44 results on '"left atrial ablation"'
Search Results
2. Pericardioesophageal fistulae after left atrial ablation: a case series.
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Shah, Savan K, Pendleton, Audrey C, Khan, Arsalan A, and Alex, Gillian C
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LEFT heart atrium , *FISTULA , *ARRHYTHMIA , *CHEST pain , *SURGICAL diagnosis , *TREATMENT effectiveness - Abstract
Pericardioesophageal fistula is an uncommon, yet serious complication that can occur after left atrial ablation for cardiac arrhythmias. Timing of this complication is variable; however, it has been reported to occur from a week to over a month post-ablation. The incidence of this complication after ablation is <0.05%; however with increasing rates of left atrial ablations, early recognition is imperative. Nonspecific symptoms, including chest pain, dysphagia, and fever, can indicate the presence of a fistula within the first month after ablation. Early drainage with subsequent definitive treatment is key to limiting morbidity. Here we report four cases of pericardioesophageal fistula all occurring ~1 month post-ablation, with two patients surviving after prompt diagnosis and surgical treatment. Successful treatment in these two cases was achieved with fistula takedown and intercostal muscle flap interposition and esophageal stenting. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Three Ablation Techniques for Atrial Fibrillation during Concomitant Cardiac Surgery: A Systematic Review and Network Meta-Analysis.
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Hanafy, Dudy Arman, Erdianto, Wahyu Prima, Husen, Theresia Feline, Nathania, Ilona, Vidya, Ananda Pipphali, Angelica, Ruth, Suwatri, Widya Trianita, Lintangella, Pasati, Prasetyo, Priscillia, and Sugisman
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ABLATION techniques , *ATRIAL fibrillation , *CARDIAC surgery , *PULMONARY veins , *OPERATIVE surgery , *CARDIOPULMONARY bypass , *CARDIAC pacemakers - Abstract
Atrial fibrillation (AF) ablation is a frequent procedure used in concomitant cardiac surgery. However, uncertainty still exists concerning the optimal extent of lesion sets. Hence, the objective of this study was to assess the results of various ablation techniques, aiming to offer a reference for clinical decision making. This review is listed in the prospective register of systematic reviews (PROSPERO) under ID CRD42023412785. A comprehensive search was conducted across eight databases (Scopus, Google Scholar, EBSCOHost, PubMed, Medline, Wiley, ProQuest, and Embase) up to 18 April 2023. Studies were critically appraised using the Cochrane Risk of Bias 2.0 for randomized control trials (RCTs) and the Newcastle Ottawa Scale adapted by the Agency for Healthcare Research and Quality (AHRQ) for cohort studies. Forest plots of pooled effect estimates and surface under the cumulative ranking (SUCRA) were used for the analysis. Our analysis included 39 studies and a total of 7207 patients. Both bi-atrial ablation (BAA) and left atrial ablation (LAA) showed similar efficacy in restoring sinus rhythm (SR; BAA (77.9%) > LAA (76.2%) > pulmonary vein isolation (PVI; 66.5%); LAA: OR = 1.08 (CI 0.94–1.23); PVI: OR = 1.36 (CI 1.08–1.70)). However, BAA had higher pacemaker implantation (LAA: OR = 0.51 (CI 0.37–0.71); PVI: OR = 0.52 (CI 0.31–0.86)) and reoperation rates (LAA: OR = 0.71 (CI 0.28–1.45); PVI: OR = 0.31 (CI 0.1–0.64)). PVI had the lowest efficacy in restoring SR and a similar complication rate to LAA, but had the shortest procedure time (Cross-clamp (Xc): PVI (93.38) > LAA (37.36) > BAA (13.89)); Cardiopulmonary bypass (CPB): PVI (93.93) > LAA (56.04) > BAA (0.03)). We suggest that LAA is the best surgical technique for AF ablation due to its comparable effectiveness in restoring SR, its lower rate of pacemaker requirement, and its lower reoperation rate compared to BAA. Furthermore, LAA ranks as the second-fastest procedure after PVI, with a similar CPB time. [ABSTRACT FROM AUTHOR]
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- 2023
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4. A case of combined pulmonary vein isolation (PVI) and watchman implant through hepatic vein in a patient with interrupted inferior vena cava (IVC).
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Girgis, Sameh, Niknam, Negar, Bhatti, Zabeer, Mohsin, Jalal, Aal, Ahmed Kamel Abdel, Hariharan, Ramesh, and Hematpour, Khashayar
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VENA cava inferior , *PULMONARY veins , *HEPATIC veins , *ATRIAL fibrillation - Abstract
Key Clinical Message: This case report describes a successful procedure involving pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure with a watchman device in a 78‐year‐old male with atrial fibrillation and an interrupted inferior vena cava. Due to the vascular anomaly, a transhepatic approach was used, which proved successful. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Long‐Term Impact of Additional Ablation After Pulmonary Vein Isolation: Results From EARNEST‐PVI Trial
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Masaharu Masuda, Koichi Inoue, Nobuaki Tanaka, Tetsuya Watanabe, Nobuhiko Makino, Yasuyuki Egami, Takafumi Oka, Hitoshi Minamiguchi, Miwa Miyoshi, Masato Okada, Takashi Kanda, Toshiaki Mano, Yasuhiro Matsuda, Hiroyuki Uematsu, Takashige Sakio, Masato Kawasaki, Akihiro Sunaga, Yohei Sotomi, Tomoharu Dohi, Daisaku Nakatani, Shungo Hikoso, and Yasushi Sakata
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left atrial ablation ,linear ablation ,persistent atrial fibrillation ,recurrence ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined. Methods and Results We conducted an extended follow‐up of the multicenter randomized controlled EARNEST‐PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12‐month rhythm outcomes in patients with persistent AF between patients randomized to a PVI‐alone strategy (n=248) or PVI‐plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow‐up period to 3 years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on‐treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI‐plus group than the PVI‐alone group (29.0% versus 37.5%, P=0.036). On‐treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF/AT recurrence rate than those with PVI only (26.3% versus 37.8%, P=0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%, P=0.76). At second ablation in 126 patients with AF/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%, P
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- 2023
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6. Ablation for Persistent Atrial Fibrillation: Is There a Light at the End of the Tunnel?
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Munther Homoud
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Editorials ,left atrial ablation ,linear ablation ,persistent atrial fibrillation ,recurrence ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2023
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7. A case of combined pulmonary vein isolation (PVI) and watchman implant through hepatic vein in a patient with interrupted inferior vena cava (IVC)
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Sameh Girgis, Negar Niknam, Zabeer Bhatti, Jalal Mohsin, Ahmed Kamel Abdel Aal, Ramesh Hariharan, and Khashayar Hematpour
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atrial fibrillation ,interrupted inferior vena cava ,left atrial ablation ,pulmonary vein isolation ,transhepatic access ,watchman device ,Medicine ,Medicine (General) ,R5-920 - Abstract
Key Clinical Message This case report describes a successful procedure involving pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure with a watchman device in a 78‐year‐old male with atrial fibrillation and an interrupted inferior vena cava. Due to the vascular anomaly, a transhepatic approach was used, which proved successful.
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- 2023
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8. Esophageal Damage Following Left Atrial Ablation in a Patient on Dabigatran: Adding Insult to Injury.
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Jalloul S, Jreij C, Karam K, Salem J, and Chaptini L
- Abstract
Dabigatran, a commonly prescribed anticoagulant medication, has been associated with esophagitis, referred to as dabigatran-induced esophagitis (DIE). We report a case of DIE occurring in a patient following left atrial ablation for atrial fibrillation. This case emphasizes the importance of recognizing the possible combined detrimental effects of left atrial ablation and dabigatran on the esophageal mucosa and highlights the clinical and endoscopic characteristics associated with DIE., Learning Points: Dabigatran-induced esophagitis (DIE) should be considered in patients on dabigatran developing esophageal symptoms after radiofrequency ablation for atrial fibrillation.DIE is a condition characterized clinically by symptoms related to esophageal dysfunction and histologically by significant inflammation of the esophageal mucosa.Physicians should be aware of the signs and symptoms of DIE and must educate patients on proper medication administration to avoid such risks., Competing Interests: Conflicts of Interests: The Authors declare that there are no competing interests., (© EFIM 2024.)
