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1.
Am Heart J ; 242: 103-114, 2021 12.
Article in English | MEDLINE | ID: mdl-34508694

ABSTRACT

BACKGROUND: Cryoballoon ablation (CBA) as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence; the impact of first-line CBA on quality of life (QoL) and symptoms has not been well characterized. METHODS: Patients aged 18 to 75 with symptomatic paroxysmal AF naïve to rhythm control therapy were randomized (1:1) to CBA (Arctic Front Advance, Medtronic) or AAD (Class I or III). Symptoms and QoL were assessed at baseline, 1, 3, 6, 9, and 12 months using the EHRA classification and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and SF-36v2 questionnaires. Symptomatic palpitations were evaluated via patient diary. RESULTS: Overall, 107 patients were randomized to CBA and 111 to AAD; crossovers occurred in 9%. Larger improvements in the AFEQT summary, subscale and treatment satisfaction scores were observed at 12 months with CBA vs AAD (all P <0.05). At 12 months, the mean adjusted difference in the AFEQT summary score was 9.9 points higher in the CBA group (95% CI: 5.5 -14.2, P <0.001). Clinically important improvements in the SF-36 physical and mental component scores were observed at 12 months in both groups, with no significant between group differences at this timepoint. In the CBA vs AAD group, larger improvements in EHRA class were observed at 6, 9 and 12 months (P <0.05) and the incidence rate of symptomatic palpitations was lower (4.6 vs 15.2 days/year post-blanking; IRR: 0.30, P <0.001). CONCLUSIONS: In patients with symptomatic AF, first-line CBA was superior to AAD for improving AF-specific QoL and symptoms. TRIAL REGISTRATION: ClinicalTrials.gov number: NCT01803438.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Adolescent , Adult , Aged , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , Humans , Middle Aged , Quality of Life , Treatment Outcome , Young Adult
2.
Europace ; 23(7): 1033-1041, 2021 07 18.
Article in English | MEDLINE | ID: mdl-33728429

ABSTRACT

AIMS: Treatment guidelines for patients with atrial fibrillation (AF) suggest that patients should be managed with an antiarrhythmic drug (AAD) before undergoing catheter ablation (CA). This study evaluated whether pulmonary vein isolation employing cryoballoon CA is superior to AAD therapy for the prevention of atrial arrhythmia (AA) recurrence in rhythm control naive patients with paroxysmal AF (PAF). METHODS AND RESULTS: A total of 218 treatment naive patients with symptomatic PAF were randomized (1 : 1) to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD (Class I or III) and followed for 12 months. The primary endpoint was ≥1 episode of recurrent AA (AF, atrial flutter, or atrial tachycardia) >30 s after a prespecified 90-day blanking period. Secondary endpoints included the rate of serious adverse events (SAEs) and recurrence of symptomatic palpitations (evaluated via patient diaries). Freedom from AA was achieved in 82.2% of subjects in the cryoballoon arm and 67.6% of subjects in the AAD arm (HR = 0.48, P = 0.01). There were no group differences in the time-to-first (HR = 0.76, P = 0.28) or overall incidence [incidence rate ratio (IRR)=0.79, P = 0.28] of SAEs. The incidence rate of symptomatic palpitations was lower in the cryoballoon (7.61 days/year) compared with the AAD arm (18.96 days/year; IRR = 0.40, P < 0.001). CONCLUSIONS: Cryoballoon CA was superior to AAD therapy, significantly reducing AA recurrence in treatment naive patients with PAF. Additionally, cryoballoon CA was associated with lower symptom recurrence and a similar rate of SAEs compared with AAD therapy.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Cryosurgery , Pulmonary Veins , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Humans , Pulmonary Veins/surgery , Recurrence , Treatment Outcome
3.
Am Heart J ; 222: 64-72, 2020 04.
Article in English | MEDLINE | ID: mdl-32018203

