Impact of Pulmonary Vein Isolation on Fractionated Atrial Potentials and Ganglionated Plexi in Patients With Persistent Atrial Fibrillation

Sairaku, Akinori; Yoshida, Yukihiko; Hanawa, Haruo; Nakano, Yukiko; Kihara, Yasuki

doi:10.1536/ihj.14-147

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…Furthermore, ablation carries high periprocedural risk of worsening heart failure in such unstable patients as our case. 13) Moreover, direct current defibrillation is not preferable because of further myocardial damage by the defibrillation itself, sedation-induced hypotension, or hemodynamic deterioration owing to sinus arrest after rapid AF termination.…”

Section: Discussionmentioning

confidence: 99%

An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension

et al. 2015

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SummaryTachyarrhythmias such as atrial fibrillation (AF) or atrial flutter (AFL) sometimes invoke life-threatening collapse of hemodynamics in patients with severe heart failure. Recently, landiolol, an ultra-short acting β1-selective antagonist, has been reported to be safe and useful for the treatment of supraventricular tachyarrhythmias with reduced left ventricular function. Here we report a case of advanced heart failure with severe hypotension who was treated successfully by landiolol for rapid AF. The patient was a 20-year old male with dilated cardiomyopathy. He presented with low output syndrome in spite of optimal medical therapy and was referred to our department to consider ventricular assist device implantation and heart transplantation. Soon after admission, he developed rapid atrial fibrillation at 180 beats per minute (bpm) followed by severe hypotension and liver enzyme elevation. Low dose landiolol at 2 μg/kg/minute was started because digoxin was not effective. After landiolol administration, his heart rate decreased to 110 bpm, and finally returned to sinus rhythm without hemodynamic deterioration. Intra-aortic balloon pumping was inserted soon after sinus recovery and he was discharged successfully with an implantable left ventricular assist device. (Int Heart J 2015; 56: 564-567) Key words: Atrial fibrillation, Stage D heart failure, Negative chronotropic effect, Ventricular assist device I t is well known that β blocker treatment is crucial for the improvement of prognosis among patients with systolic heart failure. 1-3) However, the usage of β blockers during the acute phase of decompensated heart failure is still a matter of debate. Propranolol, a classic intravenous form of β blocker, has been used widely for perioperative arrhythmias. However, there are concerns about bronchospasm due to the non-selectivity of β adrenergic receptors. Their long half-life period may also result in the prolongation of adverse events if they occur.Landiolol was developed in Japan and introduced as an ultra-short acting intravenous β blocker. It has very high selectivity for β1 receptors and is rapidly degraded by carboxylesterase and cholinesterase in the liver and blood, respectively. Recently, many papers have reported on the benefits of landiolol for the control of perioperative tachyarrhythmias. 4) However, the indication of landiolol has been limited in patients with preserved ejection fraction, and only digoxin is indicated to control heart rate in patients with severe left ventricular (LV) dysfunction.The J-Land study (Japanese landiolol versus digoxin study) demonstrated that landiolol achieved faster control of heart rate among AF/AFL patients with LV dysfunction compared with digoxin. 5,6) The safety profiles were comparable between the two drugs. In the J-Land study, however, patients with severe LV dysfunction (ejection fraction: EF < 25%) or severe hypotension (systolic blood pressure < 90 mmHg) were excluded and there has been limited experience of landiolol among such patients. We here r...

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Section: Discussionmentioning

confidence: 99%

An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension

et al. 2015

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“…This is partially because of the strategy that mainly included substrate modification. It has been accepted that PVI reduces the CFAE area, which results in the avoidance of excessive RF application [8], [15], [16] . Hence, PVI was rate was observed in those with PAF (p = 0.005 and 0.02 by the logrank test).…”

Section: Clinical Factors Relevant To the Outcomementioning

confidence: 99%

Clinical Factors Relevant to the Recurrence of Atrial Tachyarrhythmia after Extensive Defragmentation Followed by Thoracic Vein Isolation