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- 2024
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9. Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation
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Aneesh Dhorepatil, Angela L. Lang, Min Lang, Muhammad Butt, Amit Arbune, David Hoffman, Soufian Almahmeed, and Ohad Ziv
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atrial fibrillation ,catheter ablation–atrial fibrillation ,left atrial appendage ,ischemic stroke ,left atrial ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Catheter ablation (CA) for atrial fibrillation (AF), may require ablation beyond the pulmonary veins. Prior data suggest that additional LA ablation, particularly left atrial appendage (LAA) ablation, may alter atrial function leading to increased risk of ischemic stroke or transient ischemic attack (IS/TIA). We sought to study the long-term risk of IS/TIA in patients receiving ablation at the LAA compared to those receiving PVI alone and those receiving PVI with additional non-LAA locations.Methods: 350 patients who underwent CA for AF from 2008 to 2018 were included in the study. Locations of ablation in LA evaluated were the posterior wall, anterior wall, inferior wall, inter-atrial septum, lateral wall and the left atrial appendage (LAA). Patients undergoing LAA ablation were further divided as complete isolation (LAAi) and without complete isolation (LAAa).Results: Mean follow up of 4.8 years. In entire cohort, risk of IS/TIA was 1.62/100 patient-years (pys). The risk was highest in patients with LAAi (3.81/100 pys), followed by ablation LAAa (3.74/100 pys). Amongst all LA locations, only LAAi (HR 3.32, p = 0.03) and LAAa (HR 3.18, p = 0.02) were statistically significant predictors of IS/TIA after adjusting for OAC (Oral anticoagulant) use and baseline CHA2DS2VASc score.Conclusions: During long term follow-up, only ablation at the left atrial appendage with and without complete isolation was independently associated with an increased risk of IS/TIA in patients undergoing CA for AF. Potential strategies to reduce stroke risk, such as LAA closure, should be considered in these patients.
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- 2021
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10. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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G. Hindricks, T. Potpara, N. Dagres, E. Arbelo, J. J. Bax, C. Blomstrӧm-Lundqvist, G. Boriani, M. Castella, G.-A. Dan, P. E. Dilaveris, L. Fauchier, G. Filippatos, J. M. Kalman, M. La Meir, D. A. Lane, J.-P. Lebeau, M. Lettino, G. Y.H. Lip, F. J. Pinto, G. Neil Thomas, M. Valgimigli, I. C. Van Gelder, B. P. Van Putte,, and C. L. Watkins
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guidelines ,atrial fibrillation ,anticoagulation ,vitamin k antagonists ,non-vitamin k antagonist oral anticoagulants ,left atrial appendage occlusion ,rate control ,rhythm control ,cardioversion ,antiarrhythmic drugs ,catheter ablation ,pulmonary vein isolation ,left atrial ablation ,af surgery ,upstream therapy ,abc pathway ,screening ,stroke ,recommendations. ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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- 2021
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11. Quality of life in patients with long-standing persistent atrial fibrillation after surgical ablation and simultaneous coronary artery bypass grafting
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A. T. Kalybekova, S. S. Rakhmonov, V. L. Lukinov, and A. M. Chernyavsky
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atrial fibrillation ,long-standing persistent af ,coronary artery disease ,biatrial ablation ,left atrial ablation ,quality of life ,coronary artery bypass grafting ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aim. To analyze quality of life (QOL) of patients with coronary artery disease (CAD) in combination with long-standing persistent atrial fibrillation (AF) in the long-term postoperative period, depending on chosen surgical strategy for concomitant pathology.Material and methods. The analysis of QOL changes in the long-term postoperative period (12 and 24 months) in 116 patients with CAD and concomitant long-term persistent AF who selectively underwent biatrial (BA) or isolated left atrial (LA) ablation with simultaneous on-pump coronary artery bypass grafting. To assess QOL, a non-specific Medical Outcomes Study 36-Item Form Health Status Survey (SF-36) questionnaire was used. Patients were questioned in preoperative and long-term postoperative periods (12 and 24 months).Results. All SF-36 parameters significantly improve after open surgical treatment in the long-term postoperative period (24 months) with both treatment strategies (BA and LA ablation) for AF. In the BA ablation group, 74% of patients did not have arrhythmia after 12 months, and only 38,5% of patients in the LA ablation group belonged to European Heart Rhythm Association (EHRA) score class 1 (p=0,001). After 24 months, a comparison revealed a significant diff erence between the two groups in arrhythmia symptoms (p=0,014), with maintaining the advantage of the BA ablation group. After 12 and 24 months, none of the patients in both compared groups had severe class IV angina.Conclusion. SF-36 parameters were improved 24 months after surgical treatment of CAD and long-standing persistent AF, regardless of the ablation strategy. Elimination of angina symptoms and long-term maintenance of sinus rhythm can improve the QOL of patients in the long-term postoperative period.
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- 2021
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12. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC
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Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax, Jeroen J, Blomström-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis E, Fauchier, Laurent, Filippatos, Gerasimos, Kalman, Jonathan M, Meir, Mark La, Lane, Deirdre A, Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory Y H, Pinto, Fausto J, and Thomas, G Neil
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DIAGNOSIS ,MANAGEMENT ,ATRIAL fibrillation ,ELECTROCARDIOGRAPHY ,PATIENTS - Abstract
The article focuses on the 2020 ESC guidelines for the diagnosis and management of atrial fibrillation (AF) developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Topics include Electrocardiography (ECG) documentation is required to establish the diagnosis of AF; opportunistic screening for AF is recommended in hypertensive patients; and complete electrical isolation of the pulmonary veins is recommended during all AF catheter-ablation procedures.
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- 2021
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13. 3D mapping for the identification of the fossa ovalis in left atrial ablation procedures: a pilot study of a first step towards an electroanatomic-guided transseptal puncture.
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Eichenlaub, Martin, Weber, Reinhold, Minners, Jan, Allgeier, Hans-Jürgen, Jadidi, Amir, Müller-Edenborn, Björn, Neumann, Franz-Josef, Arentz, Thomas, and Lehrmann, Heiko
- Abstract
Aims: Transseptal puncture (TP) for left atrial (LA) catheter ablation procedures is routinely performed under fluoroscopic guidance. To decrease radiation exposure and increase safety alternative techniques are desirable. The aim of this study was to assess whether right atrial (RA) electroanatomic 3D mapping can reliably identify the fossa ovalis (FO) in preparation of TP.Methods and Results: Between May 2019 and August 2019, electroanatomic RA mapping was performed before TP in 61 patients with paroxysmal or persistent atrial fibrillation. Three electroanatomic methods for FO identification, mapping catheter-induced FO protrusion, electroanatomic-guided analysis, and voltage mapping, were evaluated and compared with transoesophageal echocardiography (TOE). Mapping catheter-induced FO protrusion was feasible in 60 patients (98%) with a mean displacement of 6.8 ± 2.5 mm, confirmed by TOE, and proofed to be the most valuable and easiest marker for FO identification. Electroanatomic-guided analysis localized the FO midpoint consistently in the lower half (43 ± 7%) and posterior (18.2 ± 4.4 mm) to a line between coronary sinus and vena cava superior. Analysis of RA voltage maps during sinus rhythm (n = 40, low-voltage cut-off value 1.0 and 1.5 mV) allowed secure FO recognition in 33% and 18%, only. A step-by-step approach, combining FO protrusion (first step) with anatomy criteria in case of protrusion failure (second step) would have allowed for the correct localization of a TP site within the FO in all patients.Conclusion: Right atrial electroanatomic 3D mapping prior to TP proofed to be a simple tool for FO identification and may potentially be of use in the safe and radiation-free performance of TP prior to LA ablation procedures. [ABSTRACT FROM AUTHOR]- Published
- 2020
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14. 2016 ESC GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION DEVELOPEDIN COLLABORATION WITH EACTS
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Paulus Kirchhof, Stefano Benussi, Dipak Kotecha, Anders Ahlsson, Dan Atar, Barbara Casadei, Manuel Castella, Hans-Christoph Diener, Hein Heidbuchel, Jeroen Hendriks, Gerhard Hindricks, Antonis S. Manolis, Jonas Oldgren, Bogdan Alexandru Popescu, Ulrich Schotten, Bart Van Putte, and Panagiotis Vardas
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guidelines ,atrial fibrillation ,anticoagulation ,vitamin k antagonists ,non-vitamin k antagonist oral anticoagulants ,left atrial appendage occlusion ,rate control ,cardioversion ,rhythm control ,antiarrhythmic drugs ,upstream therapy ,catheter ablation ,af surgery ,valve repair ,pulmonary vein isolation ,left atrial ablation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESCEndorsed by the European Stroke Organisation (ESO)
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- 2017
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15. Ablation for Persistent Atrial Fibrillation: Is There a Light at the End of the Tunnel?
