scholarly journals Atrial Tachycardias After Atrial Fibrillation Ablation: How to Manage?

2020 ◽  
Vol 9 (2) ◽  
pp. 54-60
Author(s):  
Yuan Hung ◽  
Shih-Ann Chen ◽  
Shih-Lin Chang ◽  
Wei-Shiang Lin ◽  
Wen-Yu Lin
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Medical Therapy ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
Pharmacological Management ◽  
Af Ablation ◽  
Density Mapping ◽  
The Past ◽  
Atrial Remodelling

With catheter ablation becoming effective for non-pharmacological management of AF, many cases of atrial tachycardia (AT) after AF ablation have been reported in the past decade. These arrhythmias are often symptomatic and respond poorly to medical therapy. Post-AF-ablation ATs can be classified into the following three categories: focal, macroreentrant and microreentrant ATs. Mapping these ATs is challenging because of atrial remodelling and its complex mechanisms, such as double ATs and multiple-loop ATs. High-density mapping can achieve precise identification of the circuits and critical isthmuses of ATs and improve the efficacy of catheter ablation. The purpose of this article is to review the mechanisms, mapping and ablation strategy, and outcome of ATs after AF ablation.

Atrial tachycardias: focal and multifocal atrial tachycardias

ESC CardioMed ◽  
2018 ◽  
pp. 2070-2075
Author(s):  
Pierre Jaïs ◽  
Nicolas Derval
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
New Technologies ◽  
Atrial Fibrillation Ablation ◽  
Practical Approach ◽  
Density Mapping ◽  
Non Invasive ◽  
Mapping System ◽  
Surface Electrocardiogram

Atrial tachycardia (AT) is increasingly observed in patients, particularly in the context of atrial fibrillation ablation. The exact electrophysiological mechanisms are not easy to establish but a practical approach consists in distinguishing macroreentries from focal ATs as this is crucial for the ablation strategy. In centrifugal arrhythmias (such as focal AT and localized reentry), the activation originates from a source and spreads centrifugally to the rest of the atria, while in macroreentries, it follows a large path around a central obstacle and reenters. The analysis of the surface electrocardiogram is of limited value to predict the macroreentrant or focal nature of the arrhythmia. Antiarrhythmic drugs are usually tried first and in case of failure, catheter ablation is considered, with or without the support of a localization/mapping system. The most challenging cases are those with multifocal AT as they are poorly responsive to drugs, difficult to ablate, and arise in patients in poor medical conditions. New technologies such as high-density mapping and non-invasive mapping may facilitate the identification of mechanisms and target(s) for catheter ablation.

QT as a predictor of recurrence after atrial fibrillation ablation and the impact of amiodarone: results from the placebo-controlled AMIO-CAT trial

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1055-1062 ◽  
Author(s):  
Søren Zöga Diederichsen ◽  
Stine Darkner ◽  
Xu Chen ◽  
Arne Johannessen ◽  
Steen Pehrson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Qt Interval ◽  
Atrial Tachycardia ◽  
Cox Regression ◽  
Drug Discontinuation ◽  
Short Term ◽  
Af Ablation ◽  
Amiodarone Treatment ◽  
The Impact

