Experience of pharmacological cardioversion with refralon in persistent atrial fibrillation and flutter according to the data of the cardiology department of Orenburg regional clinical hospital

Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

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Delayed sinus rhythm restoration after thoracoscopic left atrium fragmentation (а report of two cases)

Clinical Practice ◽

10.17816/clinpract59550 ◽

2020 ◽

Vol 11 (4) ◽

pp. 90-95

Author(s):

Sergey A. Vachev ◽

Sergey V. Korolev ◽

Alexandr S. Zotov ◽

Robert I. Khabazov ◽

Alexander V. Troitskiy

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrium ◽

Persistent Atrial Fibrillation ◽

Clinical Cases

The article presents two clinical cases of delayed restoration of the sinus rhythm in patients with long-term persistent atrial fibrillation after the procedure of thoracoscopic radiofrequency fragmentation of the left atrium. The necessity of continuing attempts to restore the sinus rhythm up to the end of the "blind period" (90 days) is discussed.

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Left atrial mechanical remodelling assessed as the velocity of left atrium appendage wall motion during atrial fibrillation is associated with maintenance of sinus rhythm after electrical cardioversion in patients with persistent atrial fibrillation

PLoS ONE ◽

10.1371/journal.pone.0228239 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0228239 ◽

Cited By ~ 3

Author(s):

Paweł Wałek ◽

Janusz Sielski ◽

Iwona Gorczyca ◽

Joanna Roskal-Wałek ◽

Katarzyna Starzyk ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrium ◽

Left Atrial ◽

Wall Motion ◽

Persistent Atrial Fibrillation ◽

Electrical Cardioversion

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The Prevalence of Low Voltage in Left Atrium in Persistent Atrial Fibrillation: Examination in Cases Maintaining Sinus Rhythm after Pharmacologic Defibrillation

Journal of Arrhythmia ◽

10.4020/jhrs.27.pe4_040 ◽

2011 ◽

Vol 27 (Supplement) ◽

pp. PE4_040

Author(s):

Higashi Yukei ◽

Hisa Shimojima ◽

Daisuke Wakatsuki ◽

Sayaka Yamaya ◽

Tokutada Sato ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrium ◽

Low Voltage ◽

Persistent Atrial Fibrillation

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Successful Treatment of Lone Persistent Atrial Fibrillation by Means of a Hybrid Thoracoscopic-Transcatheter Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31826f0462 ◽

2012 ◽

Vol 7 (4) ◽

pp. 254-258 ◽

Cited By ~ 24

Author(s):

Claudio Muneretto ◽

Gianluigi Bisleri ◽

Luca Bontempi ◽

Faisal H. Cheema ◽

Antonio Curnis

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrial ◽

Hybrid Approach ◽

Heart Rhythm ◽

Persistent Atrial Fibrillation ◽

Surgical Approaches ◽

Surgical Ablation ◽

Internally Cooled ◽

The Mean

Objective Ablation strategies for the treatment of lone persistent atrial fibrillation (AF) have rapidly evolved during the past decade both with electrophysiological (EP) and surgical approaches. We investigated the safety and efficacy of a novel staged hybrid approach combining surgical thoracoscopic and EP ablation in patients with lone persistent AF. Methods Twenty-four consecutive patients with either persistent (three patients, 12.5%) or long-standing persistent (21 patients, 87.5%) isolated AF were prospectively enrolled: the mean age was 63.2 ± 9.3 years, the mean left atrial dimension was 50.5 ± 8 mm, and the mean AF duration was 82.7 months (range, 7–240 months). The surgical procedure consisted of a monolateral, right-sided, thoracoscopic closed-chest approach to perform a “box” lesion set with a temperature-controlled, internally cooled, radiofrequency monopolar device with suction adherence (Cobra Adhere XL; Estech, San Ramon, CA USA). A continuous monitoring rhythm device (Reveal XT; Medtronic, Minneapolis, MN USA) was implanted at the time of surgery in all patients for continuous long-term monitoring of the heart rhythm. Results Successful completion of the procedure was achieved in all cases, with a mean ablation time of 29 ± 9 minutes and an overall procedural time of 84 ± 16 minutes. After surgical ablation, the exit block was documented in all cases, whereas the entrance block was achieved in 87.5% (21 of 24 patients). No intensive care unit stay was required, and no complications occurred postoperatively; hospital mortality was 0%. At a mean interval of 33 ± 2 days after surgery, an EP study was performed: bidirectional block was confirmed in 79.1% (19 of 24 patients), whereas gaps at the level of the box lesion were observed in 20.8% of the patients (5 of 24 patients). Additional transcatheter endocardial right- and left-sided lesions were performed in 62.5% of cases (15 of 24 patients). At a mean follow-up of 28 months (range, 1–55 months), 87.5% of the patients (21 of 24 patients) are in sinus rhythm, and the incidence of left atrial flutter was 0%. Conclusions The combination of thoracoscopic box lesion and transcatheter ablation in a staged hybrid approach proved to be safe, providing excellent mid-term clinical outcomes in patients with long-standing, isolated, persistent AF. Moreover, the implantable loop recorders documented such incremental benefits in sinus rhythm restoration for up to 28 months.

