scholarly journals COMPARATIVE EFFECTIVENESS OF RADIOFREQUENCY PULMONARY VEIN ISOLATION PLUS AMIODARONE THERAPY IN PREVENTING POST-CORONARY ARTERY BYPASS GRAFTING ATRIAL FIBRILLATION

2020 ◽  
Vol 26 (3) ◽  
pp. 29-36
Author(s):  
A. Sh. Revishvili ◽  
V. A. Popov ◽  
G. P. Plotnikov ◽  
A. N. Korostelev ◽  
E. S. Malyshenko ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Artery Bypass ◽  
Randomized Study ◽  
Study Groups ◽  
Wound Complications ◽  
Amiodarone Therapy ◽  
Mechanical Lung Ventilation ◽  
Significant Difference

Objective. To evaluate the effectiveness of epicardial bipolar radiofrequency ablation (RFA) of pulmonary vein ostia (PV) in comparison with its being combined with amiodarone administration for post-CABG atrial fibrillation (AF) prevention.Methods. A single-centre, prospective randomized study (PULVAB), including 96 CAD patients with no history of AF, was conducted between January 2015 and December 2018. Group 1 (control; n=34) had standard CABG alone. Group 2 (n=29) received RFA of PV as an adjunct to CABG for prevention of postoperative AF (POAF). Group 3 patients (n=33) had RFA at the time of CABG and were given amiodarone. Allocation was concealed using sequentiallynumbered opaque envelopes. The efficacy and safety of RFA concomitant with CABG were assessed, as both performed independently and combined with amiodarone administration, as well as intra-and postoperative course.Results. No differences were seen in operation length (p=0.937), cardiopulmonary bypass (CPB) or the aorta clamping times (р=0.377 and p=0.072, respectively). The study groups (CABG, CABG-RFA, CABG-RFA-amiodarone) did not differ statistically in the number of shunts placed - 3.17±0.61, 3.10±0.51 and 2.94±0,6 (p=0,121). No significant difference was noted in RFA duration between Groups 2 and 3 - 11.7±3.7 and 11.4±6.3 min, respectively (p=0,834).AF was found to occur most commonly at postoperative days two or four. The isolated CABG surgery group patients developed POAF most often of all (32,4%). The incidence of POAF was lower after RFA concomitant to CABG - 20.7% (р=0,29). A significant difference was identified in POAF incidence between Groups 1 and 3- 32.4% and 6.1%, respectively (p = 0.0065). Differences between Groups 2 and 3 proved not to be statistically significant (р= 0,086). Sinus rhythm in most of those who had developed arrhythmias was restored by pharmacological cardioversion except for three patients (one in each group). At discharge, 97.1% , 96.7% and 97% of the subjects in Groups 1, 2 and 3, respectively, exhibited sinus rhythm (p>0,05).There was no in-hospital mortality in any of the groups. Neither were there any wound complications, reoperations, perioperative myocardial infarction or cerebral circulatory disorders observed. No difference was revealed in the severity and frequency of renal or respiratory failure. The mechanical lung ventilation time and duration of stay in the ICU in the isolated CABG group were shown to be increased as compared with the CABG-RFA and CABG-RFA-amiodarone groups (p<0.05).Conclusion. The evidence from the pilot study (PULVAB) suggests that bipolar ablation of PV does not significantly complicate CABG, while being combined with amiodarone administration for prevention of rhythm disorders it significantly reduces the incidence of POAF. The in-hospital incidence of POAF tended to decrease, which was not statistically significant, though. Evaluating the efficacy of RFA concomitant with CABG, as performed independently, invites further investigation with more data analysis.

scholarly journals Mapping and ablation of non-pulmonary vein drivers of persistent atrial fibrillation: Has a STAR been born?

