Abstract 12600: Microrna From Atrial Tissue Harvested During Transseptal Puncture as a Predictor for Non-pv Trigger in Patients Undergoing Af Ablation: Preliminary Results From a Pilot Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Aaron Baker ◽  
Xue Yan ◽  
Jason Lee ◽  
Francesco Santoro ◽  
...  
Keyword(s):  
Therapeutic Option ◽  
Standard Procedure ◽  
Expression Patterns ◽  
Pulmonary Veins ◽  
Challenge Test ◽  
Inverse Correlation ◽  
Patient Specific ◽  
Af Ablation ◽  
Atrial Tissue ◽  
Nonparametric Correlation

Introduction: Catheter ablation of atrial fibrillation (AF) is the most valid therapeutic option to achieve rhythm control. Pulmonary veins (PV) are the most known trigger of AF, although recently we have become more aware of the importance of non-PV triggers. Expression of microRNA (miRNA) has been shown to be regulated in many cardiovascular disease. We sought to study expression patterns of miRNA in patients (pts) with AF undergoing ablation to facilitate their application as both diagnostic and prognostic markers. Methods: As part of the standard procedure for AF ablation a double transseptal sample of myocardial tissue is obtained via a transseptal needle. The small piece of atrial septal tissue can be retrieved from the needle as a result of piercing the atrial septum. MiRNA was hybridized to microarrays to determine relative levels of miRNAs in the samples. For a subset of the miRNAs we validated expression through quantitative real time PCR. All pts underwent PV-antrum and non-PV trigger ablation guided by isoproterenol challenge test. Results: Atrial tissue of 11 pts undergoing AF ablation has been utilized for MiRNA assessment. Mean age was 61.27 ± 10.5 years and 8 (72.7%) pts were male. Six (54.5 %) pts had paroxysmal AF. During the ablation non-PV triggers were detected in 8 (72.7 %) pts. Recurrence of AF occurred in 3(27.3 %) pts. Expression of miR-21, miR-26a and miR-29a was higher in pts with non-PV triggers, while miR-30c had lower expression in pts who had recurrence of atrial tachyarrhythmias. Spearman’s nonparametric correlation coefficient was calculated and miR-21, miR-26a, miR-29a were positively correlated with non-PV triggers (r = 0.58, p=0.06 for all three miRNAs), while miR-30c level had inverse correlation (r = (-) 0.78 %, p=0.005) with recurrence (Figure). Conclusions: Expression of miR-21, miR-26a, miR-29a correlates with the presence of non-PV triggers. This information could be clinically relevant in planning patient specific procedures.

scholarly journals Catheter ablation of long-standing persistent atrial fibrillation: the ugly type of AF?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Couto Pereira ◽  
T Rodrigues ◽  
J Brito ◽  
P Silverio Antonio ◽  
B Valente Silva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Success Rate ◽  
Cox Regression ◽  
Therapeutic Option ◽  
Pulmonary Veins ◽  
Ablation Techniques ◽  
Loop Recorder ◽  
Af Ablation ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In atrial fibrillation (AF) patients (pts), catheter ablation (CA) by isolating pulmonary veins (PVI) is the most effective therapeutic option in order to maintain sinus rhythm. The success rate of CA relies on type and duration of AF, being more successful in pts with paroxysmal AF and presenting suboptimal success in pts with long-standing persistent AF (LSPAF, >12 months). Purpose To evaluate the success of AF ablation, particularly in LSPAF. Methods Single-center prospective study of pts submitted to CA between 2004 and 2020. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional CA strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (> 30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF. Results 862 pts were submitted to AF ablation (67.3% male, mean age of 58 ± 0.41 years), including 130 pts (15.1%) with LSPAF, 63.3% with paroxysmal AF and 21.6% with short-duration persistent AF (SDPAF). In LSPAF, PVI was performed with irrigated catheter in 26.4%, PVAC in 39.5% and cryoablation in 34.1%. With a mean follow up period of 838 (IQ 159-1469) days, the 3-year success rate after a single procedure was 54.1% in LSPAF, compared to 72.4% in paroxysmal AF and 61.6% in SDPAF (LogRank - p < 0.0001 - figure 1). The risk of arrhythmic recurrence was 37% higher in patients with LSPAF comparing with other groups (HR 0.63 CI 95% 0.43-0.92, p 0.016). However after a mean of 1.17 procedures/patients, the success difference between groups was not detect (LogRank – p = 0.112 – figure 2). With additional ablation procedures (REDO), the success rate at 3 years was 82.9% LSPAF pts, compared 88.2% in paroxysmal AF pts and 83.6% in SDPAF pts. In LSPAF pts, different ablation techniques did not predict arrhythmic recurrence. Regarding comorbidities, higher prevalence of peripheral arterial disease (PAD, p = 0.005) a higher NT-proBNP (p = 0.006) and left auricular volume (p = 0.045) were associated with arrhythmic relapse. Conclusions AF ablation is more effective when performed earlier in the natural history of the disease. However, even in LSPAF pts, with additional procedures an acceptable rate of success can be achieve, independently from the ablation techniques. Abstract Figures 1 and 2: Success of AF ablation

