scholarly journals Substrate Modification in Catheter Treatment of Atrial Fibrillation

2021 ◽  
pp. 76-79
Author(s):  
Oleksandr S. Stychynskyi ◽  
Alina V. Topchii ◽  
Pavlo O. Almiz
Keyword(s):  
Atrial Fibrillation ◽  
Recurrence Rate ◽  
Pulmonary Veins ◽  
Signal Amplitude ◽  
Scar Tissue ◽  
Ablation Procedure ◽  
Atrial Myocardium ◽  
The Past ◽  
Substrate Modification ◽  
Modern Methods

According to modern concepts, atrial fibrillation (AF) occurs when there are triggers affecting the prepared substrate (atrial myocardium) in the presence of modulating factors that contribute to the occurrence of arrhythmia. Catheter treatment of AF has been most successfully developed in the field of affecting triggers (since late 1990s, the most successful was a technique of isolation of pulmonary veins which are the main source of trigger impulses in AF). Over the past two decades, various techniques have also been proposed for influencing the fibrous substrate. The aim. To analyze the most advanced techniques for influencing the fibrous substrate during catheter treatment of AF. Materials and methods. We analyzed the experience of leading electrophysiological centers in this field. Discussion. Modern studies contain various electrophysiological criteria of fibrous myocardium. However, the signal amplitude less than 0.5 mV is considered borderline between healthy and damaged tissues by most authors. The task of the catheter action on the myocardium is to separate the fibrously altered tissue and intact tissue. This can be achieved by isolating the area of fibrosis or by transforming it into a scar tissue incapable of arrhythmogenesis. It should be noted that both methods are associated with the same frequency of the absence of AF paroxysms, which can be regarded as confirmation of the advisability of influencing the substrate. The most important is that exposure of the substrate can significantly reduce the recurrence rate of AF compared to that when the ablation procedure is limited to isolation of the pulmonary veins. Conclusions. Modern methods of influencing the areas of fibrosis in the atria can significantly improve the results of catheter treatment of AF.

scholarly journals Pulmonary Vein Activity Organization to Determine Atrial Fibrillation Recurrence: Preliminary Data from a Pilot Study

Mathematics ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. 1813
Author(s):  
Raquel Cervigón ◽  
Javier Moreno ◽  
José Millet ◽  
Julián Pérez-Villacastín ◽  
Francisco Castells
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Cross Correlation ◽  
Spatial Organization ◽  
Pulmonary Veins ◽  
Transfer Entropy ◽  
First Year ◽  
Atrial Fibrillation Recurrence ◽  
Ablation Procedure ◽  
Af Recurrence

Ablation of pulmonary veins has emerged as a key procedure for normal rhythm restoration in atrial fibrillation patients. However, up to half of ablated Atrial fibrillation (AF) patients suffer recurrences during the first year. In this article, simultaneous intra-atrial recordings registered at pulmonary veins previous to the ablation procedure were analyzed. Spatial cross-correlation and transfer entropy were computed in order to estimate spatial organization. Results showed that, in patients with arrhythmia recurrence, pulmonary vein electrical activity was less correlated than in patients that maintained sinus rhythm. Moreover, correlation function between dipoles showed higher delays in patients with AF recurrence. Results with transfer entropy were consistent with spatial cross-correlation measurements. These results show that arrhythmia drivers located at the pulmonary veins are associated with a higher organization of the electrical activations after the ablation of these sites.

Use of Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation.

2021 ◽  
Author(s):  
Fatima Zaraket ◽  
Bas Deva ◽  
Jesus jimenez ◽  
Benjamin Casteigt ◽  
Begoña Benito ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Pulmonary Veins ◽  
Intracardiac Thrombus ◽  
Ablation Procedure ◽  
Recurrent Atrial Fibrillation ◽  
Rule Out

