scholarly journals Using adenosine triphosphate in catheter radiofrequency pulmonary vein isolation: does elimination of “dormant” atriovenous conduction really allow to refine long-term results?

2017 ◽  
Vol 21 (4) ◽  
pp. 23
Author(s):  
Y. S. Krivosheev ◽  
D. I. Bashta ◽  
A. A. Simonyan ◽  
T. A. Myznikova ◽  
Z. A. Mishodzheva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Adenosine Triphosphate ◽  
Conflict Of Interest ◽  
Pulmonary Veins ◽  
Prognostic Significance ◽  
Long Term Results ◽  
Data Collection And Analysis ◽  
Critical Revision

<p>This literature review looks at the efficacy of removing “dormant” atriovenous conduction, which can be identified by means of intravenous ejection of adenosine triphosphate following catheter isolation of pulmonary vein ostia in patients with atrial fibrillation. The incidence of detecting conduction “breakthroughs” in the ablation lines when carrying out drug tests after isolation of pulmonary veins, as well as the prognostic significance of this phenomenon for atrial fibrillation recurrence are evaluated. Also assessed are drawbacks and limitations of the studies looking at the possibility of improving the efficiency of catheter ablation of atrial fibrillation by combining the removal of “dormant” atriovenous conduction zones identified by adenosine triphosphate testing and the ablation of ganglionated plexi.</p><p>Received 10 April 2017. Accepted 23 October 2017.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: Y.S. Krivosheev, V.N. Kolesnikov.<br />Data collection and analysis: Y.S. Krivosheev, D.I. Bashta.<br />Drafting the article: Y.S. Krivosheev, A.A. Simonyan.<br />Critical revision of the article: V.N. Kolesnikov.<br />Final approval of the version to be published: Y.S. Krivosheev, D.I. Bashta, A.A. Simonyan, T.A. Myznikova, Z.A. Mishodzheva, V.N. Kolesnikov.</p><p> </p>

Abstract 2753: The Relationship Between Pulmonary Vein Antrum Scarring Following Atrial Fibrillation Ablation and Procedural Success: Does Pulmonary Vein Isolation Matter?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Troy J Badger ◽  
Robert S Oakes ◽  
Akram Shabaan ◽  
Nazem W Akoum ◽  
Nathan M Segerson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Posterior Wall ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Procedural Success ◽  
The Relationship ◽  
Af Recurrence

Background. A mechanism of atrial fibrillation (AF) recurrence following ablation may be incomplete pulmonary vein antrum (PVA) scarring that allows for conduction between the pulmonary veins (PV) and the left atrium (LA). We report the relationship between circumferential PV scarring detected by delayed enhancement MRI (DE-MRI) and AF recurrence following PVAI. Methods. Eighty-six patients presenting for PVAI underwent DE-MRI 3 months post ablation. Circumferential ablation with posterior wall debulking was performed in all patients. PV ostia were marked on 3D images generated from the MRI data and assessed by consensus of two independent reviewers for the extent of scarring. Complete PVA scarring was defined as a continuous ring of enhancement surrounding the PVA. For patients with incomplete scarring, the degree of scarring was estimated. Results. The figure shows two patients from the cohort, Patient 1 exhibits successful scarring of all PVA. Patient 2 shows scarring of 1 PVA. At three months post ablation, complete circumferential lesion was seen on 131/335 PVA (39.1%). Complete scarring of 4 PVA was seen in 9 patients (10.5%), scarring of 3 PVA in 11 patients (12.8%) and scarring of 2 PVA was seen in 17 patients (19.8). Twenty-nine patients (33.7%) exhibited complete scarring in 1 PVA while 20 patients (23.3%) exhibited scarring in 0 PVA. Kaplan Meier analysis (Figure [E] ), suggests that PVA isolation may be important for long-term procedural success. Conclusion: Complete pulmonary vein antrum scarring exists in a very limited number of patients, despite its apparent importance for long-term procedural success.

scholarly journals High-Power, Short-Duration Ablation in the Treatment of Atrial Fibrillation Patients

2021 ◽  
Author(s):  
Nándor Szegedi ◽  
László Gellér
Keyword(s):  
Atrial Fibrillation ◽  
Short Duration ◽  
High Power ◽  
Pulmonary Veins ◽  
Long Term Results ◽  
Control Treatment ◽  
Technical Developments ◽  
Radiofrequency Lesions ◽  
Two Phases

Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI.

scholarly journals Neocuspidization of the aortic valve

2021 ◽  
Vol 25 (2) ◽  
pp. 11
Author(s):  
B. K. Kadyraliev ◽  
V. B. Arutyunyan ◽  
I. I. Chernov ◽  
A. H. Umarov ◽  
K. Yu. Zhigalov ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Conflict Of Interest ◽  
Low Cost ◽  
Long Term Results ◽  
Final Approval ◽  
Ideal Approach ◽  
Valve Reconstruction ◽  
Critical Revision ◽  
The Ideal