scholarly journals Generation and Evaluation of Isogenic iPSC as a Source of Cell Replacement Therapies in Patients with Kearns Sayre Syndrome

Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 568
Author(s):  
Glen Lester Sequiera ◽  
Abhay Srivastava ◽  
Keshav Narayan Alagarsamy ◽  
Cheryl Rockman-Greenberg ◽  
Sanjiv Dhingra
Keyword(s):  
Mononuclear Cells ◽  
Therapeutic Option ◽  
Reactive Oxygen Species Generation ◽  
Energy Deficit ◽  
Patient Specific ◽  
Multisystem Disorder ◽  
Differentiation Potential ◽  
Cell Replacement ◽  
Mtdna Mutations ◽  
Kearns Sayre Syndrome

Kearns Sayre syndrome (KSS) is mitochondrial multisystem disorder with no proven effective treatment. The underlying cause for multisystem involvement is the energy deficit resulting from the load of mutant mitochondrial DNA (mtDNA), which manifests as loss of cells and tissue dysfunction. Therefore, functional organ or cellular replacement provides a promising avenue as a therapeutic option. Patient-specific induced pluripotent stem cells (iPSC) have become a handy tool to create personalized cell -based therapies. iPSC are capable of self-renewal, differentiation into all types of body cells including cardiomyocytes (CM) and neural progenitor cells (NPC). In KSS patients, mutations in mtDNA are largely found in the muscle tissue and are predominantly absent in the blood cells. Therefore, we conceptualized that peripheral blood mononuclear cells (PBMNC) from KSS patients can be reprogrammed to generate mutation free, patient specific iPSC lines that can be used as isogenic source of cell replacement therapies to treat affected organs. In the current study we generated iPSC lines from two female patients with clinical diagnosis of classic KSS. Our data demonstrate that iPSC from these KSS patients showed normal differentiation potential toward CM, NPC and fibroblasts without any mtDNA deletions over passages. Next, we also found that functional studies including ATP production, reactive oxygen species generation, lactate accumulation and mitochondrial membrane potential in iPSC, CM, NPC and fibroblasts of these KSS patients were not different from respective cells from healthy controls. PBMNCs from these KSS patients in the current study did not reproduce mtDNA mutations which were present in muscle biopsies. Furthermore, we demonstrate for the first time that this phenomenon provides opportunities to create isogenic mutation free iPSC with absent or very low level of expression of mtDNA deletion which can be banked for future cell replacement therapies in these patients as the disease progresses.

Clinical outcome of non-use of touch-up focal ablation catheters strategy during cryoballoon atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Matsunaga ◽  
Y Egami ◽  
M Yano ◽  
M Yamato ◽  
R Shutta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcome ◽  
Pulmonary Veins ◽  
Conventional Group ◽  
Atrial Tachyarrhythmia ◽  
Free Survival ◽  
Af Ablation ◽  
Frequent Use ◽  
Class 1 ◽  
Focal Ablation

