High incidence of acute sub-clinical circumflex artery ‘injury’ following mitral isthmus ablation

Wong, Kelvin C.K.; Lim, C.C.S.; Sadarmin, Praveen P.; Jones, Michael A.; Qureshi, Norman; Bono, J de; Rajappan, Kim; Bashir, Yaver; Betts, Timothy R.

doi:10.1093/eurheartj/ehr117

Cited by 72 publications

(56 citation statements)

References 43 publications

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“…Selective coronary angiography, performed before and after the ablation, demonstrated clinically silent but angiographically significant stenosis of distal segment of circumflex coronary artery in 28% of patients, which completely disappeared after intracoronary nitroglycerine administration. Distal coronary sinus, prolonged RF application inside the coronary sinus, smaller circumflex artery diameter, and shorter distance between circumflex artery and coronary sinus were identified as the risk factors for coronary artery lesion within this cohort [186]. Furthermore, other authors described cases of circumflex artery acute occlusion with the development of acute myocardial infarction after epicardial ablation of mitral isthmus via coronary sinus in redo procedure [187].…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 78%

“…Circumflex coronary artery and distal coronary sinus are in close anatomical relationship. In one series of patients who underwent inferior mitral isthmus ablation, coronary sinus ablation using irrigated-tip catheters was performed in 71% of patients in order to obtain transmurality of the lesion [186]. Selective coronary angiography, performed before and after the ablation, demonstrated clinically silent but angiographically significant stenosis of distal segment of circumflex coronary artery in 28% of patients, which completely disappeared after intracoronary nitroglycerine administration.…”

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

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Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

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Atrial fibrillation is the most common sustained arrhythmia in clinical practice, associated with increased mortality, risk of stroke and heart failure, as well as the reduction of the quality of life. Atrial fibrillation may be encountered in young otherwise healthy individuals, due to the isolated electrophysiological disorder limited mostly to the pulmonary veins and posterior left atrial wall, or associated with the presence of advanced underlying heart disease and numerous cardiac and non-cardiac comorbidities with significant structural remodeling of the atrial myocardium. Due to limited efficacy and serious side effects of antiarrhythmic drugs, catheter ablation of atrial fibrillation, based on the pulmonary vein isolation for paroxysmal atrial fibrillation and adjunctive substrate modification for persistent atrial fibrillation, has emerged as an attractive and promissing alternative therapeutic option for selected patients with atrial fibrillation. In this review article, we discuss the electrophysiological left atrial abnormalities underlying lone atrial fibrillation and the role of pulmonary veins in pathophysiology of arrhythmia, and we summarize results of the studies on the long term outcome of catheter ablation of atrial fibrillation, as well as the studies on comparison of antiarrhythmic drugs with catheter ablation for treatment of atrial fibrillation. In addition, we present available data that provide better understanding of mechanisms, diagnosis, prevention and treatment of specific procedure-related complications and discuss current periprocedural anticoagulation strategies and their impact on the thromboembolic risk reduction.

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Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 78%

Section: Thromboembolic Complications Preprocedural Thrombosis Tranmentioning

confidence: 99%

Catheter Ablation of Lone Atrial Fibrillation

Mujović

Marinković²,

Potpara³

et al. 2014

CPD

View full text Add to dashboard Cite

show abstract

“…Interposition of the circumflex artery between the mitral isthmus and the coronary sinus is associated with a lower probability of achieving complete mitral isthmus block [61,62]. Particularly in such cases, this may result in a higher risk of complications such as cardiac tamponade and damage to the circumflex artery [63]. Assessment of the incremental value of linear ablations after PVI requires a randomized prospective study.…”

Section: Atrial Tachycardia and Efficacy Of Linear Ablationmentioning

confidence: 99%

Catheter ablation of atrial fibrillation: Past, present, and future directions

Yoshida

Aonuma

2012

Journal of Arrhythmia

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a b s t r a c tAtrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice. Because of inadequate efficacy of pharmacological therapy, catheter ablation of AF has evolved dramatically over the last decade. Although the success rate of ablation has improved, the ablation strategy is still extensive, and the ablation procedure is technically challenging. In the past decade, electrophysiologists were eager to obtain high success rates with extensive ablation. In the present decade, further clarification of the complex mechanism of AF is required to make ablation of AF safer and much more efficient. Because the mechanism of AF is very complex, and even somewhat mysterious, it may not be easy to attain a better understanding of the mechanism involved or to discover better guidance for catheter ablation. However, it is important to note that research into AF leads to better understanding of other cardiac and non-cardiac diseases because AF develops multifactorially in association with underlying systemic pathophysiologies.

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“…Although abnormalities of the left circumflex coronary artery have been observed acutely after mitral isthmus ablation, the observed stenoses resolved with intracoronary nitroglycerin, and their long-term clinical significance was uncertain. 15 As a result of the self-protective effect of coronary blood flow, operators can ablate along the atrioventricular ring, with little consideration of the course of underlying coronary arteries, and patients can benefit from the substantial therapeutic effect of catheter ablation, with a risk of procedure-related myocardial infarction of Ͻ0.03%. 16 One series of 4655 patients described 4 patients with the complication of myocardial infarction, all of whom had epicardial radiofrequency energy delivery (2 from the pericardial space and 2 from the great cardiac vein).…”

Section: Article See P 838mentioning

confidence: 99%