Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Compagnucci, Paolo; Volpato, Giovanni; Cipolletta, Laura; Parisi, Quintino; Valeri, Yari; Campanelli, Francesca; D’Angelo, Leonardo; Ciliberti, Giuseppe; Stronati, Giulia; Carboni, Laura; Giovagnoni, Andrea; Guerra, Federico; Natale, Andrea; Casella, Michela; Dello Russo, Antonio

doi:10.1016/j.hroo.2024.04.011

Heart Rhythm O2

2024

DOI: 10.1016/j.hroo.2024.04.011

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Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Paolo Compagnucci,

Giovanni Volpato,

Laura Cipolletta

et al.

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Cited by 3 publications

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Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience

Dello Russo,

Compagnucci,

Anselmino

et al. 2024

Heart Rhythm

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Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience

Dello Russo,

Compagnucci,

Anselmino

et al. 2024

Heart Rhythm

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Ethanol marshall bundle elimination, pulmonary vein isolation, and linear ablation for atrial fibrillation with or without heart failure

Chen,

Li,

Chen

et al. 2024

Front. Cardiovasc. Med.

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BackgroundIn medical practice, atrial fibrillation (AF) is intricately associated with heart failure (HF). Currently, ethanol infusion of vein of Marshall (EIVOM) for AF ablation in HF patients remains significantly limited.MethodThis was a non-randomized, single-center, retrospective observational study. AF patients received 4-step ablation composed of EIVOM, pulmonary vein isolation (PVI) and linear ablation. The primary composite endpoint was defined as recurrence of atrial tachycardia over 30 s. Propensity score matching (PSM) was performed to reduce selection bias.ResultsFrom April 2020 to May 2022, 362 patients were included, comprising of 182 HF patients and 180 non-HF patients. EIVOM success rate was lower in HF patients than non-HF patients (86.8% vs. 93.9%). Cardiac effusion was more common in HF patients (44.0% vs. 37.2%), and 2 cases of atrial-esophageal fistula were observed in the HF group. During a median follow-up of 12 months, no significant difference in the primary endpoint was observed between HF and non-HF group. Different HF subgroups had similar AF recurrence. After PSM, AF recurrence rate remained statistically equivalent between the HF and non-HF groups.ConclusionEVIOM combining catheter ablation can be completed with comparable success rate in AF patients with or without HF. However, peri-procedural safety is a concern for HF patients undergoing EIVOM combing AF catheter ablation. During the follow-up, HF status before ablation is not related with increased AF recurrence.

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Atrial Fibrosis in Atrial Fibrillation: Mechanistic Insights, Diagnostic Challenges, and Emerging Therapeutic Targets

Karakasis,

Theofilis,

Vlachakis

et al. 2024

IJMS

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Atrial fibrosis is a hallmark of atrial cardiomyopathy and plays a pivotal role in the pathogenesis of atrial fibrillation (AF), contributing to its onset and progression. The mechanisms underlying atrial fibrosis are multifaceted, involving stretch-induced fibroblast activation, oxidative stress, inflammation, and coagulation pathways. Variations in fibrosis types—reactive and replacement fibrosis—are influenced by patient-specific factors such as age, sex, and comorbidities, complicating therapeutic approaches. The heterogeneity of fibrosis leads to distinct electrophysiological abnormalities that promote AF via reentrant activity and enhanced automaticity mechanisms. Despite advancements in imaging, such as late gadolinium enhancement CMR and electroanatomical mapping, challenges in accurately quantifying fibrosis persist. Emerging therapeutic strategies include antifibrotic agents targeting the renin–angiotensin–aldosterone system, novel pathways like TGF-β signaling, and cardio-metabolic drugs like SGLT2 inhibitors and GLP-1 receptor agonists. Innovative interventions, including microRNA modulation and lipid nanoparticle-based therapies, show promise but require validation. Knowledge gaps remain in correlating clinical outcomes with fibrosis patterns and optimizing diagnostic tools. Future research should focus on precise phenotyping, integrating advanced imaging with molecular biomarkers, and conducting robust trials to evaluate antifibrotic therapies’ efficacy in reducing AF burden and related complications.

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Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Cited by 3 publications

References 33 publications

Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience

Pulsed field vs very high-power short-duration radiofrequency ablation for atrial fibrillation: Results of a multicenter, real-world experience

Ethanol marshall bundle elimination, pulmonary vein isolation, and linear ablation for atrial fibrillation with or without heart failure

Atrial Fibrosis in Atrial Fibrillation: Mechanistic Insights, Diagnostic Challenges, and Emerging Therapeutic Targets

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