Aims Prolonged corrected QT interval (QTc) might be associated with arrhythmia recurrence after atrial fibrillation (AF) ablation. The effect of short-term amiodarone in this setting remains unknown. This study seeks to quantify short-term amiodarone’s impact on QTc, and to investigate QTc and amiodarone treatment as predictors of recurrence of arrhythmia after ablation. Methods and results The Short-term AMIOdarone treatment after CATheter ablation for atrial fibrillation (AMIO-CAT) trial randomized patients to 8 weeks of oral amiodarone or placebo following AF ablation. Scheduled and symptom-driven 12-lead electrocardiography and 3-day Holter-monitorings were performed. The endpoint was atrial fibrillation, atrial flutter or atrial tachycardia (AF/AT) lasting >30 s. The cut-off for prolonged QTc was 450 ms for men and 460 ms for women. A total of 212 patients were included, of which 108 were randomized to amiodarone and 104 to placebo. From baseline to 1 month QTc in the amiodarone group increased by 27 (±30) ms, while at 6 months QTc had normalized. After 3-months of blanking, new AF/AT recurrence was detected in 63% of patients with prolonged QTc vs. 41% of patients with normal QTc at baseline, and in multivariate Cox regression, prolonged QTc was associated with AF/AT recurrence [hazard ratio (HR) 2.19, P = 0.023]. Among patients with baseline QTc below median, amiodarone treatment decreased the rate of AF/AT recurrences (HR 0.43, P = 0.008). Conclusions Amiodarone increased QTc with 27 ms compared to placebo, and this effect decreased rapidly after drug discontinuation. Prolonged QTc at baseline independently predicted AF/AT recurrence, and baseline QTc identified patients who would possibly benefit from short-term amiodarone following ablation.

scholarly journals FIRE AND ICE: The quest for the perfect modality in atrial fibrillation ablation

2016 ◽  
Vol 2016 (3) ◽  
Author(s):  
Mohamed Sayed ◽  
Mohamed ElMaghawry
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Randomized Trial ◽  
Atrial Fibrillation Ablation ◽  
Efficacy And Safety ◽  
Af Ablation ◽  
The World ◽  
Af Recurrence

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. Catheter ablation of atrial fibrillation plays an important role in the management of AF. Radiofrequency ablation is widely used in practice all over the world. Cryoablation has emerged as an alternative method for AF ablation. The FIRE and ICE trial was a non inferiority, multicentre, randomized trial that compared between the two modalities and proved cryoablation to be non inferior to radiofrequency in terms of efficacy and safety. However, the rate of AF recurrence was markedly high in both arms of the study. 

A new approach for catheter ablation of atrial tachycardia following atrial fibrillation ablation

2012 ◽  
Vol 13 (12) ◽  
pp. 795-804 ◽  
Author(s):  
Massimiliano M. Faustino ◽  
Donato Capuzzi ◽  
Tullio Agricola ◽  
Donatella Ciammetti ◽  
Piero Pecce ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation ◽  
New Approach

Catheter Ablation of Atrial Tachycardia Following Atrial Fibrillation Ablation

2009 ◽  
Vol 20 (7) ◽  
pp. 833-838 ◽  
Author(s):  
RUKSHEN WEERASOORIYA ◽  
PIERRE JAÏS ◽  
MATTHEW WRIGHT ◽  
SEIICHIRO MATSUO ◽  
SÉBASTIEN KNECHT ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Tachycardia ◽  
Atrial Fibrillation Ablation

Posterior circulation stroke: an easily overlooked complication of catheter ablation of atrial fibrillation

2020 ◽  
Vol 13 (8) ◽  
pp. e234661
Author(s):  
Tahir Nazir ◽  
Mohiuddin Sharief ◽  
James Farthing ◽  
Irfan M Ahmed
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Treatment Options ◽  
Posterior Circulation ◽  
Diagnosis And Treatment ◽  
Neurological Deficits ◽  
Cerebellar Infarction ◽  
Af Ablation ◽  
Posterior Circulation Stroke ◽  
Ventricular Response

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

scholarly journals Catheter-related complications and mortality of atrial fibrillation ablation following introduction of contact force-sensing technology

2020 ◽  
Vol 2 (1) ◽  
pp. e000058
Author(s):  
Joseph G Akar ◽  
James P Hummel ◽  
Xiaoxi Yao ◽  
Lindsey Sangaralingham ◽  
Sanket Dhruva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Care ◽  
Contact Force ◽  
Emergency Department Visits ◽  
Atrial Fibrillation Ablation ◽  
Esophageal Injury ◽  
Force Sensing ◽  
Complication Rates ◽  
Af Ablation ◽  
Complications And Mortality