2020 ◽  
Author(s):  
Jay Montgomery
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Randomized Study ◽  
Persistent Atrial Fibrillation ◽  
Holter Monitoring ◽  
High Rate ◽  
Regression To The Mean ◽  
Invasive Treatment ◽  
Significant Difference ◽  
Linear Ablation

While pulmonary vein isolation (PVI) remains the cornerstone for invasive treatment of atrial fibrillation (AF), patients with persistent AF still have a high rate of recurrence with this method. Stochastic Trajectory Analysis of Ranked signals (STAR) mapping uses data from multiple individual wavefronts during ongoing AF to identify local drivers of persistent AF. In this non-randomized study, STAR mapping and ablation showed significantly lower recurrence of atrial arrhythmias compared to a consecutive PVI-only cohort and a propensity-matched ‘conventional ablation’ cohort (consisting of PVI plus complex fractionated atrial electrogram ablation or linear ablation). This benefit was driven by a much lower rate of AF recurrence in the STAR (6.2%) cohort vs PVI-only (44%) or ‘conventional’ (40%) with no significant difference in atrial tachycardia recurrence. Additionally, AF termination rates during ablation were approximately three times higher in the STAR cohort. While the analysis is retrospective and not randomized, the STAR cohort was also the only cohort with complete cessation of anti-arrhythmic drugs at three months and Holter monitoring at 6 and 12 months post-ablation per protocol. While STAR mapping appears to be a very promising new tool for treating persistent AF, history predicts at least some regression to the mean when future randomized comparisons are made. The authors have planned a multicenter randomized trial of PVI plus STAR mapping vs PVI-only for persistent AF. The global community of electrophysiologists and patients with AF eagerly awaits the results.

scholarly journals Efficacy of Adenosine versus Verapamil for Management of Supraventricular Tachycardia Post- Coronary Artery Bypass Grafting: A Randomized Trial

2021 ◽  
Author(s):  
Hoda Shokri ◽  
Ihab Ali
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Supraventricular Tachycardia ◽  
Normal Sinus Rhythm ◽  
Artery Bypass ◽  
Study Groups ◽  
Normal Sinus ◽  
Arterial Blood ◽  
Significant Difference

Abstract Background The aim is to compare the use of adenosine and verapamil for management of postoperative supraventricular tachycardia in terms of time of conversion of SVT to normal sinus rhythm, success rate, hospital stay length and adverse eventsMethods Patients (54–65 years old) received adenosine or verapamil groups. In the adenosine group, patients received IV adenosine 6 mg bolus then wait 2 minutes, if it failed another 12 mg IV of adenosine was administered. In the verapamil group, patients received IV verapamil 5mg bolus slowly over 2 minutes followed by a second IV bolus of 10 mg, 30 minutes after the initial dose in persistent supraventricular tachycardia (SVT). If SVT persisted, the patient was shifted to adenosine. Results Patients were followed up regarding the efficacy of drug, blood pressure, mean time of conversion of SVT (time elapsed from effective dose of the study drug till conversion of SVT to sinus rhythm) and incidence of adverse events were recorded. The efficacy of adenosine was significantly higher than verapamil (P <0.001). The time of conversion of SVT to sinus rhythm was significantly shorter in adenosine group compared with verapamil group (P < 0.001). The incidence of hypotension was comparable between the study groups. The mean arterial blood pressure and the incidence of complications were comparable.Conclusions Intravenous administration of adenosine effectively treat SVT in terms of higher efficacy and shorter time of conversion of SVT to normal sinus rhythm compared with verapamil without any significant difference regarding the incidence of side effects between the study groups.Trial registrationThis study was approved by Medical ethics committee of Ain Shams University approval number FMASU R 62/ 2019). and the protocol was prospectively registered at ClinicalTrials.gov : NCT 04203368 on December 16, 2019.

