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Ablação por radiofreqüência da fibrilação atrial paroxística: fatores determinantes da eficácia clínica a longo-prazo; Radiofrequency ablation of paroxysmal atrial fibrillation: factors determining long-term clinical efficacy

SARTINI, Raul José Pádua; SCANAVACCA, Maurício Ibrahim; SOSA, Eduardo; MOREIRA, Luiz Felipe; LARA, Sissy; HARDY, Carina; DARRIEUX, Francisco; HACHUL, Denise
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica
POR
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56.68%
FUNDAMENTO: A maioria dos trabalhos tem descrito preditores de recorrência de fibrilação atrial após ablação por cateter, com tempos de seguimento relativamente curtos. OBJETIVO: Avaliar retrospectivamente, em longo prazo, os preditores de recorrência de fibrilação atrial paroxística (FA) em pacientes submetidos ao isolamento das veias pulmonares, após um único procedimento. MÉTODOS: Foram estudados 139 pacientes (102 homens com idade média de 55 ± 12 anos) submetidos à ablação por radiofreqüência, por meio das técnicas ostial ou extra-ostial de abordagem do átrio esquerdo, associadas ou não à ablação do istmo cavo-tricuspídeo (ICT). Variáveis pré, intra e pós-ablação foram avaliadas por análise uni e multivariada, para determinar os preditores de recorrência da FA após um procedimento. RESULTADOS: Após um seguimento de 33 ± 12 meses, observou-se que maior tempo de história de FA, uso de mais antiarrítmicos e recorrência de FA num período de sessenta dias pós-procedimento aumentaram o risco de recorrência de FA em longo prazo. Por sua vez, a associação de flutter atrial e a ablação concomitante do ICT reduziram o risco de recorrência. CONCLUSÃO: Variáveis clínicas como tempo de história de FA e maior quantidade de antiarrítmicos já utilizadas influenciam os resultados da ablação por cateter. Em pacientes com flutter atrial associado...

Atrial Coronary Arteries in Areas Involved in Atrial Fibrillation Catheter Ablation

MEO, Januario Pardo; SCANAVACCA, Mauricio; SOSA, Eduardo; CORREIA, Aristides; HACHUL, Denise; DARRIEUX, Francisco; LARA, Sissy; HARDY, Carina; JATENE, Fabio; JATENE, Marcelo
Fonte: LIPPINCOTT WILLIAMS & WILKINS Publicador: LIPPINCOTT WILLIAMS & WILKINS
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
66.64%
Background-The proximity to vascular structures is a limiting factor during radiofrequency ablation. However, little or no attention has been given to the atrial arterial circulation during the development of atrial fibrillation (AF) catheter ablation techniques. Methods and Results-We examined the atrial arterial circulation in areas involved in AF ablation in 24 heart specimens by colored resin injection and careful dissection. The sinus node artery (SNA) arose from the circumflex artery in 42% of case; proximal to the LA appendage in 29%, crossing the left atrium (LA) anterior wall; and after the LA appendage in the remaining 13%, crossing the mitral isthmus and passing close to the left pulmonary veins (PVs), the LA roof, and the right superior PV. In 58%, the SNA arose from the right coronary artery. Major arteries (>= 1 mm in external diameter) were found in the mitral isthmus in 54%, at the LA roof in 54%, and at the LA anterior wall in 29%. Around the left PV ostia, there were areas with major arteries in up to 37% (at the roof and inferior segments) and around the right PV ostia in up to 29% (at the roof segment). Conclusions-Major atrial coronary arteries, including the SNA, were commonly found in the areas involved in AF ablation and could cause difficulties in obtaining transmural lesions and electric isolation or even lead to ischemic sinus node or atrial dysfunction. (Circ Arrhythm Electrophysiol. 2010;3:600-605.)

Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results

PACHON, M. Jose Carlos; PACHON, M. Enrique Indalecio; PACHON, Maria Zelia Cunha; LOBO, Tasso Julio; PACHON, M. Juan Carlos; SANTILLANA, P. Tomas Guilhermo
Fonte: OXFORD UNIV PRESS Publicador: OXFORD UNIV PRESS
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
56.7%
Aims Neurally meditated reflex or neurocardiogenic or vasovagal syncope (NMS) is usually mediated by a massive vagal reflex. This study reports the long-term outcome of NMS therapy based on endocardial radiofrequency (RF) catheter ablation of the cardiac vagal nervous system aiming permanent attenuation or elimination of the cardioinhibitory reflex (cardioneuroablation). Methods and results A total of 43 patients (18F/25M, 32.9+/-15 years) without apparent cardiopathy (left ventricular ejection fraction=68.6+/-5%) were included. All had recurrent NMS (4.7+/-2 syncope/patient) with important cardioinhibition (pauses=13.5+/-13 s) at head-up tilt test (HUT), normal electrocardiogram (ECG), and normal atropine test (AT). The patients underwent atrial endocardial RF ablation using spectral mapping to track the neurocardiac interface (AF Nest Mapping). The follow-up (FU) consisted of clinical evaluation, ECG (1 month/every 6 months/or symptoms), Holter (every 6 months/or symptoms), HUT (>= 4 months/or symptoms), and AT (end of ablation and >= 6 months). A total of 44 ablations (48+/-9 points/patient) were performed. Merely three cases of spontaneous syncope occurred in 45.1+/-22 months (two vasodepressor, one undefined). Only four partial cardioinhibitory responses occurred in post-ablation HUT without pauses or asystole (sinus bradycardia). Long-term AT (21.7+/-11 months post) was negative in 33 (76.7%...

Estudo sobre o efeito de técnicas preventivas na incidência de lesões esofageanas após ablação do átrio esquerdo para tratamento de fibrilação atrial; Study on the effect of preventive techniques in the incidence of esophageal lesions after left atrial ablation for treatment of atrial fibrillation

Oliveira , Barbara Daniela da Eira
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 20/05/2015 PT
Relevância na Pesquisa
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Introdução: Na última década, desde a descrição inicial da ablação das veias pulmonares, a ablação por cateter da fibrilação atrial (FA) tem evoluído consideravelmente em eficácia e segurança, consolidando-se como opção terapêutica em pacientes selecionados com FA. No entanto, a ablação da FA é um procedimento complexo e não isento de riscos. Ainda que seja uma complicação rara, o desenvolvimento de fístulas átrio-esofágicas (FAE) é a segunda complicação responsável por morte relacionada ao procedimento e responde por 16% dos casos de morte após ablação de FA. Consensos atuais não orientam recomendações definitivas para prevenção de lesões esofágicas, consideradas lesões precursoras de FAE. O objetivo deste trabalho foi comparar a incidência de lesões esofageanas e periesofageanas por ecoendoscopia após ablação de fibrilação atrial, utilizando diferentes estratégias de proteção esofágica durante as aplicações de radiofrequência na parede posterior do átrio esquerdo. Método: No período de outubro/2012 a julho/2014, foram estudados 45 pacientes submetidos à ablação percutânea de FA, portadores de FA paroxística ou persistente há menos de um ano. Todos os pacientes foram submetidos a ablação circunferencial com isolamento elétrico das veias pulmonares...

Segurança da ablação de fibrilação atrial com RNI terapêutico : comparação com a transição com heparina de baixo peso; Safety of ablation for atrial fibrillation with therapeutic INR : comparison with transition to low-molecular-weight heparin

