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1.
Methodist Debakey Cardiovasc J ; 17(1): 52-55, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104321

RESUMO

Catheter ablation has become a cornerstone treatment for atrial fibrillation (AF). Pulmonary vein isolation is the accepted approach for paroxysmal AF ablation, but it is less effective for persistent AF. The vein of Marshall (VOM) is located in the epicardial left atrium and can be a source of AF triggers as well as a tract for autonomic nerves. It directly communicates with the underlying myocardium, including the left atrial ridge and the posterior mitral isthmus. This review discusses the latest evidence regarding the mechanisms, procedural aspects, and outcomes of VOM ethanol infusion when used as an adjunct to pulmonary vein isolation in patients with persistent AF.


Assuntos
Técnicas de Ablação , Fibrilação Atrial/cirurgia , Vasos Coronários/cirurgia , Etanol/administração & dosagem , Técnicas de Ablação/efeitos adversos , Potenciais de Ação , Animais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Vasos Coronários/fisiopatologia , Etanol/efeitos adversos , Frequência Cardíaca , Humanos , Infusões Intravenosas , Veias Pulmonares/fisiopatologia , Veias Pulmonares/cirurgia
2.
Methodist Debakey Cardiovasc J ; 17(1): 56-64, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104322

RESUMO

The surgical treatment of atrial fibrillation (AF) has evolved significantly over the last 20 years and even more so in the last 5 years. There are now many clinically successful surgical procedures focused on eliminating AF and AF-related stroke. This review discusses the current types of surgical AF procedures, including minimally invasive and hybrid, and may assist clinicians in understanding the various surgical AF options available to patients today.


Assuntos
Técnicas de Ablação , Fibrilação Atrial/cirurgia , Denervação Autônoma , Sistema Nervoso Autônomo/cirurgia , Átrios do Coração/inervação , Frequência Cardíaca , Acidente Vascular Cerebral/prevenção & controle , Técnicas de Ablação/efeitos adversos , Potenciais de Ação , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Denervação Autônoma/efeitos adversos , Sistema Nervoso Autônomo/fisiopatologia , Humanos , Procedimento do Labirinto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
3.
J Interv Cardiol ; 2021: 5591590, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34149322

RESUMO

Background: High power shorter duration (HPSD) ablation may lead to safe and rapid lesion formation. However, the optimal radio frequency power to achieve the desired ablation index (AI) or lesion size index (LSI) is insubstantial. This analysis aimed to appraise the clinical safety and efficacy of HPSD guided by AI or LSI (HPSD-AI or LSI) in patients with atrial fibrillation (AF). Methods: The Medline, PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing HPSD-AI or LSI and low power longer duration (LPLD) ablation. Results: Seven trials with 1013 patients were included in the analysis. The analyses verified that HPSD-AI or LSI revealed benefits of first-pass pulmonary vein isolation (PVI) (RR: 1.28; 95% CI: 1.05-1.56, P = 0.01) and acute pulmonary vein reconnection (PVR) (RR: 0.65; 95% CI: 0.48-0.88, P = 0.005) compared with LPLD. HPSD-AI or LSI showed higher freedom from atrial tachyarrhythmia (AT) (RR = 1.32, 95% CI: 1.14-1.53, P = 0.0002) in the subgroup analysis of studies with PVI ± (with or without additional ablation beyond PVI). HPSD-AI or LSI could short procedural time (WMD: -22.81; 95% CI, -35.03 to -10.60, P = 0.0003), ablation time (WMD: -10.80; 95% CI: -13.14 to -8.46, P < .00001), and fluoroscopy time (WMD: -7.71; 95% CI: -13.71 to -1.71, P = 0.01). Major complications and esophageal lesion in HPSD-AI or LSI group were no more than LDLP group (RR: 0.58; 95% CI: 0.20-1.69, P = 0.32) and (RR: 0.84; 95% CI: 0.43-1.61, P = 0.59). Conclusions: HPSD-AI or LSI was efficient for treating AF with shorting procedural, ablation, and fluoroscopy time, higher first-pass PVI, and reducing acute PVR and may increase freedom from AT for patients with additional ablation beyond PVI compared with LPLD. Moreover, complications and esophageal lesion were low and no different between two groups.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Duração da Terapia , Fluoroscopia/métodos , Humanos , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento
5.
Medicina (Kaunas) ; 57(5)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065174

