Long-Term Success for the Convergent Atrial Fibrillation Procedure: 4-Year Outcomes

Geršak, Borut; Jan, Matevž

doi:10.1016/j.athoracsur.2016.04.018

Cited by 37 publications

(48 citation statements)

References 15 publications

(23 reference statements)

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“…In our study, we observed complication rate of 12.5% in the CVP group. A comparable complication rate was previously reported for a similar minimally invasive procedure used for treatment of persistent AF in a single‐center and multicenter study . CVP could be a safer option when compared to more invasive surgical approaches to paroxysmal AF treatment and more effective when compared to CA.…”

Section: Discussionsupporting

confidence: 71%

“…Some data exist supporting ablation of the embryologically similar PV antra and LA posterior wall as a continuity in the treatment of AF . Moreover, the epicardial lesion pattern utilized in this study has also shown good long‐term outcomes in a mostly persistent AF patient population with 31% and 36% recurrence rates (cutoff of 1% AF burden) after 1 and 4 years of ILR monitoring …”

Section: Discussionmentioning

confidence: 57%

“…18,19 [20][21][22] Moreover, the epicardial lesion pattern utilized in this study has also shown good long-term outcomes in a mostly persistent AF patient population with 31% and 36% recurrence rates (cutoff of 1% AF burden) after 1 and 4 years of ILR monitoring. 23 Procedural duration did not differ significantly between both groups, which can be attributed to much shorter duration of the endocardial part of the procedure in the CVP group. It can be assumed that extensive epicardial ablation reduced the extent and duration of endocardial ablation.…”

Section: Discussionmentioning

confidence: 80%

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Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

Jan

Žižek

Geršak

et al. 2018

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 80%

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Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

Jan

Žižek

Geršak

et al. 2018

Cardiovasc electrophysiol

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“…Freedom from arrhythmia at 6 and 12 months post-procedure was 78.3% and 84.1%, respectively. Geršak et al reported similar success with convergent procedure for treatment in 76 patients with paroxysmal and non-paroxysmal AF and at 4 years follow up, 81% of patients were in sinus rhythm (86,87). Potential benefits of convergent procedure include less radiation exposure, shorter electrophysiology catheterbased procedure, reduction in the likelihood of esophageal injury that may be caused by endocardial ablation.…”

Section: Hybrid Approachmentioning

confidence: 66%

Ablation of long-standing persistent atrial fibrillation

Mody¹,

Raza²,

Jacobson³

et al. 2017

Ann. Transl. Med.

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Atrial fibrillation (AF) is the most commonly encountered arrhythmia in the clinical setting affecting nearly 6 million people in United States and the numbers are only expected to rise as the population continues to age. Broadly it is classified into paroxysmal, persistent and longstanding persistent AF.Electrical, structural and autonomic remodeling are some of the diverse pathophysiological mechanisms that contribute to the persistence of AF. Our review article emphasizes particularly on long standing persistent atrial fibrillation (LSPAF) aspect of the disease which poses a great challenge for electrophysiologists. While pulmonary vein isolation (PVI) has been established as a successful ablation strategy for paroxysmal AF, same cannot be said for LSPAF owing to its long duration, complexity of mechanisms, multiple triggers and substrate sites that are responsible for its perpetuation. The article explains different approaches currently being adopted to achieve freedom from atrial arrhythmias. These mainly include ablation techniques chiefly targeting complex fractionated atrial electrograms (CFAE), rotors, linear lesions, scars and even considering hybrid approaches in a few cases while exploring the role of delayed enhancement magnetic resonance imaging (deMRI) in the pre-procedural planning to improve the overall short and long term outcomes of catheter ablation.

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“…The well‐established use of catheter ablation in the treatment of AF as a safe and effective alternative to pharmaceutical therapy nevertheless appears to have reached an upper limit of long‐term success. Long‐term outcomes after AF ablation remain 40%‐65% successful after single procedure . The cause for procedure failure when no pulmonary vein reconnection occurs has prompted multiple hypotheses to explain continued AF occurrence.…”

Section: Discussionmentioning

confidence: 99%

Single‐center experience of the FIRM technique to ablate paroxysmal and persistent atrial fibrillation

Henley

Foreman

Padanilam

et al. 2019

Cardiovasc electrophysiol

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Introduction Focal impulse and rotor modulation (FIRM)‐guided ablation has had mixed results of published success, and most studies have had a follow‐up for a year or less. We aimed to study a consecutive group of patients followed for at least 1.5 years, subgrouped into those with an initial FIRM ablation and those with a previous, failed ablation who now received a FIRM guided one, to evaluate for success in each group and factors that might affect success. Methods Of 181 patients, 167 were available for analysis. Group 1 (n = 122) had a first or primary ablation (paroxysmal atrial fibrillation [PAF] 51; persistent atrial fibrillation [PeAF] 71) and group 2 (n = 45) had a redo ablation (PAF 18; PeAF 27). All patients were done under general anesthesia. FIRM mapping was done in the right atrium first and then the left, and only rotors consistently seen on multiple epochs were ablated, using 15 to 30 W. Rotor ablation was discontinued when remapping showed elimination of rotational activity at the site. Wide area catheter ablation was done for pulmonary vein isolation (PVI). Routine follow‐up was at 3, 6, and 12 months of the first year, with a Holter monitor at 6 months, and then every 6 months thereafter. Event recorders were given to patients with potential arrhythmic symptoms. Results Mean follow‐up was 16 months. Nearly 40% of patients had obstructive sleep apnea; mean body mass index was 32; and average left atrial size was 39.7 mm and 46.2 mm for PAF and PeAF patients, respectively. Freedom from atrial arrhythmia recurrence was: in group 1 patients, 82.4% for PAF and 67.6% for PeAF patients; in group 2 patients, 83.3% for PAF, but only 40.7% for PeAF patients. Comparing outcomes for the first 10 patients studied to the next 20 or more done by three operators showed no difference, suggesting no learning curve affecting the ablation results. Furthermore, the univariate analysis did not show any demographic factor to have an independent significance for ablation success or failure. Spontaneous termination during rotor ablation occurred in 76.8% of PAF and 27.6% of PeAF patients but did not affect the long‐term outcomes for maintenance of sinus rhythm. Conclusions FIRM‐guided atrial ablation plus PVI in our patient population resulted in good success from a recurrence of atrial arrhythmias in patients undergoing an initial ablation procedure. For those with persistent AF undergoing a second procedure now using FIRM guidance plus PVI, the results are lower. Further research is needed to define better the appropriate population for FIRM‐guided ablation and the degree of ablation needed for success in these patients.

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Long-Term Success for the Convergent Atrial Fibrillation Procedure: 4-Year Outcomes

Cited by 37 publications

References 15 publications

Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

Ablation of long-standing persistent atrial fibrillation

Single‐center experience of the FIRM technique to ablate paroxysmal and persistent atrial fibrillation

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