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Homoud M
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- Humans, Atrial Fibrillation surgery, Pulmonary Veins
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- 2023
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16. Long-Term Impact of Additional Ablation After Pulmonary Vein Isolation: Results From EARNEST-PVI Trial.
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Masuda M, Inoue K, Tanaka N, Watanabe T, Makino N, Egami Y, Oka T, Minamiguchi H, Miyoshi M, Okada M, Kanda T, Mano T, Matsuda Y, Uematsu H, Sakio T, Kawasaki M, Sunaga A, Sotomi Y, Dohi T, Nakatani D, Hikoso S, and Sakata Y
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- Humans, Heart Atria, Atrial Fibrillation diagnosis, Atrial Fibrillation surgery, Pulmonary Veins surgery, Atrial Appendage, Atrial Flutter diagnosis, Atrial Flutter surgery
- Abstract
Background An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined. Methods and Results We conducted an extended follow-up of the multicenter randomized controlled EARNEST-PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12-month rhythm outcomes in patients with persistent AF between patients randomized to a PVI-alone strategy (n=248) or PVI-plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow-up period to 3 years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on-treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI-plus group than the PVI-alone group (29.0% versus 37.5%, P =0.036). On-treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF/AT recurrence rate than those with PVI only (26.3% versus 37.8%, P =0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%, P =0.76). At second ablation in 126 patients with AF/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%, P <0.0001). Conclusions Left atrial ablation in addition to PVI was efficacious during 3-year follow-up. Linear ablation was superior to other ablation strategies but may increase iatrogenic ATs. Registration URL: http://www.umin.ac.jp/ctr/index-j.htm; Unique identifier: UMIN000019449.
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- 2023
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17. Avoiding oesophageal injury during cardiac ablation: insights gained from mediastinal anatomy.
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Marar, Devan, Muthusamy, Venkatraman, and Krishnan, Subramaniam C.
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Aims: This study investigates the lateral displacement of the oesophagus at the level of the left atrium (LA) in 11 cadavers.Methods and results: The study was conducted using human cadavers. An endotracheal stylet probe was inserted into the eosphagus. The pericardium overlying the posterior LA was fixed in place. The lateral movement of the oesophagus from side to side was recorded. The initial study method had the stylet probe extending to the gastroesophageal (GE) junction. A revised protocol had the distal end of the endotracheal stylet probe ∼4 cm cranial to the GE junction. In six cadavers using the initial study method, the oesophagus was displaced a mean of 1.8 ± 0.35 cm to the right and 2 ± 0.48 cm to the left. In five cadavers, using the revised method, the oesophagus was displaced by a mean of 2.26 ± 0.27 cm to the right and 2.3 ± 0.66 cm to the left.Conclusion: Mediastinal anatomy, specifically the presence of a loose connective tissue that attaches the oesophagus to the parietal pericardium overlying the posterior LA wall will allow for a lateral displacement of the oesophagus. This should decrease or eliminate the likelihood of thermal injury of the oesophagus. Using an endotracheal stylet, we investigated the lateral displacement of the oesophagus in 11 human cadavers. In six with the stylet extending to the GE junction, the oesophagus was displaced a mean of 3.8 cm. In five, with stylet 4 cm cranial to the junction, the displacement was 4.56 cm. [ABSTRACT FROM AUTHOR]- Published
- 2018
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18. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
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Kirchhof, Paulus, Benussi, Stefano, Kotecha, Dipak, Ahlsson, Anders, Atar, Dan, Casadei, Barbara, Castella, Manuel, Diener, Hans-Christoph, Heidbuchel, Hein, Hendriks, Jeroen, Hindricks, Gerhard, Manolis, Antonis S., Oldgren, Jonas, Popescu, Bogdan Alexandru, Schotten, Ulrich, Van Putte, Bart, and Vardas, Panagiotis
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ATRIAL fibrillation , *PUBLIC health , *CAREGIVERS , *MEDICAL equipment ,HEALTH of patients - Abstract
The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and,where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. [ABSTRACT FROM AUTHOR]
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- 2016
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19. Dramatic Aneurysmal Atrial Septum Identified with Intracardiac Echo Complicating Transseptal Puncture
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Harpaul S Sandhu, Chandra Dass, Crystal Chen, Martin G. Keane, and Isaac R. Whitman
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medicine.medical_specialty ,Atrial septal aneurysm ,Intracardiac echocardiography ,Transthoracic echocardiography ,business.industry ,Interventional Imaging ,Echo (computing) ,General Medicine ,medicine.disease ,Left atrial ablation ,Intracardiac injection ,Atrial septum ,Supraventricular tachycardia ,Internal medicine ,medicine ,Cardiology ,business ,ComputingMethodologies_COMPUTERGRAPHICS - Abstract
Graphical abstract, Highlights • Atrial septal aneurysm is a largely underdiagnosed phenomenon. • Septal anatomy is best delineated using intracardiac echocardiography. • Septal anatomy is clinically relevant with procedures involving transseptal puncture. • Atrial septal aneurysms may be associated with supraventricular tachycardias.
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- 2020
20. Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery
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Daniel Martins, Pedro Queirós, Joao Paulo Almeida, Gualter Silva, and João Primo
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medicine.medical_specialty ,left atrial ablation ,medicine.medical_treatment ,Perforation (oil well) ,Cardiology ,Catheter ablation ,tachycardia induced cardiomyopathy ,Tachycardia-induced cardiomyopathy ,Internal medicine ,medicine ,Palpitations ,cardiovascular diseases ,Atrial tachycardia ,Ejection fraction ,radio-frequency ablation ,Interventional cardiology ,business.industry ,interventional cardiology ,General Engineering ,video-assisted thoracoscopic surgery (vats) ,atrial tachycardia ,medicine.disease ,Cardiac/Thoracic/Vascular Surgery ,cardiovascular system ,minimally invasive surgery ,Sarcoidosis ,medicine.symptom ,business - Abstract
A 35-year-old female with sarcoidosis sought medical attention due to palpitations. The ECG showed an atrial tachycardia (AT), apparently originating in the left atrium. A 24-hour Holter monitoring revealed AT to be present during the entire day. Cardiac magnetic resonance exhibited no cardiac involvement by sarcoidosis but registered a mildly depressed left ventricular ejection fraction (LVEF). Atrial electroanatomical mapping showed the earliest activation zone on the distal portion of the left atrial appendage (LAA). Considering the high risk for perforation with catheter ablation in this region, she was sent to thoracoscopic surgical LAA exclusion with a clip device; it was possible to witness the termination of the arrhythmia during the procedure. She was safely discharged two days after surgery and has completed a one-year follow-up without recurrence of AT or symptoms, and with normalization of LVEF.