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Subjective identification and ablation of drivers in persistent atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehab724.0505 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

E Franco ◽

C Lozano-Granero ◽

R Matia ◽

A Hernandez-Madrid ◽

I Sanchez-Perez ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Left Atrium ◽

Atrial Flutter ◽

Pulmonary Vein ◽

Persistent Atrial Fibrillation ◽

Atrial Arrhythmias ◽

Ablation Success ◽

Tailored Approach ◽

Approach Group

Abstract Background Ablation of drivers in persistent atrial fibrillation (AF) has shown controversial results. Purpose To test the efficacy of a tailored approach for persistent AF ablation which includes pulmonary vein isolation (PVI) plus “subjective” identification and ablation of drivers. Methods From May 2017 to December 2019, selected patients with persistent AF and ongoing AF at the beginning of the ablation procedure were included. Conventional high-density mapping catheters (PentaRay NAV, IntellaMap Orion or Advisor HD Grid) were used. Drivers were subjectively identified as: a) fractionated continuous (or quasi-continuous) electrograms on 1–2 adjacent bipoles, without dedicated software (Figure 1A, dashed line; PR = PentaRay NAV); and b) sites with spatiotemporal dispersion (i.e. all the cycle length comprised within the mapping catheter) plus non-continuous fractionation on single bipoles (Figure 1B, arrows; in panels A and B: paper speed 200 mm/s; ORB = 24-pole ORBITER Woven catheter, blue bipoles around tricuspid annulus and green bipoles into the coronary sinus). Ablation included PVI + focal or linear ablation targeting sites with drivers. Ablation success was defined as conversion to sinus rhythm or atrial flutter during ablation. Follow-up included visits with 24h Holter ECG at 3–6–12 months. Survival free from atrial arrhythmias lasting >30 seconds was compared between patients ablated with this tailored approach, and all consecutive patients with persistent AF treated with a PVI-only strategy during the same period. Results 158 Patients received ablation: 35 with the tailored approach (61,7±10,2 years; 29% females) and 123 with only PVI (62,5±9,6 years; 25% females; 89% cryoablation). Basal characteristics were similar (Table 1). In the tailored-approach group, 14 patients (40%) presented 28 detectable sites with continuous fractionated electrograms, 26 on the left atrium and 2 on the right atrium, which was only mapped if ablation of drivers in the left atrium was not successful; 12 (43%) were located within the pulmonary vein antra. 27 patients (77%) showed 103 sites with spatiotemporal dispersion (4 [3–5] per patient). Ablation success was achieved in 17 patients (48%; conversion to sinus rhythm, n=7; conversion to atrial flutter, n=10) in the tailored-approach group and 1 patient (0,8%, sinus rhythm) in the PVI-only group. Excluding a 3-month blanking period, the tailored approach, compared to only PVI, improved one-year freedom from atrial arrhythmias (71% Vs 51%, p=0,05) and mean survival free from atrial arrhythmias (26±3 months; 95% CI 21–32 months Vs 18±2 months; 95% CI 15–22 months) (Figure 1C), at the cost of a longer median procedural time (246 [212–277] vs 108 [81–143] min, p<0,001) and fluoroscopy time (51 [36–76] vs 33 [21–45] min, p<0,001). Conclusion Subjective identification and ablation of drivers, added to PVI, improved freedom from atrial arrhythmias. FUNDunding Acknowledgement Type of funding sources: None. Table 1. Basal characteristics Figure 1

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