Abstract 13509: A Prospective Randomized Study on the Prevalence, Characteristics, and Predictors of Pulmonary Vein Reconnections and the Clinical Outcomes Between Contact Force-Guided and Conventional Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kohki Nakamura ◽  
Shigeto Naito ◽  
Takehito Sasaki ◽  
Kentaro Minami ◽  
Eri Goto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Pulmonary Vein ◽  
Contact Force ◽  
Randomized Study ◽  
Lower Percentage ◽  
Logistic Regression Models ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Purpose: To prospectively investigate the differences in pulmonary vein reconnections (PVRs) and clinical outcomes between contact force (CF)-guided and conventional circumferential PV isolation (CPVI) of atrial fibrillation (AF). Methods: A total of 120 consecutive AF patients (63±10 years; 88 males) undergoing an initial CPVI were randomized to ablation with a target CF of 20g (CF-group; n=60) or that with operators blinded to the CF information (Blind-group; n=60). The right and left CPVI lines were each divided into 12 segments, and the occurrence of PVRs and CF-related parameters were evaluated in each segment. Time-dependent and adenosine-dependent PVRs were assessed twice during the procedure, just after completing the CPVI and at the end of the procedure. Results: The CF-group had significantly fewer PVRs (0.67±0.91/patient vs. 1.16±1.16/patient; P=0.007), a higher percentage of adenosine-dependent transient PVRs (60.5% vs. 28.8%; P=0.001), and lower percentage of persistent PVRs than the Blind-group. The mean CF was higher in the CF-group than in the Blind-group (Median, 18.0g vs. 16.1g; P<0.001), with the most significant difference observed along the posterior right-sided PVs (P-RPVs) and anterior left-sided PVs (A-LPVs). In multiple logistic regression models, the mean CF was a negative predictor of PVRs along the P-RPVs and A-LPVs in the Blind-group (odds ratios, 0.728 and 0.786; P<0.001 and 0.007), while no significant predictor was identified in the CF-group or along the anterior RPVs and posterior LPVs in the Blind-group. In the Kaplan-Meier analysis, the arrhythmia-free survival rate at 12 months was 91.2% in the CF-group (29.8% with antiarrhythmic drugs [AADs]) and 89.4% in the Blind-group (21.1% with AADs), respectively (P=0.596). Conclusions: CF-guided CPVI can reduce PVRs and result in a higher percentage of adenosine-dependent transient PVRs, and may be particularly beneficial along regions where a relatively low CF tends to be applied: the P-RPVs and A-LPVs. The comparable clinical outcomes may be due to (1) the learning curve effect obtained by the CF-guided technique, which improved the ablation electrode-tissue contact in the Blind-group, and (2) repeated provocation and elimination of dormant PV conduction.

scholarly journals Persistent atrial fibrillation presenting in sinus rhythm: Pulmonary vein isolation versus pulmonary vein isolation plus electrogram-guided ablation

2013 ◽  
Vol 106 (10) ◽  
pp. 501-510 ◽  
Author(s):  
Frederic A. Sebag ◽  
Najia Chaachoui ◽  
Nick W. Linton ◽  
Sana Amraoui ◽  
James Harrison ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

Hypersensitivity Reaction to Amiodarone in a Patient with a Previous Reaction to an lodinated Radiocontrast Agent

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1310-1314 ◽  
Author(s):  
Leanne Stafford
Keyword(s):  
Atrial Fibrillation ◽  
Hypersensitivity Reaction ◽  
Product Information ◽  
Artery Bypass ◽  
Amiodarone Therapy ◽  
Class Iii ◽  
Radiocontrast Agent ◽  
Triple Vessel Disease ◽  
Intravenous Amiodarone ◽  
Previous Reaction

Objective: To describe a case of a hypersensitivity reaction to oral amiodarone in a patient with a previous reaction to an iodinated radiocontrast agent. Case Summary: A 55-year-old man experienced facial urticaria after intraarterial injection of iohexol, an iodinated radiocontrast agent, during coronary angiography, which was successfully treated with intravenous hydrocortisone and promethazine. The procedure revealed significant triple vessel disease, and the patient subsequently underwent coronary artery bypass grafting in October 2006. Postoperatively, the patient experienced 2 episodes of fast atrial fibrillation, the first of which was treated successfully with intravenous amiodarone. The second episode resulted in the commencement of therapy with oral amiodarone 400 mg 3 times daily. Within one hour after the first dose, the patient experienced tip swelling and tingling, which was again treated with intravenous promethazine. Amiodarone was stopped; the patient remained in sinus rhythm and was discharged without further incident. Discussion: Amiodarone is a class III antiarrhythmic agent frequently used in the management of atrial fibrillation after cardiac surgery. The approved product information lists known hypersensitivity to iodine as a contraindication to its administration, but no other cases of amiodarone hypersensitivity in a patient with a previous reaction to an iodinated radiocontrast agent have been published, Conversely, it has been suggested that the drug may be safely used in such patients. The Naranjo probability scale supported a probable adverse reaction of hypersensitivity associated with amiodarone therapy in this patient. Conclusions: Prescribers should exercise caution in the administration of amiodarone to patients with a true, documented history of hypersensitivity to an iodinated compound.