ABSTRACT

BACKGROUND: Radiofrequency current (RFC) catheter ablation for patients with paroxysmal atrial fibrillation (AF) has been shown to be safe and effective in first-line therapy. Recent data demonstrates that RFC ablation provides better clinical outcomes compared to antiarrhythmic drug (AAD) in the treatment of early AF disease. Furthermore, studies comparing RFC and cryoballoon have established comparable efficacy and safety of pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF. OBJECTIVES: The Cryo-FIRST trial was designed to compare AAD treatment against cryoballoon PVI as a first-line therapy in treatment naïve patients with AF. Efficacy and safety will be compared between the two cohorts and amongst subgroups. METHODS: The primary hypothesis is that cryoablation is superior to AAD therapy. To test this hypothesis, patients will be randomized in a 1:1 design. Using a 90-day blanking period, primary efficacy endpoint failure is defined as (at least) one episode of atrial arrhythmia with a duration >30 sec (documented by 7-day Holter or 12-lead ECG). Secondary endpoints (Quality-of-Life, rehospitalization, arrhythmia recurrence rate, healthcare utilization, and left atrial function) and adverse events will also be evaluated. Study enrollment will include 218 patients in up to 16 centers. CONCLUSIONS: This study will be a multi-national randomized controlled trial comparing cryoablation against AAD as a first-line treatment in patients with paroxysmal AF. The results may help guide the selection of patients for early AF disease therapy via cryoballoon ablation.


Subject(s)
Ablation Techniques/methods , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/therapy , Cryosurgery/methods , Electrocardiography , Heart Conduction System/physiopathology , Atrial Fibrillation/physiopathology , Atrial Function, Right/physiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Pulmonary Veins/surgery , Quality of Life , Recurrence , Single-Blind Method , Treatment Outcome
4.
J Cardiovasc Electrophysiol ; 24(5): 525-9, 2013 May.
Article in English | MEDLINE | ID: mdl-23350967

ABSTRACT

BACKGROUND: In the Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) study, an intention-to-treat approach was used and may have diminished the observed degree of treatment effect. We present a subanalysis of the VTACH study by treatment actually received. METHODS AND RESULTS: The VTACH study was a prospective, open, randomized controlled trial, undertaken in 16 European centers, comparing defibrillator implantation with and without ventricular tachycardia (VT) ablation in patients with stable VT, previous myocardial infarction, and reduced left-ventricular ejection fraction. Of the 52 patients in the ablation group, 7 (13%) did not receive VT ablation and 19% of patients assigned to implantable cardioverter defibrillator (ICD) only treatment group crossed over and had an ablation. The primary endpoint (first recurrence of any documented VT or ventricular fibrillation [VF]) was reached after a median of 19.5 months in the ablation group and 5.9 months in the ICD only group (P = 0.01). Overall, 685 VT/VF events occurred per year of follow-up in 22 patients of the ablation group and 4,986 events in 43 patients of the control group (P = 0.024). In the ICD only group, median numbers of VT/VF episodes were 25 (IQR 5.8-45.3) and 1.5 (IQR 0-24.8) per patient and year before and after crossover (n = 12), respectively. CONCLUSION: On-treatment analysis of the VTACH study emphasizes the effectiveness of VT ablation in patients receiving ICD treatment because of monomorphic VT post myocardial infarction. VT ablation clearly prolonged time to recurrence of VT/VF episodes and markedly decreased VT/VF burden.


Subject(s)
Catheter Ablation , Defibrillators, Implantable , Myocardial Infarction/complications , Tachycardia, Ventricular/surgery , Aged , Female , Humans , Intention to Treat Analysis , Male , Prospective Studies , Prosthesis Implantation , Stroke Volume , Ventricular Fibrillation
5.
Pacing Clin Electrophysiol ; 35(5): 532-43, 2012 May.
Article in English | MEDLINE | ID: mdl-22428529

