scholarly journals Evaluatıon Of The Effect Of Pulmonary Veın Isolatıon Treatment With Left Atrıal Catheter Ablatıon Method On Atrıal Conductıon Tımes In Patıents With Paroxysmal Atrıal Fıbrıllatıon

2021 ◽  
Author(s):  
ibrahim dönmez ◽  
fatma erdem ◽  
tolga memioğlu ◽  
emrah acar
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Doppler Echocardiography ◽  
Left Atrial ◽  
Tissue Doppler ◽  
Tissue Doppler Echocardiography ◽  
Conduction Delay ◽  
Conduction Time ◽  
Rf Ablation ◽  
Interatrial Conduction

Purpose:Atrial fibrillation(AF) causes structural, electrical, and cellular remodeling in the atrium. Evaluation of intra- and interatrial conduction time, which is measured by tissue doppler echocardiography, indicates structural and electrical remodeling in the atrium. The aim of this study was to evaluate the effect of pulmonary vein isolation applied with RF ablation therapy on intra- and interatrial conduction time and to investigate the structural and electrically remodeling after treatment. Methods:Fifty-two patients with symptomatic PAF despite at least one antiarrhythmic drug and without structural heart disease were included in the study. Two patients were excluded because of complications developed during and after the operation. Fifty patients (28 female; mean age: 51.68 ± 11.731; mean left atrial diameter: 36.79 ± 4.318) who underwent CARTO® 3D pulmonary vein isolation applied with the RF ablation system were followed-up. Intra- and the inter-atrial electromechanical delay was measured in all patients by tissue doppler echocardiography before and three months after RF ablation. Results:All intra- and interatrial conduction times were significantly decreased 3 months after RF ablation procedure(PA lateral p = 0.022; PA septum p = 0.002; PA tricuspid p = 0.019, interatrial conduction delay p= 0,012, intra-atrial conduction delay p = 0.029). Conclusion:The results of our study suggest that providing stable sinus rhythm by the elimination of the AF triggering mechanisms with RF ablation of pulmonary vein isolation may slow down,stop or even improve structural remodeling at substrate level secondary to AF even in patients who did not yet develop atrial fibrosis and permanent structural changes.

scholarly journals Evaluation of the Effect of Pulmonary Vein Isolation Treatment With Left Atrial Catheter Ablation Method on Atrial Conduction Times in Patients With Paroxysmal Atrial Fibrillation

2021 ◽  
Author(s):  
Ibrahim Donmez ◽  
Fatma Hizal Erdem ◽  
Tolga Memioğlu ◽  
Emrah Acar
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Tissue Doppler ◽  
Conduction Delay ◽  
Conduction Time ◽  
Rf Ablation ◽  
Interatrial Conduction

Abstract PurposeAtrial fibrillation (AF) causes structural, electrical, and cellular remodeling in the atrium. Evaluation of intra- and interatrial conduction time, which is measured by tissue doppler echocardiography, indicates structural and electrical remodeling in the atrium. In the meta-analysis of the studies investigating rhythm control treatment strategy in paroxysmal atrial fibrillation; radiofrequency (RF) ablation has been shown to be superior over antiarrhythmics in ensuring and protecting sinus rhythm. The aim of this study was to evaluate the effect of pulmonary vein isolation applied with RF ablation therapy on intra- and interatrial conduction time and to investigate the structural and electrically remodeling after treatment.MethodsFifty-two patients with symptomatic PAF despite at least one antiarrhythmic drug and without structural heart disease were included in the study. Two patients were excluded because of complications developed during and after the operation. Fifty patients (28 female; mean age: 51.68 ± 11.731; mean left atrial diameter: 36.79 ± 4.318) who underwent CARTO® 3D pulmonary vein isolation applied with the RF ablation system were followed-up. Intra- and the inter-atrial electromechanical delay was measured in all patients by tissue doppler echocardiography before and three months after RF ablation. ResultsAll intra- and interatrial conduction times were significantly decreased 3 months after RF ablation procedure (PA lateral p = 0.022; PA septum p = 0.002; PA tricuspid p = 0.019, interatrial conduction delay p= 0,012, intra-atrial conduction delay p = 0.029).ConclusionThe results of our study suggest that providing stable sinus rhythm by the elimination of the AF triggering mechanisms with RF ablation of pulmonary vein isolation may slow down, stop or even improve structural remodeling at substrate level secondary to AF even in patients who did not yet develop atrial fibrosis and permanent structural changes.