Saad, Eduardo Benchimol; Costa, Ieda P.; Costa, Rodrigo E. da; Inácio Júnior, Luiz Antonio O.; Slater, Charles; Camiletti, Angelina; Moura Neto, Dario G. de; Maldonado, Paulo; Camanho, Luiz Eduardo; Polanczyk, Carisi Anne
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf; application/pdf
POR
Relevância na Pesquisa
56.76%
Fundamento: O manejo ideal da anticoagulação oral (ACO) no período pré e pós-ablação de fibrilação atrial (FA) ainda é motivo de controvérsia. Objetivo: Comparar duas estratégias de anticoagulação: suspensão da warfarina com a utilização de heparina de baixo peso molecular (HBPM) e a realização da ablação sem a suspensão da warfarina, mantendo o RNI terapêutico (entre 2,0 e 3,0). Métodos: 140 pacientes (pt) portadores de FA persistente/ permanente submetidos à ablação por cateter de FA foram divididos em dois grupos: no grupo I (70 pt), a warfarina foi suspensa cinco dias antes do procedimento e utilizada terapia de transição com HBPM (enoxaparina 1 mg/kg 2x/dia pré-ablação e 0,5 mg/kg 2x/dia após o procedimento); no grupo II (70 pt), a warfarina não foi suspensa e o procedimento foi realizado com RNI terapêutico. Ambos os grupos receberam heparina intravenosa (TCA > 350 seg) durante o procedimento. Resultados: No Grupo I, observou-se complicação hemorrágica maior (1,4%) e 4 pt (5,7%) com complicações hemorrágicas menores. No Grupo II, 2 pt (2,8%) apresentaram complicações hemorrágicas menores e 1 pt apresentou sangramento maior; porém, este ocorreu após uso de HBPM por RNI < 2,0. Não houve complicação tromboembólica ou morte cardiovascular nos dois grupos após 16 ± 8 meses. Conclusão: A realização de ablação por cateter de FA sem a suspensão de ACO e RNI terapêutico é uma estratégia semelhante em segurança e eficácia quando comparada à tradicional transição com HBPM...

Useful clinical features for the selection of ideal patients with strial fibrillation for mapping and catheter ablation

Mehta,Niraj; Távora,Maria Zildany Pinheiro; Takeschita,Noriaki; Figueiredo,Edilberto; Lourenço,Ricardo M.; Germiniani,Hélio; Précoma,Dalton
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 EN
Relevância na Pesquisa
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OBJECTIVE: To identify useful clinical characteristics for selecting patients eligible for mapping and ablation of atrial fibrillation. METHODS: We studied 9 patients with atrial fibrillation, without structural heart disease, associated with: 1) antiarrhythmic drugs, 2) symptoms of low cardiac output, and 3) intention to treat. Seven patients had paroxysmal atrial fibrillation and 2 had recurrent atrial fibrillation. RESULTS: In the 6 patients who underwent mapping (all had paroxysmal atrial fibrillation), catheter ablation was successfully carried out in superior pulmonary veins in 5 patients (the first 3 in the left superior pulmonary vein and the last 2 in the right superior pulmonary vein). One patient experienced a recurrence of atrial fibrillation after 10 days. We observed that patients who had short episodes of atrial fibrillation on 24-hour Holter monitoring before the procedure were those in whom mapping the focus of tachycardia was possible. Tachycardia was successfully suppressed in 4 of 6 patients. The cause of failure was due to the impossibility of maintaining sinus rhythm long enough for efficient mapping. CONCLUSION: Patients experiencing short episodes of atrial fibrillation during 24-hour Holter monitoring were the most eligible for mapping and ablation...

Catheter ablation of atriofascicular Mahaim fibers guided by the activation potential

Silva,Márcio Augusto; Berardi,Gel; Kraemer,Alessandro; Nadalin,Elenir; Jorge,José Carlos Moura
Fonte: Sociedade Brasileira de Cardiologia - SBC Publicador: Sociedade Brasileira de Cardiologia - SBC
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 EN
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66.75%
OBJECTIVE: To determine whether recording of the activation potential may be used as an isolated criterion to guide catheter ablation of atriofascicular Mahaim fibers. METHODS: We studied 6 patients (5 females, mean age of 26±7.3 years) with paroxysmal tachycardias with a wide QRS complex, whose electrophysiological study diagnosed atriofascicular Mahaim fibers. Mapping and catheter ablation were performed in sinus rhythm, guided only by the recording of the activation potential of the fiber. RESULTS: Efficacy in ablation was achieved in all patients. The fibers were located in the right lateral region of the tricuspid ring in 3 patients, right posterolateral region in 2, and right anterolateral region in 1. A mean of 5.3±3 radiofrequency applications was performed. The mean fluoroscopy time was 46.6±25 minutes, and the mean duration of the procedure was 178.6±108 minutes. No complication occurred. In a mean 20-month follow-up, all patients were asymptomatic and receiving no antiarrhythmic drugs. CONCLUSION: Catheter ablation of Mahaim fibers may be performed with good safety and efficacy by mapping the activation potential of the tricuspid ring in sinus rhythm.

