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We thank Dr. Ren and colleagues for their interest in our study on early mortality following catheter ablation of atrial fibrillation (AF) ([1][1]), and we agree that intracardiac echocardiography (ICE) can be an indispensable tool for AF ablation. At our institution, ICE is used during all AF

Background The use of intracardiac electrograms to guide atrial fibrillation (AF) ablation has yielded conflicting results. Objectives The authors evaluated the usefulness of spatiotemporal dispersion, a visually recognizable electric footprint of AF drivers, for the ablation of all forms of AF. Methods The authors prospectively enrolled 105 patients admitted for AF ablation. AF was sequentially mapped in both atria with a 20-pole PentaRay catheter. The authors tagged and ablated only regions displaying electrogram dispersion during AF. Results were compared to a validation set in which a conventional ablation approach was used (pulmonary vein isolation/stepwise approach). To establish the mechanism underlying spatiotemporal dispersion of AF electrograms, the authors conducted realistic numerical simulations of AF drivers in a 2-dimensional model and optical mapping of ovine atrial scar-related AF. Results Ablation at dispersion areas terminated AF in 95% of the 105 patients. After ablation of 17 ± 10% of the left atrial surface and 18 months of follow-up, the atrial arrhythmia recurrence rate was 15% after 1.4 ± 0.5 procedures per patient versus 41% in the validation set after 1.5 ± 0.5 procedures per patient (arrhythmia free-survival: 85% vs. 59%; log-rank p Conclusions The clustering of intracardiac electrograms exhibiting spatiotemporal dispersion is indicative of AF drivers. Their ablation allows for a nonextensive and patient-tailored approach to AF ablation. (Substrate Ablation Guided by High Density Mapping in Atrial Fibrillation [SUBSTRATE HD]; NCT02093949)

Cardiac perforation is a rare but potentially fatal complication of atrial fibrillation (AF) ablation that can require surgical repair for definitive management. As such, there is controversy regarding the safety of performing AF ablation at centers without on-site cardiothoracic surgery (CTS). The

Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear. We performed a retrospective

Data are limited regarding atrial fibrillation (AF) ablation in patients with heart failure with preserved ejection fraction (HFpEF). National Readmission Database (NRD) from 2016 was used to identify patients with AF and HFpEF that underwent AF ablation using appropriate ICD-10 codes. The primary

Chronic pulmonary vein reconnection (CPVR) remains a challenge in atrial fibrillation (AF) patients (pts) undergoing catheter ablation. Preventing CPVR may improve the long-term outcome of AF ablation. In this study, we report the impact of contact force sensing (CFS) technology on CPVR rates.

Atrial fibrillation (AF) commonly complicates hypertrophic cardiomyopathy (HCM). We aimed to determine the safety and efficacy of AF catheter ablation in HCM patients. Medline, Embase, Cochrane, clinicaltrials.gov, were searched until August 2019. Studies reporting the outcomes of AF ablation in

In a recent issue of the Journal, Cheng et al. ([1][1]) reported a trend of increasing complications and 30-day mortality following AF ablation from 2010 through 2015. The authors hypothesize that these trends may be due to increasing age and comorbidity burden or perhaps to increasing performance

Stiff left atrial (LA) syndrome and pulmonary vein stenosis (PVS) are potential complications of atrial fibrillation (AF) ablation. In patients with mitral stenosis (MS) and prior AF ablation, identifying the cause of dyspnea is vital for management. A 74-year-old male with AF ablation a decade

A frequent need for re-ablations and limited overall success rates are still major limitations of catheter ablation procedures for the treatment of atrial fibrillation (AF). These limitations include not only the durability of the pulmonary vein isolation (PVI) lines, but also the pathophysiological understanding of the arrhythmia's substrate. Long-term single procedure success rates in non-paroxysmal AF are disappointingly low for current stepwise ablation approaches adding the placement of linear lines and electrogram-based ablation after circumferential PVI isolation. In the future, substrate modification in AF ablation should move toward individualized patient-tailored ablation procedures. Magnetic resonance imaging could play a major role for noninvasively describing the localization and extent of fibrotic areas. Specific new strategies that could be used include precise localization and ablation of rotors that maintain the arrhythmia using multielectrode mapping during AF and box isolation of fibrotic areas guided by electroanatomic voltage mapping during sinus rhythm.

The guidelines for surgical AF treatment state that it is reasonable to perform left atrial appendage excision or exclusion (LAAE) with AF ablation for longitudinal thromboembolic morbidity prevention, and should be routinely performed. LAAE is commonly performed by excision, epicardial stapling

We evaluated the association of BMI with comorbidities such as hypertension (HTN) and diabetes (DM) and long-term ablation success in AF patients undergoing catheter ablation A total of 4,236 consecutive AF patients undergoing AF ablation were included in the analysis. Based on the baseline BMI

Although procedure-related in-hospital deaths during index admission following catheter ablation of AF have been reported to be 0.02 - 0.2%, there are limited data on early mortality during the first 30 days after AF ablation. We sought to identify rates, trends and predictors of early mortality

Recent randomized controlled study suggested improved outcomes after atrial ablation in patients with HFrEF. We utilized the 1999-2014 National Inpatient Sample(NIS) database to study early effects of AF ablation in patients with HFrEF and HFpEF. We identified patients with HFrEF or HFpEF, who were

