Zsuzsanna Kis

Type and rate of atrial fibrillation termination due to rotational activity ablation combined with pulmonary vein isolation

There remains controversy about the optimal ablation technique and termination rate of atrial fibrillation (AF) during catheter ablation in patients with persistent AF. The aim of this study was to determine the rate and timing of AF termination during combined pulmonary vein isolation (PVI) and focal impulse and rotor modulation (FIRM)‐guided ablation of rotational activity (RoAc).

Two-Year Follow-Up after Contact Force Sensing Radiofrequency Catheter and Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study

Background. There are little comparative data on catheter ablation of paroxysmal atrial fibrillation (AF) using the contact force radiofrequency (CF-RF) catheter versus the second-generation cryoballoon (CB2). Methods and results. This is a single center, retrospective, nonrandomized study of 98 patients with symptomatic, drug-refractory paroxysmal AF who underwent their first PVI ablation using either the CB2 (n = 40) or CF-RF (n = 58). The mean age was 60 years with 63% men, a mean LA size of 42 mm. The procedure duration (74 ± 17 versus 120 ± 49 minutes p < 0.05) was shorter for CB2 group; the fluoroscopy time (14 ± 17 versus 16 ± 5 minutes, p = 0.45) was similar. Complete PVI was achieved in 96% of patients with RF-CF and 98% with CB2. Phrenic nerve palsies (2 transient and 1 persistent) occurred exclusively in the CB2 group and 1 severe, nonlethal complication (pericardial tamponade) occurred in the CF-RF group. At 24-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia (AT) after a single procedure without antiarrhythmic drug, was comparable in CF-RF group and CB2 group (65.5% versus 67%, resp., log rank p = 0.54). Conclusion. Both the CB2 and the RF-CF ablation appeared safe; the success rate at 2 years was comparable between both technologies.

A paroxysmalis pitvarfibrilláció kezelésének transzkatéteres ablatiós technikái: új generációs krioballon vagy kontakterő-méréssel kombinált rádiófrekvenciás ablatio?

Absztrakt Bevezetes: A paroxysmalis pitvarfibrillacio eszkozos kezeleseben elterjedt a kontakterő-meressel kombinalt radiofrekvencias ablatio es az uj generacios krioballonnal vegzett ablatios modszer. Celkitűzes: A szerzők celja, hogy osszehasonlitsak a ket ablatios modszerrel kezelt betegek utankovetesi adatait. Modszer: Prospektiv modon 96 (radiofrekvencias ablatio: 58, krioballon: 38) beteg (65 ferfi, 28–70 ev) proceduralis es 1 eves utankovetesi adatait elemeztek. A beavatkozas utan 1, 3, 6 es 12 honappal EKG-, Holter-monitoros vizsgalat es ambulans vizit tortent. Eredmenyek: A proceduraidő es a sugaridő a ket csoportban: radiofrekvencias ablatio: 118,5 ± 15 perc; 15,8 ± 6 perc; krioballon: 73,5 ± 16 perc (p<0,05); 13,8 ± 4,1 perc (p = 0,09) volt. A radiofrekvencias csoportban 76,5%, a krioballoncsoportban 81% volt az 1 eves sikerarany. A radiofrekvencias csoportban 1 esetben percutan punkcioval kezelhető pericardialis tamponad, a krioballoncsoportban 2 esetben atmeneti nervusphrenicus-benulas torten...

The Short and Long-Term Efficacy of Pulmonary Vein Isolation as a Sole Treatment Strategy for Paroxysmal Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Pulmonary vein isolation (PVI) is an accepted treatment strategy for catheter ablation (CA) of paroxysmal atrial fibrillation (PAF). In this study, we aimed to assess the short, mid- and long-term outcome of PVI as a sole treatment strategy for PAF. Methods: Six bibliographic electronic databases were searched to identify all published relevant stud-ies until December 14, 2015. Search of the scientific literature was performed for studies describing outcomes with mean follow-up > 24 months after PAF ablation. Only articles with 1, 3 or 5-year fol-low up were included, from the same group of investigators. Results: Of the 2398 references reviewed for eligibility, 13 articles (enrolling a total of 1774 patients) were included in the final analysis. Pooled analysis showed that the 12- and 62 -month success rate of a single CA procedure was 78% (95% CI 0.76% to 0.855) and 59% (95% CI 0.56% to 0.64%), re-spectively. The results did not differ by type of CA performed. Major complications mentioned in the enrolled studies were cerebrovascular event, pericardial tamponade and PV stenosis. Conclusion: There is a progressive and significant decline in freedom from AF between 1, 3 and 5-year after successful PVI in patients with PAF. Our analysis suggests that a high short-time success rate after PVI does not necessarily result in high chronic success rate.