<p>Aortic valve reconstruction remains the ideal approach to treat aortic valve disease, with an aim to increase durability and prevent anticoagulation. Owing to its availability, handling ease, and low cost, autopericardium has been regularly used since the early days of cardiac surgery. Many of these methods have not been standardized yet and are underutilized. One method with promising long-term results is neocuspidization of the aortic valve, as described by Ozaki using glutaraldehyde-fixed autopericardium. Neocuspidization of the aortic valve includes valve prosthetics with its own pericardium. We performed a literature review on aortic valve neocuspidization.</p><p>Received 13 October 2020. Revised 6 November 2020. Accepted 11 November 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: B.K. Kadyraliev, V.B. Arutyunyan, I.I. Chernov, A.H. Umarov, K.Yu. Zhigalov, A. Weymann, S.T. Enginoev<br />Drafting the article: B.K. Kadyraliev, V.B. Arutyunyan, S.T. Enginoev<br />Critical revision of the article: V.B. Arutyunyan, A.H. Umarov, S.T. Enginoev<br />Final approval of the version to be published: B.K. Kadyraliev, V.B. Arutyunyan, I.I. Chernov, A.H. Umarov, K.Yu. Zhigalov, <br />A. Weymann, S.T. Enginoev</p>

Common ostium of the left pulmonary veins – to freeze or not to freeze – that was the question?

2017 ◽  
Vol 4 (45) ◽  
pp. 33-34
Author(s):  
Michał Orczykowski
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Clinical Results ◽  
Common Pulmonary Vein

Second-generation cryoballoon (CB2) - based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Nevertheless, the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV) are still a matter of debate. Commented paper by Heeger ChH, et al. analyzes this issue with some practical conclusions.

scholarly journals Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O H M A Riad ◽  
T Wong ◽  
A N Ali ◽  
M T Ibrahim ◽  
M A Abdelhamid ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p &lt; 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

scholarly journals Arrhythmia Termination During Radiofrequency Delivery Improves Outcomes after Catheter Ablation for Persistent and Long Standing Persistent Atrial Fibrillation

2021 ◽  
Vol 31 (2) ◽  
pp. 335-342
Author(s):  
Alexandrina NASTASA ◽  
Corneliu IORGULESCU ◽  
Stefan BOGDAN ◽  
Silvia DEACONU ◽  
Stefan PETRE ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Atrial Tachycardia ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Long Term Results ◽  
Electrical Shock ◽  
Overdrive Pacing

Background: Achieving long-term successful outcomes with catheter ablation (CA) of persistent atrial fi brillation (PsAF) remains a challenge. Multiple attempts to determine effective ablation strategies besides the pulmonary veins (PV) were made but, so far, there is no agreed standard approach and no clear consensus as to which is the best one. Among the most frequently used techniques was ablation of complex atrial fractionated electrograms (CFAE) but studies showed contradictory results. The optimal procedural endpoint also needs further refi nement. Objectives: We sought to evaluate outcomes in regard to patient characteristics and procedural termination. We also aimed to assess whether continuation of antiarrythmic therapy in the blanking period (1 to 3 months after the procedure) influences long term results. Methods: We enrolled consecutive patients with persistent and long-standing PsAF (LS-PsAF) who underwent one or more radiofrequency catheter ablations (RF CA) - pulmonary vein antral isolation (PVAI), followed by CFAE or resultant atrial tachycardia/flutter elimination, were retrospectively analyzed. Procedural objective was tachyarrhythmia (AF or resultant atrial flutters/tachycardias) termination (TT) to sinus rhythm (SR) during RF delivery. If after extensive substrate based or activation guided ablation sinus rhyhtm was not restored, conversion was performed with antiarrhythmic drugs (AAD), overdrive pacing or electrical shock. Screening for arrhythmia recurrence was performed via clinical interview and 48 hours Holter monitoring at 1,3 and 6 months and then every 6 months. Results: The cohort included 94 patients (age 54.5±11.4, 67 (71%) males, CHADSVASc 2.3±2, 11 (12%) LS-PsAF) Acute restoration of sinus rhythm (SR) was achieved in 93.4% of the cases, 43% by ablation of CFAE or resultant atrial tachycardia/fl utter(AT/AFL), 36.2% by electric cardioversion, 7.4% by chemical conversion, 3.1 % overdrive pacing, 3.7 % spontaneuous / mechanical. The long term success rate after a mean of 1.7±0.8 procedures was 59% at a mean follow-up period of 80±28 months. Freedom from AF was significantly higher when arrhythmia termination was obtained during RF delivery (p – 0.003). Short-term use of AAD in the blanking period did not lead to improved long term outcomes. Conclusions: In patients with PsAF and LS-PsAF restoration of sinus rhyhtm during RF delivery for pulmonary vein isolation, ablation of CFAE or resultant atrial tachyarrhythmia predicts long term procedural success. Further research to determine the best strategy to achieve this outcome is necessary.

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