ABSTRACT

BACKGROUND: The goal of this study was to analyze impact of metabolic syndrome (MetS) and impaired renal function on long-term follow-up after catheter ablation of atrial fibrillation (AF). METHODS AND RESULTS: A total of 702 consecutive patients with AF (age = 58 year, history of AF = 5 year, male = 478, paroxysmal atrial fibrillation = 416, coronary artery disease = 62, hypertension = 487) considered for catheter ablation were enrolled in the study. The MetS was diagnosed at admission in 276 patients. The renal function was estimated by glomerular filtration rate (eGFR). Pulmonary vein isolation (PVI) was performed either with cryoballoon technique (n = 260) or circumferential PVI (n = 442) with a 3.5-mm irrigated tip catheter. A 7-day-Holter electrocardiogram was performed at each follow-up visit. Any episode of documented AF after an initial 3-month blanking period was considered as clinical endpoint. Out of 702 patients, 370 (52.7%) were free of AF recurrences at median follow-up of 15 six interquartile range (12.7-42.3) months. The patients with MetS had significantly lower success rate than those without (128/276 (46.4%) vs 242/426 (56.8%), P = 0.006). Among 103 patients with eGFR < 68 mL/min only 35 (34%) were free of recurrences compared with 335/599 (55.9%) in patients with GFR ≥ 68 mL/min (P = 0.001). Both parameters were revealed in multivariate analysis to be independent predictors for outcome after catheter ablation. CONCLUSION: The results of our study clearly demonstrated that outcome after 1st catheter ablation of AF is poor in patients with MetS and/or impaired renal function. This observation has a potential clinical impact for the follow up management of these patients.


Subject(s)
Atrial Fibrillation/epidemiology , Atrial Fibrillation/prevention & control , Catheter Ablation/statistics & numerical data , Kidney Diseases/epidemiology , Metabolic Syndrome/epidemiology , Aged , Comorbidity , Female , Germany/epidemiology , Humans , Kidney Diseases/surgery , Male , Metabolic Syndrome/surgery , Middle Aged , Prevalence , Risk Assessment , Risk Factors , Secondary Prevention , Treatment Outcome
6.
Circulation ; 122(22): 2239-45, 2010 Nov 30.
Article in English | MEDLINE | ID: mdl-21098435

ABSTRACT

BACKGROUND: Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block. METHODS AND RESULTS: A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001). CONCLUSIONS: Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.


Subject(s)
Catheter Ablation/methods , Cryosurgery/methods , Tachycardia, Atrioventricular Nodal Reentry/surgery , Adult , Aged , Atrioventricular Block/epidemiology , China , Endpoint Determination , Europe , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prospective Studies , Risk Factors , Tachycardia, Atrioventricular Nodal Reentry/mortality , Treatment Outcome
7.
Lancet ; 375(9708): 31-40, 2010 Jan 02.
Article in English | MEDLINE | ID: mdl-20109864

ABSTRACT

BACKGROUND: In patients with ventricular tachycardia (VT) and a history of myocardial infarction, intervention with an implantable cardioverter defibrillator (ICD) can prevent sudden cardiac death and thereby reduce total mortality. However, ICD shocks are painful and do not provide complete protection against sudden cardiac death. We assessed the potential benefit of catheter ablation before implantation of a cardioverter defibrillator. METHODS: The Ventricular Tachycardia Ablation in Coronary Heart Disease (VTACH) study was a prospective, open, randomised controlled trial, undertaken in 16 centres in four European countries. Patients aged 18-80 years were eligible for enrolment if they had stable VT, previous myocardial infarction, and reduced left-ventricular ejection fraction (LVEF; 30%). Patients were followed up for at least 1 year. The primary endpoint was the time to first recurrence of VT or ventricular fibrillation (VF). Analysis was by intention to treat (ITT). This study is registered with ClinicalTrials.gov, number NCT00919373. FINDINGS: 107 patients were included in the ITT population (ablation group, n=52; control group, n=55). Two patients (one in each group) withdrew consent immediately after randomisation without any follow-up data and one patient (ablation group) was excluded because of a protocol violaton. Mean follow-up was 22.5 months (SD 9.0). Time to recurrence of VT or VF was longer in the ablation group (median 18.6 months [lower quartile 2.4, upper quartile not determinable]) than in the control group (5.9 months [IQR 0.8-26.7]). At 2 years, estimates for survival free from VT or VF were 47% in the ablation group and 29% in the control group (hazard ratio 0.61; 95% CI 0.37-0.99; p=0.045). Complications related to the ablation procedure occurred in two patients; no deaths occurred within 30 days after ablation. 15 device-related complications requiring surgical intervention occurred in 13 patients (ablation group, four; control group, nine). Nine patients died during the study (ablation group, five; control group, four). INTERPRETATION: Prophylactic VT ablation before defibrillator implantation seemed to prolong time to recurrence of VT in patients with stable VT, previous myocardial infarction, and reduced LVEF. Prophylactic catheter ablation should therefore be considered before implantation of a cardioverter defibrillator in such patients. FUNDING: St Jude Medical.