Abstract Background It has been reported that frequent use of touch-up focal ablation catheters was related to worse outcomes after cryoballoon (CB) atrial fibrillation (AF) ablation. It is unknown whether non-use of touch-up focal ablation catheters strategy affects the outcome of AF ablation. Therefore, this study aimed to assess whether non-use of touch-up focal ablation catheters strategy improve clinical outcome after AF ablation using CB. Methods A total of 151 consecutive patients who received CB ablation from February 2017 to August 2019 were enrolled. Non-use of a touch-up focal ablation catheters strategy was started from February 2018. Patients were divided into 2 groups according to the type of strategy. In the non-touch-up group, pulmonary veins were isolated without touch-up focal ablation catheters as much as possible and in conventional group, touch-up focal ablation catheters were used as required. The 1-year atrial tachyarrhythmia free survival without class 1 or 3 antiarrhythmic drugs after a 90-day blanking period was assessed between the 2 groups. Results The conventional group consisted of 76 patients and the non-touch-up group consisted of 75 patients. Baseline characteristics were comparable between 2 groups. Touch-up focal ablation catheters were used more in the conventional group (11 patients, 14%) than non-touch-up group (0 patients, 0%) (p<0.001). Pulmonary isolation was achieved in all patients of both groups. Atrial tachyarrhythmia recurrence occurred more frequently in the non-touch-up group (15/75 patients, 20%) than conventional group (7/76 patients, 9%) (p=0.045). Conclusion Non-use of a touch-up focal ablation catheters strategy may be related to worse outcome after CB AF ablation. Funding Acknowledgement Type of funding source: None

Abstract WP374: Implementation of the Stroke Transition Discharge Center Improves 30-day Readmission Rate

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susan Quimby ◽  
Javicia Peterson-Cole
Keyword(s):  
Readmission Rate ◽  
Inverse Correlation ◽  
Signs And Symptoms ◽  
Patient Specific ◽  
Readmission Rates ◽  
Hospital System ◽  
Practice Nurses ◽  
Time Period ◽  
Number Of Patients ◽  
Discharge Center

Background: Stroke patients and their caregivers require formalized education, medications, testing and rehabilitation to assist in prevention of recurrence and of post-stroke complications for optimal outcomes. Objective: The purpose of this program was to evaluate the effect of the Stroke Transition Discharge Center (STDC) on stroke readmission. Methods: The Advanced Practice Nurses (APN) see all stroke and TIA patients one week after discharge from hospital to home or one week after discharge from rehab to home. During the hour encounter, the APN reviews medications, test results, signs and symptoms of stroke, complete education including patient specific risk factors and ensure appropriate follow up. The APN coordinates and facilitates multiple services and disciplines impacting the patient, assuring the most efficient and effective goal-directed activities are provided at the right time and in partnership with all other disciplines providing care. Results: Implementation of the STDC enhances patient outcomes and improves 30-day readmission rates. Prior to our intervention, the readmission rate was 15.3%. After the implementation of the STDC, there was a 61% reduction in 30-day readmission rates to 6%, which is significantly below the hospital system benchmark of 11%. There was an increase in the readmission rate in the first two quarters of 2016 noted. There is an inverse correlation with the number of patients seen in the STDC during the same time period. Further analysis demonstrates that only one readmission in this time period had been seen prior in the STDC. Conclusion: Implementing the Stroke Transition Discharge Center demonstrated a dramatic reduction in 30-day readmission rates. Our data suggests that utilization of the clinic and participation by the patients has a direct and inverse effect on readmissions. Further data will need to be collected to determine if this is a sustained response.

scholarly journals Epicardial Box Lesion Using Bipolar Biparietal Radiofrequency and Multimodality Scar Evaluation - a case series

2021 ◽  
Author(s):  
G P Bijvoet ◽  
S M Chaldoupi ◽  
E Bidar ◽  
R J Holtackers ◽  
J G L M Luermans ◽  
...  
Keyword(s):  
Pulmonary Veins ◽  
Case Series ◽  
Small Population ◽  
Surgical Ablation ◽  
Af Ablation ◽  
Surgical Tool ◽  
Atrial Remodelling ◽  
Magnetic Resonance Imaging Mri ◽  
Thoracoscopic Procedure

