High-Density (HD) Wave Mapping in Subjects With Atrial Fibrillation as a Predictor of Recurrence After a Single Ablation Procedure Using a PVI-Only Strategy

Abstract Funding Acknowledgements Dr Teres was funded by Swiss Heartrhythm Foundation Introduction pulmonary vein (PV) reconnections due to gaps on circumferential ablation lines are responsible for atrial fibrillation recurrences after catheter ablation. We sought to analyze the local left atrial wall thickness (LAWT) of PV line gaps at AF redo ablation during real-time catheter positioning. LAWT was measured on the MDCT 3D reconstruction and fused with the LA anatomy using CARTO-merge. Objective To analyze the relationship between local reconnection gaps and the LAWT during AF redo procedures. Methods Single-Center cohort study that included 41 consecutive patients referred for AF redo procedure. All patients had a MDCT prior to the ablation procedure. LAWT maps were semi-automatically computed from the MDCT as the local distance between the LA endo and epicardium. Each PV line was subdivided into 8 segments and mean LAWT was computed. During the procedure, the local gap was defined as the earliest activation site at the reconnected segment of the circumferential PV line (Figure 1A & 1B). Results 41 patients [31 (75.6%) male, age 60 ± 10 years] were included. Mean LAWT was 1.36 ± 0.20 mm. Mean PV circumferential line WT was higher in left PVs than in the right PVs 1.68 ± 0.57 vs. 1.31 ± 0.39 mm p < 0.001 respectively. Mean WT of the reconnected points was 44% higher than the mean WT of the segment where the reconnection was located. Mean reconnection point WT was at the 87th percentile of the circumferential line in the LPVs and at the 76th percentile in the RPVs. The reconnected point WT was higher in the LPVs than RPVs 2.13 ± 1.14 vs. 1.47 ± 0.48 mm p < 0.001 respectively. The most frequent location for reconnections was the left anterior carina (71%), with a mean WT of 2.24 ± 0.91mm; and the right anterior carina (56%) with a mean WT of 1.57 ± 0.62mm (Figure 2A & 2B). Conclusions Reconnection points were more frequently present in the thicker segments of the PV circumferential line. The most frequently reconnected segment was the anterior carina in both right and left PVs. Atrial wall thickness maps derived from MDCT are useful to guide AF redo procedures. Abstract Figure. 1) Activation & WT map; 2) Segment WT

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THE DURATION OF PERSISTENT ATRIAL FIBRILLATION PRIOR TO THE HYBRID (VATS MAZE + CATHETER) ABLATION PROCEDURE PREDICTS RECURRENCE RATE AT ONE YEAR

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)30865-9 ◽

2018 ◽

Vol 71 (11) ◽

pp. A324

Author(s):

Chase Phillips ◽

Daniel Kaiser ◽

L. Bing Liem ◽

Peter Chang Sing ◽

Gansevoort Dunnington ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Recurrence Rate ◽

Persistent Atrial Fibrillation ◽

Ablation Procedure ◽

One Year

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The CHADS2 and CHA2DS2-VASC scores predict atrial fibrillation in dyslipidemic individuals: Role of incorporating low high-density lipoprotein cholesterol levels

Atherosclerosis ◽

10.1016/j.atherosclerosis.2017.06.554 ◽

2017 ◽

Vol 263 ◽

pp. e173

Author(s):

Fotios Barkas ◽

Moses Elisaf ◽

Sempastian Filippas Ntekouan ◽

Eleni Pappa ◽

Evangelos Liberopoulos

Keyword(s):

Atrial Fibrillation ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Density Lipoprotein ◽

High Density ◽

Lipoprotein Cholesterol ◽

Cholesterol Levels

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Dabigatran in the ischemic patient undergoing atrial fibrillation ablation

ABOUTOPEN ◽

10.19156/abtpn.2018.0065 ◽

2018 ◽

Vol 4 (1) ◽

pp. 154-157

Author(s):

Roberto Spoladore

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Anticoagulant Therapy ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Poor Response ◽

