scholarly journals Radiofrequency ablation and antiarrhythmic therapy in the treatment of patients with paroxysmal and persistent atrial fibrillation: clinical effects

2015 ◽  
Vol 6 (3) ◽  
pp. 38-47
Author(s):  
M. G Bubnova ◽  
D. M Aronov ◽  
M. M Makhinova
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Radiofrequency Ablation ◽  
Randomized Clinical Trials ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Antiarrhythmic Therapy ◽  
Clinical Effects

The purpose of this article is to discuss the issues related to the treatment of patients with paroxysmal and persistent atrial fibrillation (AF). The article discusses the indications for patients with radiofrequency catheter (RFC) ablation of the mouths of the pulmonary veins and based on the results of randomized clinical trials analyzed the clinical effects of this procedure, depending on the type of AF. The article discusses the initiation of antiarrhythmic therapy and the duration of its application after RFC.

Simultaneous Catheter and Epicardial Ablations Enable a Comprehensive Atrial Fibrillation Procedure

2011 ◽  
Vol 6 (4) ◽  
pp. 243-247 ◽  
Author(s):  
Andy C. Kiser ◽  
Mark D. Landers ◽  
Ker Boyce ◽  
Matjaž šinkovec ◽  
Andrej Pernat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Chronic Atrial Fibrillation ◽  
Lesion Pattern ◽  
Atrial Size ◽  
Cardiac Surgeon ◽  
Successful Collaboration

Objective Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues. Methods Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a “box” lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation. Results Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m2; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm. Conclusions Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.

scholarly journals The first clinical experience of Marshall’s vein alcohol ablation in complex treatment of persistent atrial fibrillation

2021 ◽  
pp. 29-35
Author(s):  
V.V. Boiko ◽  
◽  
S.V. Rybchynskyi ◽  
D.O. Lopin ◽  
A.S. Vnukova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Clinical Experience ◽  
Clinical Case ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Scientific Data ◽  
Interventional Treatment ◽  
Alcohol Ablation ◽  
Mitral Isthmus

This article describes the first in Ukraine clinical experience of alcohol ablation of Marshall’s vein in the complex interventional treatment of persistent atrial fibrillation (AF). Current scientific data suggest that when drug therapy is ineffective, ablation of AF substrate is a most important stage in the treatment of arrhythmia, as well as optimal method of control and prevention of further cardiovascular events. The standard treatment for paroxysmal AF is radiofrequency ablation (RFA) with electrical isolation of the pulmonary veins (PVI). However, due to the involvement of other pathogenetic mechanisms, a sole PVI is less effective in persistent forms of arrhythmia. For example, in persistent AF forms pathological electrical activity often occurs beyond the pulmonary veins. In particular, it can be observed in the area of ​​the posterior wall of the left atrium and mitral isthmus resulting in perimitral atrial flutter. RFA in this area can reduce the rate of arrhythmia recurrence. However, achieving a stable bidirectional conduction block in the area of ​​lateral mitral isthmus with endocardial RFA is technically challenging. An option to improve the effectiveness of RFA in this case, apart from epicardial RFA in the distal coronary sinus, is an alternative method, i.e. alcoholic ablation of Marshall’s vein by introducing ethanol into its lumen, occluded by a balloon. The presented clinical case shows combined variant of persistent AF minimally invasive treatment using alcoholic Marshall’s vein ablation and RFA with PVI target. Key words: atrial fibrillation, radiofrequency ablation, alcoholic ablation, Marshall vein, clinical case.

Comparative efficacy and safety of different catheter ablation strategies for persistent atrial fibrillation: a network meta-analysis of randomized clinical trials

2021 ◽  
Author(s):  
Andrea Saglietto ◽  
Andrea Ballatore ◽  
Fiorenzo Gaita ◽  
Marco Scaglione ◽  
Roberto De Ponti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Catheter Ablation ◽  
Left Atrium ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Persistent Atrial Fibrillation ◽  
Linear Lesions ◽  
Procedural Complications ◽  
Reduced Risk

Abstract Aims Whereas pulmonary vein isolation (PVI) is the universally agreed target in catheter ablation of paroxysmal atrial fibrillation (AF), an ideal ablation set in persistent AF remains questioned. Aim of this study is to conduct a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing different ablation strategies in persistent AF patients. Methods and results Network meta-analysis was performed in a frequentist framework with the different ablation strategies constituting the competitive arms of interest. Primary efficacy endpoint was recurrences of atrial tachyarrhythmia (AF, atrial flutter, and/or organized atrial tachycardia). Secondary endpoints included major peri-procedural complications, procedure, and fluoroscopy duration. PubMED/MEDLINE and EMBASE databases were searched through June 2020. 2548 records were screened and 57 full-text articles assessed. Eventually 24 RCTs were included, encompassing 3245 patients (median follow-up 15 months, IQR 12–18). Compared to PVI alone, PVI plus linear lesions in the left atrium and elimination of extra-PV sources was the only strategy associated with a reduced risk of arrhythmia recurrence (RR 0.49, 95%CI 0.27–0.88). Most treatment arms were associated with longer procedural time compared with PVI; however, major peri-procedural complications and fluoroscopy time did not differ. Conclusion A comprehensive strategy including PVI, linear lesions in the left atrium, and elimination of extra-PV sources (constrained by a heterogeneous definition across studies) was associated with reduced risk of recurrent atrial tachyarrhythmias compared to PVI alone. All investigated treatment arms yielded similar safety profiles. Further research should rely on enhanced substrate-based approach definitions to solve one of the most evident knowledge gaps in interventional electrophysiology.

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.

Radiofrequency Ablation in the Pulmonary Veins for Paroxysmal, Drug-resistant Atrial Fibrillation

2004 ◽  
Vol 23 (6) ◽  
pp. 255-263 ◽  
Author(s):  
Elizabeth J. Thompson ◽  
Deborah A. Reich ◽  
Jennifer L. Meadows
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Veins ◽  
Drug Resistant

scholarly journals Clinical success of cryoballoon pulmonary vein isolation in patients with atrial fibrillation

2019 ◽  
Vol 7 (4S) ◽  
pp. 6-14
Author(s):  
T. Y. Chichkova ◽  
S. E. Mamchur ◽  
E. A. Khomenko
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Direct Current ◽  
Clinical Success ◽  
Persistent Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Clinical Effects ◽  
Rf Ablation

Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).Methods.230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.Results.77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).Conclusion.The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

Impact of the Distribution and Structure of Myocardium in the Pulmonary Veins for Radiofrequency Ablation of Atrial Fibrillation

2002 ◽  
Vol 25 (9) ◽  
pp. 1352-1356 ◽  
Author(s):  
CHRISTIAN WEISS ◽  
ANDREAS GOCHT ◽  
STEPHAN WILLEMS ◽  
MATTHIAS HOFFMANN ◽  
TIM RISIUS ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Veins
Sign in / Sign up

Export Citation Format

Share Document