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Pulmonary Vein Ablation ◽  
Group A ◽  
Group B

Abstract Background Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Circumferential pulmonary vein ablation is still the standard approach in these patients. However, the results are not very favourable and more complex ablation strategies are the subject of current controversy. Therefore, we have evaluated the effect of an additional linear lesion at the roof of the left atrium on the long-term outcome. Methods A total of 220 patients (114 men, 106 women; mean age 69 years (SD ± 14 years)) with symptomatic persistent atrial fibrillation underwent a circumferential pulmonary vein ablation procedure in combination with an additional linear lesion at the roof of the left atrium (group A). After discharge, patients were scheduled for repeated visits at the arrhythmia clinic at 1, 3, 6, 12, 24, 36, 48, 60, 72, 84, 96 and 102 months after the ablation procedure. The long-term follow-up data was compared to 220 patients who underwent circumferential pulmonary vein ablation without an additional linear lesion at the roof of the left atrium (group B). Results The ablation procedure could be performed as planned in all patients. Fifty-one out of 220 patients (23.2 %) in group A and 53 out of 220 patients (24.1 %) in group B experienced an arrhythmia recurrence within the first 3 months after ablation requiring an electrical cardioversion. At 102-month follow-up, analysis of a 168-hour ECG recording revealed no evidence for an arrhythmia recurrence in 125/220 patients (56.8 %) in group A and in 103/220 patients (46.8 %) in group B. In 66/220 patients (30.0 %) in group A and 59/220 patients (26.8 %) in group B, only short episodes of paroxysmal atrial fibrillation were documented. In 29 patients (13.2 %) in group A, a recurrence of persistent atrial fibrillation (&gt; 48 hours) was revealed by the long-term recordings (group B: 58 patients (26.4 %)). The lower arrhythmia recurrence rate in group A was partially due to a lower incidence of atypical atrial flutter after catheter ablation. The rate of repeat ablation procedures was significantly lower in group A than in group B. There were no major complications. Conclusions Catheter ablation of persistent atrial fibrillation comprising a circumferential pulmonary vein ablation and an additional linear lesion at the roof of the left atrium provides more favourable results than circumferential pulmonary vein ablation alone. The effect is more pronounced during long-term than during short-term follow-up.

scholarly journals In Vitro Effect of Drilling Speed on the Primary Stability of Narrow Diameter Implants with Varying Thread Designs Placed in Different Qualities of Simulated Bone

Materials ◽  
2019 ◽  
Vol 12 (8) ◽  
pp. 1350
Author(s):  
Georgios E. Romanos ◽  
Daniel J. Bastardi ◽  
Rachel Moore ◽  
Apoorv Kakar ◽  
Yaro Herin ◽  
...  
Keyword(s):  
In Vitro Study ◽  
Primary Stability ◽  
Drilling Speed ◽  
Group A ◽  
The One ◽  
Group B ◽  
Vitro Effect ◽  
The Impact ◽  
Narrow Diameter Implants

It is hypothesized that there is no statistically significant impact of drilling speed (DS) on the primary stability (PS) of narrow-diameter implants (NDIs) with varying thread designs placed in dense and soft simulated bone. The aim of this in vitro study was to evaluate the impact of DS on the PS of NDIs with varying thread designs placed in dense and soft simulated bone. Two hundred and forty osteotomies for placement of various implant macro-designs were divided into three groups (80 implants per group): Group A (NobelActive, 3.0/11.5 mm); Group B (Astra OsseoSpeed-EV, 3.0/11 mm); and Group C (Eztetic-Zimmer, 3.1/11.5 mm) implants. These implants were placed in artificial dense and soft simulated bone using DSs of 800 and 2000 revolutions per minute (RPM). Resonance frequency analysis (RFA) and implant stability quotient (ISQ) were assessed. Group comparisons were performed using the one-way analysis of variance with Tukey’s post hoc tests. Level of significance was set at P < 0.05. In groups A and B, there was no difference in the ISQ for NDIs inserted in dense bone at 800 and 2000 RPM. In Group C, ISQ was significantly higher for NDIs placed in dense bone at 800 PRM compared to 2000 RPM (P < 0.05). In Group A, ISQ values were significantly higher for NDIs inserted in soft bone at 2000 RPM as compared to those inserted at 800 RPM (P < 0.05). For NDIs, a lower drilling speed in dense artificial simulated bone and a higher drilling speed in soft artificial simulated bone is associated with high primary stability.

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