Objectives This study sought to determine whether ablation of recently described stable atrial fibrillation (AF) sources, either directly by Focal Impulse and Rotor Modulation (FIRM) or coincidentally when anatomic ablation passes through AF sources, may explain long-term freedom from AF. Background It is unclear why conventional anatomic AF ablation can be effective in some patients yet ineffective in others with similar profiles. Methods The CONFIRM (Conventional Ablation for AF With or Without Focal Impulse and Rotor Modulation) trial prospectively revealed stable AF rotors or focal sources in 98 of 101 subjects with AF at 107 consecutive ablation cases. In 1:2 fashion, subjects received targeted source ablation (FIRM) followed by conventional ablation, or conventional ablation alone. We determined whether ablation lesions on electroanatomic maps passed through AF sources on FIRM maps. Results Subjects who completed follow-up (n = 94; 71.2% with persistent AF) showed 2.3 ± 1.1 concurrent AF rotors or focal sources that lay near pulmonary veins (22.8%), left atrial roof (16.0%), and elsewhere in the left (28.2%) and right (33.0%) atria. AF sources were ablated directly in 100% of FIRM cases and coincidentally (e.g., left atrial roof) in 45% of conventional cases (p Conclusions Elimination of stable AF rotors and focal sources may explain freedom from AF after diverse approaches to ablation. Patient-specific AF source distributions are consistent with the reported success of specific anatomic lesion sets and of widespread ablation. These results support targeting AF sources to reduce unnecessary ablation, and motivate studies on FIRM-only ablation. (The Dynamics of Human Atrial Fibrillation; NCT01008722 )

During the 16 years that have passed since first identification of the pulmonary veins (PVs) as a common site for focal triggers that initiate atrial fibrillation (AF), catheter ablation of AF has matured as a treatment modality. AF ablation is now recommended as a Class 1 therapy for treatment of

Despite the primary trigger for atrial fibrillation (AF) being within the pulmonary vein, current treatments avoid direct ablation of this substrate because of the prohibitive incidence of pulmonary vein (PV) stenosis. Given the suboptimal results with contemporary thermal AF ablation, we previously

Atrial fibrillation (AF) significantly impairs patients’ quality of life (QOL) and has a great effect on health care resource utilization (HCU). We performed a study to compare the effect of a multi-electrode Pulmonary Vein Ablation Catheter (PVAC) vs. traditional point-by-point AF ablation

Necessity of long-term oral anticoagulation therapy (OAT) in patients underwent apparently successful AF ablation remains controversial. Large-scale randomized study on this topic is difficult and costly. The Chinese Atrial Fibrillation Registry study is a prospective, multicenter, hospital-based

Complications of atrial fibrillation (AF) ablation include thromboembolism, tamponade, pulmonary vein stenosis, acute lung injury and phrenic nerve injury (PNI), all of which can present with shortness of breath (SOB). A 55-year-old obese female underwent radiofrequency AF ablation. Shortly after

Limited data suggests that females may have increased recurrence of atria fibrillation (AF) after AF ablation. We intended to confirm this by performing a meta-analysis of studies reporting gender specific outcomes after AF ablation. A PubMed search with term “Atrial Fibrillation Ablation”

ST2 is associated with cardiac hypertrophy and fibrosis. High sensitivity cardiac troponin-T (hs-cTnT) is a marker of cardiac injury. Our hypothesis is that hs-cTnT stratifies ST2 defined risk of atrial arrhythmia (AA) recurrence. 23 patients undergoing AF ablation were enrolled. All underwent wide

Incidental findings (IF) are commonly seen in pre-procedural cardiac CT scan obtained prior to Atrial Fibrillation (AF) ablation. We intended to evaluate the prevalence and significance of these IF in otherwise healthy patient undergoing AF ablation. We performed a retrospective observational study

Diabetes mellitus is known to be an independent risk factor of atrial fibrillation (AF). This study investigated the impact of uncontrolled diabetes on the outcome of catheter ablation in AF patients. Four hundred twelve patients with history of diabetes undergoing AF ablation were included in this

Catheter ablation (CA) is superior to anti-arrhythmic therapy at reducing recurrences of atrial fibrillation (AF); however, there is limited data regarding whether this translates into a reduction in health care resource utilization. Our objective was to evaluate the impact of AF ablation on long

Comparisons between remote magnetic navigation (RMN) and manual catheter navigation (Manual) for ablation of atrial fibrillation (AF) have earlier been reported with controversial results. We aim to compare the efficacy and outcome of these two methods for AF ablation based on our data from a larger

AF ablation in the patients involving PV stumps from prior lobectomy and pneumonectomy has not been described in literature. We describe a multicenter experience of all patients with residual PV stumps after lung resection undergoing AF ablation. 14 patients with lung resection (for tumors in 9

Pulmonary vein isolation is an effective therapy for curing symptomatic atrial fibrillation (AF). It is known the severity of left atrial (LA) enlargement affect the success of AF ablation, while little is known about the impact of intracardiac pressure on the ablation outcome. The prospective

Atrial fibrillation (AF) has been widely recognized as a modern-day disease epidemic ([1,2][1]). Although AF ablation has been a major advance, offering a new spectrum of treatment options for symptomatic patients, high recurrence rates have significantly tempered initial optimism ([2,3][2]).

Uninterrupted warfarin with intra-procedural heparin is a commonly used anticoagulation strategy during atrial fibrillation (AF) ablation to decrease thromboembolic risk. We intended to study if novel oral anticoagulants (NOAC) had comparable efficacy and safety to that of warfarin for AF ablation

The impact of pericardial fat as assessed by CT scan on outcomes after atrial fibrillation (AF) ablation is not known. We performed pericardial fat volume (PFV) assessment by volume rendering method from CT scans of all consecutive patients undergoing AF ablation at our institute. Baseline