Abstract Background: Pulmonary veins isolation (PVI) is a standard treatment for recurrent atrial fibrillation (AF). Uninterrupted anticoagulation for minimum 3 weeks before the ablation and exclusion of left atrial (LA) thrombus with transesophageal echography (TEE) immediately before or during the procedure minimize peri-procedural risk. We aimed to demonstrate the utility of cardiac tomography (CT) and cardiac magnetic resonance (CMR) to rule out LA thrombus prior to PVI.Methods: Patients undergoing PVI for recurrent AF were retrospectively evaluated. Only patients that started anticoagulation at least 3 weeks prior to the CT/CMR and subsequently uninterrupted until the ablation procedure were selected. An intracardiac echo (ICE) catheter was used in all patients to evaluate LA thrombus. The results of CT/CMR were compared to ICE imaging.Results: We included 272 consecutive patients averaging 54.5 years (71% male; 30% persistent AF). Average CHA2DS2VASC Score was 0.9 and mean LA diameter was 43 mm, 111 patients on Acenocumarol and 161 on direct oral anticoagulants. Anticoagulation was started 227±392 days before the CT/CMR, and 291±416 days before the ablation procedure. CT/CMR diagnosed intracardiac thrombus in 2 cases, both in the LA appendage. A new CT/CMR revealed resolution of thrombus after 6 additional months of uninterrupted anticoagulation. No macroscopic thrombus was observed in any patients with ICE (negative predictive value of 100%; p<0.01).Conclusions: CT and MRI are excellent surrogates to TEE and ICE to rule out intracardiac thrombus in patients adequately anticoagulated prior AF ablation. This is true even for delayed procedures as long as anticoagulation is uninterrupted.

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 &lt; 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 CRYOABLATION IN ATRIAL FIBRILLATION: RATIONALE OF THE NATIONAL PROSPECTIVE REGISTRY AND PRELIMINARY RESULTS

2018 ◽  
pp. 21-25
Author(s):  
E. N. Mikhailov ◽  
T. A. Lyubimtseva ◽  
K. V. Davtyan ◽  
A. G. Topchian ◽  
E. S. Tarasyuk ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Pulmonary Veins ◽  
National Study ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Safety And Efficacy ◽  
Informational System ◽  
Real Clinical Practice

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

Enhanced Imaging Modalities in Atrial Fibrillation

2010 ◽  
Vol 6 (4) ◽  
pp. 54
Author(s):  
Matthew Wright ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Imaging Modalities ◽  
Resonance Imaging ◽  
Ablation Procedure ◽  
The Past ◽  
Magnetic Resonance Imaging Mri ◽  
Enhanced Imaging ◽  
Mapping Systems ◽  
Repeat Procedures

The wealth of imaging options for the practising electrophysiologist has exploded over the last decade, primarily due to the ability to effectively ablate patients with atrial fibrillation (AF). Currently, an electrophysiologist is able to chose to from pre-procedural computed tomography (CT), magnetic resonance imaging (MRI), procedural fluoroscopy, ultrasound, electroanatomic mapping systems and various combinations of these imaging modalities to help plan and perform the ablation procedure. Increasingly these imaging tools are also being used in follow-up to assess scar formation and help guide repeat procedures when necessary. This article will focus predominantly on the development of fluoroscopic techniques over the past decade.

scholarly journals Current State of the Surgical Treatment of Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Elena Sandoval ◽  
Manuel Castella ◽  
Jose-Luis Pomar
Keyword(s):  
Atrial Fibrillation ◽  
Standard Treatment ◽  
Pulmonary Veins ◽  
Maze Procedure ◽  
Energy Devices ◽  
The Past ◽  
Current State ◽  
Invasive Techniques ◽  
Reproducible Manner

Surgery of atrial fibrillation (AF) was first described in 1991 by James Cox in what was named the Cox-Maze procedure, and over the years it has been considered the gold-standard treatment, with best results in maintaining sinus rhythm in the long term. Nevertheless, the complexity and aggressivity of the first techniques of cut-and-sew limited the application of this procedure, and few centers were dedicated to AF surgery. In the past years, however, new devices able to ablate atrial tissue with cryotherapy, radiofrequency, or ultrasounds have facilitated this operation. In the mid-term, other energy devices with laser or microwave have been abandoned due to a lack of consistency in getting transmural lesions in a consistent and reproducible manner. Additionally, better knowledge of the physiopathology of AF, with the importance of triggering zones around the pulmonary veins, has started new minimally invasive techniques to approach paroxysmal and persistent AF patients through thoracoscopy.

scholarly journals Cardiac Tomography and Cardiac Magnetic Resonance to Predict the Absence of Intracardiac Thrombus in Anticoagulated Patients Undergoing Atrial Fibrillation Ablation.