Subject(s)
Catheter Ablation , Coronary Disease/complications , Defibrillators, Implantable , Tachycardia, Ventricular/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Catheter Ablation/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Tachycardia, Ventricular/therapy , Treatment Outcome
8.
Europace ; 13(1): 37-44, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20829189

ABSTRACT

AIMS: Cerebral embolism is a possible serious complication during catheter ablation of atrial fibrillation (AF). The purpose of this prospective pilot study was to analyse the incidence and possible impact of cryo ablation on cerebral lesions and possible differences to radiofrequency (RF) ablation during pulmonary vein isolation (PVI). METHODS AND RESULTS: Pulmonary vein isolation was performed in 89 patients, either with the cryoballoon technique (n = 45) or with RF ablation (n = 44). Phenprocoumon was stopped 3 days before intervention and replaced by subcutaneous low-molecular-weight heparin. During the catheter procedure, an infusion of unfractionated heparin was maintained to achieve an activated clotting time (ACT) of > 300 s. Cerebral magnetic resonance imaging scans were performed 1 day before and after PVI, and at 3-month follow-up. Chronic lesions were observed in 11 patients (12.3%) before PVI without statistically significant difference between the two groups. None of the patients had neurological symptoms during or following the procedure. Seven patients (7.9%) developed acute lesions 1 day after PVI, without statistically significant difference between the group treated by cryoenergy (8.9%) and RF ablation (6.8%). Patients with acute lesions were significantly older compared with those without acute cerebral lesions. No additional cerebral lesions during follow-up were observed. CONCLUSION: A considerable portion of patients with AF but without any neurological symptoms had chronic cerebral lesions before PVI. Additional acute lesions could be added after the procedure. Both ablation techniques showed additional cerebral acute lesions with no neurological symptoms after PVI.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Intracranial Embolism/epidemiology , Pulmonary Veins/surgery , Atrial Fibrillation/epidemiology , Catheter Ablation/methods , Cerebral Infarction/epidemiology , Comorbidity , Cryosurgery/methods , Female , Follow-Up Studies , Humans , Incidence , Intracranial Embolism/diagnosis , Magnetic Resonance Imaging , Male , Middle Aged , Pilot Projects , Prevalence , Prospective Studies , Risk Factors
9.
Europace ; 13(1): 102-8, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20876601

ABSTRACT

AIMS: Gold electrodes have the theoretical advantage of creating bigger lesions than platinum-iridium (Pt-Ir) electrodes. We performed a prospective randomized study to compare the clinical efficacy of standard 8 mm Pt-Ir tip catheter (control) and 8 mm gold-tip catheters in the ablation of the cavotricuspid isthmus (CTI)-dependent atrial flutter. METHODS AND RESULTS: A total of 463 patients undergoing CTI ablation in 19 clinical centres were randomized to receive the treatment by gold-tip or control catheter. The primary endpoint was cumulative radiofrequency (RF) application duration until achieving bidirectional CTI block. It did not differ significantly for the two catheters. The gold-tip catheter was, however, associated with a higher ablation success rate (94.3 vs. 89.0%, P = 0.042) and a substantially lower incidence of char and coagulum formation (4.8 vs. 37.9%, P < 0.001), which required exchange of 1 gold-tip (0.4%) and 10 control catheters (4.6%, P = 0.005). The gold-tip catheter delivered more mean power (52 ± 12 W) than the control catheter (48 ± 13 W, P < 0.001). Both mean and maximum temperatures measured by the thermocouple integrated in the catheter tip were statistically significantly lower in the gold (mean: 53.2 ± 4.7°C, max: 68.7 ± 6.6°C) than in the control catheter (54.3 ± 5.2 and 70.2 ± 7.0°C, respectively, P < 0.05). Fluoroscopy time, procedure duration, procedural-related complications, and arrhythmia recurrence during 6 months of follow-up did not differ between the two catheters. CONCLUSION: Owing to a higher primary ablation success rate and reduced incidence of char/coagulum formation, gold may be preferred over Pt-Ir as electrode material for 8 mm tip catheters for CTI ablation. ClinicalTrials.gov: NCT00326001 (http://clinicaltrials.gov/ct2/show/NCT00326001).