Rf Ablation ◽

Ablation Procedure ◽

Total Period ◽

Hemorrhagic Events

Trans-catheter ablation of atrial fibrillation (AF) is a common treatment for symptomatic AF. Among the major complications of AF ablation are stroke, transient ischemic attacks and peri-procedural cardiac tamponade. Various clinical trials have shown that uninterrupted treatment with vitamin K antagonists (VKA) is associated with a lower incidence of embolic events compared to discontinuation of therapy; until recently, in the absence of equally solid evidence, this practice was not extended to the new oral anticoagulants (NOAC) not VKA due to the fear of hemorrhagic complications potentially associated with the use of an "irreversible" anticoagulant. The case of a patient suffering from numerous comorbidities is reported here. In light of the poor response to anti-arrhythmics, a TC-RF ablation was performed, with suspension of dabigatran administration only on the day of the procedure (for a total period <24 hours). Although the fear of the risk of bleeding potentially associated with the trans-catheter ablation procedure may still induce clinicians to stop anticoagulant therapy, even the decision to discontinue anticoagulant therapy with dabigatran on the day of surgery alone is challenged by recent evidence in the literature supporting the efficacy of dabigatran in reducing the incidence of hemorrhagic events during and after ablation, including the results of the RE-CIRCUIT study (Cardiology)

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Abstract 19031: Prediction and Incidence of Non-PV Trigger Foci of Atrial Fibrillation With Regard to Clinical Profile

Circulation ◽

10.1161/circ.132.suppl_3.19031 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yasushi Mukai ◽

Shujiro Inoue ◽

Susumu Takase ◽

Shunsuke Kawai ◽

Akiko Chishaki ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Superior Vena ◽

Vena Cava ◽

Atrial Pacing ◽

Spontaneous Firing ◽

Ablation Procedure ◽

Clinical Background ◽

Clinical Profiles ◽

Af Recurrence

Introduction: Non-PV triggers play significant roles in initiating atrial fibrillation (Af). We hypothesized that location of non-PV Af triggers is predictable to some extent from clinical background and may have influence on clinical outcome after ablation. Methods: We analyzed consecutive 109 patients (76 men) with Af who underwent catheter ablation and investigation of Af triggers. Af was induced under recordings of intra-cardiac electrograms before ablation procedure in the following ways (1) watching spontaneous firing, (2) induction with intravenous infusion of isoproterenol and adenosine, (3) burst atrial pacing and/or intentional defibrillation to watch immediate recurrence of Af. Af triggers were analyzed and compared to clinical profiles and therapeutic outcome. Results: Eighty-four were paroxysmal Af and 25 were persistent. Any ectopic trigger of Af was identified in 73 patients (66%) with 99 foci. Seventy-eight foci were PVs (79%) whereas 21 (21%) were non-PV triggers. In general, non-PV foci were notably identified in female (P<0.01) whereas age, LA diameter or Af type was not significantly relevant to the presence of non-PV foci. Among non-PV foci, superior vena cava (SVC, n=5), crista terminals (CT, n=5) and left atrium (LA, n=5) were prevalent sites. CT was prevalently noted in younger females (P<0.01), whereas SVC was regardless of age. Non-PV foci in the LA were preferably noted in patients with persistent Af (P<0.05). Importantly, multiple or non-PV foci were not significantly correlated to Af recurrence after ablation, whereas LA diameter was weakly correlated. Conclusion: Presence and sites of non-PV foci are rather predictable by simple clinical profiles such as gender, age and type of Af. Multiple or non-PV foci may not be associated with worse clinical outcome as long as they can be successfully targeted and ablated.

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Thromboembolic Events Following Atrial Fibrillation Cardioversion and Ablation: What’s the Culprit?

Medicina ◽

10.3390/medicina55080505 ◽

2019 ◽

Vol 55 (8) ◽

pp. 505

Author(s):

Francesco De Sensi ◽

Gennaro Miracapillo ◽

Luigi Addonisio ◽

Marco Breschi ◽

Alberto Cresti ◽

...

Keyword(s):

Atrial Fibrillation ◽

Septal Defect ◽

Femoral Vein ◽

Global Evaluation ◽

Thromboembolic Events ◽

Ablation Procedure ◽

Af Ablation ◽

Vein Thrombosis ◽

Iatrogenic Atrial Septal Defect

Stroke is a rare but possible complication after atrial fibrillation (AF) ablation. However, its etiopathogenesis is far from being completely characterized. Here we report a case of stroke, with recurrent peripheral embolism after AF ablation procedure. In our patient, an in situ femoral vein thrombosis and iatrogenic atrial septal defect were simultaneously detected. A comprehensive review of multiple pathophysiological mechanisms of stroke in this context is provided. The case underlines the importance of a global evaluation of patients undergoing AF ablation.

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