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. 

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.

scholarly journals Complications of Cryoballoon Pulmonary Vein Isolation

2019 ◽  
Vol 8 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Shinsuke Miyazaki ◽  
Hiroshi Tada
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
First Generation ◽  
Standard Technique ◽  
Collateral Damage ◽  
Efficacy And Safety ◽  
The World

Since the cryoballoon (CB) was introduced into clinical practice, more than 400,000 patients have undergone a pulmonary vein (PV) isolation with a CB throughout the world. Although the efficacy of the first-generation CB was limited, the recently introduced secondgeneration CB has achieved a greater uniformity in cooling, which has facilitated a shorter time to PV isolation, shorter procedural times, higher rates of freedom from atrial fibrillation and low rates of PV reconnections. Currently, a single short freeze strategy with a single 28 mm balloon has become the standard technique based on the balance of procedural efficacy and safety. However, enhanced cooling characteristics may also result in a greater potential for collateral damage to non-cardiac structures. Knowledge about the potential complications is essential when performing the procedure. In this article, we describe the important complications that should be noted during a CB procedure, and how to minimise the risk of complications based on our experience.

Abstract 2755: Increased Efficacy of Catheter Ablation Of Atrial Fibrillation by Using Adenosine to Reveal Dormant Pulmonary Vein Conduction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Laurent Macle ◽  
Atul Verma ◽  
Paul Novak ◽  
Paul Khairy ◽  
Mario Talajic ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Af Ablation ◽  
Dormant Conduction ◽  
Af Recurrence

Recurrences of atrial fibrillation (AF) after catheter ablation are frequently associated with recovery of conduction between the pulmonary veins (PV) and the atrium. The recovery of PV conduction could be explained by the presence of dormant conduction between the PV and the atrium. Adenosine can be used during AF ablation procedures to reveal transient re-conduction of the isolated pulmonary vein (dormant PV conduction). We prospectively evaluate the utility of iv adenosine to guide elimination of dormant PV conduction by additional radiofrequency (RF) applications during AF ablation procedures. Thirty-four consecutive patients (30 male; age 51+/−8 years) referred for catheter ablation of drug-refractory AF (Paroxysmal 31/Persistent 3) were studied. Electrical PV isolation (PVI) was performed using Irrigated-tip radiofrequency (RF) ablation and was guided by a circular mapping catheter. After PVI, the presence of dormant conduction in each vein was assessed by injection of 12 mg of adenosine. If dormant conduction was present, additional RF energy was delivered at sites of transient re-conduction. Abolition of the dormant conduction was then demonstrated by repeated injections of adenosine. The recurrence rate of arrhythmia after one procedure was evaluated. The results were compared to an historical control group comprising the previous 34 consecutive patients who underwent PVI without the use of adenosine. Electrical PVI was achieved in 100% of PV’s and all 34 patients underwent the adenosine evaluation. Dormant PV conduction was observed in 17/34 patients and could be eliminated in all by additional RF delivery. Procedural and fluoroscopy times were 163±30 and 49±13 minutes, respectively. After a mean follow-up of 8.0±3.1 months, 6/34 (18%) patients experienced AF recurrence with 28/34 (82%) remaining free of arrhythmia without the use of antiarrhythmic drugs. When compared to the 14/34 patients (41%) from the historical control group who had AF recurrence, a significant reduction was observed (P<0.01). The use of adenosine to guide elimination of dormant PV conduction increases the success rate of AF ablation procedures. This needs to be evaluated in a randomized multicenter trial.

scholarly journals Healthcare utilization and outcomes in atrial fibrillation ablation patients with and without insertable cardiac monitoring

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.C Mansour ◽  
E.M Gillen ◽  
A Garman ◽  
S Rosemas ◽  
P.D Ziegler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Healthcare Utilization ◽  
Cardiac Monitoring ◽  
Funding Source ◽  
Detection Rates ◽  
Af Ablation ◽  
Af Recurrence ◽  
Clinic Visits