Subject(s)
Atrial Flutter/surgery , Catheter Ablation/instrumentation , Gold , Iridium , Platinum , Aged , Catheter Ablation/methods , Electrodes , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Retrospective Studies , Thermal Conductivity , Treatment Outcome
10.
Europace ; 10(7): 884-7, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18375968

ABSTRACT

We described a case of a 58-year-old man with organic changes consistent with right ventricular cardiomyopathy. He also had a loss-of-function mutation in the cardiac sodium channel gene SCN5A, described in Brugada syndrome. He first presented with non-sustained ventricular tachycardia and was implanted with an implantable cardioverter defibrillator. He remained asymptomatic for 8 years until he developed recurrent episodes of ventricular tachyarrhythmias, which required multiple shocks. The patient was treated with a combination of quinidine and verapamil and since then remained free of arrhythmias.


Subject(s)
Arrhythmogenic Right Ventricular Dysplasia/genetics , Arrhythmogenic Right Ventricular Dysplasia/physiopathology , Electrocardiography , Muscle Proteins/genetics , Mutation/genetics , Sodium Channels/genetics , Anti-Arrhythmia Agents/therapeutic use , Arrhythmogenic Right Ventricular Dysplasia/drug therapy , Humans , Male , Middle Aged , NAV1.5 Voltage-Gated Sodium Channel , Quinidine/therapeutic use , Verapamil/therapeutic use
11.
Herzschrittmacherther Elektrophysiol ; 19(2): 79-83, 2008 Jun.
Article in German | MEDLINE | ID: mdl-18629456

ABSTRACT

The ablation of supraventricular tachycardias is a curative procedure with high success rates. Due to considerably improvement of quality of life, it becomes the therapy of first choice in nearly all kinds of symptomatic supraventricular reentry tachycardias. Following the guidelines for the management of patients with atrial fibrillation, pulmonary vein isolation is still second choice of therapy after ineffective medical treatment. In experienced electrophysiological centres a complication rate of < 2% and an intention to treat mortality of < 0.1% can be expected.


Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Catheter Ablation/adverse effects , Catheter Ablation/methods , Heart Conduction System/surgery , Pulmonary Veins/surgery , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/surgery , Humans
12.
Heart Rhythm ; 7(12): 1761-7, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20691284

ABSTRACT

BACKGROUND: Cerebral embolic events represent recognized side effects after catheter ablation in the treatment of recurrent atrial fibrillation (AF). OBJECTIVE: The study was performed to analyze the neuropsychological outcome and to detect new embolic ischemic brain lesions after therapeutic left atrial catheter ablation of AF. METHODS: We enrolled 23 patients with recurrent AF who underwent elective circumferential pulmonary vein isolation. The primary endpoint was the neuropsychological outcome 3 months after intervention in contrast to the results of non-AF controls (n = 23) without ablation and in covariance of baseline performance. Cerebral diffusion-weighted magnetic resonance imaging (DWI) was performed in 21 AF patients at baseline, 2-4 days, and 3 months after intervention. RESULTS: In 3/21 patients (14.3%), new ischemic lesions were detected on DWI shortly after intervention. In one patient, a territorial middle cerebral artery infarct occurred with severe clinical symptoms. The other two patients represented clinically silent small lesions. In contrast to the control group and in covariance of baseline performance, the ablation group showed worse neuropsychological outcome in verbal memory (one of five cognitive domains) with an effect size of d = 0.93[t (.05; 42) = -3.53; P < .001; false discovery rate (FDR)(crit) ≤ .01]. CONCLUSION: Adverse neuropsychological changes after left atrial catheter ablation are verifiable in verbal memory and, conjoined with ischemic brain lesions on DWI, might represent cerebral side effects of this procedure.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/adverse effects , Cognition Disorders/etiology , Adult , Diffusion Magnetic Resonance Imaging , Female , Humans , Male , Memory Disorders/etiology , Middle Aged , Neuropsychological Tests , Recurrence , Ultrasonography, Doppler, Transcranial
13.
Dtsch Arztebl Int ; 106(4): 41-7, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19564966

