Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation

Elayi, Claude S.; Biase, Luigi Di; Barrett, Conor D.; Ching, Chi Keong; Aly, Moataz al; Lucciola, Maria Teresa; Bai, Rong; Horton, Rodney; Fahmy, Tamer S.; Khaykin, Yaariv; Shah, Jignesh; Morales, Gustavo; Hongo, Richard; Sheng, Hao; Beheiry, Salwa; Arruda, Mauricio; Schweikert, Robert A.; Cummings, Jennifer E.; Burkhardt, J. David; Wang, Paul; Al‐Ahmad, Amin; Cauchemez, B; Gaïta, Fiorenzo

doi:10.1016/j.hrthm.2010.01.038

Cited by 130 publications

(100 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although termination of AF has been shown by some to be predictive of longer-term outcome, other studies have not confirmed this finding. 399,400,401,515,621,641,642 It is unclear whether acute, intraprocedural termination is a true indication of procedural success, or simply might indicate patients with less persistent AF who are destined to do better regardless of the approach used. A substudy of the STAR AF II trial has suggested this latter point.…”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

Self Cite

1,769

1,468

View full text Add to dashboard Cite

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

Self Cite

1,769

1,468

View full text Add to dashboard Cite

“…In contrast to ablation of PAF, in which the end point of electric isolation of the pulmonary veins (PVs) is recommended by the guidelines, the optimal end point of CA in the setting of persAF is still under debate. 3,[19][20][21][22] The stepwise ablation approach aiming at procedural AF termination was introduced by Haïssaguerre et al 10,23 in 2005. Long-term follow-up data on any ablation approach for persAF are limited.…”

mentioning

confidence: 99%

Five-Year Follow-Up After Catheter Ablation of Persistent Atrial Fibrillation Using the Stepwise Approach and Prognostic Factors for Success

Schreiber

Rostock

Fröhlich

et al. 2015

Circ: Arrhythmia and Electrophysiology

154

View full text Add to dashboard Cite

A total of 549 patients with persAF underwent CA using the stepwise approach at our institution in 2007 to 2009. Of these, 493 © 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination. Methods and Results-A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007)(2008)(2009)

show abstract

“…46 There are several hypotheses on this topic. First, it is possible that additional sources continue in unmapped regions of the atrium, that sustain AF acutely but are insufficient to sustain AF long-term.…”

Section: Ablation Of Atrial Fibrillation Sourcesmentioning

confidence: 99%

Role of Rotors in the Ablative Therapy of Persistent Atrial Fibrillation

Schricker¹,

Zaman²,

Narayan³

2015

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Catheter ablation is more effective than pharmacological therapy for the secondary prevention of patients with paroxysmal 1,2 and persistent 3,4 atrial fibrillation (AF) and has an emerging role in the primary prevention of paroxysmal AF. 5,6 Nevertheless, in randomised clinical trials (RCTs) its success in treating patients with paroxysmal AF is 40-60 % for a single procedure and 70 % for multiple procedures at one year, 1,2 and results for persistent AF are lower. 7,8 Thus, there is an urgent unmet need to improve our understanding of mechanistic targets for AF in each patient, to match recent advances in ablation energy delivery and catheter positioning.This report reviews mechanistic data on human AF, mapping technologies that provide the opportunity to reconcile fundamental mechanisms in individual patients and their therapeutic application. Atrial Fibrillation MechanismsAF is initiated by triggers predominantly near the pulmonary veins (PV), 9 with increasingly recognised sites outside the PVs. [10][11][12] To improve success, ablation to eliminate AF triggers should thus also target non-PV triggers, although they are transient and difficult to locate. Another potential ablative target is the mechanistic cascade by which triggers initiate AF, yet this is relatively unstudied. We recently showed -using wide-area mapping during spont aneous and induced AF -that the first cycles of AF after a trigger exhibit a single organised re-entrant spiral wave or focal driver (see Figure 1) that subsequently disorganises. 13 Remarkably, these AF-initiating mechanisms may be relatively spatially fixed for each patient -even for different triggers from both atria -separated by 2.1 ± 1.7 cm from trigger sites (see Figure 1). 13 Thus, AF initiation is likely to be a two-step mechanistic process, in which 1) a trigger initiates an organised spiral wave or focal source at patient-specific anatomical sites that 2) lead rapidly to disorganisation to produce the classical AF phenotype. This begs the question of whether AF maintenance is driven by self-sustaining disorganisation, or whether disorganisation is actually sustained by localised AF drivers (rotors or focal drivers).Self-sustaining disorganisation was traditionally considered the mechanism of AF maintenance. This mechanism is supported by computational models in which multiple wavelets sustain AF if there is enough room in the atrium ('critical mass'), 14 proposals that dissociation between the epicardium and endocardium may be contributory 15 and plaque recordings from the atria of patients in the operating room showing re-entry without apparent organisation. Limitations to these studies are that fibrillatory maps are based upon recordings that poorly represent local activation;16 only small areas of the atria were mapped (<10-20 %) and while these studies show that disorganisation exists they did not test if it self-sustains. The success of widespread ablation or Maze surgery supports the concept of self-sustaining disorganisation, but are also consistent with coinci...

show abstract

Atrial fibrillation termination as a procedural endpoint during ablation in long-standing persistent atrial fibrillation

Cited by 130 publications

References 29 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Five-Year Follow-Up After Catheter Ablation of Persistent Atrial Fibrillation Using the Stepwise Approach and Prognostic Factors for Success

Role of Rotors in the Ablative Therapy of Persistent Atrial Fibrillation

Contact Info

Product

Resources

About