- Published
- 2021
21. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)
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Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax, Jeroen J., Blomström-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis E., Fauchier, Laurent, Filippatos, Gerasimos, Kalman, Jonathan M., La Meir, Mark, Lane, Deirdre A., Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory Y. H., Pinto, Fausto J., Thomas, G. Neil, Valgimigli, Marco, Van Gelder, Isabelle C., Van Putte, Bart P., Watkins, Caroline L., Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax, Jeroen J., Blomström-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis E., Fauchier, Laurent, Filippatos, Gerasimos, Kalman, Jonathan M., La Meir, Mark, Lane, Deirdre A., Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory Y. H., Pinto, Fausto J., Thomas, G. Neil, Valgimigli, Marco, Van Gelder, Isabelle C., Van Putte, Bart P., and Watkins, Caroline L.
- Abstract
Correction in: European Heart Journal, Volume 42, Issue 5, 1 February 2021, Page 507, https://doi.org/10.1093/eurheartj/ehaa798Correction in: European Heart Journal, Volume 42, Issue 5, 1 February 2021, Pages 546–547, https://doi.org/10.1093/eurheartj/ehaa945
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- 2021
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22. CoolLoop® First: A First In Man Study To Test A Novel Circular Cryoablation System In Paroxysmal Atrial Fibrillation.
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Stuehlinger, Markus, Hoenig, Simon, Spuller, Karin, Koman, Christian, Stoeger, Markus, Poelzl, Gerhard, Ulmer, Hanno, Pachinger, Otmar, and Steinwender, Clemens
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CRYOSURGERY , *ATRIAL fibrillation - Abstract
Introduction: Pulmonary vein (PV) isolation is the mainstay of catheter treatment of paroxysmal atrial fibrillation (AF). The CoolLoop® cryoablation catheter (AFreeze® GmbH; Innsbruck, Austria) was developed to create wide and complete circular lesions around the PVs. In this study we evaluated feasibility and safety of this novel ablation system in humans. Methods: 10 patients (6M/4F; 57.6±7.6y) with paroxysmal AF were included in 2 referral centers. The CoolLoop® catheter was positioned at each PV antrum using a steerable transseptal sheath. Subsequently, 2-6 double-freezes over 5min were performed at each vein and PVisolation was assessed thereafter using a circular mapping catheter. During cryoablation of the right PVs, pacing was used to monitor phrenic nerve function. Results: The CoolLoop® catheter could be successfully positioned at each PV. A mean of 5.6±1.8 cryoablations were performed in the LSPV, 5.2±1.6 in the LIPV, 6.3±2.5 in the RSPV and 5.4±1.6 in the RIPV, respectively. Mean procedure time was 251±60min and mean fluoroscopy time was 44.0±13.2min. 6 / 10 LSPV, 6 / 10 LIPV, 5 / 10 RSPV and 6 / 10 RIPV could be isolated exclusively using the novel cryoablation system. One patient developed groin hematoma and a brief episode of ST-elevation due to air embolism was observed in another subject. No other clinical complications occurred during 3 months of follow up. Conclusions: PV-isolation for paroxysmal atrial fibrillation using the CoolLoop® catheter is feasible and appears safe. Clinical long term efficacy still needs to be evaluated and will be compared with established catheters used for AF ablation. [ABSTRACT FROM AUTHOR]
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- 2015
23. Left atrial catheter ablation subsequent to Watchman® left atrial appendage device implantation: a single centre experience.
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Walker, Daniel T. and Phillips, Karen P.
- Abstract
Aims: Left atrial appendage device occlusion is an increasingly accepted therapy for stroke prevention in atrial fibrillation. The feasibility and safety of left atrial catheter ablation procedures in the presence of a left atrial appendage device implant is unclear. We report on 10 cases of successful left atrial catheter ablation therapy for atrial fibrillation in patients with an implanted Watchman® device.Methods and Results: Consecutive patients with an existing Watchman® left atrial appendage implant and symptomatic antiarrhythmic-drug refractory atrial fibrillation or atrial tachycardias requiring left atrial catheter ablation therapy were included. Open irrigated tip ablation and circular mapping catheters were positioned in the left atrium via double transseptal access. Ten patients underwent successful left atrial geometry creation and complex atrial arrhythmia mapping and ablation in the presence of a chronically implanted Watchman® device. Arrhythmia targets included left atrial flutters, a focal tachycardia, left atrial CFAE zones, and pulmonary vein electrical isolation. The appearances of the Watchman® device position and device integrity were confirmed to be satisfactory in all patients at the end of the procedure based on fluoroscopy and intracardiac echocardiography imaging. There were no procedural complications.Conclusion: Left atrial catheter ablation therapy in the presence of an implanted Watchman® left atrial appendage occlusion device was efficacious and uncomplicated in our small single centre experience. [ABSTRACT FROM AUTHOR]- Published
- 2015
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24. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS) : the Task Force for the diagnosis and management of atrialfibrillation of the European Society of Cardiology (ESC) : developed with the special contribution of the European HeartRhythm Association (EHRA) of the ESC
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Hindricks, Gerhard, Potpara, Tatjana, Dagres, Nikolaos, Arbelo, Elena, Bax, Jeroen J., Blomström-Lundqvist, Carina, Boriani, Giuseppe, Castella, Manuel, Dan, Gheorghe-Andrei, Dilaveris, Polychronis E., Fauchier, Laurent, Petersen, Steffen E., Piccini, Jonathan P., Popescu, Bogdan A., Pürerfellner, Helmut, Richter, Dimitrios J., Roffi, Marco, Rubboli, Andrea, Scherr, Daniel, Schnabel, Renate B., Simpson, Iain A., Raatikainen, Pekka, Shlyakhto, Evgeny, Sinner, Moritz F., Steffel, Jan, Suwalski, Piotr, Svetlosak, Martin, Touyz, Rhian M., Windecker, Stephan, Baigent, Colin, Collet, Jean-Philippe, Dean, Veronica, Boveda, Serge, Fitzsimons, Donna, Gale, Chris P., Grobbee, Diederick E., Halvorsen, Sigrun, Lung, Bernard, Jüni, Peter, Petronio, Anna Sonia, Sousa Uva, Miguel, Delassi, Tahar, Sisakian, Hamayak S., Papiashvili, Giorgi, Chasnoits, Alexandr, De Pauw, Michel, Smajić, Elnur, Shalganov, Tchavdar, Avraamides, Panayiotis, Kautzner, Josef, Gerdes, Christian, Alaziz, Ahmad Abd, Kampus, Priit, Vassilikos, Vassilios P., Csanádi, Zoltán, Arnar, David O., Galvin, Joseph, Barsheshet, Alon, Caldarola, Pasquale, Rakisheva, Amina, Filippatos, Gerasimos, Bytyçi, Ibadete, Kerimkulova, Alina, Kalejs, Oskars, Njeim, Mario, Puodziukynas, Aras, Groben, Laurent, Sammut, Mark A., Grosu, Aurel, Boskovic, Aneta, Moustaghfir, Abdelhamid, Kalman, Jonathan M., de Groot, Natasja, Poposka, Lidija, Anfinsen, Ole-Gunnar, Mitkowski, Przemyslaw P., Cavaco, Diogo, Siliste, Calin, Mikhaylov, Evgeny N., Bertelli, Luca, Kojic, Dejan, Hatala, Robert, La Meir, Mark, Fras, Zlatko, Arribas, Fernando, Juhlin, Tord, Sticherling, Christian, Abid, Leila, Atar, Ilyas, Sychov, Oleg, Bates, Matthew G. D., Zakirov, Nodir U., Lane, Deirdre A., Lebeau, Jean-Pierre, Lettino, Maddalena, Lip, Gregory Y. H., Pinto, Fausto J., Thomas, G. Neil, Valgimigli, Marco, Van Gelder, Isabelle C., Van Putte, Bart P., Watkins, Caroline L., Kirchhof, Paulus, Kühne, Michael, Aboyans, Victor, Ahlsson, Anders, Balsam, Pawel, Bauersachs, Johann, Benussi, Stefano, Brandes, Axel, Braunschweig, Frieder, Camm, A. John, Capodanno, Davide, Casadei, Barbara, Conen, David, Crijns, Harry J. G. M., Delgado, Victoria, Dobrev, Dobromir, Drexel, Heinz, Eckardt, Lars, Folliguet, Thierry, Gorenek, Bulent, Haeusler, Karl Georg, Heidbuchel, Hein, Iung, Bernard, Katus, Hugo A., Kotecha, Dipak, Landmesser, Ulf, Leclercq, Christophe, Lewis, Basil S., Mascherbauer, Julia, Merino, Jose Luis, Merkely, Béla, Mont, Lluís, Mueller, Christian, Nagy, Klaudia V., Oldgren, Jonas, Pavlović, Nikola, Pedretti, Roberto F. E., and Repositório da Universidade de Lisboa
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Rate control ,AF surgery ,Guidelines ,Upstream therapy ,Recommendations ,Left atrial appendage occlusion ,Atrial fibrillation ,Pulmonary vein isolation ,Left atrial ablation ,Antiarrhythmic drugs ,Cardioversion ,Stroke ,Anticoagulation ,Vitamin K antagonists ,Screening ,Non-vitamin K antagonist oral anticoagulants ,Rhythm control ,Catheter ablation ,ABC pathway - Abstract
© 2020 European Society of Cardiology. All rights reserved., Atrial fibrillation (AF) poses significant burden to patients, physicians, and healthcare systems globally. Substantial research efforts and resources are being directed towards gaining detailed information about the mechanisms underlying AF, its natural course and effective treatments (see also the ESC Textbook of Cardiovascular Medicine: CardioMed) and new evidence is continuously generated and published. The complexity of AF requires a multifaceted, holistic, and multidisciplinary approach to the management of AF patients, with their active involvement in partnership with clinicians. Streamlining the care of patients with AF in daily clinical practice is a challenging but essential requirement for effective management of AF. In recent years, substantial progress has been made in the detection of AF and its management, and new evidence is timely integrated in this third edition of the ESC guidelines on AF. The 2016 ESC AF Guidelines introduced the concept of the five domains to facilitate an integrated structured approach to AF care and promote consistent, guideline-adherent management for all patients. The Atrial Fibrillation Better Care (ABC) approach in the 2020 ESC AF Guidelines is a continuum of this approach, with the goal to further improve the structured management of AF patients, promote patient values, and finally improve patient outcomes.