ABSTRACT

BACKGROUND: In Europe, sudden cardiac death (SCD) is one of the most common causes of death. Although sudden cardiac death usually happens in older people, 5% to 10% of the affected individuals are young and apparently healthy. Sudden death in infants, children, and young adults is relatively rare, with an incidence of 1 to 5 per 100 000 persons per year. Nonetheless, up to 7000 asymptomatic children die in the USA each year, almost half of them without any warning signs or symptoms. METHOD: Selective literature review. RESULTS: Although structural cardiovascular abnormalities explain most cases of sudden cardiac death in young people, the cause of death remains unexplained after autopsy in 10% to 30% of cases. Potentially lethal ion channel disorders (channelopathies) such as the long QT syndromes (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and the Brugada syndrome (BrS) may account for at least one-third of these unexplained cases. Most of these diseases are hereditary with autosomal-dominant transmission, i.e., there is a 50% chance that the children of affected individuals will be affected themselves. CONCLUSIONS: Post-mortem genetic screening for sequence variations in cardiac ion channel genes has become an important forensic tool for elucidating the cause of sudden cardiac death. Moreover, it allows the identification of other family members bearing the previously undiagnosed gene defect, who can then undergo a cardiological evaluation if indicated by their clinical history.


Subject(s)
Arrhythmias, Cardiac/genetics , Arrhythmias, Cardiac/mortality , Death, Sudden, Cardiac/epidemiology , Genetic Predisposition to Disease/epidemiology , Genetic Predisposition to Disease/genetics , Ion Channels/genetics , Myocardium/metabolism , Child , Humans , Risk Assessment
14.
Heart Rhythm ; 6(12): 1699-705, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19959115

ABSTRACT

BACKGROUND: Recent studies have shown that cryoablation and radiofrequency (RF) ablation are comparable with regard to success rates and safety in the treatment of common atrial flutter (AFL). Long-term success requires persistence of bidirectional conduction block (BCB) in the inferior cavotricuspid isthmus (CTI). OBJECTIVE: The purpose of this study was to determine the persistence of BCB in a prospective randomized multicenter trial of the two ablation techniques. METHODS: A total of 191 patients were randomized to RF ablation or cryoablation of the CTI using an 8-mm-tip catheter. In all patients, BCB was defined as the ablation end-point. Primary end-point of the study was nonpersistence of achieved BCB and/or ECG-documented relapse of common AFL within 3-month follow-up. RESULTS: Acute success rates were 91% (83/91) in the RF group and 89% (80/90) in the cryoablation group (P = NS). Invasive follow-up after 3 months with repeated electrophysiologic study was available for 60 patients in the RF group and 64 patients in the cryoablation group. Persistent BCB could be confirmed in 85% of the RF group versus 65.6% of the cryoablation group. The primary end-point was achieved in 15% of the RF group and 34.4% of the cryoablation group (P = .014). As a secondary end-point, pain perception during ablation was significant lower in the cryoablation group (P <.001). CONCLUSION: Persistence of BCB in patients treated with cryoablation reinvestigated after 3 months is inferior to that patients treated with RF ablation, as evidenced by the higher recurrence rate of common AFL seen in this study.