Aortic Valve Rupture Due to Radiofrequency Ablation of Left Ventricular Outflow Tract Extrasystole

A 72-year-old man with left ventricle outflow tract extrasystole was admitted for a radiofrequency catheter ablation (RFCA) procedure. Transthoracic echocardiographic examination showed moderately decreased global systolic left ventricle function. The three-leaflet aortic valve function was normal. Coronary angiography examination detected mild coronary artery disease. The frequent monotop PVCs were (30% on the 24-hour Holter) thought to be the cause by systolic dysfunction of the left ventricle. Therefore, an electrophysiology study and RFCA were indicated. Prior to the procedure informed consent was obtained. The CARTO electroanatomical navigation system and a Navistar F curve contact force (CF) sensing catheter were used for mapping the outflow tract region. The earliest activation site of the PVC was mapped transaortically at the basal–anterior left ventricular wall, under the left coronary cusp. Afterward, it was eliminated successfully (30 W, 10 g using an irrigated tip 4 mm ablation catheter). The following day severe dyspnea and a new onset cardiac murmur were found. The transesophageal echocardiography examination revealed that the left aortic valve leaflet was ruptured causing severe aortic valve insufficiency (Fig. 1). Due to the symptomatic acute severe aortic valve insufficiency the patient underwent emergency aortic valve surgery. During the operation a 5–7 mm rupture could be seen on the left leaflet and non-coronary commissure of the aortic valve (Fig. 2). Resuspension and commissuroplasty of the ruptured leaflet were performed with good result. This is the first aortic valve injury reported when using a CF sensing ablation catheter. It seems unlikely that radiofrequency caused the rupture but

Left atrial appendage thrombus formation during atrial fibrillation ablation under sufficient heparinization

Left atrial appendage (LAA) is implicated as a major location for cardiac thrombus formation. The percutaneous LAA occlusion (LAAO) procedure is recommended for thromboembolic prevention in certain patients with atrial fibrillation (AF). Transesophageal echocardiography (TEE) is routinely performed prior to AF ablation and …

The Role of Atrial Fibrosis Detected by Delayed – Enhancement MRI in Atrial Fibrillation Ablation

INTRODUCTION Atrial Fibrillation (AF) is associated with remodeling of the atrial tissue, which leads to fibrosis that can contribute to the initiation and maintenance of AF. Delayed- Enhanced Cardiac Magnetic Resonance (DE-CMR) imaging for atrial wall fibrosis detection was used in several studies to guide AF ablation. The aim of present study was to systematically review the literature on the role of atrial fibrosis detected by DE-CMR imaging on AF ablation outcome. METHODS Eight bibliographic electronic databases were searched to identify all published relevant studies until 21st of March, 2016. Search of the scientific literature was performed for studies describing DE-CMR imaging on atrial fibrosis in AF patients underwent Pulmonary Vein Isolation (PVI). RESULTS Of the 763 citations reviewed for eligibility, 5 articles (enrolling a total of 1040 patients) were included into the final analysis. The overall recurrence of AF ranged from 24.4 - 40.9% with median follow-up of 324 to 540 days after PVI. With less than 5-10% fibrosis in the atrial wall there was a maximum of 10% recurrence of AF after ablation. With more than 35% fibrosis in the atrial wall there was 86% recurrence of AF after ablation. CONCLUSION Our analysis suggests that more extensive left atrial wall fibrosis prior ablation predicts the higher arrhythmia recurrence rate after PVI. The DE-CMR imaging modality seems to be a useful method for identifying the ideal candidate for catheter ablation. Our findings encourage wider usage of DE-CMR in distinct AF patients in a pre-ablation setting.