Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

McCarthy, Patrick M.; Cox, James L.; Kislitsina, Olga N.; Kruse, Jane; Churyla, Andrei; Malaisrie, S. Chris; Mehta, Christopher K.

doi:10.3390/jcm11010210

Cited by 18 publications

(14 citation statements)

References 91 publications

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“…The mechanisms of TBS include alterations in myocardial architecture, ion channel metabolism, and gene expression [ 5 , 6 , 7 ]. Over the past decade, catheter ablation has advanced significantly, enabling a high proportion of AF and AFL to be completely eliminated [ 8 , 9 , 10 ]. Typically, SND will become apparent after atrial arrhythmias have been eliminated.…”

Section: Discussionmentioning

confidence: 99%

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

Chung

Chao

et al. 2022

JCM

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Identification of sinus node dysfunction (SND) before termination of persistent AFL by catheter ablation (CA) is challenging. This study aimed to investigate the characteristics and predictors of acute and delayed SND after AFL ablation. We retrospectively enrolled 221 patients undergoing CA of persistent AFL in a tertiary referral center. Patients with SND who required a temporary pacemaker (TPM) after termination of AFL or a permanent pacemaker (PPM) during follow-up were identified. Acute SND requiring a TPM was found in 14 of 221 (6.3%) patients following successful termination of AFL. A total of 10 of the 14 patients (71.4%) recovered from acute SND. An additional 11 (5%) patients presenting with delayed SND required a PPM during follow-up, including 4 patients recovering from acute SND. Of these, 9 of these 11 patients (81.8%) underwent PPM implantation within 1 year after the ablation. In multivariable analysis, female gender and a history of hypothyroidism were associated with the requirement for a TPM following termination of persistent AFL, while older age and a history of hypothyroidism predicted PPM implantation. This study concluded that the majority of patients with acute SND still require a PPM implantation despite the initial improvement. Therefore, it is reasonable to monitor the patients closely for at least one year after AFL ablation.

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Section: Discussionmentioning

confidence: 99%

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

Chung

Chao

et al. 2022

JCM

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“…One of the reasons catheter ablation for LSpAF can fail is the inability to create complete and permanent lesions of conduction block in the desired areas of the atrium ( 19 ). Contiguous, uniformly transmural atrial lesions are difficult to create with the tip of a long catheter in a beating, working heart ( 20 ). Another potential source of failure for LSpAF treatment with catheter ablation is that following initial pulmonary vein isolation, the localization and ablation of alleged focal AF drivers ( 21 ) outside the pulmonary veins are based solely on intraprocedural mappings.…”

Section: Discussionmentioning

confidence: 99%

Dynamic electrophysiological mechanism in patients with long-standing persistent atrial fibrillation

Osorio-Jaramillo

Cox

Klenk

et al. 2022

Front. Cardiovasc. Med.

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BackgroundImproved understanding of the mechanisms that sustain persistent and long-standing persistent atrial fibrillation (LSpAF) is essential for providing better ablation solutions. The findings of traditional catheter-based electrophysiological studies can be impacted by the sedation required for these procedures. This is not required in non-invasive body-surface mapping (ECGI). ECGI allows for multiple mappings in the same patient at different times. This would expose potential electrophysiological changes over time, such as the location and stability of extra-pulmonary vein drivers and activation patterns in sustained AF.Materials and methodsIn this electrophysiological study, 10 open-heart surgery candidates with LSpAF, without previous ablation procedures (6 male, median age 73 years), were mapped on two occasions with a median interval of 11 days (IQR: 8–19) between mappings. Bi-atrial epicardial activation sequences were acquired using ECGI (CardioInsight™, Minneapolis, MN, United States).ResultsBi-atrial electrophysiological abnormalities were documented in all 20 mappings. Interestingly, the anatomic location of focal and rotor activities changed between the mappings in all patients [100% showed changes, 95%CI (69.2–100%), p < 0.001]. Neither AF driver type nor their number varied significantly between the mappings in any patient (median total number of focal activities 8 (IQR: 1–16) versus 6 (IQR: 2–12), p = 0.68; median total number of rotor activities 48 (IQR: 44–67) versus 55 (IQR: 44–61), p = 0.30). However, individual zones showed a high number of quantitative changes (increase/decrease) of driver activity. Most changes of focal activity were found in the left atrial appendage, the region of the left lower pulmonary vein and the right atrial appendage. Most changes in rotor activity were found also at the left lower pulmonary vein region, the upper half of the right atrium and the right atrial appendage.ConclusionThis clinical study documented that driver location and activation patterns in patients with LSpAF changes constantly. Furthermore, bi-atrial pathophysiology was demonstrated, which underscores the importance of treating both atria in LSpAF and the significant role that arrhythmogenic drivers outside the pulmonary veins seem to have in maintaining this complex arrhythmia.

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“…Atrial fibrillation (AF) is the most common cardiac arrythmia, affecting approximately 33 million people worldwide [1]. Only 3% of all AF is associated with concomitant cardiac disease [2]. Endocardial catheter ablation (ECA) remains the mainstay of intervention in AF, however, its success may be limited by its inability to create transmural endocardial ablation lines [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

Eranki

Wilson-Smith

Williams

et al. 2022

J Cardiothorac Surg

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Introduction Atrial fibrillation (AF) is the most common arrhythmia. Hybrid convergent ablation (HCA) is an emerging procedure for treating longstanding AF with promising results. HCA consists of a subxiphoid, surgical ablation followed by completion endocardial ablation. This meta-analysis of randomized control trials (RCT’s) and propensity score-matched studies aims to examine the efficacy and safety of HCA compared to endocardial catheter ablation (ECA) alone on patients with AF. Methods This review was written in accordance with preferred reporting items for systematic reviews and meta-analyses recommendations and guidance. The primary outcome for the analysis was freedom from AF (FFAF) at final follow up. Secondary outcomes were mortality and significant complications such as tamponade, sternotomy, esophageal injury, atrio-esophageal fistulae post procedurally. Results Four studies where included, with a total of 233 patients undergoing HCA and 189 patients undergoing ECA only. Pooled analysis demonstrated that HCA cohorts had significantly higher rates of FFAF than ECA cohorts, with an OR of 2.78 (95% CI 1.82–4.24, P < 0.01, I2 = 0). Major post-operative complications were observed in significantly more patients in the HCA group, with an OR of 5.14 (95% CI 1.70–15.54, P < 0.01). There was only one death reported in the HCA cohorts, with no deaths in the ECA cohort. Conclusion HCA is associated with a significantly higher FFAF than ECA, however, it is associated with increased post-procedural complications. There was only one death in the HCA cohort. Large RCT’s comparing the HCA and ECA techniques may further validate these results.

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Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions

Cited by 18 publications

References 91 publications

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

Dynamic electrophysiological mechanism in patients with long-standing persistent atrial fibrillation

Hybrid convergent ablation versus endocardial catheter ablation for atrial fibrillation: a systematic review and meta-analysis of randomised control trials and propensity matched studies

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