Yazaki

Watarai

Enta

et al. 2018

Journal of Atrial Fibrillation

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“…34 It has been suggested that ganglionated plexi may have a role in the initiation and maintenance of both paroxysmal and non-paroxysmal AF. [35][36][37][38][39][40][41] Localisation is usually performed on the endocardium either anatomically, by vagal response following high-frequency stimulation, or by Fourier transform in sinus rhythm. 35,37 Although ganglionated plexi ablation significantly reduces AF recurrence, the long-term success rate is lower than after PVI.…”

Section: Pathophysiology Of Atrial Fibrillation and Atrial Fibrillatimentioning

confidence: 99%

“…35,37 Although ganglionated plexi ablation significantly reduces AF recurrence, the long-term success rate is lower than after PVI. [35][36][37][38][39][40][41] Interestingly, in addition to PVI, the suppression of ganglionated plexi response -particularly that observed during cryoablation -may reduce AF recurrence. 40,41 Although many authors believe that additional ablations are required for non-paroxysmal AF or some paroxysmal AF, no randomised studies have consistently shown which strategy to use.…”

Section: Pathophysiology Of Atrial Fibrillation and Atrial Fibrillatimentioning

confidence: 99%

Pharmacological Tests in Atrial Fibrillation Ablation

Gourraud

Andrade

Macle

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, occurring in approximately 2 % of the general population.1-3 A progressive increase in both the prevalence and incidence of AF has been demonstrated in recent years, defining AF as a major economic and public health issue. 1 The identification of sites of AF initiation and/or maintenance within the pulmonary veins (PVs) has led to the development of percutaneous procedures to electrically isolate the PVs from the left atrium (LA). 4 Large observational studies and multiple randomised-controlled trials have demonstrated that catheter ablation is universally superior to anti-arrhythmic drugs (AADs) for the maintenance of sinus rhythm (66-89 % versus 9-58 %, respectively) and results in a greater improvement in arrhythmia-related symptoms, exercise capacity and quality of life.1,2,5-8 As a result, catheter ablation has become the 'standard of care' for the maintenance of sinus rhythm in symptomatic patients in whom drugs are ineffective or poorly tolerated.While the results of ablation are unequivocally superior to medical therapy, they are unfortunately not flawless: approximately 30 % of paroxysmal AF patients will experience arrhythmia recurrence after a single ablation procedure.8 As most recurrences are in association with PV reconnection or as a result of non-PV triggers, several pharmacological challenges have been proposed to improve outcomes. [9][10][11][12] This article reviews the pathophysiological background and evidence for the use of pharmacological challenges during catheter ablation procedures. Pathophysiology of Atrial Fibrillation and Atrial Fibrillation Catheter AblationDespite decades of progress, there is no comprehensive pathophysiological explanation of AF. Early hypotheses postulated that AF resulted from the co-existence of multiple independent wavelets propagating randomly throughout the left and right atria (the 'multiple wavelet hypothesis'). 13,14 This hypothesis suggested that as long as the atria had a sufficient electrical mass, and an adequately short refractory period, AF could be initiated and indefinitely perpetuated. 15 Based on this theory, the early surgical interventions for AF were designed to reduce the excitable mass of atrial tissue by compartmentalising the atria into smaller regions incapable of sustaining a critical number of circulating wavelets. 16 Unfortunately this strategy has proved to be of limited efficacy and has been associated with a substantial risk of major complications. 17In the late 1990s, Haïssaguerre and colleagues demonstrated that AF is a triggered arrhythmia initiated by rapid repetitive discharges, predominantly from the proximal aspect of the PVs. 4 This discovery led to the development of percutaneous procedures to directly eliminate spontaneous focal ectopic activity within the PVs. However, early AF recurrences from the targeted and other nontargeted PVs led to modification of the ablation strategy to electrically isolate all of the PV...

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Impact of Pulmonary Vein Isolation on Fractionated Atrial Potentials and Ganglionated Plexi in Patients With Persistent Atrial Fibrillation

Cited by 6 publications

References 19 publications

An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension

An Experience of Landiolol Use for an Advanced Heart Failure Patient With Severe Hypotension

Clinical Factors Relevant to the Recurrence of Atrial Tachyarrhythmia after Extensive Defragmentation Followed by Thoracic Vein Isolation

Pharmacological Tests in Atrial Fibrillation Ablation

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