scholarly journals Atrial Cardiomyopathy: a Role in the Pathogenesis of Atrial Fibrillation and Influence on the Results of Its Treatment

2021 ◽  
pp. 85-89
Author(s):  
Oleksandr S. Stychynskyi ◽  
Pavlo O. Almiz ◽  
Alina V. Topchii
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Heart Function ◽  
Gene Mutations ◽  
Electroanatomical Mapping ◽  
Thromboembolic Complications ◽  
Atrial Myocardium ◽  
Magnetic Resonance Data ◽  
Resonance Data

The work is dedicated to the issue of atrial cardiomyopathies (ACs). They have a significant effect on the heart function, provoke rhythm disturbances and increase the risk of thromboembolic complications. The aim. To analyze the latest publications on the topic. The material for the analysis were the papers published by the leading arrhythmological clinics. Discussion. This paper describes the origin of the term “atrial cardiomyopathy”, highlights the conditional classification of changes in the atrial myocardium according to the EHRAS classification. The causes of this nosological form may be some types of gene mutations, as well as hypertension, congestive circulatory failure, diabetes mellitus, myocarditis, etc. ACs play an important role in the occurrence of atrial fibrillation (AF) and also affect its natural course and treatment outcomes. Electroanatomical mapping and magnetic resonance data show significant fibrotic changes in the atria in individuals with this form of arrhythmia. The DECAAF study (Delayed enhancement MRI and atrial fibrillation catheter ablation) showed that fibrotic changes in the atrial myocardium are directly related to the frequency of recurrent arrhythmias after catheter ablation. The DECAAFII study confirmed the effectiveness of the influence on the fibrous substrate in the catheter treatment of AF at stages 1 and 2 of fibrosis. The results of catheter treatment depend on the severity of fibrosis, which shows the importance of taking this factor into account when determining the indications for ablation. Conclusions. Thus, AC is an important component of the pathogenesis of AF. Improvement of techniques for influencing the fibrous substrate will improve the results of catheter treatment of AF.

First experience of 3D rotational angiography fusion with NavX electroanatomical mapping to guide catheter ablation of atrial fibrillation

Heart Rhythm ◽  
2013 ◽  
Vol 10 (3) ◽  
pp. 422-427 ◽  
Author(s):  
Mahendra Carpen ◽  
John Matkins ◽  
George Syros ◽  
Maxim V. Gorev ◽  
Zoubin Alikhani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Electroanatomical Mapping ◽  
Rotational Angiography ◽  
3D Rotational Angiography ◽  
Guide Catheter

scholarly journals The Electrophysiology of Atrial Fibrillation: From Basic Mechanisms to Catheter Ablation

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Panagiotis Ioannidis ◽  
Theodoros Zografos ◽  
Evangelia Christoforatou ◽  
Konstantinos Kouvelas ◽  
Andreas Tsoumeleas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Basic Science ◽  
Advanced Technology ◽  
Atrial Myocardium ◽  
Pathophysiological Mechanisms ◽  
Basic Science Knowledge

The electrophysiology of atrial fibrillation (AF) has always been a deep mystery in understanding this complex arrhythmia. The pathophysiological mechanisms of AF are complex and often remain unclear despite extensive research. Therefore, the implementation of basic science knowledge to clinical practice is challenging. After more than 20 years, pulmonary vein isolation (PVI) remains the cornerstone ablation strategy for maintaining the sinus rhythm (SR). However, there is no doubt that, in many cases, especially in persistent and long-standing persistent AF, PVI is not enough, and eventually, the restoration of SR occurs after additional intervention in the rest of the atrial myocardium. Substrate mapping is a modern challenge as it can reveal focal sources or rotational activities that may be responsible for maintaining AF. Whether these areas are actually the cause of the AF maintenance is unknown. If this really happens, then the targeted ablation may be the solution; otherwise, more rough techniques such as atrial compartmentalization may prove to be more effective. In this article, we attempt a broad review of the known pathophysiological mechanisms of AF, and we present the recent efforts of advanced technology initially to reveal the electrical impulse during AF and then to intervene effectively with ablation.

scholarly journals Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Fei Hang ◽  
Liting Cheng ◽  
Zhuo Liang ◽  
Ruiqing Dong ◽  
Xinlu Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Intracardiac Echocardiography ◽  
Transseptal Puncture ◽  
Electroanatomical Mapping ◽  
Curative Effect ◽  
Significant Difference ◽  
Zero Fluoroscopy

