Clinical outcome of ablation for long-standing persistent atrial fibrillation with or without defragmentation

Objective

To assess the outcome and associated risks of atrial defragmentation for the treatment of long-standing persistent atrial fibrillation (LSP-AF).

Methods

Thirty-seven consecutive patients (60.4 ± 7.3 years; 28 male) suffering from LSP-AF who underwent pulmonary vein isolation (PVI) and linear ablation were compared. All patients were treated with the Stereotaxis magnetic navigation system (MNS). Two groups were distinguished: patients with (n = 20) and without (n = 17) defragmentation. The primary endpoint of the study was freedom of AF after 12 months. Secondary endpoints were AF termination, procedure time, fluoroscopy time and procedural complications. Complications were divided into two groups: major (infarction, stroke, major bleeding and tamponade) and minor (fever, pericarditis and inguinal haematoma).

Results

No difference was seen in freedom of AF between the defragmentation and the non-defragmentation group (56.2 % vs. 40.0 %, P = 0.344). Procedure times in the defragmentation group were longer; no differences in fluoroscopy times were observed. No major complications occurred. A higher number of minor complications occurred in the defragmentation group (45.0 % vs. 5.9 %, P = 0.009). Mean hospital stay was comparable (4.7 ± 2.2 vs. 3.4 ± 0.8 days, P = 0.06).

Conclusion

Our study suggests that complete defragmentation using MNS is associated with a higher number of minor complications and longer procedure times and thus compromises efficiency without improving efficacy.     

Tachyarrhythmia in patients with congenital heart disease: inevitable destiny?

The prevalence of patients with congenital heart disease (CHD) has increased over the last century. As a result, the number of CHD patients presenting with late, postoperative tachyarrhythmias has increased as well. The aim of this review is to discuss the present knowledge on the mechanisms underlying both atrial and ventricular tachyarrhythmia in patients with CHD and the advantages and disadvantages of the currently available invasive treatment modalities.     

Safety and feasibility of atrial fibrillation ablation using Amigo® system versus manual approach: A pilot study

Background

The Amigo^® Remote Catheter System is a relatively new robotic system for catheter navigation. This study compared feasibility and safety using Amigo (RCM) versus manual catheter manipulation (MCM) to treat paroxysmal atrial fibrillation (PAF). Contact force (CF) and force-time integral (FTI) values obtained during pulmonary vein isolation (PVI) ablation were compared.

Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy in a 4-year-old child

We present a rare case of tachycardiomyopathy in a 4-year-old girl. The child had incessant atrial tachycardia (AT) and refractory heart failure. Right atrial appendage (RAA) was localised as the source of the ectopic tachycardia. The child underwent successful radiofrequency ablation (RFA) using 3-D electroanatomical mapping. Fluoroscopy was used sparingly only to rule out underlying anomalies. The left ventricular functions returned to normal by one month after the procedure. RAA AT is rare in very young children and usually necessitates surgical appendectomies. RFA is a challenge in such age groups and there are very few published literature on RAA AT in very young children.     

Comparison between surgical and catheter based ablation in atrial fibrillation,should surgical based ablation be implemented as first line? - A meta-analysis of studies

IntroductionAblation remains a modality of choice in select patients with Atrial fibrillation (AF). Which is done via a surgical or catheter-based approach.ObjectiveThis meta-analysis aimed to compare the efficacy of Surgical and Catheter ablation in the management of AF.MethodsElectronic search on PubMed (MEDLINE), EBSCO, EuropePMC, Clinicaltrials.gov, and Google Scholar was done. Studies comparing the use of surgical or catheter ablation in patients with AF were included. The Primary outcome of interest was Arrhythmia free patients at 12 months post-ablation.ResultsEight studies (744 patients) reported a statistically significant difference in Arrhythmia recurrence rate between surgical and catheter-based ablation. The pooled hazard ratio was chosen to compare the risk of AF recurrence between these groups with pooled Hazard ratio comparing surgical to catheter approach of 0.40 [0.35,0.45], p < 0.001 favoring surgical approach; low heterogeneity I² 22%, p = 0.25. Meta-analyses were also performed on procedural time, length of stay and major adverse events.ConclusionThe increased rate of adverse effects and length of hospitalization impedes the implementation of surgical ablation as primary ablation method of AF in general. However, the result of our meta-analysis shows the promising result of surgical ablation compared to catheter-based ablation.     

Electrophysiological Features of Atrial Flutter in Cardiac Sarcoidosis: A Report of Two Cases

We report two cases of systemic sarcoidosis with atrial flutter as the clinical manifestation. In one patient, who had symptoms of shorter duration, the arrhythmia was no longer inducible after a course of glucocorticoid therapy. Electroanatomical mapping in the other case revealed patchy fibrosis of the left atrial myocardium and multiple macro-reentrant circuits. Sinus rhythm could be restored with ablation of these reentrant circuits. To our knowledge, this is the first report on the demonstration of atrial scarring in a patient with sarcoidosis using 3-D electroanatomical mapping. These two cases illustrate that the inflammation of atrial myocardium is the primary mechanism of atrial arrhythmias in patients with cardiac sarcoidosis.     

P波离散度对房颤消融术后复发的预测价值

目的：探讨P波离散度对心房颤动（房颤）导管消融术后复发的预测价值。方法：连续收集经导管消融的房颤患者120例,根据是否复发分为复发组与对照组,分别测定和比较两组术后心电图最大P波时限（Pmax）及最小P波时限（Pmin）并计算P波离散度（Pd）。结果：房颤消融术后,53例病人复发,复发组最大P波时限（132±23mm VS 102±25mm）及P波离散度（33±9mm VS 29±10mm）均显著高于非复发组,差异有统计学意义（P〈0.05）。结论：P波离散度可用于辅助预测房颤导管消融术后是否复发。     

P波离散度对房颤消融术后复发的预测价值

目的:探讨P波离散度对心房颤动(房颤)导管消融术后复发的预测价值。方法:连续收集经导管消融的房颤患者120例,根据是否复发分为复发组与对照组,分别测定和比较两组术后心电图最大P波时限(Pmax)及最小P波时限(Pmin)并计算P波离散度(Pd)。结果:房颤消融术后,53例病人复发,复发组最大P波时限(132±23mm VS 102±25mm)及P波离散度(33±9mm VS 29±10mm)均显著高于非复发组,差异有统计学意义(P0.05)。结论:P波离散度可用于辅助预测房颤导管消融术后是否复发。     

Anatomic Guidance For Ablation: Atrial Flutter,Fibrillation, and Outflow Tract Ventricular Tachycardia

After initial documentation of excellent efficacy with radiofrequency ablation, this procedure is being performed increasingly in more complex situations and for more difficult arrhythmia. In these circumstances, an accurate knowledge of the anatomic basis for the ablation procedure will help maintain this efficacy and improve safety. In this review, we discuss the relevant anatomy for electrophysiology interventions for typical right atrial flutter, atrial fibrillation, and outflow tract ventricular tachycardia. In the pediatric population, maintaining safety is a greater challenge, and here again, knowing the neighboring and regional anatomy of the arrhythmogenic substrate for these arrhythmias may go a long way in preventing complications.