Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials

Charitakis, Emmanouil; Metelli, Silvia; Karlsson, Lars; Antoniadis, Antonios; Liuba, Ioan; Almroth, Henrik; Jönsson, Anders; Schwieler, Jonas; Sideris, Skevos; Tsartsalis, Dimitrios; Dragioti, Elena; Chaimani, Anna

doi:10.3390/diagnostics12020433

Cited by 3 publications

(3 citation statements)

References 89 publications

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“…Therefore, mechanisms other than PVs’ firing have been hypothesized for AF initiation and maintenance in these settings. Although meta-analyses suggest a potential incremental benefit in terms of procedural efficacy for extra-PVI lesions in patients with persistent AF [ 63 , 64 ], no conclusive evidence has been provided to date. Furthermore, in 2014, a meta-regression analysis reported no differences in sinus rhythm maintenance between the PVI-only approach and extended left atrial ablation in patients with AF and HFrEF [ 65 ].…”

Section: Catheter Ablationmentioning

confidence: 99%

Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review

Brasca

Menè

Perego

2023

JCM

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Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Patients with structural heart disease (SHD) are at an increased risk of developing this arrhythmia and are particularly susceptible to the deleterious hemodynamic effects it carries. In the last two decades, catheter ablation (CA) has emerged as a valuable strategy for rhythm control and is currently part of the standard care for symptomatic relief in patients with AF. Growing evidence suggests that CA of AF may have potential benefits that extend beyond symptoms. In this review, we summarize the current knowledge of this intervention on SHD patients.

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Section: Catheter Ablationmentioning

confidence: 99%

Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review

Brasca

Menè

Perego

2023

JCM

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“…AF also confers a 3-fold enhanced risk for congestive cardiac failure as well as a 2-fold enhanced risk for dementia or demise [ 1 ]. Over the last decades, tremendous advancement has been achieved in the radical treatment of AF, especially in percutaneous catheter ablation procedures and cardiac Cox maze surgeries, which successfully restore the sinus rhythm in most AF patients [ 40 , 41 , 42 , 43 , 44 ]. However, the recurrence events of AF subsequent to catheter-based ablation or cardiac surgical therapy remain a major clinical challenge [ 45 , 46 , 47 , 48 , 49 ], irrespective of the decreasing but formidable periprocedural complications, encompassing pulmonary vein stenosis, systemic thromboembolism, esophageal injury, atrial-esophageal fistula, and cardiac perforation/tamponade [ 50 ].…”

Section: Introductionmentioning

confidence: 99%

Discovery of TBX20 as a Novel Gene Underlying Atrial Fibrillation

Li,

Guo

et al. 2023

Biology

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Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via whole-genome genotyping with genetic markers and a linkage assay in a family suffering from AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89 cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. An exome-wide sequencing assay unveiled that, at the defined locus, the mutation in the TBX20 gene, NM_001077653.2: c.695A>G; p.(His232Arg), was solely co-segregated with AF in the family. Additionally, a Sanger sequencing assay of TBX20 in another family suffering from AF uncovered a novel mutation, NM_001077653.2: c.862G>C; p.(Asp288His). Neither of the two mutations were observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while they had no effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-predisposing gene, shedding light on the mechanism underlying AF and suggesting clinical significance for the allele-specific treatment of AF patients.

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“…Frequent sites receiving additional CA are left atrial appendage, superior vena cava, sites showing high AF complexity, low voltage areas and areas with high dominant frequency (DF) [10,18]. Nevertheless, the effect of creating additional lesions in the atria is under dispute for some studies [10,43,82].…”

Section: Af Treatmentmentioning

confidence: 99%

Characterization of the Substrate Modification in Patients Undergoing Catheter Ablation of Atrial Fibrillation.

Vraka¹

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Atrial fibrillation (AF) continues to be the most common cardiac arrhythmia, affecting nowadays 2 − 4% of global adult population. Considering the current trend for longevity, prognostics for AF prevalence in the forthcoming years are disheartening, while quality of life of AF individuals is often negatively affected. Despite the high popularity of catheter ablation (CA) as the major AF treatment, there is still room and need for improvement, especially in persistent AF patients. Time spent in AF has a significant impact on AF confrontation and evolution, with 1 − 15% of paroxysmal AF patients progressing to persistent AF annually, hence facing higher complications regarding the AF therapy. Therefore, from early diagnosis to late follow-up therapy, every aspect of AF study that can contribute to the AF confrontation is of utmost importance.CA of pulmonary veins (PVs) is based on the declaration of PVs as the primary AF foci. However, multiple atrial sites can contribute to the AF propagation, either by triggering or by sustaining the AF activity. AF or atrial substrate is the term used to describe all these sites that are involved with the AF activity due to anatomical alterations causing further electrical and functional disturbance. Precise mapping of the atrial substrate and reliable recording of the atrial substrate modification, as a positive marker after CA sessions, are critical in the combat against AF. Electrocardiograms (ECGs) and electrograms (EGMs) are vastly recruited to map the atrial substrate or evaluate the atrial substrate modification.EGMs are mainly recruited for AF substrate mapping in order to detect any areas that provoke or perpetuate AF and indicate them as candidate CA targets after CA of PVs. This is especially important for persistent AF patients, where additional CA is often necessary in order to increase the CA efficiency. Hence, AF mapping via EGMs is an indispensable part of the CA procedure. On the other hand, with the ability to observe the atria universally, ECGs' main application is found in predicting the CA outcome by either assessing the atrial substrate modification or by analyzing electrical characteristics of the atrial component of the ECG from recordings acquired prior to CA. For recordings during AF, these are the f -waves, while for recordings in sinus rhythm (SR), these are the P-waves.Despite the extensive analysis on either recording types, some significant gaps exist. Additional CA out of PVs increases significantly the time spent in operation room, provoking higher health risks and increasing the healthcare costs. Furthermore, whether additional CA is actually beneficial regarding the CA outcome is under dispute. Regarding the atrial substrate modification analysis, various thresholds have been adopted in order to define a prolonged P-wave, which is directly connected with the atrial substrate and poor CA prognostics. Additionally, data acquired from P-wave analysis are quite generic, refering to the entire atria, while analysis could be improved by providing mor...

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Comparing Efficacy and Safety in Catheter Ablation Strategies for Paroxysmal Atrial Fibrillation: A Network Meta-Analysis of Randomized Controlled Trials

Cited by 3 publications

References 89 publications

Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review

Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review

Discovery of TBX20 as a Novel Gene Underlying Atrial Fibrillation

Characterization of the Substrate Modification in Patients Undergoing Catheter Ablation of Atrial Fibrillation.

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