Aims. 3D electroanatomical mapping combined with intracardiac echocardiography- (EAM-ICE-) guided transseptal puncture has been proven safe and effective during the radiofrequency catheter ablation (RFCA) procedure used to treat paroxysmal atrial fibrillation (PAF). In this study, we aimed to compare the curative effect and safety of RFCA via F (fluoroscopy) and zero-fluoroscopy transseptal puncture guided by EAM-ICE in patients with PAF. Methods and Results. A prospective study in which 110 patients with PAF were included and assigned to two groups was conducted. Fifty-five (50%) patients were enrolled in the EAM-ICE group, whereas the other 55 (50%) patients were enrolled in the F group. There were no significant differences in baseline characteristics between the two groups. The transseptal duration time was longer in the EAM-ICE group (19.8 ± 3.0 min vs. 8.6 ± 1.2 min, p ≤ 0.01 ); however, fluoroscopy was not used in the EAM-ICE group compared with the F group (0 mGy vs. 109.1 ± 57.9 mGy). Similarly, there was also no significant difference in the recurrence rate of atrial fibrillation between the EAM-ICE and F groups (25.5% vs. 18.2%, p = 0.356 ). Conclusion. RFCA via EAM-ICE-guided zero-fluoroscopy transseptal puncture in patients with PAF is safe and effective for long-term follow-up.

scholarly journals Atypical atrial flutter: a new methodology for critical isthmi identification?

2020 ◽  
Author(s):  
Pedro Adragão ◽  
Daniel Matos ◽  
Francisco Moscoso Costa ◽  
Pedro Carmo ◽  
Diogo Cavaco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Flutter ◽  
Cycle Length ◽  
Low Voltage ◽  
Supraventricular Arrhythmia ◽  
Low Density ◽  
Electroanatomical Mapping ◽  
Activation Times ◽  
Density Zone

ABSTRACTIntroductionAtypical atrial flutter is a supraventricular arrhythmia that can be treated with catheter ablation. However, the best approach is still to be defined and this strategy has suboptimal results. The Carto® electroanatomical mapping (EAM) system can display a histogram of the local activation times (LAT) of the tachycardia cycle length (TCL). This study aimed to assess the ability of this new tool to identify the critical isthmus of this arrhythmia.MethodsRetrospective analysis of a unicentric registry of individuals who underwent left AFL ablation during a 1-year period with Carto® EAM. All patients with non-left AFL, lack of high-density EAM, less than 2000 collected points or lack of mapping in any of the left atrium walls or structures were excluded. We compared the ablation sites of arrhythmia termination to the sites of histogram valleys (LAT-Valleys), defined as areas of low-voltage (<0.3mV) with 10% or more of the TCL and less than 20% density points relative to the highest density zone. The longest LAT-Valley was designated as the primary valley, while additional valleys were named as secondary.ResultsA total of 9 patients (6 men, median age 75 IQR 71-76 years) were included. All patients presented with left AFL and 66% had a previous atrial fibrillation and/or flutter ablation. The median TCL and number collected points were 254 (220─290) milliseconds and 3300 (IQR 2410─3926) points, respectively. All AFL presented with at least 1 LAT-Valley in the analysed histograms, which corresponded to heterogeneous low-voltage areas (<0.3mV). All arrhythmias were effectively terminated after undergoing radiofrequency ablation in the primary LAT-Valley location.ConclusionA low-density and prolonged LAT-Valley in a heterogeneous low-voltage area compose an electrophysiologic triad that allows the identification of the AFL critical isthmus. Further studies are needed to assess the usefulness of this tool for improving catheter ablation outcomes.

Choosing the Proper Candidate and Technique for Atrial Fibrillation Ablation

2010 ◽  
Vol 6 (4) ◽  
pp. 74
Author(s):  
Dipen Shah ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Rate Control ◽  
Left Atrial ◽  
Disease Duration ◽  
Control Strategies ◽  
Atrial Fibrosis ◽  
Atrial Myocardium ◽  
Atrial Size ◽  
Left Atrial Fibrosis

The increasing popularity of catheter ablation for atrial fibrillation has been associated with a variety of techniques and ablation strategies as well as widening indications. A critical analysis of outcomes after catheter ablation is necessary to discern those patients unlikely to benefit from catheter ablation in order to propose rate control strategies with confidence. Left atrial size, advanced age, long standing mitral valve disease, duration of atrial fibrillation as well as left atrial fibrosis are currently thought to be important parameters associated with poorer outcomes. Determining the best suited ablation techniques from amongst different strategies of pulmonary vein (PV) isolation, atrial and coronary sinus ablation for specific subgroups of patients may avoid unnecessary ablation and preserve contractile atrial myocardium.

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