RESUMO

In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Insuficiência Cardíaca , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Insuficiência Cardíaca/complicações , Humanos , Masculino , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
6.
Kardiol Pol ; 79(5): 525-530, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125925

RESUMO

BACKGROUND: Pre-ablation identification of left atrial (LA) low voltage areas (LVA) among long-standing persistent atrial fibrillation (LSPAF) population remains challenging. AIMS: The aim of the study was to analyze the potential of selected scores originally developed to assess arrhythmia recurrences, thromboembolic complications, or progression from paroxysmal to persistent AF to predict the presence of LA-LVA in LSPAF patients. METHODS: One hundred and fifty-two patients underwent pulmonary vein isolation followed by high-density-high-resolution LA voltage mapping. AF risk scores, such as APPLE, ATLAS, CAAP-AF, DR-FLASH, CHA2DS2-VASc, and HATCH were retrospectively calculated. A receiver operating characteristic curve analysis was performed to evaluate the ability of the scores to predict LVA. RESULTS: Low voltage areas were detected in 52% of the patients. 28% of the patients with LVA presented severe global LVA burden, whereas 56% of the patients showed a disseminated pattern of remodeling. CAAP-AF ≥7, DR-FLASH ≥4, and CHA2DS2-VASc ≥3 predicted the presence of LVA, whereas ATLAS ≤7 indicated the absence of LVA. ATLAS ≤8, CAAP-AF ≤9, DR-FLASH ≤4, and CHA2DS2-VASc ≤3 predicted the absence of severe LVA. APPLE ≤3 and CHA2DS2-VASc ≤2 predicted the absence of a LVA disseminated pattern. Among predictive scores, ATLAS (AUC, 0.633, 95% CI, 0.543-0.723, P = 0.004), DR-FLASH (AUC, 0.696; 95% CI, 0.594-0.81; P <0.001), and CHA2DS2-VASc (AUC, 0.644; 95% CI 0.518-0.77; P = 0.025) were the best predictors for the absence of LVA, severe LVA and a disseminated pattern of LVA, respectively. CONCLUSIONS: Atrial fibrillation risk stratification with specific scoring systems can unmask the presence of LA-LVA in the LSPAF population.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
7.
Kardiol Pol ; 79(5): 531-538, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125926

RESUMO

BACKGROUND: Left atrial (LA) fibrosis is associated with a higher rate of recurrence of atrial fibrillation (AF) after pulmonary vein isolation (PVI). Body mass index (BMI) is strongly associated with the prevalence of AF, but there is insufficient data about the association between BMI and LA fibrosis. AIMS: The aim of the study was to examine the association between LA fibrosis and BMI in patients with AF undergoing PVI. METHODS: In 114 patients an electro-anatomical voltage map was created using the CARTO 3 three-dimensional system before PVI. The total fibrosis area (voltage criteria ≤0.5 mV), percentage, and the number of fibrotic areas were calculated. A general linear model was used to determine the differences in BMI with confounders between groups of patients with differing extents of fibrosis and numbers of focuses. RESULTS: Advanced fibrosis was found in 53 (47%) patients, in up to 9 areas with a median of 2 and an interquartile range (IQR) of 0-3. The median total fibrotic area was 27.3 cm2 with an IQR of 0.1-30.3 cm2. Patients were stratified by percentage of fibrotic area: <5%, 5%-20%, 20%-35%, and above 35%; no significant difference in mean BMI was found between the groups (P = 0.57). When stratified by the number of fibrotic areas (0, 1, 2, and ≥3 fibrotic areas), no difference in BMI was noted between the groups (P = 0.67). CONCLUSIONS: Fibrosis of the LA, as the strongest predictor of AF recurrence after PVI, does not correlate with BMI in patients with AF where PVI is indicated.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Índice de Massa Corporal , Fibrose , Humanos , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento
14.
Nutr Metab Cardiovasc Dis ; 31(6): 1798-1808, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-33985896