Catheter ablation of ventricular fibrillation in structurally normal hearts targeting the RVOT and Purkinje ectopy

Weerasooriya, R.; Hsu, L.; Scavee, C.; Sanders, P.; Hocini, M.; Cabrera, J.; Horlitz, M.; Schley, P.; Guelker, H.; Jais, P.; Haissaguerre, M.
Fonte: Urban & Vogel Publicador: Urban & Vogel
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
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Catheter ablation for ventricular fibrillation in structurally normal hearts is in its infancy. Recently, catheter ablation of idiopathic ventricular fibrillation as well as ventricular fibrillation associated with the long QT and Brugada syndromes has been described. This review article is a summary of our current understanding of the technique and results of catheter ablation of ventricular fibrillation in structurally normal hearts.; Rukshen Weerasooriya, Li-Fern Hsu, Christophe Scavée, Prashanthan Sanders, Mélèze Hocini, Jose A. Cabrera, Marc Horlitz, Philipp Schley, Hartmut Guelker, Pierre Jaïs, Michel Haïssaguerre

Electrophysiologic and clinical consequences of linear catheter ablation to transect the anterior left atrium in patients with atrial fibrillation

Sanders, P.; Jais, P.; Hocini, M.; Hsu, L.; Scavee, C.; Sacher, F.; Rotter, M.; Takahashi, Y.; Pasquie, J.L.; Shah, D.; Garrigue, S.; Clementy, J.; Haissaguerre, M.
Fonte: Elsevier Inc. Publicador: Elsevier Inc.
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
Relevância na Pesquisa
56.72%
Background While the Maze procedure is effective in maintaining sinus rhythm in patients with AF, it is associated with significant morbidity. This prospective clinical study evaluates the feasibility and consequences of limited LA linear ablation to transect the anterior LA in patients with AF. Methods Twenty-four patients (51.2 ± 7.3 years) with paroxysmal (n = 16) or chronic (n = 8) AF resistant to pulmonary vein (PV) isolation were studied. To transect the anterior LA, linear ablation was performed joining the superior PVs; this line was then connected to the anterior mitral annulus. Pulmonary vein isolation and cavotricuspid isthmus ablation were performed in all cases. Ablation was performed using an irrigated catheter with the endpoint of achieving complete linear block demonstrated by online double potentials, differential pacing techniques, and an activation detour. Results Of 20 patients in AF prior to linear ablation, arrhythmia terminated in 12 (60%), including half the patients with chronic AF, during ablation. Despite repeated ablation, complete linear block was achieved in only 14 of 24 patients (58%). Complete linear conduction block resulted in an activation detour around the mitral annulus and PVs with a delay of 158 ± 30 ms (P = .0001)...

Catheter ablation for ventricular tachycardia

Lim, H.; Singleton, C.; Alasady, M.; McGavigan, A.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
66.72%
Sudden cardiac death due to ventricular arrhythmias remains the most common cause of death in developed nations. Implantable cardioverter defibrillators have been shown to improve mortality in high-risk groups for ventricular tachyarrhythmias, but they are not curative, with the risk of arrhythmia recurrence remaining unaltered. It is also important to remember that ventricular tachycardia (VT) in the setting of a structurally normal heart is often not associated with an increased risk of sudden death and catheter ablation is a potentially curative procedure in this cohort. Recent advances in catheter ablation for VT have increased the efficacy in creating adequate lesions, accurate three-dimensional maps and mapping haemodynamically unstable VT, all of which have increased the utility of this modality in the treatment of ventricular arrhythmias. In this article, we review the recent advances that have fuelled renewed interest in catheter ablation of VT, its clinical utility and who should be referred.; H. S. Lim, C. B. Singleton, M. Alasady and A. D. McGavigan

