Abstract 2161: Left Atrium Reverse Remodeling After Pulmonary Vein Isolation. Will It Be a Predictor for Non-recurrence of Atrial Fibrillation?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
kiyotake Ishikawa ◽  
Yukihiko Yoshida ◽  
Sumio Morita ◽  
Kenji Furusawa ◽  
Noriyoshi Kanemura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Reverse Remodeling ◽  
Transverse Diameter ◽  
Before And After ◽  
History Of ◽  
Af Recurrence

Background: Left atrium (LA) dilation plays an important role in development and persistence of atrial fibrillation (AF). Some cases show structural reverse remodeling of LA after catheter ablation of AF. The aim of this study was to assess the clinical significance of LA reverse remodeling. Method and Results: Echocardiographic data before and after ablation was obtained in 173 cases who underwent pulmonary vein isolation from January 2006 to April 2008 (74.0% men, 61.0±11 years old; paroxysmal AF 114, persistent AF 34, permanent AF 25). Mean atrial diameter before ablation was 39.0±6.1mm (paroxysmal 37.7±5.6mm, persistent 40.7±5.3mm, and permanent 43.0±6.8mm) and LA reverse remodeling was defined as 10% decrement of LA transverse diameter. Half of the cases were taking anti-arrhythmic drugs after ablation, and AF recurrence occurred in 16.8% (29/173) during mean follow up period of 8.5±6.3 months. Reverse remodeling of LA was seen in 34.1% (59/173) and AF recurrence rate in this group was 11.9% (7/59), whereas 19.3% (22/114) without reverse remodeling (P=0.29). However, limited in patients with LA diameter over 40mm (44.5%; 77/173), 3.2% (1/31) of AF recurrence was seen in those with reverse remodeling, while 21.7% (10/46) without reverse remodeling (P=0.04). LA reverse remodeling was observed significantly frequent in patients without history of hypertension(41.5% without hypertension vs 25.6% with hypertension, P=0.036). Conclusion: LA reverse remodeling after catheter ablation of AF in dilated LA patient is a simple and useful predictor for non-recurrence of AF. Hypertension could be a disturbance for LA reverse remodeling.

scholarly journals Atrial Fibrillation Ablation Using Vein of Marshall Ethanol Infusion

2021 ◽  
pp. 52-55
Author(s):  
Adi Lador ◽  
Miguel Valderrábano
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Atrial Fibrillation Ablation ◽  
Autonomic Nerves ◽  
Ethanol Infusion ◽  
Mitral Isthmus

Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it is less effective for persistent AF. The vein of Marshall (VOM) is located in the epicardial left atrium and can be a source of AF triggers as well as a tract for autonomic nerves. It directly communicates with the underlying myocardium, including the left atrial ridge and the posterior mitral isthmus. This review discusses the latest evidence regarding the mechanisms, procedural aspects, and outcomes of VOM ethanol infusion when used as an adjunct to pulmonary vein isolation in patients with persistent AF.

scholarly journals Radiofrequency vs. Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on AF Burden: The RACE-AF Randomized Controlled Trial

2021 ◽  
Author(s):  
Samuel K. Sørensen ◽  
Arne Johannessen ◽  
René Worck ◽  
Morten L. Hansen ◽  
Jim Hansen
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Controlled Trial ◽  
Pulmonary Veins ◽  
Primary Methods ◽  
Second Procedure ◽  
Af Recurrence

Background - Recurrent paroxysmal atrial fibrillation (PAF) after catheter ablation is presumably caused by failure to achieve durable pulmonary vein isolation (PVI). The primary methods of PVI are radiofrequency (RF) and cryoballoon (CRYO) catheter ablation, but these methods have not been directly compared with respect to PVI durability and the effect thereof on AF burden (% of time in AF). Methods - Accordingly, we performed a randomized trial including 98 patients (68% male, 61 [55-67] years) with PAF assigned 1:1 to PVI by contact-force sensing, irrigated RF catheter or second-generation CRYO catheter. Implantable cardiac monitors were inserted ≥1 month before PVI for assessment of AF burden and recurrence, and all patients, irrespective of AF recurrence, underwent a second procedure 4-6 months after PVI to determine PVI durability. Results - In the second procedure, 152/199 (76%) pulmonary veins (PVs) were found durably isolated after RF and 161/200 (81%) after CRYO (NS), corresponding to durable isolation of all veins in 47% of patients in both groups (NS). Median AF burden before PVI was 5.4% (interquartile range: 0.5-13.0%) vs. 4.0% (0.6-18.1%), RF vs. CRYO, and reduced to 0.0% (0.0-0.1%) and 0.0% (0.0-0.5%), respectively - a reduction of 99.9% (92.9-100.0%) and 99.3% (85.9-100.0%) (all NS). AF burden after PVI significantly correlated to the number of durably isolated PVs (p < 0.01), but 9/45 (20%) patients with durable isolation of all veins had recurrence of AF within 4-6 months after PVI (excluding a 3-month blanking period). Conclusions - PVI by RF and CRYO catheter ablation produce similar moderate to high PVI durability. Both treatments lead to marked reductions in AF burden, which is related to the number of durably isolated PVs. However, for one fifth of PAF patients, complete and durable PVI was not sufficient to prevent even short-term AF recurrence.

scholarly journals Emerging Technologies for Pulmonary Vein Isolation

2020 ◽  
Vol 127 (1) ◽  
pp. 170-183 ◽  
Author(s):  
F. Daniel Ramirez ◽  
Vivek Y. Reddy ◽  
Raju Viswanathan ◽  
Mélèze Hocini ◽  
Pierre Jaïs
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Occupational Injuries ◽  
Pulmonary Veins ◽  
Health Resources ◽  
Patient Comfort ◽  
Considerable Morbidity

Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with considerable morbidity and mortality. Electrically isolating the pulmonary veins from the left atrium by catheter ablation is superior to antiarrhythmic drug therapy for maintaining sinus rhythm, but its success varies depending on multiple factors, including arrhythmic burden. Although procedural outcomes have improved over the years, further gains are limited by a seemingly zero-sum relationship between effectiveness and safety, which is largely a product of the available technologies. Current energies used to create contiguous, transmural, and durable atrial lesions can result in serious complications if they reach the esophagus or phrenic nerve, for instance—structures that can be adjacent to the atrial myocardium, often within millimeters of the energy source. Consequently, high rates of pulmonary vein-left atrium reconnections are consistently seen in clinical studies and in clinical practice as operators appropriately forgo ablation effectiveness to protect patients from harm. However, as ablative technologies evolve to circumvent this stalemate, safer, and more effective pulmonary vein isolation seems increasingly realistic. Furthermore, the innovative nature of these technologies raises the prospect of markedly improved procedural efficiency, which could increase patient comfort, reduce operator occupational injuries, and enhance the use of health resources—all of which are increasingly important considerations particularly as the demand for catheter ablation for atrial fibrillation continues to rise. We herein review 3 promising candidate ablation technologies with the potential to revolutionize the management of patients with atrial fibrillation: electroporation (pulsed-field ablation), expandable lattice-tip radiofrequency ablation/electroporation, and ultra-low temperature cryoablation.

scholarly journals Effect of continuous positive airway pressure therapy on recurrence of atrial fibrillation after catheter ablation in patients with obstructive sleep apnea: A randomized controlled trial

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
T-E Hunt ◽  
GM Traaen ◽  
L Aakeroy ◽  
C Bendz ◽  
B Oeverland ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Randomized Study ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority OnBehalf OUH Background Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). Studies have reported an association between OSA and increased AF burden, as well as increased recurrence of AF after catheter ablation. However, whether treatment with positive airway pressure (CPAP) can reduce the risk of AF recurrence after pulmonary vein isolation has still not been established. Purpose This is the first randomized study evaluating the effect of CPAP treatment on AF recurrence after pulmonary vein isolation in patients with AF and OSA. Methods Consecutive patients with AF referred for catheter ablation were included after being screened positive for OSA (apnea-hypopnea index [AHI] ≥ 15 events/h). All patients received an implantable loop recorder 6 months prior to ablation to quantify the arrhythmia burden. Patients were randomized to CPAP treatment or no treatment of OSA during five months before and 12 months after ablation. The primary end point was AF recurrence, defined as one episode of AF lasting longer than 30 seconds after catheter ablation, with an initial 90-day blanking period. We also compared AF burden measured in percent of time in AF and assessed five months before and 3-12 months after catheter ablation. Results We included 83 patients (65% male, age 61 ± 7.3 years), of which 37 patients were treated with CPAP and 46 controls. The mean baseline AHI in patients with CPAP was 26.7 ± 14.7 and in patients with usual care 26.3 ± 12.3. AF-burden prior to catheter ablation expressed as median [IQR] percent of time was 2.7 [0.9-9.1] in the CPAP-group compared to 1.8 [0.2-6.4] in the control group (p = 0.24). There was no signal to a difference in AF recurrence rate between patients with or without CPAP treatment. As shown in figure, we found overlapping curves with a final 21 patients [57%] vs. 26 patients (57%) presenting at least 30 seconds of AF. After catheter ablation and blanking period, patients with CPAP treatment had an AF burden of 0.0 [0.0-0.3] % compared to 0.0 [0.0-0.3] % in patients without CPAP (p = 0.64). Conclusion In this randomized study concomitant treatment with CPAP on top of pulmonary vein isolation had no added effect on the risk of AF recurrence in patients with OSA. Although several patients revealed at least 30 seconds of AF 3-12 months after ablation, there was a great reduction in percent AF burden after catheter ablation independent of CPAP treatment. Abstract Figure

scholarly journals Characterization of Changes in P-Wave VCG Loops Following Pulmonary-Vein Isolation

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1923
Author(s):  
Nuria Ortigosa ◽  
Óscar Cano ◽  
Frida Sandberg
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
P Wave ◽  
Atrial Fibrillation Recurrence ◽  
Time Segment ◽  
P Waves ◽  
Before And After ◽  
Propagation Pattern

Atrial fibrillation is the most common type of cardiac arrhythmia in clinical practice. Currently, catheter ablation for pulmonary-vein isolation is a well-established treatment for maintaining sinus rhythm when antiarrhythmic drugs do not succeed. Unfortunately, arrhythmia recurrence after catheter ablation remains common, with estimated rates of up to 45%. A better understanding of factors leading to atrial-fibrillation recurrence is needed. Hence, the aim of this study is to characterize changes in the atrial propagation pattern following pulmonary-vein isolation, and investigate the relation between such characteristics and atrial-fibrillation recurrence. Fifty patients with paroxysmal atrial fibrillation who had undergone catheter ablation were included in this study. Time-segment and vectorcardiogram-loop-morphology analyses were applied to characterize P waves extracted from 1 min long 12-lead electrocardiogram segments before and after the procedure, respectively. Results showed that P-wave vectorcardiogram loops were significantly less round and more planar, P waves and PR intervals were significantly shorter, and heart rate was significantly higher after the procedure. Differences were larger for patients who did not have arrhythmia recurrences at 2 years of follow-up; for these patients, the pre- and postprocedure P waves could be identified with 84% accuracy.

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