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

Medicina ◽  
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.

One Year Incidence of Iatrogenic Atrial Septal Defect After Cryoballoon Ablation for Atrial Fibrillation

2013 ◽  
Vol 25 (1) ◽  
pp. 11-15 ◽  
Author(s):  
JUAN SIEIRA ◽  
GIAN-BATTISTA CHIERCHIA ◽  
GIACOMO DI GIOVANNI ◽  
GIULIO CONTE ◽  
CARLO DE ASMUNDIS ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Cryoballoon Ablation ◽  
Iatrogenic Atrial Septal Defect ◽  
One Year

scholarly journals Short coupling with high burden of atrial ectopy in twenty-four hour holter recording predicts recurrence of atrial arrhythmia after atrial fibrillation ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Okajima ◽  
H Imai ◽  
Y Murase ◽  
N Kano ◽  
Y Ogawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Atrial Arrhythmia ◽  
Controlled Study ◽  
Ablation Procedure ◽  
High Burden ◽  
Af Ablation ◽  
Atrial Ectopy ◽  
Holter Recordings

Abstract Background Atrial arrhythmia recurrence is experienced in up to 20% of patients after initially receiving a catheter ablation for atrial fibrillation (AF). Therefore, it is important to define predictors of atrial arrhythmia recurrence. Atrial ectopy (AE) with short coupling interval (S-AE) has been reported to be a trigger of AF. On the other hand, high burden of AE has been reported to be a useful predictor of atrial arrhythmia recurrences after AF ablation. Thus, the combination of the incidence of S-AE and AE burden during a 24-hour Holter recording could be a useful predictor of atrial arrhythmia recurrence after AF ablation. Purpose To investigate this hypothesis, we performed a retrospective case-controlled study. Methods We enrolled 180 patients who underwent their first catheter ablation procedure for AF and performed a 24-hour Holter recording between 90 to 365 days after their ablation procedure. Patients who performed an additional ablation procedure before the Holter recording were excluded. Finally, we analyzed 173 patients (age: 65±10 years, female: 28.3%, non-paroxysmal: 27.7%). The Holter recordings were analyzed by the same experienced technicians. We defined AE as a narrow QRS complex occurring >25% than prior R-R interval, and S-AE as AE occurring >55% earlier than expected. The relationship between the characteristics of AE during the Holter recording and atrial arrhythmia recurrences was investigated. Results The Holter recordings were performed at a median of 103 (IQR: 98–138) days after ablation. The median number of AE were 144 (IQR: 54–699) beats per day, and S-AE was recorded in 49 patients (28.3%). Forty-two patients (24.3%) had a recurrence of atrial arrhythmia during a median 488-day follow up period. Patients with S-AE had a recurrence of atrial arrhythmia more frequently than those without S-AE (44.9% vs 16.1%, p<0.001). We found the cut-off point of AE burden as 241 beats per day by the receiver operating characteristic curve with 74% sensitivity and 70% specificity to predict atrial arrhythmia recurrence. We divided the patients into four groups according to the presence or absence of S-AE and high AE burden. In the Kaplan-Meier analysis, patients with S-AE and high AE burden had the highest atrial arrhythmia recurrence rate (Log-rank test: p<0.001). In the Cox multivariate analysis, S-AE with high AE burden was an independent predictor of atrial arrhythmia recurrence (HR: 4.27, 95% CI: 2.32–7.85, p<0.001). Conclusion For AF patients who underwent their first catheter ablation, S-AE (>55% earlier than expected) with high AE burden (>241 beats per day) during the 24-hour Holter recording predicted recurrences of atrial arrhythmia. These results can help to develop follow-up strategies after AF ablation. Funding Acknowledgement Type of funding source: None

scholarly journals Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Florian Straube ◽  
Janis Pongratz ◽  
Alexander Kosmalla ◽  
Benedikt Brueck ◽  
Lukas Riess ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Phrenic Nerve Palsy ◽  
Dose Area Product ◽  
Af Ablation ◽  
Predictors Of Recurrence

Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.

scholarly journals Protection of the Esophagus During Catheter Ablation of Atrial Fibrillation

2020 ◽  
Author(s):  
Mahmoud Houmsse ◽  
Emile Daoud
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Potential Risk ◽  
High Frequency ◽  
Esophageal Injury ◽  
Ablation Procedure ◽  
High Occurrence ◽  
Af Ablation ◽  
Important Concern

Esophageal injury still occurs with high frequency during ablation of atrial fibrillation (AF). The purpose of this study is to provide a review of methods to protect the esophagus from injury during AF ablation. Despite advances in imaging and ablation, the potential risk of esophageal injury during AF ablation remains an important concern with a high occurrence of esophageal injury (≈15%). There have been numerous studies evaluating varied techniques for esophageal protection including active cooling and displacement of the esophagus. These techniques are reviewed in this manuscript as well as the role of esophageal protection in managing patients undergoing AF ablation procedure.

scholarly journals Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Zheng ◽  
Meng Wang ◽  
Qun-feng Tang ◽  
Feng Xue ◽  
Ku-lin Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cerebrovascular Accident ◽  
Independent Risk Factor ◽  
Magnetic Navigation ◽  
Ablation Procedure ◽  
Af Ablation ◽  
History Of ◽  
Ischemic Attack ◽  
Risk Predictors ◽  
Low Ejection Fraction

Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates.Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X2 = 20.63 P < 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.Conclusions: Ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.Clinical Trial Registration: ChiCTR2100046505.

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