Abstract Background Surgical epicardial AF ablation can be performed as a stand-alone (thoracoscopic) procedure or concomitant to other cardiac surgery. In hybrid AF ablation thoracoscopic surgical epicardial ablation is combined with a percutaneous endocardial ablation. The Medtronic Gemini-S clamp is a surgical tool that uses irrigated bipolar biparietal RF energy applied with two clamp lesions that overlap to create one epicardial box lesion including the posterior LA wall and the pulmonary veins. Case summary We describe three patients with therapy-refractory persistent AF and different stages of atrial remodelling in whom the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System was used for hybrid AF ablation. Acute endocardial validation at the end of the hybrid ablation revealed a complete box lesion in all three cases. At 2-year follow-up, two out of three patients had recurrence of atrial arrhythmias. Invasive electro-anatomical mapping confirmed persistence of the box lesion, and the mechanism of arrhythmia recurrence in both patients was unrelated to posterior left atrium or the pulmonary veins. The third patient has been without arrhythmia symptoms since the ablation procedure. A 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) illustrates the ablation scar non-invasively in two cases. Discussion Thoracoscopic biparietal RF AF ablation with the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System results in permanent transmural scar formation, irrespective of the stage of atrial remodelling, as shown in this small population by means of multimodality scar evaluation.

Abstract 12471: Optimal Prediction of Atrial Fibrillation Recurrence After Ablation: A Computational Anatomy Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marta Varela ◽  
Felipe Bisbal ◽  
Ernesto Zacur ◽  
Esther Guiu ◽  
Antonio Berruezo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Complete Characterization ◽  
Statistical Shape Model ◽  
Patient Specific ◽  
Shape Variation ◽  
Global Features ◽  
Linear Discriminant ◽  
Af Ablation ◽  
Statistical Shape

Background: Left atrial structural remodelling, assessed by left atrial (LA) sphericity or antero-posterior diameter, has been shown to predict recurrence after atrial fibrillation (AF) ablation. The study aimed to perform a computational shape analysis of the LA to quantitatively characterise the LA shape remodelling process and identify metrics that optimally predict recurrence. Methods: Pre-procedural bright-blood MRIs of the LA of patients undergoing AF ablation were segmented. Patient-specific smooth 3D meshes were fitted to the segmentations. A statistical shape model of the LA was created and the global features underpinning the observed shape variation extracted as principal components (PCs). PCs were optimally combined to create non-empirical atlas-based metrics using linear discriminant analysis. Meshes depicting mean and extreme recurrent and non-recurrent LA shapes were also synthetized. The capability of different metrics to predict recurrence was evaluated using the area under the ROC curve (AUC) of a leave 1 out cross validation test. Results: In total, 111 patients were included. At 12 months follow-up, LA sphericity was the best predictor of recurrence (AUC: 0.66) over novel atlas-based metrics (AUC: 0.65). At 24 months, atlas-based metrics were the best predictors of recurrence (AUC: 0.66), outperforming a combination of sphericity and volume (AUC: 0.64), sphericity alone (AUC: 0.63) and any other traditional metric. Conclusions: Novel atlas-based metrics improve the prediction of recurrence at 2 years post-AF ablation. They allow a more complete characterization of the LA shape remodelling process, for example by allowing the synthesis of recurrent and non-recurrent LA shapes, which may contribute to patient stratification for AF ablation.

Abstract 16237: Zero Fluoroscopy Ablation of Atrial Fibrillation: A Safety and Feasibility Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Rodney Horton ◽  
Chintan Trivedi ◽  
Prasant Mohanty ◽  
Sanghamitra Mohanty ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Radiation Risk ◽  
Control Group ◽  
Short Term ◽  
Af Ablation ◽  
And Control ◽  
Zero Fluoroscopy

Introduction: Radiofrequency catheter ablation of atrial fibrillation is performed under fluoroscopic guidance and therefore carries radiation risk exposure for the both the patient and the operator. Three-dimensional mapping systems and newer technologies to allow non-fluoroscopic catheter visualization together with intracardiac echo have reduced but not abolished the fluoroscopy exposure. We aim to demonstrate the feasibility, the safety and the efficacy of catheter ablation for atrial fibrillation without the use of fluoroscopy. Methods: A totally fluoro-less approach was developed for AF ablation at our Institution. 94 consecutive AF patients underwent zero fluoroscopy catheter ablation for atrial fibrillation. In the zero fluoroscopy cases, the fluoroscopy arm was kept far away from the patient table. Access including double trans-septal, mapping with the Carto 3 system and ablation were all performed without fluoroscopy with the use of ICE and the Carto 3 system. These 94 patients were compared with 94 control patients matched for age, sex and type of AF who underwent AF ablation by the same operator with the use of fluoroscopy. Results: Baseline characteristics were similar between fluoroless (N=94, Age=64.5 ± 10.1, 75.5% male, 48% paroxysmal) and control (N=94, Age=65.1 ± 9.9, 72.3% male, 50% paroxysmal) group. Non-PV triggers were detected and ablated in 51 (54.3%) and 56 (59.6%) patients in fluoroless and control group respectively (p=0.5). Average fluoro time in control group was 10.1 ± 4.7 minutes. Procedure duration was comparable (120.4 ± 25.8 vs. 122.2 ± 28.7, p =0.6). After the short term median follow-up of 4.5 (4 – 6.5) months, 10 (10.6 %) patients in flourless and 9 (9.6%) patients in control group experienced recurrences (p=0.8).One pericardial effusion requiring pericardiocenteis occurred in the fluoroless group. Conclusions: Our series show that zero fluoroscopy ablation of atrial fibrillation with the use of newer technologies is feasible, safe and efficacious at the short term follow up. Importantly in our series the double transeptal was performed without fluoroscopy and the ablation was not limited to the pulmonary veins only but included ablation of the posterior wall, the coronary sinus and the left atrial appendage.