ObjectivesContact force-sensing catheters allow real-time catheter-tissue contact force monitoring during atrial fibrillation. These catheters were rapidly adopted into clinical practice following market introduction in 2014, but concerns have been raised regarding collateral damage such as esophageal injury. We sought to examine whether the introduction of force-sensing catheters was associated with a change in short-term and intermediate-term acute care use, complications and mortality following atrial fibrillation ablation.DesignRetrospective cohort analysis. We used inverse probability treatment weight matching to account for the differences in baseline characteristics between groups.SettingWe examined patients included in the OptumLabs Data Warehouse who underwent ablation for atrial fibrillation before (2011–2013) and after (2015–2017) the market introduction of contact force-sensing catheters.Main outcome measuresWe examined 30-day and 90-day rates of all-cause acute care use, including hospitalizations and emergency department visits, as well as death and hospitalization for catheter-related complications, including atrioesophageal fistula, pericarditis, cardiac tamponade/perforation and stroke/transient ischemic attack.ResultsOur sample included 3470 and 5772 patients who underwent atrial fibrillation (AF) ablation before and after market introduction of contact force-sensing catheters, respectively. Complication rates were low and did not differ between the two periods (p>0.10 for each outcome). The 30-day and 90-day mortality was 0.1% and 0.3%, respectively after market introduction and unchanged from prior to 2014. The 90-day rates of all-cause acute care use decreased, from 27.0% in 2011–2013 to 23.9% in 2015–2017 (p<0.001).ConclusionsAF ablation-related catheter complications and mortality are low and there has been no significant change following the introduction of force-sensing catheters.

scholarly journals B-PO05-104 UTILITY OF ISOPROTERENOL INFUSION DURING CATHETER ABLATION OF ATRIAL FIBRILLATION: INSIGHTS FROM THE UC SAN DIEGO AF ABLATION REGISTRY

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S414
Author(s):  
Omar Mahmoud Aldaas ◽  
Douglas Darden ◽  
Praneet S. Mylavarapu ◽  
Frederick T. Han ◽  
Kurt S. Hoffmayer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
San Diego ◽  
Af Ablation ◽  
Isoproterenol Infusion

scholarly journals Randomized comparison between dexmedetomidine–remifentanil and midazolam–fentanyl for deep sedation during catheter ablation of atrial fibrillation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Young Choi ◽  
Sung-Hwan Kim ◽  
Ju Youn Kim ◽  
Youmi Hwang ◽  
Tae-Seok Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Positive Pressure ◽  
Efficacy And Safety ◽  
Af Ablation ◽  
Hemodynamic Compromise ◽  
3D Mapping System ◽  
Sedative Agents

Abstract Background and objectives The efficacy of dexmedetomidine for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has not been well established. We evaluated the efficacy and safety of sedation using dexmedetomidine with remifentanil compared to conventional sedative agents during RFCA for AF. Subjects and methods A total of 240 patients undergoing RFCA for AF were randomized to either the dexmedetomidine (DEX) group (continuous infusion of dexmedetomidine and remifentanil) or the midazolam (MID) group (intermittent injections of midazolam and fentanyl) according to sedative agents. Non-invasive positive pressure ventilation was applied to all patients during the procedure. The primary outcome was patient movement during the procedure resulting in a 3D mapping system discordance, and the secondary outcome was adverse events including respiratory or hemodynamic compromise. Results During AF ablation, the incidence of the primary outcome was significantly reduced for the DEX group (18.2% vs. 39.5% in the DEX and the MID groups, respectively, p < 0.001). The frequency of a desaturation event (oxygen saturation < 90%) did not significantly differ between the two groups (6.6% vs. 1.7%, p = 0.056). However, the incidences of hypotension not owing to cardiac tamponade (systolic blood pressure < 80 mmHg, 19.8% vs. 8.4%, p = 0.011) and bradycardia (HR < 50 beats/min: 39.7% vs. 21.8%, p = 0.003) were higher in the DEX group. All efficacy and safety results were consistent within the predefined subgroups. Conclusion The combined use of dexmedetomidine and remifentanil provides higher stability sedation during AF ablation, but can lead to more frequent hemodynamic compromise compared to midazolam and fentanyl.

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