scholarly journals Cardiac Sympathetic Activity and Rhythm Control Following Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation—A Prospective 123I-mIBG-SPECT/CT Imaging Study

2021 ◽  
Vol 11 (10) ◽  
pp. 995
Author(s):  
Philipp S. Lange ◽  
Christian Wenning ◽  
Nemanja Avramovic ◽  
Patrick Leitz ◽  
Robert Larbig ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Nervous System ◽  
Drug Therapy ◽  
Sinus Rhythm ◽  
Sympathetic Activity ◽  
Sympathetic Innervation ◽  
Rhythm Control ◽  
Antiarrhythmic Drug Therapy ◽  
Cardiac Sympathetic Innervation

Background: Pulmonary vein isolation (PVI) and antiarrhythmic drug therapy are established treatment strategies to preserve sinus rhythm in atrial fibrillation (AF). However, the efficacy of both interventional and pharmaceutical therapy is still limited. Solid evidence suggests an important role of the cardiac sympathetic nervous system in AF. In this blinded, prospective observational study, we studied left ventricular cardiac sympathetic activity in patients treated with PVI and with antiarrhythmic drugs. Prospectively, Iodine-123-benzyl-guanidine single photon emission computer tomography (123I-mIBG-SPECT) was performed in a total of 23 patients with paroxysmal AF, who underwent PVI (n = 20) or received antiarrhythmic drug therapy only (n = 3), respectively. 123I-mIBG planar and SPECT/CT scans were performed before and 4 to 8 weeks after PVI (or initiation of drug therapy, respectively). For semiquantitative SPECT image analysis, attenuation-corrected early/late images were analyzed. Quantitative SPECT analysis was performed using the AHA 17-segment model of the left ventricle. Results: PVI with point-by-point radiofrequency ablation led to a significantly (p < 0.05) higher visual sympathetic innervation defect score when comparing pre-and post PVI. Newly emerging innervation deficits post PVI were localized predominantly in the inferior lateral wall. These findings were corroborated by semiquantitative SPECT analysis identifying inferolateral segments with a reduced tracer uptake in comparison to SPECT before PVI. Following PVI, patients with an AF relapse showed a different sympathetic innervation pattern compared to patients with sufficient rhythm control. Conclusions: PVI results in novel defects of cardiac sympathetic innervation. Differences in cardiac sympathetic innervation remodelling following PVI suggest an important role of the cardiac autonomous nervous system in the maintenance of sinus rhythm following PVI.

scholarly journals Antiarrhythmic Drug Therapy for Maintaining Sinus Rhythm Early after Pulmonary Vein Ablation in Patients with Symptomatic Atrial Fibrillation

2014 ◽  
Vol 32 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Christian Sohns ◽  
Valerie von Gruben ◽  
Samuel Sossalla ◽  
Leonard Bergau ◽  
Joachim Seegers ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Antiarrhythmic Drug ◽  
Antiarrhythmic Drug Therapy ◽  
Pulmonary Vein Ablation

scholarly journals The RACE to the EAST. In pursuit of rhythm control therapy for atrial fibrillation—a dedication to Harry Crijns

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii34-ii39
Author(s):  
Bruno Reissmann ◽  
Günter Breithardt ◽  
A John Camm ◽  
Isabelle C Van Gelder ◽  
Andreas Metzner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cardiovascular Death ◽  
Rhythm Control ◽  
Related Factors ◽  
Antiarrhythmic Drug Therapy ◽  
Coronary Syndrome ◽  
Control Therapy

Abstract The RACE trial was one of the first landmark trials to establish whether restoring and maintaining sinus rhythm could reduce morbidity and mortality in patients with atrial fibrillation (AF). Its neutral outcome shaped clinical decision-making for almost 20 years. However, there were two important treatment-related factors associated with mortality of rhythm control therapy at that time: One was safety of antiarrhythmic drug therapy, and the other one withdrawal of anticoagulation after restoration of sinus rhythm. Both concerns have been overcome, and, moreover, important knowledge considering the importance of time for the treatment of AF has been gained. These insights led to the concept of the EAST-AFNET 4 trial, and after more than two decades in the pursuit of ongoing therapeutic improvement, early rhythm control therapy has demonstrated to reduce a composite of cardiovascular death, stroke, and hospitalization for worsening of HF or acute coronary syndrome, by 21% (first primary outcome, absolute reduction 1.1 per 100 patient-years). For this entire period, Harry Crijns characterized the treatment of AF patients, and contributed decisively to realizing the benefit of rhythm control therapy. It is almost easier to list the clinical trials without Harry's involvement than to list those which he co-designed and led.

scholarly journals Catheter Ablation of Atrial Fibrillation – Techniques and Technology

2012 ◽  
Vol 1 ◽  
pp. 29 ◽  
Author(s):  
George Katritsis ◽  
Hugh Calkins ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
The Elderly ◽  
Late Recurrence ◽  
Aged Patients ◽  
Antiarrhythmic Drug Therapy ◽  
Patient Groups ◽  
Maintain Sinus Rhythm

For certain patients with atrial fibrillation (AF) catheter ablation is now an important, therapeutic, intervention. It is established that catheter ablation is more effective than antiarrhythmic drug therapy at maintaining middle-aged patients with paroxysmal AF in sinus rhythm. However, the role of catheter ablation in other patient groups is not yet well defined. Particularly in patients with long-standing persistent AF, heart failure and the elderly, the efficacy of catheter ablation remains uncertain. At experienced centers catheter ablation for AF can be performed with reasonable safety and efficacy. However, major complications can occasionally occur. Late recurrence of AF is not uncommon and many patients will require a further procedure to maintain sinus rhythm. Fortunately, there are promising developments in the techniques and technology used for AF ablation that are likely to improve the outcomes of the procedure.

Review of Contemporary Antiarrhythmic Drug Therapy for Maintenance of Sinus Rhythm in Atrial Fibrillation

2011 ◽  
Vol 17 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Sandeep Singla ◽  
Pascal Karam ◽  
Abhishek J. Deshmukh ◽  
Jawahar Mehta ◽  
Hakan Paydak
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Sinus Rhythm ◽  
Antiarrhythmic Drug ◽  
Antiarrhythmic Drug Therapy
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