Abstract 4653: Isolation Of Pulmonary Veins Using A Novel Decapolar Catheter For Mapping And Ablation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Stefan Weber ◽  
Sabine Fredersdorf ◽  
Clemens Jilek ◽  
Norbert Heinicke ◽  
Carsten Jungbauer ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
High Volume ◽  
Procedure Time ◽  
Ablation Procedure ◽  
Catheter Position ◽  
3D Navigation ◽  
Af Ablation ◽  
Ablation Success ◽  
Increasing Demand

Background: Ablation of atrial fibrillation (AF) is one of the most time consuming procedures in interventional electrophysiology. Currently, the selection of catheters and ablation techniques is still a matter of debate. Due to the rapidly increasing demand of ablation procedures, technical advances would be helpful to reduce complexity and procedure time in AF ablation. Therefore we investigated the feasibility of a novel decapolar ablation catheter (PVAC) combined with a duty-cycled, low-power RF generator for pulmonary vein (PV) isolation. The system does not require 3D mapping and is the first to enable mapping, pacing and circular as well as segmental ablation with a single catheter. Methods: AF mapping and ablation was performed in 15 consecutive patients with intermittent AF (mean age 58±12 years, 6 males) using the PVAC- catheter. To visualize the pulmonary vein anatomy, CT or MRI scan was performed in addition to PV angiography before ablation procedure. Additionally all patients underwent transesophageal echocardiography to rule out left atrial (LA) thrombi. Ablation procedure was performed by introducing the PVAC to the LA via single transseptal puncture. An optimal and stable catheter position for mapping and ablation was achieved by using a steerable sheath and an over the wire technique. RF energy was typically delivered for 60s for circular and 30 to 60s for segmental ablations. Ablation success was defined by disappearance of PV signals and complete exit block obtained by PVAC stimulation. Results: Isolation of all four PVs could be achieved in 59/60 veins (98%). A very small and hypoplastic right inferior PV could not be reached. The median RF application time until all PV were isolated successfully was 23±7 min. First half of ablations were performed by circular RF application, second half with segmental applications until isolation. Procedure time for ablation was 81±14 min. Total fluoroscopy time was 31±9 min. There were no procedural complications. Conclusion: Mapping and ablation of pulmonary veins can be performed safe and fast, with low procedure times using a single catheter without 3D navigation or assisted steering. Thus this system may be of high interest not only for high volume but all centers performing AF ablation.

Vorhofflimmern: Wie wichtig ist der Erhalt des Sinusrhythmus?

2020 ◽  
Vol 145 (08) ◽  
pp. 543-549
Author(s):  
Christian Meyer ◽  
Andreas Metzner ◽  
Paulus Kirchhof
Keyword(s):  
Quality Of Life ◽  
Antiarrhythmic Drugs ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Af Ablation ◽  
Stroke Risk Factors ◽  
Control Therapy ◽  
Rhythm Stability

AbstractRhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. AF ablation maintains sinus rhythm more effectively than antiarrhythmic drug therapy. Antiarrhythmic drugs remain effective after AF ablation, underpinning the synergistic mechanisms of action of AF ablation and antiarrhythmic drugs. Different lifestyle interventions might additionally improve symptoms and rhythm stability in patients with AF. AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis.

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