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- 2020
25. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation.
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Camm, A. John, Lip, Gregory Y.H., De Caterina, Raffaele, Savelieva, Irene, Atar, Dan, Hohnloser, Stefan H., Hindricks, Gerhard, Kirchhof, Paulus, Bax, Jeroen J., Baumgartner, Helmut, Ceconi, Claudio, Dean, Veronica, Deaton, Christi, Fagard, Robert, Funck-Brentano, Christian, Hasdai, David, Hoes, Arno, Knuuti, Juhani, Kolh, Philippe, and McDonagh, Theresa
- Published
- 2012
26. Guidelines for the management of atrial fibrillation.
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Camm, A. John, Kirchhof, Paulus, Lip, Gregory Y.H., Schotten, Ulrich, Savelieva, Irene, Ernst, Sabine, Van Gelder, Isabelle C., Al-Attar, Nawwar, Hindricks, Gerhard, Prendergast, Bernard, Heidbuchel, Hein, Alfieri, Ottavio, Angelini, Annalisa, Atar, Dan, Colonna, Paolo, De Caterina, Raffaele, De Sutter, Johan, Goette, Andreas, Gorenek, Bulent, and Heldal, Magnus
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- 2010
27. 2016 ESC GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION DEVELOPEDIN COLLABORATION WITH EACTS
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Gerhard Hindricks, Jeroen M.H. Hendriks, Bart P. van Putte, Hein Heidbuchel, Panagiotis Vardas, Ulrich Schotten, Barbara Casadei, Manuel Castellá, Dipak Kotecha, Stefano Benussi, Hans-Christoph Diener, Anders Ahlsson, Jonas Oldgren, Antonis S. Manolis, Paulus Kirchhof, Dan Atar, and Bogdan A. Popescu
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af surgery ,medicine.medical_specialty ,left atrial appendage occlusion ,left atrial ablation ,Management of atrial fibrillation ,Rhythm control ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,cardioversion ,antiarrhythmic drugs ,Internal medicine ,catheter ablation ,medicine ,Diseases of the circulatory (Cardiovascular) system ,atrial fibrillation ,cardiovascular diseases ,030212 general & internal medicine ,guidelines ,anticoagulation ,reproductive and urinary physiology ,pulmonary vein isolation ,rate control ,rhythm control ,urogenital system ,business.industry ,Task force ,Rate control ,valve repair ,non-vitamin k antagonist oral anticoagulants ,upstream therapy ,Heart Rhythm ,vitamin k antagonists ,RC666-701 ,embryonic structures ,Cardiology ,biological phenomena, cell phenomena, and immunity ,Cardiology and Cardiovascular Medicine ,business - Abstract
The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO)
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- 2017
28. Hypertrophic Cardiomyopathy and Atrial Fibrillation: A Review.
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Palyam V, Azam AT, Odeyinka O, Alhashimi R, Thoota S, Ashok T, and Sange I
- Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiological condition that exhibits various clinical symptoms. The leading cause of atrial fibrillation (AF) in patients with HCM is advanced diastolic dysfunction and left atrial dilatation and remodeling. In addition to the gradual symptomatic and functional decline caused by AF, there is an increased risk of thromboembolic disease and mortality, especially if there is a rapid ventricular rate or obstruction of the left ventricular outflow tract. The mainstay of management of AF in HCM is a combination of non-pharmacological lifestyle and risk factor modification, long-term anticoagulation, and rhythm control with anti-arrhythmic medications, septal ablation, and radiofrequency catheter ablation. This article has examined the development of AF in HCM, its clinical symptomatology, and its impact, highlighting its management and the mortality associated with AF in HCM., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Palyam et al.)
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- 2022
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29. Long-Term Stroke Risk in Patients Undergoing Left Atrial Appendage Ablation With and Without Complete Isolation.
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Dhorepatil A, Lang AL, Lang M, Butt M, Arbune A, Hoffman D, Almahmeed S, and Ziv O
- Abstract
Background: Catheter ablation (CA) for atrial fibrillation (AF), may require ablation beyond the pulmonary veins. Prior data suggest that additional LA ablation, particularly left atrial appendage (LAA) ablation, may alter atrial function leading to increased risk of ischemic stroke or transient ischemic attack (IS/TIA). We sought to study the long-term risk of IS/TIA in patients receiving ablation at the LAA compared to those receiving PVI alone and those receiving PVI with additional non-LAA locations. Methods: 350 patients who underwent CA for AF from 2008 to 2018 were included in the study. Locations of ablation in LA evaluated were the posterior wall, anterior wall, inferior wall, inter-atrial septum, lateral wall and the left atrial appendage (LAA). Patients undergoing LAA ablation were further divided as complete isolation (LAAi) and without complete isolation (LAAa). Results: Mean follow up of 4.8 years. In entire cohort, risk of IS/TIA was 1.62/100 patient-years (pys). The risk was highest in patients with LAAi (3.81/100 pys), followed by ablation LAAa (3.74/100 pys). Amongst all LA locations, only LAAi (HR 3.32, p = 0.03) and LAAa (HR 3.18, p = 0.02) were statistically significant predictors of IS/TIA after adjusting for OAC (Oral anticoagulant) use and baseline CHA
2 DS2 VASc score. Conclusions: During long term follow-up, only ablation at the left atrial appendage with and without complete isolation was independently associated with an increased risk of IS/TIA in patients undergoing CA for AF. Potential strategies to reduce stroke risk, such as LAA closure, should be considered in these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Dhorepatil, Lang, Lang, Butt, Arbune, Hoffman, Almahmeed and Ziv.)- Published
- 2021
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30. Surgical ablation for the treatment of atrial fibrillation in different patient populations : A study of clinical outcomes including rhythm, quality of life, atrial function and safety
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Bagge, Louise and Bagge, Louise
- Abstract
Patients with atrial fibrillation (AF) have markedly reduced quality of life (QoL) and catheter ablation has become a useful tool in the rhythm control therapy. However, because of the poor outcome for patients with persistent AF, new surgical ablation strategies for rhythm control are emerging. The aims of this thesis were to evaluate QoL, the main indication for rhythm control, after three different types of surgical ablation for AF, two stand-alone epicardial AF ablation procedures and one concomitant procedure during mitral valve surgery (MVS), and to perform a long-term follow-up of one of the techniques with regard to rhythm outcome, left atrial function, exercise capacity and safety. As the first center in the Nordic countries to adopt the video-assisted epicardial pulmonary vein isolation and ganglionated plexi ablation combined with left atrial appendage excision (LAA), the freedom from AF at one year follow-up was found to be 71% and associated with improved exercise capacity, QoL and symptoms as well as preserved left atrial function and size. The most common complication was bleeding events (14%). After 10 years, the improved symptoms and QoL remained, reaching comparable levels of the general Swedish population, despite a marked decline in the rate of freedom from AF (36%). 4 strokes appeared during follow-up despite LAA excision in 3 of these patients. In order to improve the rhythm outcome for patients with longstanding persistent AF a box-lesion was added to the procedure. At one year follow-up, both symptoms and QoL improved and was indistinguishable from those in the Swedish general population. Finally, concomitant AF ablation during MVS did not improve QoL compared to MVS alone in a double blinded randomized controlled trial. Moreover, no difference was seen between patients in AF or sinus rhythm at one year follow-up, irrespective of the allocated therapy, indicating that their preoperative symptoms were mainly related to their valve disease. In
- Published
- 2018
31. Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery.