Subject(s)
Atrial Flutter/surgery , Catheter Ablation , Cryosurgery , Heart Conduction System/surgery , Tricuspid Valve/surgery , Vena Cava, Inferior/surgery , Aged , Cardiac Electrophysiology , Female , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , Time Factors , Treatment Outcome
16.
J Am Coll Cardiol ; 52(4): 273-8, 2008 Jul 22.
Article in English | MEDLINE | ID: mdl-18634982

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the efficacy safety of the novel cryoballoon device (Arctic Front, Cryocath, Quebec, Canada). BACKGROUND: Antral pulmonary vein (PV) ablation with radiofrequency energy is widely used as a strategy for catheter ablation of paroxysmal atrial fibrillation (PAF). A novel double lumen cryoballoon catheter was designed for circumferential pulmonary vein isolation (PVI) with the cryoablation technique. METHODS: We consecutively enrolled 346 patients with symptomatic, drug refractory paroxysmal (n = 293) or persistent (n = 53) atrial fibrillation (AF). In all patients, PVI of all targeted PVs was the therapeutic aim. The primary end points of this nonrandomized study were: 1) acute isolation rate of targeted PV; and 2) first electrocardiogram-documented recurrence of AF. The secondary end point was occurrence of PV stenosis or atrio-esophageal fistula. RESULTS: The 1,360 of 1,403 PVs (97%) were targeted with balloons or balloons in combination with the use of Freezor Max (Cryocath). We found that ablation with the cryoballoon resulted in maintenance of sinus rhythm in 74% of patients with PAF and 42% of patients with persistent AF. No PV narrowing occurred. The most frequent complication was right phrenic nerve palsy observed during cryoballoon ablation at the right superior PV. CONCLUSIONS: Pulmonary vein isolation with a new cryoballoon technique is feasible. Sinus rhythm can be maintained in the majority of patients with PAF by circumferential PVI using a cryoballoon ablation system. Cryoablation was less effective in patients with persistent AF than in patients with PAF.


Subject(s)
Angioplasty, Balloon/methods , Atrial Fibrillation/therapy , Cryotherapy , Pulmonary Veins , Aged , Angioplasty, Balloon/instrumentation , Atrial Fibrillation/physiopathology , Electrophysiologic Techniques, Cardiac , Feasibility Studies , Female , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Treatment Outcome
17.
Ann Noninvasive Electrocardiol ; 11(1): 34-7, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16472280

ABSTRACT

BACKGROUND: It has been shown that mortality risk in patients after myocardial infarction could be estimated by heart rate turbulence (HRT), a short-term change in heart rate after ventricular premature beat (VPB), presumably caused by baroreceptor mechanism. We sought to determine whether pharmacological blockade with atropine, or augmentation of vagal tone with pirenzepine given in small doses would influence HRT. METHODS: In 30 patients with normal echocardiogram, and without signs or symptoms of coronary artery disease, after electrophysiologic examination or radiofrequency ablation for supraventricular arrhythmias was completed, turbulence onset (TO) and turbulence slope (TS) in basal state, after 1.3 mg IV pirenzepine and finally, after atropine in dose of 0.04 mg/kg of body weight were compared. RESULTS: As assessed by Friedman ANOVA test both pirenzepine and atropine caused a significant change in both TO (P < 0.01) and TS (P < 0.01). The mean basal TO of -3.6 +/- 2.9%, changed after pirenzepine to -5.99 +/- 5.6% (P < 0.01), and after atropine it changed to -3.3 +/- 18.1% (P < 0.01). The mean basal TS of 18.6 +/- 10.1 ms/R-R interval increased after pirenzepine to 26.8 +/- 19.9 ms/R-R interval (P < 0.05), and decreased after atropine to 1.2 +/- 0.8 ms/R-R interval (P < 0.01). Mean cycle length increased after pirenzepine from 706.8 +/- 106.8 to 830 +/- 151.9 ms (P < 0.01), and decreased after atropine to 454.2 +/- 58.1 ms (P < 0.01). CONCLUSION: A conclusion could be drawn that vagomymetic manipulation with intravenous pirenzepine increases HRT; vagal blockade with atropine decreases HRT. This finding suggests that a normal vagal innervation of heart is a prerequisite for the phenomenon of HRT.