Long-term effects of catheter ablation for lone atrial fibrillation: progressive atrial electroanatomic substrate remodeling despite successful ablation

Teh, A.; Kistler, P.; Lee, G.; Medi, C.; Heck, P.; Spence, S.; Morton, J.; Sanders, P.; Kalman, J.
Fonte: Elsevier Inc. Publicador: Elsevier Inc.
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
66.67%
BACKGROUND: Whether curative ablation can prevent progression of the atrial electroanatomic remodeling associated with atrial fibrillation (AF) is not known. OBJECTIVE: The purpose of this study was to determine whether successful radiofrequency ablation (RFA) of AF can prevent progression of the atrial substrate associated with AF. METHODS: Detailed right atrial electroanatomic maps from 11 patients without apparent structural heart disease undergoing RFA of AF at baseline and ≥6 months following successful RFA were compared to 11 control patients undergoing electrophysiologic evaluation of supraventricular tachycardia. Bipolar voltage, conduction, effective refractory periods (ERPs), and signal complexity were assessed. RESULTS: At baseline compared with the control group, the AF group demonstrated (1) lower voltage (P <.001); (2) slowed conduction (P = .005); (3) more prevalent complex signals (P <.001); (4) prolonged regional refractoriness (P <.05), and (5) left atrial dilation (P = .01). At 10 ± 13 month follow-up, the AF group demonstrated the following compared to baseline: (1) lower voltage (P <.05); (2) either no improvement or further slowing of conduction; (3) further prolongation of regional refractoriness (P <.05); and (4) reversal of left atrial dilation (P <.05). CONCLUSION: Patients with lone AF demonstrate evidence of an abnormal atrial substrate at baseline compared to control patients without AF. This substrate does not appear to reverse even after successful catheter ablation. These findings may have implications for long-term outcomes of ablation and for timing of ablative intervention.; Andrew W. Teh...

Substrate and trigger ablation for reduction of atrial fibrillation trial - Part II (STAR AF II): design and rationale

Verma, A.; Sanders, P.; MacLe, L.; Deisenhofer, I.; Morillo, C.; Chen, J.; Jiang, C.Y.; Ernst, S.; Mantovan, R.
Fonte: Mosby Inc Publicador: Mosby Inc
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
56.72%
BACKGROUND: The optimal ablation approach for patients with persistent atrial fibrillation (AF) remains unknown. In particular, it is unclear if pulmonary vein (PV) antral isolation (PVI) is sufficient as a lone strategy for persistent AF. Furthermore, if additional substrate ablation is to be added, the ideal approach to substrate ablation is yet to be determined. OBJECTIVE: The aim of this study is to determine the optimal strategy of catheter ablation of persistent AF by comparing the efficacy of 3 strategies: PVI vs PVI plus complex fractionated electrogram (CFE) ablation (PVI + CFE) vs PVI plus linear ablation (PVI + Lines). STUDY DESIGN: The STAR AF II study (ClinicalTrials.gov NCT01203748) is a prospective, multicenter, randomized trial with a blinded assessment of outcomes. A total of 549 patients will be randomized in a 1:4:4 fashion to one of the investigation arms: PVI, PVI + CFE, and PVI + Lines, respectively. Patients undergoing a first-time ablation procedure for symptomatic, persistent AF that is refractory to at least 1 antiarrhythmic medication will be included. Persistent AF will be defined as a sustained episode lasting >7 days and <3 years. Patients with a left atrial parasternal size ≥60 mm will be excluded. The primary end point is freedom from documented AF >30 seconds at 18 months after 1 or 2 ablation procedures with or without antiarrhythmic medications. CONCLUSIONS: The STAR AF II study is a randomized trial designed to evaluate the optimal approach for catheter ablation of persistent AF.; Atul Verma...