Abstract Background Atrial fibrillation (AF) is associated with increased risk of stroke and progression to heart failure, and as a result, increased mortality. Catheter ablation can reduce AF burden, potentially allowing discontinuation from anticoagulant medication in some patients. Post ablation, guidelines recommend ECG monitoring in patients discontinuing anticoagulation to monitor potential AF recurrence. Short-term ECG monitors have lower detection rates for AF recurrence, while long-term insertable cardiac monitors (ICM) increase detection rates and the opportunity to manage and treat AF, when it recurs. Whether more intensive monitoring via ICMs translates to improvements in health outcomes or reduced costs is not well understood. Purpose We examined healthcare utilization/costs and anticoagulant discontinuation following AF ablation, in patients with vs. without ICM. Methods Patients with a catheter ablation for AF between January 1, 2011 - March 31, 2018 were identified in a large U.S. administrative claims database. Patients with ICM implant within 1 year pre- or post-ablation were propensity score matched to patients without ICM, based on: demographics, comorbidities, CHAD2S2-VASc score, medication use and healthcare costs in baseline. Results A total of 691 ICM patients were identified and matched 1:3 with 2,073 non-ICM patients. Mean age was 65 years, 38% were female, and mean (SD) CHAD2S2-VASc was 2.29 (1.53). During an average follow-up from ablation discharge of 37 (19) months, ICM patients incurred fewer AF- and HF-related hospitalizations: mean 0.51 (0.91) vs. 0.62 (1.56) AF-related, p=0.018, and 0.14 (0.48) vs. 0.24 (1.30) HF-related hospitalizations per patient, p=0.00. Correspondingly, average per-patient costs for AF- and HF-related hospitalizations were lower in the ICM cohort: $13,041 ($30,831) vs. $17,140 ($55,576), p=0.016 and $3,921 ($17,865) vs. $6,746 ($33,148), p=0.005. The ICM cohort had a greater number of AF-related clinic visits during follow-up: 14.2 (13.0) vs. 10.2 (11.7) visits per patient, p&lt;0.0001. The proportion of patients undergoing a repeat AF ablation during follow-up was higher in the ICM cohort (22.3% vs. 18.3%, P&lt;0.0001), while the proportion with cardioversions was lower (21.0% vs. 25.1%, p=0.031). In patients indicated for anticoagulation (CHAD2S2-VASc≥2), the rate of anticoagulant discontinuation (defined as gap in coverage ≥90 days) was high in both cohorts: 89.5% and 84.6% of patients in ICM and non-ICM groups, respectively. Conclusions AF ablation patients with ICM experienced fewer AF- and HF-related hospitalizations/costs and fewer cardioversions during follow-up. The greater number of AF-related clinic visits and repeat AF ablations observed in ICM patients indicate closer management. Of note, anticoagulant discontinuation was similarly high in the non-ICM cohort despite guidelines recommending rigorous cardiac monitoring for AF recurrence in the context of discontinuation. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic

P985The long-term impact of maintaining sinus rhythm on the risk for death or heart failure after catheter ablation for atrial fibrillation in a real world clinical practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Yoshizawa ◽  
H Shiomi ◽  
M Tanaka ◽  
T Aizawa ◽  
S Yamagami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
P Value ◽  
Af Ablation ◽  
Risk Of Death ◽  
The Impact ◽  
Af Recurrence

Abstract Background Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated. Purpose To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization. Methods The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation. Results Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P<0.001). After adjusting for baseline confounders, the lower risk of SR-group relative to AF-group for death or HF was still statistically significant (HR: 2.05, 95% CI: 1.11–3.58, P=0.02). Risks for a Composite of Death or HF Hazard Ratio (95% CI) Crude HR P value Adjusted HR P value AF recurrence 2.59 (1.43–4.43) 0.002 2.05 (1.11–3.58) 0.02 Age>75 years old 2.55 (1.56–4.10) <0.001 2.32 (1.39–3.81) 0.002 Female 0.85 (0.49–1.43) 0.56 0.73 (0.40–1.25) 0.26 PeAF 1.25 (0.68–2.16) 0.45 0.98 (0.52–1.75) 0.94 LSAF 1.10 (0.46–2.23) 0.82 0.70 (0.28–1.53) 0.39 LVEF>50% 0.27 (0.16–0.48) <0.001 0.57 (0.31–1.09) 0.09 Past history of HF 7.06 (4.18–11.6) <0.001 4.67 (2.51–8.41) <0.001 CKD 4.74 (2.08–9.39) <0.001 2.23 (0.94–4.69) 0.07 AF, Atrial fibrillation; PeAF, Persistent AF; LSAF; Long standing AF; HF, Heart failure; CKD, Chronic kidney disease. Figure 1 Conclusions Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.

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.

scholarly journals Factors associated with the efficacy of atrial fibrillation radiofrequency catheter ablation: opinion of the specialists who use the “Ablation Index” module

2021 ◽  
Vol 28 ◽  
pp. 3-16
Author(s):  
E. N. Mikhaylov ◽  
N. Z. Gasimova ◽  
S. A. Ayvazyan ◽  
E. A. Artyukhina ◽  
G. A. Gromyko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Efficacy And Safety ◽  
Web Based ◽  
Electronic Survey ◽  
Factors Associated ◽  
Ablation Index

This document provides an overview of current problems and trends in the catheter ablation of atrial fibrillation, summarizes the opinions of specialists, obtained during a web-based electronic  survey, on aspects and parameters of radiofrequency ablation. The  approaches on improving the efficacy and safety of radiofrequency  catheter ablation of atrial fibrillation are provided. 

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