Subject(s)
Anti-Arrhythmia Agents/pharmacology , Atropine/pharmacology , Heart Rate/drug effects , Muscarinic Antagonists/pharmacology , Pirenzepine/pharmacology , Ventricular Premature Complexes/drug therapy , Analysis of Variance , Atropine/administration & dosage , Female , Heart Conduction System/drug effects , Humans , Injections, Intravenous , Male , Middle Aged , Pirenzepine/administration & dosage , Statistics, Nonparametric
18.
Pacing Clin Electrophysiol ; 29(2): 146-52, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16492299

ABSTRACT

INTRODUCTION: Cryoablation is successful in the treatment of common atrial flutter. Long-term clinical success is mainly dependent on persistence of bidirectional conduction block (BCB) in the inferior cavotricuspid isthmus (CTI). Only few data on persistence of BCB post cryoablation with the reported technique are available. This prospective study aimed to test efficacy of cryo energy and persistence of BCB in the CTI 1 month post cryoablation. METHODS: Cryoablation of the CTI was performed in 50 consecutive patients (64 +/- 12 years, 40 males) with symptomatic common atrial flutter using a novel 9 Fr 8-mm-tip catheter. BCB in the CTI 30 minutes following the final cryoapplication was the ablation endpoint. Thirty days post ablation, persistence of BCB was controlled by repeat electrophysiological study (EPS). RESULTS: In all patients BCB was achieved with a mean of 9 (IQR 7-17.5) cryo applications and a mean cryo time of 2,378 seconds (IQR 1,680-3,474 seconds). In 5 of 50 patients, common atrial flutter recurred within 1 month post cryoablation. In 30 of 32 recurrence-free patients, persistence of BCB was verified. In 2 patients, resumption of isthmus conduction was detectable. Including relapses, 81.1% of patients (30/37) showed persistence of BCB. No patients reported pain during cryoapplication. No procedural complications were observed. CONCLUSIONS: Cryoablation of the CTI using a large-tip catheter is feasible and safe in the treatment of common atrial flutter. Acute and short-term success rates are comparable to those reported for radiofrequency (RF) ablation. Besides short-term clinical success, the persistence of BCB demonstrates efficacy of the cryoablation technique.


Subject(s)
Atrial Flutter/surgery , Cryosurgery , Adult , Aged , Aged, 80 and over , Atrial Flutter/physiopathology , Electrophysiologic Techniques, Cardiac , Female , Heart Block/physiopathology , Heart Conduction System/physiopathology , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Statistics, Nonparametric , Treatment Outcome , Tricuspid Valve/physiopathology
20.
Europace ; 8(7): 495-8, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16798762

ABSTRACT

AIMS: The purpose of this study was to determine the occurrence of asymptomatic episodes of atrial fibrillation (AF) and wrong AF perception after pulmonary vein isolation (PVI). We evaluated the success of ablation by using the following measurements: (i) clinical symptoms and duration of symptoms noticed by patients and (ii) synchronous event recording (ER). METHODS AND RESULTS: Eighty patients with paroxysmal AF underwent PVI and were provided repeatedly with a portable ER upon discharge and every 3 months for a year. The ER automatically detects arrhythmias by a detection algorithm and can also be manually triggered by the patient. In 46/80 patients (57.5%), episodes of AF were documented. Asymptomatic AF was detected in 21.3%. In 9/80 patients (11.3%), who reported clinical AF recurrence, no AF could be shown by ER. We compared patients' perception to have suffered AF episodes with the ERs and found a sensitivity of 75% and a specificity of 92%. CONCLUSION: Reliance on perception of AF by patients after PVI results in an underestimation of recurrence of the arrhythmia. We observed a maximal occurrence of silent AF or wrong perception of AF in 26/80 (32.6%) patients.


Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation/methods , Pulmonary Veins/surgery , Analysis of Variance , Chi-Square Distribution , Electrocardiography , Electrocardiography, Ambulatory , Female , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Signal Processing, Computer-Assisted/instrumentation , Statistics, Nonparametric , Treatment Outcome
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