Radiofrequency catheter ablation for ventricular tachycardia

Haqqani, H.; Roberts-Thomson, K.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
66.64%
The management of ventricular tachycardia (VT) has evolved considerably in recent times. The majority of patients with VT have structural heart disease and often implantable defibrillators. Implantable defibrillators can terminate ventricular arrhythmias and prevent sudden death but do not prevent these arrhythmias from occurring. Ventricular tachycardia may also occur in patients without structural heart disease and although these patients generally have a benign prognosis, the symptoms can be significant. Radiofrequency catheter ablation has a definite role as an alternative to anti-arrhythmic therapy in both groups of patients. This review outlines the indications, techniques and outcomes of catheter ablation in the management of patients with ventricular tachycardia.; Haris M. Haqqani and Kurt C. Roberts-Thomson

Catheter ablation of atrial arrhythmias: State of the art

Lee, G.; Sanders, P.; Kalman, J.
Fonte: Lancet Ltd Publicador: Lancet Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
66.77%
Catheter ablation is at the forefront of the management of a range of atrial arrhythmias. In this Series paper, we discuss the underlying mechanisms and the current role of catheter ablation for the three most common atrial arrhythmias encountered in clinical practice: focal atrial tachycardia, atrial flutter, and atrial fibrillation. The mechanisms of focal atrial tachycardia and atrial flutter are well understood, and these arrhythmias are amenable to curative catheter ablation with high success rates. In most cases, paroxysmal atrial fibrillation is initiated by triggers located within pulmonary vein musculature. Circumferential ablation to isolate this musculature is associated with high success rates for elimination of paroxysmal atrial fibrillation in selected populations. Because of the problem of recurrent pulmonary vein connection, more than one procedure will be needed in about 30% of patients, and new technologies are being developed to reduce this occurrence. The mechanisms that sustain persistent atrial fibrillation are not well understood and are the subject of continuing investigation. As such, ablation approaches and technologies for this arrhythmia are still evolving. This is the second in a Series of three papers about cardiac arrhythmia; Geoffrey Lee...

National Heart Foundation of Australia consensus statement on catheter ablation as a therapy for atrial fibrillation

Kalman, J.; Sanders, P.; Brieger, D.; Aggarwal, A.; Zwar, N.; Tatoulis, J.; Tay, A.; Wilson, A.; Branagan, M.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
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Summary - Atrial fibrillation (AF) is estimated to affect 1%–2% of the population. It is increasing in prevalence and is associated with excess mortality, considerable morbidity and hospitalisations. AF is responsible for a significant and growing societal financial - Catheter ablation is an increasingly used therapeutic strategy for the management of AF; however, some confusion exists among those caring for patients with this condition about the role and optimal use of ablative treatments for AF. - Our aim in this consensus statement is to provide recommendations on the use of primary catheter ablation for AF in Australia, on the basis of current evidence. - Our consensus is that the primary indication for catheter ablation of AF is the presence of symptomatic AF that is refractory or intolerant to at least one Class 1 or Class 3 antiarrhythmic medication. - In selecting patients for catheter ablation of AF, consideration should be given to the patient’s age, duration of AF, left atrial size and the presence of significant structural heart disease. Best results are obtained in younger patients with paroxysmal AF, no structural heart disease and smaller atria. - Ablation techniques for patients with persistent AF are still undergoing evaluation. - Discontinuation of warfarin or equivalent therapies is not considered a sole indication for this procedure. - After AF ablation...

Complications of catheter ablation of atrial fibrillation a systematic review

Aakriti, G.; Perera, T.; Ganesan, A.; Sullivan, T.; Lau, D.; Roberts-Thomson, K.; Brooks, A.; Sanders, P.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.77%
BACKGROUND—Atrial fibrillation ablation is an established therapy; however, limited data are available on associated complications. This systematic review determines the incidence and potential predictors of acute complications. METHODS AND RESULTS—Electronic searches were conducted in MEDLINE and EMBASE for English scientific literature up to the 18th June 2012. A total of 2065 references were retrieved and evaluated for relevance. Reference lists of retrieved studies and review articles were examined to ensure all relevant studies were included. Data were extracted from 192 studies, total of 83 236 patients. The incidence of periprocedural complications for catheter ablation of atrial fibrillation was 2.9% (95% confidence interval, 2.6–3.2). There was a significant decrease in the acute complication rate in 2007 to 2012 compared with 2000 to 2006 (2.6% versus 4.0%; P=0.003). The complication rates reported were higher in prospective studies compared with those that retrospectively described complications (3.5% versus 2.7%; P=0.03). There were no significant associations among procedure duration, ablation time or ablation strategy, and acute complication rate. CONCLUSIONS—Catheter ablation of atrial fibrillation has a low incidence of periprocedural complications. The acute complication rate has decreased significantly in recent years. This may reflect improved catheter technology and experience. The use of different strategies across centers worldwide seems to be safe with no established relationship between procedural variables and complication rate.; Aakriti Gupta...

