Atrial Fibrillation Ablation: When and Why?

Ablation of Atrial Fibrillation (AF) has quickly become an alternative strategy to impact the adverse symptoms and outcomes associated with or caused by AF. Early reports in 1998 demonstrated spontaneous initiation of AF by ectopic beats originating in the Pulmonary Veins (PVs) followed rapidly by showing that Radio Frequency (RF) circumferential ablation around the orifices of the PVs could “electrically disconnect” the PVs from the Left Atria (LA). This resulted in the explosive growth utilizing this procedure for AF Ablation (AFA) across a wide demographic spectrum of recipients. Foreseeable healthy debates have surfaced as to who best benefits and who may actually suffer complications or harm from AFA utilizing present techniques. Disagreement also persists as to whether AFA fundamentally and universally reduces stroke, death, hospitalization or does it initiate a more nuanced set of outcomes. The present effort asks the simple question: Has AFA matured to the point of requisite explicative review? Is it time now to peel back the layers and identify which cohort will be optimally served by AFA and perhaps which ones need demonstration of benefit? The present brief review suggests that prudent employment of AFA must now identify disparities in the variables reflected in these cohort outcomes. This will enable judgment in the use of AFA and the achievement of optimal outcomes.

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A study on pulmonary venous ostia pattern in the left atrium and its clinical applications

National Journal of Clinical Anatomy ◽

10.1055/s-0040-1701737 ◽

2018 ◽

Vol 7 (04) ◽

pp. 201-204

Author(s):

Rajesh S. ◽

Vijaya Kumar S. ◽

Manikanda Reddy V.

Keyword(s):

Atrial Fibrillation ◽

Radio Frequency ◽

Left Atrium ◽

Pulmonary Vein ◽

Anatomical Variation ◽

Pulmonary Veins ◽

Clinical Applications ◽

Ectopic Beats ◽

The Right ◽

Formalin Fixed

Abstract Background & aims : Normally four pulmonary veins open into the left atrium. Frequently there are variations in the number of pulmonary veins opening in to the left atrium. Ectopic beats in atrial fibrillation commonly originates from the ostia of the pulmonary veins. The treatment of atrial fibrillation is by radio frequency ablation of the focus of origin and hence the knowledge of anatomical variation of pulmonary veins is necessary to find the ectopic focus in the origin of atrial fibrillation. Materials and Method : In this study the variation of pulmonary venous ostia pattern in the left atrium was studied in 80 formalin fixed adult cadaveric hearts. Results and Conclusion : 63 hearts showed no variation in the pulmonary venous ostia pattem which accounts for 78.75%, rest of the 17 hearts showed variation in the pulmonary venous ostia which accounts for 21.25%, the variation in the number of pulmonary veins was slightly higher for the left side [11.25%] when compared to the right sided variation [ 10%], the number of hearts which showed bilateral variation was noted in 2 hearts - both showed a single pulmonary vein opening on either side which accounts for 2.5%

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672 Impact of pulmonary veins atypical anatomy on atrial fibrillation ablation outcomes in segmental ostial approach

EP Europace ◽

10.1016/s1099-5129(05)80481-7 ◽

2005 ◽

Vol 7 ◽

pp. 163-163

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Veins ◽

Atrial Fibrillation Ablation

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Evaluation of a new approach for persistent atrial fibrillation: Ablation index-guided pulmonary veins isolation with contiguous lesions

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.10.176 ◽

2019 ◽

Vol 11 (1) ◽

pp. 80

Author(s):

P. Taghji ◽

Sok-Sithikun Bun ◽

B. Enache ◽

Decebal Gabriel Latcu ◽

N. Saoudi

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

New Approach ◽

Ablation Index

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Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and Successful Ablation

Case Reports in Cardiology ◽

10.1155/2016/4979182 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

John J. Lee ◽

Denis Weinberg ◽

Rishi Anand

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Artery ◽

Pulmonary Vein ◽

Pulmonary Veins ◽

Lung Perfusion ◽

Atrial Fibrillation Ablation ◽

Clinical Severity ◽

Pulmonary Vein Stenosis ◽

Multiple Imaging ◽

Vein Stenosis

Pulmonary vein stenosis is a well-established possible complication following an atrial fibrillation ablation of pulmonary veins. Symptoms of pulmonary vein stenosis range from asymptomatic to severe exertional dyspnea. The number of asymptomatic patients with pulmonary vein stenosis is greater than originally estimated; moreover, only about 22% of severe pulmonary vein stenosis requires intervention. We present a patient with severe postatrial fibrillation (AF) ablation pulmonary vein (PV) stenosis, which was seen on multiple imaging modalities including cardiac computed tomography (CT) angiogram, lung perfusion scan, and pulmonary angiogram. This patient did not have any pulmonary symptoms. Hemodynamic changes within a stenosed pulmonary vein might not reflect the clinical severity of the obstruction if redistribution of pulmonary artery flow occurs. Our patient had an abnormal lung perfusion and ventilation (V/Q) scan, suggesting pulmonary artery blood flow redistribution. The patient ultimately underwent safe repeat atrial fibrillation ablation with successful elimination of arrhythmia.

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Experience in cryobaloon atrial fibrillation ablation – Polish operators perspective

In a good rythm ◽

10.5604/01.3001.0013.4759 ◽

2019 ◽

Vol 2 (51) ◽

pp. 4-7

Author(s):

Agnieszka Wojdyła-Hordyńska ◽

Jakub Baran ◽

Paweł Derejko

Keyword(s):

Atrial Fibrillation ◽

Second Generation ◽

Pulmonary Veins ◽

Atrial Fibrillation Ablation ◽

Cryoballoon Ablation ◽

Years Of Experience ◽

Technology Changes ◽

Front Advance ◽

Arctic Front ◽

Over 40 Years

The first use of cryoablation in the treatment of arrhythmia has already been described over 40 years ago [1]. Since the introduction of cryoballoon in pulmonary veins isolation in atrial fibrillation treatment, the method has started to attract a lot of interest. Over 350,000 procedures around the word were carried out only by 2018 [2]. Recently, there have been several new publications on the results of second-generation cryoballoon ablation [2, 3, 4]. In view of technology changes, and to summarize years of experience in the treatment of atrial fibrillation, the first Cryousers conference was organized, and held in 2018 in Poland. During this meeting a survey was conducted, obtaining data on the practice of atrial fibrillation treatment in 38 Polish electrophysiological centers performing cryoablation of atrial fibrillation using both balloons, Arctic Front Advance, Medtronic Inc., Minneapolis MN, and radiofrequency point by point ablation. Around 3,745 cryoballoon procedures were performed in the surveyed centers during the year preceding the survey. The survey concerned practical issues related to the qualification and preparation of patients for the procedure, its course, and the results of pulmonary veins isolation in Poland.

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Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

10.37191/mapsci-jccr-2(1)-021 ◽

2021 ◽

Author(s):

Sara Rita Vacirca

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Heart Surgery ◽

Pulmonary Veins ◽

Open Heart Surgery ◽

Atrial Fibrillation Ablation ◽

Surgical Ablation ◽

Before And After ◽

The Mean ◽

Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

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