2021 ◽  
Author(s):  
Fatima Zaraket ◽  
Bas Deva ◽  
Jesus Jimenez ◽  
Benjamin Casteigt ◽  
Begoña Benito ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Pulmonary Veins ◽  
Intracardiac Thrombus ◽  
Ablation Procedure ◽  
Recurrent Atrial Fibrillation ◽  
Rule Out

Abstract Background: Pulmonary veins isolation (PVI) is a standard treatment for recurrent atrial fibrillation (AF). Uninterrupted anticoagulation for minimum 3 weeks before the ablation and exclusion of left atrial (LA) thrombus with transesophageal echography (TEE) immediately before or during the procedure minimize peri-procedural risk. We aimed to demonstrate the utility of cardiac tomography (CT) and cardiac magnetic resonance (CMR) to rule out LA thrombus prior to PVI. Methods: Patients undergoing PVI for recurrent AF were retrospectively evaluated. Only patients that started anticoagulation at least 3 weeks prior to the CT/CMR and subsequently uninterrupted until the ablation procedure were selected. An intracardiac echo (ICE) catheter was used in all patients to evaluate LA thrombus. The results of CT/CMR were compared to ICE imaging. Results: We included 272 consecutive patients averaging 54.5 years (71% male; 30% persistent AF). Average CHA2DS2VASC Score was 0.9 and mean LA diameter was 43 mm, 111 patients on Acenocumarol and 161 on direct oral anticoagulants. Anticoagulation was started 227±392 days before the CT/CMR, and 291±416 days before the ablation procedure. CT/CMR diagnosed intracardiac thrombus in 2 cases, both in the LA appendage. A new CT/CMR revealed resolution of thrombus after 6 additional months of uninterrupted anticoagulation. No macroscopic thrombus was observed in any patients with ICE (negative predictive value of 100%; p<0.01).Conclusions: CT and MRI are excellent surrogates to TEE and ICE to rule out intracardiac thrombus in patients adequately anticoagulated prior AF ablation. This is true even for delayed procedures as long as anticoagulation is uninterrupted.

Abstract 4114: Identification of Gap Lesions Following Failed Atrial Fibrillation Ablation: Using Three-Dimensional Delayed Enhancement MRI to Guide Re-ablation Procedure

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Troy J Badger ◽  
Robert S Oakes ◽  
Eric N Fish ◽  
Nathan M Segerson ◽  
Nazem W Akoum ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Three Dimensional ◽  
3D Models ◽  
Scar Tissue ◽  
Delayed Enhancement ◽  
Ablation Procedure ◽  
Repeat Procedure ◽  
Mri Scans ◽  
Second Procedure

Objectives. Pulmonary vein antrum (PVA) isolation is a common ablation strategy to treat patients with atrial fibrillation (AF). Incomplete lesion formation around the PVA is thought to contribute to recurrence of AF. We report a new multi-step approach to ensure complete PVA scarring by using 3D delayed enhancement MRI (DE-MRI) models of the LA to show regions needing ablation during repeat procedure. Methods. Five patients who suffered AF recurrence following PVAI elected to undergo a second procedure. All 5 patients received DE-MRI scans 3 months following each procedure. 3D segmentation of the LA was performed to evaluate for complete PVA scarring. Application of a color look-up table was used to illuminate scar tissue. Regions of healthy PVA myocardium was marked following the failed ablation and targeted during repeat procedure. Results. All patients showed incomplete PVA scarring after the first ablation. All patients had increased PVA scarring following the repeat procedure. 4 (80%) patients were free of AF (determined by 8 day Holter recordings, ECG and event monitoring) at 3-month follow-up. The figure below shows lack of continuous scar (orange/white) around the left and right PVA following the failed procedure. Gap lesions of healthy myocardium (blue) were identified and targeted (yellow arrows) prior to repeat ablation. Following the successful repeat procedure, all four PVA had continuous scar lesions. Conclusion. 3D DE-MRI models of the LA may identify gaps in RF lesions following failed PVA isolation. These 3D models may assist in procedure planning for the second ablation procedure by identifying the regions necessary for re-ablation.

Sign in / Sign up

Export Citation Format

Share Document