Ten-year trends in the use of catheter ablation for treatment of atrial fibrillation vs. the use of coronary intervention for the treatment of ischaemic heart disease in Australia

Kumar, S.; Walters, T.; Halloran, K.; Morton, J.; Hepworth, G.; Wong, C.; Kistler, P.; Sanders, P.; Kalman, J.
Fonte: W B Saunders Co Ltd Publicador: W B Saunders Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.7%
AIMS Percutaneous coronary intervention (PCI) and catheter ablation are well-accepted therapeutic interventions for treatment of coronary artery disease and atrial fibrillation (AF), respectively. We sought to examine temporal trends in the provision of these services over the past decade in Australia. METHODS AND RESULTS A retrospective review of the numbers of PCIs and AF ablations from 2000/01 to 2009/10 was performed on data from three sources: the Australian Institute of Health, Welfare and Aging (AIHW), Medicare Australia database (MA), and local records at a high volume tertiary referral centre (RMH) for AF ablation. Linear regression models were fitted comparing trends in population-adjusted procedural numbers over the 10-year period. There was a 5% per year population-adjusted increment in PCIs over 10 years from both the AIHW and MA sources, respectively (P < 0.001). This was similar to the growth rate of all cardiovascular procedures (AIHW: 5.1 vs. 3.8%/year, P = 0.27). Atrial fibrillation ablations showed a 30.9, 23.2, and 39.8% per year population-adjusted increment over 10 years from the AIHW, MA, and RMH sources respectively (P < 0.001 for all). Growth of AF ablations was significantly higher than PCIs (P < 0.001 for AIHW and MA sources) and all cardiovascular procedures (AIHW: 30.9 vs. 3.8%/year...

Kann das Substrat ventrikulärer Tachykardien im Sinusrhythmus identifiziert werden? Die nicht-ischämische Kardiomyopathie als Herausforderung für eine Katheterablation; Can the substrate of ventricular tachycardia be identified during sinus rhythm? – Non-ischemic dilated cardiomyopathy as a challenge for catheter ablation

Girrbach, Felix Frederic
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
66.82%
Hintergrund: Die substratorientierte Ablation ventrikulärer Tachykardien (VT) bei Patienten nach Myokardinfarkt kann durch endokardiale Elektrogrammcharakteristika im Sinusrhythmus geleitet werden. Die Bedeutung von fraktionierten Elektrogrammen für eine Identifizierung von Arealen mit Ursprung klinischer VTs bei nicht-ischämischen Kardiomyopathie (NICM) wurde in der vorliegenden Studie untersucht. Methoden: 11 Patienten (8 männlich, 3 weiblich, mittlere LVEF 31 ± 11 %) wurden im Zeitraum vom Februar 2005 bis März 2008 einer elektrophysiologischen Untersuchung (EPU) unterzogen. Es wurde eine substratorientierte Ablation durchgeführt mit dem Ziel lokal verzögerte, fraktionierte Potentiale mit einer bipolaren Spannungamplitude von < 1,5 mV in bis zu 1 cm Umkreis um die beste VT-Pace-Map-Position zu abladieren. Der linke Ventrikel wurde in 17 Segmente eingeteilt und Segmente im Bereich des besten VT-Pace-Maps als arrhythmogenes Areal definiert. Als Kontrollareale wurden Areale mit räumlichem Abstand zum arrhythmogenem Areal definiert. Die bei der elektrophysiologischen Untersuchung des linken Ventrikels im Sinusrhythmus und/ oder während ventrikulärem Pacing aquirierten Elektrogramme wurden durch die Parameter bipolare Amplitude...