scholarly journals The outcome of ablation for non-paroxysmal atrial fibrillation targeting spatiotemporal electrogram dispersion compared with ganglionated plexi ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Sakata ◽  
T Tanaka ◽  
S Yamashita ◽  
K Yamashiro
Keyword(s):  
Atrial Fibrillation ◽  
Study Groups ◽  
Atrial Arrhythmia ◽  
Single Procedure ◽  
Ganglionated Plexi ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Left And Right ◽  
Fibrillatory Conduction ◽  
And Control

Abstract Background Although catheter ablation targeting ganglionated plexi (GP) playing an important role in formation of triggers and substrates of atrial fibrillation (AF) has been reported as one of the effective ablation strategies in non-paroxysmal AF (non-PAF) patients, its effectiveness varies among the study groups. More recently, ablation targeting spatiotemporal electrogram dispersion (STED) areas, assumed to contain AF drivers in forms of rotational activation is proposed. However, the optimal ablation strategy for non-PAF is still controversial since the exact mechanisms of non-PAF are not well understood. Purpose To investigate the effectiveness of GP ablation for autonomic modification and STED ablation for modulation of AF drivers. Methods Consecutive 149 non-PAF patients who underwent STED ablation in our center were enrolled. We detected STED areas within the whole left and right atrium during AF using PentaRay®, and ablated them. If AF was terminated during STED ablation, we finished the procedure without burning the remaining STED areas. If not, electrical cardioversion was applied. The outcome was compared with that in consecutive 156 non-PAF patients undergoing GP ablation previously in our center. Results (1) The clinical characteristics were comparable between two groups (see Table). (2) A Kaplan-Meier curve showed that there was no significant difference between the freedom rates from non-PAF/non-paroxysmal atrial tachycardia (non-PAT) after single procedure in STED group and GP group (Figure, left). (3) However, the freedom rates from non-PAT in STED group was significantly lower than that GP group (Figure, right). Conclusions The recurrence type of atrial arrhythmia after ablation was remarkably different between ablation of STED and GP. STED ablation might eliminate fibrillatory conduction and control AF driver in patients with non-PAF. Freedom from atrial arrhythmia Funding Acknowledgement Type of funding source: None

scholarly journals Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001718
Author(s):  
Bart A Mulder ◽  
Meelad I H Al-Jazairi ◽  
Federico T Magni ◽  
Hessel F Groenveld ◽  
Robert G Tieleman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Area Under The Curve ◽  
Holter Monitoring ◽  
Underlying Disease ◽  
Volume Index ◽  
Left Atrium Volume

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

scholarly journals Effect of preoperative atrial fibrillation on long-term results after Off Pump Coronary Artery Bypass

2021 ◽  
Vol 38 (6) ◽  
pp. 5-15
Author(s):  
Soslan T. Enginoev ◽  
Dmitriy A. Kondratiev ◽  
Gasan M. Magomedov ◽  
Tamara K. Rashidova ◽  
Bakytbek K. Kadyraliev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Long Term Results ◽  
Off Pump ◽  
Group I ◽  
Pump Coronary Artery Bypass

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB). Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I 82 patients with sinus rhythm (SR) before surgery, Group II (control) 102 patients with AF before surgery. The average age of the included patients was 61 6.7 years, with 95 % CI: 6062. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7102.0) months. Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (911) and 14 (1116) hours, respectively, p 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF 2 (2 %), p = 0.7), strokes (in the group with SR 1 (1.2 %), in the group with AF 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF 63.9 %, p = 0.016). Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

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