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Queirós P, Silva G, Almeida J, Martins D, and Primo J
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A 35-year-old female with sarcoidosis sought medical attention due to palpitations. The ECG showed an atrial tachycardia (AT), apparently originating in the left atrium. A 24-hour Holter monitoring revealed AT to be present during the entire day. Cardiac magnetic resonance exhibited no cardiac involvement by sarcoidosis but registered a mildly depressed left ventricular ejection fraction (LVEF). Atrial electroanatomical mapping showed the earliest activation zone on the distal portion of the left atrial appendage (LAA). Considering the high risk for perforation with catheter ablation in this region, she was sent to thoracoscopic surgical LAA exclusion with a clip device; it was possible to witness the termination of the arrhythmia during the procedure. She was safely discharged two days after surgery and has completed a one-year follow-up without recurrence of AT or symptoms, and with normalization of LVEF., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Queirós et al.)
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- 2021
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32. Diffuse Cerebral Air Emboli After an Esophagogastroduodenoscopy One Month Post Left Atrial Ablation for Atrial Fibrillation.
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Abu-Shaban K, Liu X, and Siders B
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We present a case of a patient who presented to the emergency department with vague abdominal pain one month after undergoing a left atrial ablation procedure for atrial fibrillation. While in the emergency department, the patient started to have episodes of hematemesis. Esophagogastroduodenoscopy (EGD) was performed and the patient become hypotensive and unresponsive after. Imaging confirmed atrioesophageal fistula and widespread cerebral air emboli and diffuse ischemia. Air emboli were likely introduced through the fistula during the EGD., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Abu-Shaban et al.)
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- 2021
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33. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis
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Yi Chin Tsai, Ashleigh Xie, Mark La Meir, Kevin Phan, Tristan D. Yan, Narendra Kumar, Promovendi CD, RS: CARIM - R2 - Cardiac function and failure, Cardiologie, CTC, Clinical sciences, Cardio-vascular diseases, and Surgical clinical sciences
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Ablation Techniques ,Adult ,Male ,Bradycardia ,medicine.medical_specialty ,medicine.medical_treatment ,Biatrial ,law.invention ,Randomized controlled trial ,Risk Factors ,law ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Sinus rhythm ,Heart Atria ,Cardiac Surgical Procedures ,Aged ,Evidence-Based Medicine ,business.industry ,Surgical ablation ,Atrial fibrillation ,Middle Aged ,Ablation ,medicine.disease ,Left atrial ablation ,Cardiac surgery ,Surgery ,Survival Rate ,Meta-analysis ,Treatment Outcome ,Concomitant ,Cohort ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Surgical ablation performed concomitantly with cardiac surgery has emerged as an effective curative strategy for atrial fibrillation (AF). Left atrial (LA) lesion sets for ablation have been suggested to reduce procedural times and post-surgical bradycardia compared with biatrial (BA) lesions. Given the inconclusive literature regarding BA vs. LA ablation, the present meta-analysis sought to assess the current evidence. Methods and results Electronic searches were performed using six databases from their inception to December 2013, identifying all relevant randomized trials and observational studies comparing BA vs. LA surgical ablation AF patients undertaking cardiac surgery. In 10 included studies, 2225 patient results were available for analysis to compare BA ( n = 888) vs. LA ( n = 1337) ablation. Sinus rhythm prevalence was higher in the BA cohort compared with the LA cohort at 6-month and 12-month follow-up, but similar beyond 1 year. Permanent pacemaker implantations were higher in the BA cohort, but 30-day and late mortality, neurological events, and reoperation for bleeding were similar between BA and LA groups. Conclusions Biatrial and LA ablations produced comparable 30-day and late mortality but LA was associated with significantly reduced permanent pacemaker implantation rates. Biatrial ablation appeared to be more efficacious than LA ablation in achieving SR at 1 year, but this difference was not maintained beyond 1 year. Trends appear to be driven by the preferential selection of long-standing and persistent AF patients for the BA approach. Future randomized studies of adequate follow-up are required to validate risks and benefits of BA vs. LA surgical ablation.
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- 2015
34. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Werner Budts, Stefan Agewall, Jeroen M.L. Hendriks, Gonzalo Barón Esquivias, Anders Ahlsson, Antonis S. Manolis, Hans-Christoph Diener, José Luis Zamorano, Maxine Guenoun, Panagiotis Vardas, Dan Atar, John J.V. McMurray, Gerasimos Filippatos, Paulus Kirchhof, Raffaele De Caterina, Philippe Kolh, Clare J Taylor, Ulrich Schotten, Piotr Ponikowski, Isabelle C. Van Gelder, Manuel Castellá, Jonas Oldgren, Piotr Suwalski, John Camm, Adriaan A. Voors, Barbara Casadei, Spiridon Deftereos, José M. Ferro, Stefan H. Hohnloser, Juan Tamargo, Katja Zeppenfeld, Bogdan A. Popescu, Stephan Windecker, Donna Fitzsimons, Raphael Rosenhek, Dipak Kotecha, Gregory Y.H. Lip, Filip Casselman, Hein Heidbuchel, Stefano Benussi, Gerhard Hindricks, Bart P. Van Putte, Scipione Carerj, Antonio Coca, Irina Savelieva, Athanasios J. Manolis, Frank Ruschitzka, Dobromir Dobrev, Sanjay Sharma, Bulent Gorenek, RS: CARIM - R2.11 - Experimental atrial fibrillation, Fysiologie, and University of Zurich
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Male ,Rate control ,AF surgery ,medicine.medical_treatment ,Medizin ,Management of atrial fibrillation ,2700 General Medicine ,Comorbidity ,Upstream therapy ,030204 cardiovascular system & hematology ,Left atrial appendage occlusion ,Cardioversion ,Cardiac Resynchronization Therapy ,Electrocardiography ,0302 clinical medicine ,Risk Factors ,Atrial Fibrillation ,Prevalence ,Mass Screening ,030212 general & internal medicine ,Stroke ,Valve repair ,reproductive and urinary physiology ,Societies, Medical ,Evidence-Based Medicine ,Incidence ,Disease Management ,Atrial fibrillation ,General Medicine ,Left atrial ablation ,3. Good health ,Survival Rate ,Europe ,embryonic structures ,Cardiology ,Rhythm control ,Catheter ablation ,Female ,Medical emergency ,biological phenomena, cell phenomena, and immunity ,Cardiology and Cardiovascular Medicine ,Anti-Arrhythmia Agents ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,610 Medicine & health ,Hemorrhage ,Guidelines ,Pulmonary vein isolation ,Anticoagulation ,03 medical and health sciences ,Sex Factors ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,HAS-BLED ,urogenital system ,Task force ,business.industry ,Anticoagulants ,medicine.disease ,10020 Clinic for Cardiac Surgery ,Antiarrhythmic drugs ,Heart Rhythm ,Non-Vitamin K antagonist oral anticoagulants ,Vitamin K antagonists ,CHA2DS2–VASc score ,Non-vitamin K antagonist oral anticoagulants ,Surgery ,Morbidity ,business - Abstract
The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO)
- Published
- 2016
35. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association
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Focused update ,Rate control ,Guidelines ,Upstream therapy ,Left atrial appendage occlusion ,Atrial fibrillation ,Pulmonary vein isolation ,Left atrial ablation ,European Society of Cardiology ,Antiarrhythmic drugs ,Cardioversion ,Anticoagulation ,Rhythm control ,Novel oral anticoagulants - Published
- 2012
36. Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)
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Anticoagulation ,Rate control ,Rhythm control ,Guidelines ,Upstream therapy ,Atrial fibrillation ,Pulmonary vein isolation ,Left atrial ablation ,European Society of Cardiology - Published
- 2010
37. 3D mapping for the identification of the fossa ovalis in left atrial ablation procedures: a pilot study of a first step towards an electroanatomic-guided transseptal puncture.
