scholarly journals The Convergent Procedure – A Standardised and Anatomic Approach Addresses the Clinical and Economic Unmet Needs of the Persistent Atrial Fibrillation Population

2013 ◽  
Vol 2 (2) ◽  
pp. 145 ◽  
Author(s):  
James McKinnie ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Option ◽  
Patient Population ◽  
Treatment Options ◽  
Structural Heart Disease ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Management Approach ◽  
Success Rates

A standardised treatment management approach is needed to address the escalating worldwide prevalence of atrial fibrillation (AF). The persistent and longstanding persistent AF patient population particularly needs this standardised treatment option to manage their AF. These patients have underlying structural heart disease that result in increased hospitalizations, long-term medical management that increases the cost burden of the healthcare system. Approximately 100 patients have undergone the Convergent Procedure at our center since its introduction 2 years ago, as a treatment option for AF patients. The epicardial and endocardial ablation procedures performed sequentially in a single setting has shown a single procedure success rate of 80%, similar to published success rates at other centers. The epicardial posterior wall isolation silences a majority of known substrates and the endocardial procedure completes the pulmonary vein isolation, creates the cavotricuspid line and provides diagnostic confirmation. The Convergent Procedure should be considered as a first line treatment option for the persistent and longstanding persistent AF patient population who have very limited or no treatment options for the long-term successful management of their AF.

Abstract 16416: Non PV Triggers Ablation Improves the Success Rate of Catheter Ablation of Persistent Atrial Fibrillation After a Single Procedure: Results From a Prospective Multicenter Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Luigi Di Biase ◽  
Chintan Trivedi ◽  
Prasant Mohanty ◽  
Sanghamitra Mohanty ◽  
Rong Bai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Single Procedure ◽  
Group I ◽  
Group Ii

Introduction: Catheter ablation of persistent atrial fibrillation (AF) has a lower success rate when compared to paroxysmal AF patients. Whether in persistent AF patients ablation of the pulmonary vein antrum and posterior wall is sufficient to achieve long term freedom from AF is debated in the literature. We investigated if the ablation on non pv triggers from first procedure in addition to PV and posterior wall(PW) isolation could improve the procedural success rate. Methods: 622 consecutive pts with persistent AF undergoing the first AF ablation were analysed and divided into 2 groups according to their ablation strategy. In group 1, pulmonary vein plus posterior wall ablation was performed (n=203) while in group 2 pulmonary veins plus posterior wall plus sustained and non sustained non pv triggers as disclosed by isoproterenol challenge were ablated. (n=419). All patients were followed up with intensive holter and event monitoring. Results: Clinical baseline characteristics were not statistically different between groups. After 17.8 ± 8.8 months follow-up, 118(58.1%) Group I and 283 (67.5%) Group II patients were free from any atrial tachyarrhythmias (log-rank p= 0.027). After adjusting for age, gender and clinically relevant variables, PVI and PW ablation alone was associated with significantly high recurrence. (Hazard ratio: 1.4, 95% Confidence Interval = 1.1– 1.8, p=0.02). Further, Group I patients undergoing redo procedure after a failed ablation had more NPV trigger Group II (80% vs 60%, p = 0.002, respectively, figure), while the number of patients with PV reconnection were similar between groups (65% vs. 64%, p=1.0). Conclusions: The results of our study shows that after a single procedure the ablation of non PV triggers, improves the long-term success rate in patients with persistent AF.

scholarly journals Cryoballoon Ablation for Persistent and Paroxysmal Atrial Fibrillation: Procedural Differences and Results from the Spanish Registry (RECABA)

2021 ◽  
Author(s):  
Ermengol Valles ◽  
Jesus Jimenez ◽  
Julio Martí-Almor ◽  
Jorge Toquero ◽  
Jose Ormaetxe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Structural Heart Disease ◽  
Persistent Atrial Fibrillation ◽  
Long Term Results ◽  
Cryoballoon Ablation ◽  
Arterial Line ◽  
Post Market

Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8±10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs 11.4%; p<0.001) and left atrium dilation (72.6 vs 43.3%; p<0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs 22.2%; p<0.001), with an arterial line (32.2 vs 44.6%; p<0.001) and assisted transeptal puncture (11.9 vs 17.9%; p=0.025). During an application, PeAF patients had a longer time to -30°C (35.91±14.20 vs 34.93±12.87 sec; p=0.021) and a colder balloon nadir temperature during vein isolation (-35.04±9.58 vs -33.61±10.32ºC; p=0.004), but received fewer bonus freeze applications (30.7 vs 41.1%; p<0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p=0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.

Cryoablation for persistent and longstanding persistent atrial fibrillation: results from a multicentre European registry

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 375-381 ◽  
Author(s):  
Vinit Sawhney ◽  
Richard J Schilling ◽  
Rui Providencia ◽  
Matthew Cadd ◽  
Dhanuka Perera ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Ambulatory Monitoring ◽  
Persistent Atrial Fibrillation ◽  
P Value ◽  
Success Rates ◽  
Long Term Follow Up ◽  
Randomised Control Trials