Simplified method for esophagus protection during radiofrequency catheter ablation of atrial fibrillation - prospective study of 704 cases

Mateos,José Carlos Pachón; Mateos,Enrique I Pachón; Peña,Tomas G Santillana; Lobo,Tasso Julio; Mateos,Juán Carlos Pachón; Vargas,Remy Nelson A; Pachón,Carlos Thiene C; Acosta,Juán Carlos Zerpa
Fonte: Sociedade Brasileira de Cirurgia Cardiovascular Publicador: Sociedade Brasileira de Cirurgia Cardiovascular
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2015 EN
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66.84%
AbstractIntroduction:Although rare, the atrioesophageal fistula is one of the most feared complications in radiofrequency catheter ablation of atrial fibrillation due to the high risk of mortality.Objective:This is a prospective controlled study, performed during regular radiofrequency catheter ablation of atrial fibrillation, to test whether esophageal displacement by handling the transesophageal echocardiography transducer could be used for esophageal protection.Methods:Seven hundred and four patients (158 F/546M [22.4%/77.6%]; 52.8±14 [17-84] years old), with mean EF of 0.66±0.8 and drug-refractory atrial fibrillation were submitted to hybrid radiofrequency catheter ablation (conventional pulmonary vein isolation plus AF-Nests and background tachycardia ablation) with displacement of the esophagus as far as possible from the radiofrequency target by transesophageal echocardiography transducer handling. The esophageal luminal temperature was monitored without and with displacement in 25 patients.Results:The mean esophageal displacement was 4 to 9.1cm (5.9±0.8 cm). In 680 of the 704 patients (96.6%), it was enough to allow complete and safe radiofrequency delivery (30W/40ºC/irrigated catheter or 50W/60ºC/8 mm catheter) without esophagus overlapping. The mean esophageal luminal temperature changes with versus without esophageal displacement were 0.11±0.13ºC versus 1.1±0.4ºC respectively...

Korean Atrial Fibrillation (AF) Network: Genetic Variants for AF Do Not Predict Ablation Success

Choi, Eue-Keun; Park, Jae Hyung; Lee, Ji-Young; Nam, Chung Mo; Hwang, Min Ki; Uhm, Jae-Sun; Joung, Boyoung; Ko, Young-Guk; Lee, Moon-Hyoung; Lubitz, Steven A; Ellinor, Patrick T; Pak, Hui-Nam
Fonte: John Wiley & Sons, Ltd Publicador: John Wiley & Sons, Ltd
Tipo: Artigo de Revista Científica
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Background: Genomewide association studies have identified several loci associated with atrial fibrillation (AF) and have been reportedly associated with response to catheter ablation for AF in patients of European ancestry; however, associations between top susceptibility loci and AF recurrence after ablation have not been examined in Asian populations. We examined whether the top single nucleotide polymorphisms (SNPs) at chromosomes 4q25 (PITX2), 16q22 (ZFHX3), and 1q21 (KCNN3) were associated with AF in a Korean population and whether these SNPs were associated with clinical outcomes after catheter ablation for AF. Methods and Results: We determined the association between 4 SNPs and AF in 1068 AF patients who underwent catheter ablation (74.6% male, aged 57.5±10.9 years, 67.9% paroxysmal AF) and 1068 age- and sex-matched controls. The SNPs at the PITX2 and ZFHX3 loci, but not the KCNN3 locus, were significantly associated with AF (PITX2/rs6843082_G: odds ratio 3.41, 95% CI 2.55 to 4.55, P=1.32×10−16; PITX2/rs2200733_T: odds ratio 2.05, 95% CI 1.66 to 2.53, P=2.20×10−11; ZFHX3/rs2106261_A: odds ratio 2.33, 95% CI 1.87 to 2.91, P=3.75×10−14; KCNN3/rs13376333_T: odds ratio 1.74, 95% CI 0.93 to 3.25, P=0.085). Among those patients who underwent catheter ablation for AF...