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Eichenlaub M, Weber R, Minners J, Allgeier HJ, Jadidi A, Müller-Edenborn B, Neumann FJ, Arentz T, and Lehrmann H
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- Heart Atria diagnostic imaging, Heart Atria surgery, Humans, Pilot Projects, Punctures, Treatment Outcome, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Atrial Septum diagnostic imaging, Atrial Septum surgery, Catheter Ablation
- Abstract
Aims: Transseptal puncture (TP) for left atrial (LA) catheter ablation procedures is routinely performed under fluoroscopic guidance. To decrease radiation exposure and increase safety alternative techniques are desirable. The aim of this study was to assess whether right atrial (RA) electroanatomic 3D mapping can reliably identify the fossa ovalis (FO) in preparation of TP., Methods and Results: Between May 2019 and August 2019, electroanatomic RA mapping was performed before TP in 61 patients with paroxysmal or persistent atrial fibrillation. Three electroanatomic methods for FO identification, mapping catheter-induced FO protrusion, electroanatomic-guided analysis, and voltage mapping, were evaluated and compared with transoesophageal echocardiography (TOE). Mapping catheter-induced FO protrusion was feasible in 60 patients (98%) with a mean displacement of 6.8 ± 2.5 mm, confirmed by TOE, and proofed to be the most valuable and easiest marker for FO identification. Electroanatomic-guided analysis localized the FO midpoint consistently in the lower half (43 ± 7%) and posterior (18.2 ± 4.4 mm) to a line between coronary sinus and vena cava superior. Analysis of RA voltage maps during sinus rhythm (n = 40, low-voltage cut-off value 1.0 and 1.5 mV) allowed secure FO recognition in 33% and 18%, only. A step-by-step approach, combining FO protrusion (first step) with anatomy criteria in case of protrusion failure (second step) would have allowed for the correct localization of a TP site within the FO in all patients., Conclusion: Right atrial electroanatomic 3D mapping prior to TP proofed to be a simple tool for FO identification and may potentially be of use in the safe and radiation-free performance of TP prior to LA ablation procedures., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2020
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38. Dramatic Aneurysmal Atrial Septum Identified with Intracardiac Echo Complicating Transseptal Puncture.
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Chen CB, Sandhu HS, Keane MG, Dass C, and Whitman IR
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- 2020
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39. Zerebrale Ischämien im Zuge einer Pulmonalvenenisolation bei symptomatischem paroxysmalen Vorhofflimmern
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Herm, Juliane Maria
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cognition ,left atrial ablation ,silent stroke ,ischemic stroke ,atrial fibrillation - Abstract
Einleitung: Die linksatriale Pulmonalvenenisolation (PVI) ist eine etablierte therapeu-tische Option bei symptomatischem Vorhofflimmern (VHF). Akute zerebrale Ischä-mien sind eine bekannte Komplikation der PVI und treten bei etwa 0,5-1% aller Pati-enten auf. Darüber hinaus treten bei bis zu 39% aller Patienten mittels Magnetreso-nanztomographie (MRT) detektierbare zerebrale Ischämien ohne konsekutive neuro-logische Defizite auf, deren klinische Relevanz bislang nicht abschließend geklärt ist. Methodik: In die prospektive monozentrische Studie „Mesh Ablator versus Cryobal-loon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation“ (MAC-PAF) wurden bis zum vorzeitigen Abbruch der Studie 44 Patienten mit symptomati-schem paroxysmalen VHF eingeschlossen. Diese wurden 1:1 für eine PVI unter Verwendung des HD Mesh Ablator® oder des Arctic Front® Katheters randomisiert. Eine zerebrale MRT bei 3 Tesla, eine neurologische Untersuchung und eine neuro-psychologische Testung erfolgten vor und innerhalb von 48 Stunden nach PVI, sowie nach sechs Monaten. Primärer Endpunkt war das Erreichen einer vollständigen PVI gemessen am Erregungsleitungsblock (EB) aller Pulmonalvenen (PV). Sekundäre Endpunkte waren das Auftreten zerebraler Ischämien und deren neu-ro(psycho)logische Folgen. Ergebnisse: Es erfolgten 41 Ablationen bei 37 der 44 eingeschlossenen Patienten, die im Median 63 Jahre alt, zu 43% weiblich waren und einen medianen CHA2DS2-VASc Score von 2 aufwiesen. Im Rahmen der Intention-to-treat-Analyse bestand ein vollständiger EB bei 9,5% der HD Mesh Ablator® randomisierten Patienten, sowie bei 56,5% der Arctic Front® randomisierten Patienten (p=0,001). Im unmittelbar post-interventionell durchgeführten MRT fanden sich 56 akute zerebrale Läsionen bei 16 (43%) aller 37 Patienten, ohne dass fokal-neurologische oder neuropsychologische Defizite nachgewiesen werden konnten. Sechs Monate nach erfolgter PVI waren le-diglich sieben (12,5%) dieser Läsionen als zerebrale Gliose in 5 (31,3%) der 16 Pati- enten nachweisbar. Auch bei persistierenden zerebralen Läsionen ließ sich kein neu-ro(psycho)logisches Defizit aufzeigen. Schlussfolgerung: Im Rahmen der prospektiven randomisierten MACPAF-Studie zeigte sich der Arctic Front® Katheter dem HD Mesh Ablator® Katheter im Hinblick auf das Erreichen einer vollständigen PVI aller PV überlegen. Postinterventionell fanden sich im MRT bei 43% aller Patienten zumindest eine akute zerebrale Läsion. Auch wenn jede achte zerebrale Läsion nach sechs Monaten eine Gliose verursach-te, konnten keine signifikanten neurokognitiven Defizite nachgewiesen werden., Introduction: Pulmonary vein isolation (PVI) is an established therapeutic approach in symptomatic atrial fibrillation (AF). Acute cerebral ischemia is a known complica-tion and occurs in about 0.5-1% of all patients. Furthermore, magnetic resonance imaging (MRI) has detected cerebral ischemia without consecutive neurological defi-cits in up to 39% of all patients. The clinical relevance of these brain lesions is fully understood. Method: According to the protocol of the prospective monocentric study „Mesh Abla-tor versus Cryoballoon Pulmonary Vein Ablation of Symptomatic Paroxysmal Atrial Fibrillation“ (MACPAF), patients with symptomatic paroxysmal AF were randomized 1:1 to PVI using the HD Mesh Ablator® or the Arctic Front® catheter. Until premature study termination, 44 patients were included. Cerebral 3 Tesla MRI, neurological ex-amination and neuropsychological testing were performed before and within 48 hours after PVI, as well as after six months. The primary endpoint was achieving complete PVI, verified by an exit- block (EB) of all pulmonary veins (PV). Secondary endpoints were the incidence of cerebral ischemia and their neuro(psycho)logical impact. Results: We performed 41 ablations in 37 of 44 randomized patients. Median age was 63 years, 43% were female and median CHA2DS2-VASc score was 2. According to intention-to-treat analysis, complete EB was achieved in 9.5% of all patients ran-domized to the HD Mesh Ablator®, and in 56.5% of all patients randomized to the Arctic Front® catheter (p=0.001). MRI immediately after PVI showed 56 acute cere-bral lesions in 16 (43%) of all 37 patients while no neurological or neurocognitive def-icits could be detected. After six months, seven (13%) of these acute brain lesions could be detected as cerebral gliosis in 5 (31%) of 16 patients. However, persisting brain lesions had no effect on cognitive performance. Conclusion: The MACPAF study revealed superiority of the Arctic Front® catheter over the HD Mesh Ablator® catheter concerning complete PVI of all PV. According to post-procedural 3T MRI, at least one ischemic brain lesion was found in 43% of all patients. While every eighth cerebral lesion formed a glial scar after six months, this was not associated with a significantly impaired cognitive function.