Abstract Aims Although cryoballoon pulmonary vein isolation is a well-established treatment for paroxysmal atrial fibrillation (AF), it’s role in persistent AF is unclear. We examined procedural success and long-term outcomes of cryoablation in persistent and longstanding persistent AF. Methods and results International multicentre registry from three UK and eight European centres. Consecutive patients undergoing cryoablation for persistent AF included. Procedural data, complications, and follow-up were prospectively recorded. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram with open access to arrhythmia nurses thereafter. Ambulatory monitoring was dictated by symptoms. Success was defined as freedom from AF or atrial tachycardia lasting &gt;30 s off antiarrhythmic drugs (AADs). Six hundred and nine consecutive cryoablation procedures. Mean procedure and fluoroscopy times were 95 ± 65 and 13 ± 10 min. Single procedure success rates were 368/602 (61%) off AADs over a median of 2.4 (1.0–4.0) years. Arrhythmia-free survival off AADs was 64% and 57% for persistent and longstanding persistent AF at 24 months of follow-up (P = 0.02). Rate of repeat ablations was 20% in persistent and 32% in longstanding persistent AF (P = 0.006). Cox regression analyses showed a significant association between duration of AF and left atrial diameter and arrhythmia recurrence [hazard ratio (HR) 1.05, P-value 0.01 and HR 1.02, P-value 0.004]. Conclusion Cryoablation for persistent AF is safe, fast and has good outcomes at long-term follow-up. Cryoablation is reasonable as a first line option for these patients. Short procedure times may help increase capacity of cardiac units to meet the rising demand for AF ablation. Randomised control trials are needed to compare outcomes with different techniques.

scholarly journals Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1176-1184 ◽  
Author(s):  
Arunashis Sau ◽  
Sayed Al-Aidarous ◽  
James Howard ◽  
Joseph Shalhoub ◽  
Afzal Sohaib ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Success Rates ◽  
Factors Affecting ◽  
Improved Outcomes ◽  
Linear Ablation ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Aims Ablation of persistent atrial fibrillation (PsAF) has been performed by many techniques with varying success rates. This may be due to ablation techniques, patient demographics, comorbidities, and trial design. We conducted a meta-regression of studies of PsAF ablation to elucidate the factors affecting atrial fibrillation (AF) recurrence. Methods and results  Databases were searched for prospective studies of PsAF ablation. A meta-regression was performed. Fifty-eight studies (6767 patients) were included. Complex fractionated atrial electrogram (CFAE) ablation reduced freedom from AF by 8.9% [95% confidence interval (CI) −15 to −2.3, P = 0.009). Left atrial appendage [LAA isolation (three study arms)] increased freedom from AF by 39.5% (95% CI 9.1–78.4, P = 0.008). Posterior wall isolation (PWI) (eight study arms) increased freedom from AF by 19.4% (95% CI 3.3–38.1, P = 0.017). Linear ablation or ganglionated plexi ablation resulted in no significant effect on freedom from AF. More extensive ablation increased intraprocedural AF termination; however, intraprocedural AF termination was not associated with improved outcomes. Increased left atrial diameter was associated with a reduction in freedom from AF by 4% (95% CI −6.8% to −1.1%, P = 0.007) for every 1 mm increase in diameter. Conclusion  Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes.

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 Electropathological Substrate of Long-Standing Persistent Atrial Fibrillation in Patients With Structural Heart Disease

2010 ◽  
Vol 3 (6) ◽  
pp. 606-615 ◽  
Author(s):  
Maurits A. Allessie ◽  
Natasja M.S. de Groot ◽  
Richard P.M. Houben ◽  
Ulrich Schotten ◽  
Eric Boersma ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Structural Heart Disease ◽  
Persistent Atrial Fibrillation

Abstract 16884: Evaluating the Effectiveness of Atrial Fibrillation Ablation Guided by Spatiotemporal Electrogram Dispersion

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Brian Liu ◽  
Arismendy Nunez-Garcia ◽  
Cao Tran ◽  
Michael Wu
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Tachycardia ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
External Validation ◽  
Posterior Wall ◽  
High Rate ◽  
Single Center Experience ◽  
The Mean

Introduction: Catheter ablation of atrial fibrillation (AF) guided by spatiotemporal dispersion (SD) of electrograms has been proposed as an ablation strategy to treat patients with persistent AF. However, external validation of this technique is lacking. Here we report a single center experience using ablation by SD. Hypothesis: Targeting regions with SD is associated with a high rate of termination and favorable freedom from AF among patients with persistent AF. Methods: Patients with persistent AF who underwent SD from November 2018 to January 2020 were included in this study. All patients underwent pulmonary vein isolation (PVI) in addition to targeting areas of SD. Lesions on areas of electrogram dispersion were anchored to the PVI or to mitral or posterior wall lines where appropriate. EKG, Holter, event monitors or device interrogations were obtained at 3 and 6 months to assess for arrhythmia recurrence. Results: 44 patients met the inclusion criteria and were included in the study. The patients had a mean age of 69±8 years and were 68 % male. The prevalence of comorbidities was as follows: hypertension (89%), diabetes (21%), OSA (37%) and CAD (26%). Average CHADSVASC score was 2.9±1.4, LVEF was 53±11% and left atrium (LA) diameter was 5.2±1 cm. The recurrence rate of AF at 6 months was 14% whereas the recurrence of atrial tachycardia was 20%. Acute AF termination was observed in 73% of the patients. Termination to sinus occurred in 38% of the patients and the remaining terminated to atrial tachycardia which was subsequently ablated to sinus. The mean procedure duration was 240±90 minutes. Univariate analysis showed recurrence was associated with LA diameter (r=.52; p<.001). No recurrences were observed among patients with a LA diameter < 5 cm. Termination rates were higher among patients with LA diameter < 5 cm when compared to LA diameter ≥ 5 cm. However, it did not reach statistical significance (80% vs. 60%; p=.21). Conclusions: The target of electrograms with SD during AF ablation added to PVI was associated with a high termination rate and a good freedom from AF recurrence at 6 months. The ideal candidate for this procedure may be those with LA diameter < 5 cm among persistent AF. The long-term efficacy of this technique merits further studies in larger populations.

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