P2466The impact of circumferential pulmonary vein isolation on global and regional left atrial function in patients with paroxysmal atrial fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Blendea ◽  
S Istratoaie ◽  
S Pop ◽  
M Mansour
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Lateral Wall ◽  
Interatrial Septum ◽  
Tissue Doppler ◽  
Doppler Flow ◽  
Circumferential Pulmonary Vein Isolation

Abstract Introduction The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined. Purpose The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE) Methods We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function. Results The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values. Conclusion In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.

scholarly journals Mechanistic insights into heterogeneous radiofrequency ablation effects at the left atrial posterior wall during pulmonary vein isolation

2019 ◽  
Author(s):  
David R. Tomlinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Rf Ablation ◽  
Overdrive Pacing ◽  
Left Atrial Posterior ◽  
Tissue Motion

AbstractBackgroundIndependent investigations demonstrate greater radiofrequency (RF) ablation effects at left- sided left atrial posterior wall (LAPW) sites.ObjectiveTo investigate mechanisms underlying RF ablation heterogeneity during contact-force (CF) and VISITAG™ Module (Biosense Webster)-guided pulmonary vein isolation (PVI).MethodsConsecutive patients undergoing PVI during atrial overdrive pacing comprised 2 cohorts: intermittent positive pressure ventilation (IPPV, 14-16/min, 6-8ml/kg); high frequency jet ventilation (HFJV, 150/min, Monsoon III, Acutronic). Temperature-controlled (17ml/min, 48°C) RF data was retrospectively assessed at first-annotated (target 15s) LAPW sites: 30W during IPPV; 20W at left-sided sites during HFJV.ResultsTwenty-five and 15 patients underwent PVI during IPPV and HFJV, respectively. During IPPV, left versus right-sided median impedance drop (ImpD) was 13.6Ω versus 9.9Ω (p<0.0001) respectively and mean time to pure R unipolar electrogram (UE) morphology change 4.9s versus 6.7s (p=0.007) respectively. During HFJV, ImpD was greater at left-sided sites (9.7Ω versus 7.4Ω, p=0.21) and time to pure R UE significantly shorter: 4.3s versus 6.1s (p=0.02). Minimum case impedance subtracted from pre-RF baseline impedance (BI) generated site-specific ΔBI. Left-sided sites demonstrated significantly greater ΔBI, correlating strongly with Ln(ImpD) – IPPV r=0.84 (0.65 – 0.93), HFJV r=0.77 (0.35 – 0.93).At right-sided sites, ΔBI and Ln(ImpD) were without correlation during IPPV, but correlation was modest during HFJV (r=0.54, -0.007 – 0.84).ConclusionsΔBI may usefully indicate catheter-tissue contact surface area (SA). Consequently, greater left-sided LAPW RF effect may result from greater contact SA and in-phase catheter-tissue motion; HFJV may reduce right-sided out-of-phase catheter-tissue motion. Modifying RF delivery based on ΔBI may improve PVI safety and efficacy.

Abstract 249: The Costs and Acute Outcomes Following Pulmonary Vein Isolation for Atrial Fibrillation in Elderly Patients a Comparison Between Cryoballoon and Radiofrequency Ablation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Chao-Feng Chen
Keyword(s):  
Atrial Fibrillation ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Dwell Time ◽  
Complication Rates ◽  
Rf Ablation ◽  
Significant Difference

Backgroup: Limited comparative data exist regarding catheter ablation (CA) of atrial fibrillation (AF) using second-generation cryoballoon (CB-2) ablation versus radiofrequency (RF) ablation in elderly patients (>75 years ). This study aims to compare the costs and periprocedural outcomes in elderly patients using these two strategies. Methods: Elderly patients (>75years) with symptomatic drug-refractory AF were included in the study. Pulmonary vein isolation (PVI) was performed in all patients by CB or RF. The costs and periprocedural outcomes of the two strategies are compared using SPSS 22. Results: 324 elderly patients with symptomatic drug-refractory paroxysmal/short-lasting persistent AF received PVI using RF (n=176) and CB-2 (n=148) from September 2016 to April 2019. The CB-2 was associated with shorter procedure duration and left atrial dwell time (128.9±18.3 vs. 152.8±18.9 minutes, P<0.001; 89.4±18.4 vs. 101.9± 22.2minutes, P <0.001), but greater fluoroscopy utilization (24.3±10.9 vs. 19.2±7.5 minutes, P <0.001). Periprocedural complications occurred in 3.4% (CB-2) and 9.1% (RF) of patients (P=0.037). There was no significant difference between 2 groups for AF/atrial tachycardia (AT) recurrence until discharge (16.2 vs. 18.7%, P = 0.552). The length of stay after ablation was shorter, but the costs were greater in the CB-2 group ( P <0.001). Conclusions: Both CB-2 and RF ablation appear to be safe and effective for AF in elderly patients (>75 years). In addition, CB-2 is associated with shorter procedure time, left atrial dwell time, and length of stay after ablation, as well as lower complication rates, but its costs and fluoroscopy time are greater than those of the RF group.

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