- Published
- 2014
40. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association
- Author
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Schotten, Ulrich, Van Gelder, Isabelle C., Fysiologie, Cardiologie, and RS: CARIM School for Cardiovascular Diseases
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Focused update ,Rate control ,Guidelines ,Upstream therapy ,Left atrial appendage occlusion ,Atrial fibrillation ,Pulmonary vein isolation ,Left atrial ablation ,European Society of Cardiology ,Antiarrhythmic drugs ,Cardioversion ,Anticoagulation ,Rhythm control ,Novel oral anticoagulants - Published
- 2012
41. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.
- Author
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, and Zeppenfeld K
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- Atrial Fibrillation epidemiology, Cardiology, Cardiovascular Diseases epidemiology, Europe, Humans, Patient Education as Topic, Risk Factors, Stroke prevention & control, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Disease Management
- Published
- 2016
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42. CoolLoop® First: A First In Man Study To Test A Novel Circular Cryoablation System In Paroxysmal Atrial Fibrillation.
- Author
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Stuehlinger M, Hoenig S, Spuller K, Koman C, Stoeger M, Poelzl G, Ulmer H, Pachinger O, and Steinwender C
- Abstract
Introduction: Pulmonary vein (PV) isolation is the mainstay of catheter treatment of paroxysmal atrial fibrillation (AF). The CoolLoop® cryoablation catheter (AFreeze® GmbH; Innsbruck, Austria) was developed to create wide and complete circular lesions around the PVs. In this study we evaluated feasibility and safety of this novel ablation system in humans., Methods: 10 patients (6M/4F; 57.6±7.6y) with paroxysmal AF were included in 2 referral centers. The CoolLoop® catheter was positioned at each PV antrum using a steerable transseptal sheath. Subsequently, 2-6 double-freezes over 5min were performed at each vein and PV-isolation was assessed thereafter using a circular mapping catheter. During cryoablation of the right PVs, pacing was used to monitor phrenic nerve function., Results: The CoolLoop® catheter could be successfully positioned at each PV. A mean of 5.6±1.8 cryoablations were performed in the LSPV, 5.2±1.6 in the LIPV, 6.3±2.5 in the RSPV and 5.4±1.6 in the RIPV, respectively. Mean procedure time was 251±60min and mean fluoroscopy time was 44.0±13.2min. 6 / 10 LSPV, 6 / 10 LIPV, 5 / 10 RSPV and 6 / 10 RIPV could be isolated exclusively using the novel cryoablation system. One patient developed groin hematoma and a brief episode of ST-elevation due to air embolism was observed in another subject. No other clinical complications occurred during 3 months of follow up., Conclusions: PV-isolation for paroxysmal atrial fibrillation using the CoolLoop® catheter is feasible and appears safe. Clinical long term efficacy still needs to be evaluated and will be compared with established catheters used for AF ablation.
- Published
- 2015
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43. Left atrial catheter ablation subsequent to Watchman® left atrial appendage device implantation: a single centre experience.
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Walker DT and Phillips KP
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- Aged, Echocardiography, Female, Fluoroscopy, Humans, Male, Middle Aged, Prostheses and Implants, Tomography, X-Ray Computed, Treatment Outcome, Anticoagulants therapeutic use, Atrial Appendage surgery, Atrial Fibrillation therapy, Catheter Ablation methods, Pulmonary Veins surgery, Warfarin therapeutic use
- Abstract
Aims: Left atrial appendage device occlusion is an increasingly accepted therapy for stroke prevention in atrial fibrillation. The feasibility and safety of left atrial catheter ablation procedures in the presence of a left atrial appendage device implant is unclear. We report on 10 cases of successful left atrial catheter ablation therapy for atrial fibrillation in patients with an implanted Watchman® device., Methods and Results: Consecutive patients with an existing Watchman® left atrial appendage implant and symptomatic antiarrhythmic-drug refractory atrial fibrillation or atrial tachycardias requiring left atrial catheter ablation therapy were included. Open irrigated tip ablation and circular mapping catheters were positioned in the left atrium via double transseptal access. Ten patients underwent successful left atrial geometry creation and complex atrial arrhythmia mapping and ablation in the presence of a chronically implanted Watchman® device. Arrhythmia targets included left atrial flutters, a focal tachycardia, left atrial CFAE zones, and pulmonary vein electrical isolation. The appearances of the Watchman® device position and device integrity were confirmed to be satisfactory in all patients at the end of the procedure based on fluoroscopy and intracardiac echocardiography imaging. There were no procedural complications., Conclusion: Left atrial catheter ablation therapy in the presence of an implanted Watchman® left atrial appendage occlusion device was efficacious and uncomplicated in our small single centre experience., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)
- Published
- 2015
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44. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis.
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Phan K, Xie A, Tsai YC, Kumar N, La Meir M, and Yan TD
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- Adult, Aged, Evidence-Based Medicine, Female, Heart Atria surgery, Humans, Male, Middle Aged, Risk Factors, Survival Rate, Treatment Outcome, Ablation Techniques mortality, Atrial Fibrillation mortality, Atrial Fibrillation surgery, Cardiac Surgical Procedures mortality
- Abstract
Aims: Surgical ablation performed concomitantly with cardiac surgery has emerged as an effective curative strategy for atrial fibrillation (AF). Left atrial (LA) lesion sets for ablation have been suggested to reduce procedural times and post-surgical bradycardia compared with biatrial (BA) lesions. Given the inconclusive literature regarding BA vs. LA ablation, the present meta-analysis sought to assess the current evidence., Methods and Results: Electronic searches were performed using six databases from their inception to December 2013, identifying all relevant randomized trials and observational studies comparing BA vs. LA surgical ablation AF patients undertaking cardiac surgery. In 10 included studies, 2225 patient results were available for analysis to compare BA (n = 888) vs. LA (n = 1337) ablation. Sinus rhythm prevalence was higher in the BA cohort compared with the LA cohort at 6-month and 12-month follow-up, but similar beyond 1 year. Permanent pacemaker implantations were higher in the BA cohort, but 30-day and late mortality, neurological events, and reoperation for bleeding were similar between BA and LA groups., Conclusions: Biatrial and LA ablations produced comparable 30-day and late mortality but LA was associated with significantly reduced permanent pacemaker implantation rates. Biatrial ablation appeared to be more efficacious than LA ablation in achieving SR at 1 year, but this difference was not maintained beyond 1 year. Trends appear to be driven by the preferential selection of long-standing and persistent AF patients for the BA approach. Future randomized studies of adequate follow-up are required to validate risks and benefits of BA vs. LA surgical ablation., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
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