RESUMO

BACKGROUND AND AIMS: The nutritional risk of patients who undergo atrial fibrillation (AF) ablation varies. Its impact on the recurrence after ablation is unclear. We sought to evaluate the relationship between the nutritional risk and arrhythmia recurrence in patients who undergo AF ablation. METHODS AND RESULTS: We enrolled 538 patients (median 67 years, 69.9% male) who underwent their first AF ablation. Their nutritional risk was evaluated using the pre-procedural geriatric nutritional risk index (GNRI), and the patients were classified into two groups: No-nutritional risk (GNRI â‰§ 98) and Nutritional risk (GNRI < 98). The primary endpoint was a recurrence of an arrhythmia, and its relationship to the nutritional risk was evaluated. We used propensity-score matching to adjust for differences between patients with a GNRI-based nutritional risk and those without a nutritional risk. A nutritional risk was found in 10.6% of the patients, whereas the remaining 89.4% had no-nutritional risk. During a mean follow-up of 422 days, 91 patients experienced arrhythmia recurrences. The patients with a nutritional risk had a significantly higher arrhythmia recurrence rate both in the entire study cohort (Log-rank p = 0.001) and propensity-matched cohort (Log-rank p = 0.006). In a Cox proportional hazard analysis, the nutritional risk independently predicted arrhythmia recurrences in the entire study cohort (hazard ratio [HR]: 3.91, 95% confidence interval [CI]: 1.84-8.35, p < 0.001) and propensity-matched cohort (HR: 6.49, 95% CI: 1.42-29.8, p = 0.016). CONCLUSION: A pre-procedural malnutrition risk was significantly associated with increased arrhythmia recurrences in patients who underwent AF ablation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Avaliação Geriátrica , Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Veias Pulmonares/cirurgia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Humanos , Masculino , Desnutrição/complicações , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Veias Pulmonares/fisiopatologia , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
BMC Health Serv Res ; 21(1): 435, 2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33957918

RESUMO

BACKGROUND/PURPOSE: Interventional cardiac electrophysiology (EP) is a rapidly evolving field in Canada; a nationwide registry was established in 2011 to conduct a periodic review of resource allocation. METHODS: The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, success rates, and wait times. Leading physicians from each EP lab were contacted electronically; participation was voluntary. RESULTS: All Canadian EP centres were identified (n = 30); 50 and 45 % of active centres participated in the last 2 instalments of the registry. A mean of 508 ± 270 standard and complex catheter ablation procedures were reported annually for 2015-2016 by all responding centres. The most frequently performed ablation targets atrial fibrillation (PVI) arrhythmia accounting for 36 % of all procedures (mean = 164 ± 85). The number of full time physicians ranges between 1 and 7 per centre, (mean = 4). The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1-4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85 % centres; 38 % of the respondents use circular ablation techniques. CONCLUSIONS: This initiative provides contemporary data on invasive electrophysiology lab practices. The EP registry provides activity benchmarks on national trends and practices.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Canadá/epidemiologia , Técnicas Eletrofisiológicas Cardíacas , Eletrofisiologia , Humanos , Sistema de Registros , Resultado do Tratamento
16.
Ann R Coll Surg Engl ; 103(6): 444-451, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058117

RESUMO

INTRODUCTION: Despite early enthusiasm, minimally invasive cardiac surgery has had a low uptake compared with novel techniques in interventional cardiology. Steep learning curves from high-volume centres have deterred smaller units from engaging, even though low-volume centres undertake a large proportion of surgical interventions worldwide. We sought to identify the safety and experience of learning minimally invasive cardiac surgery after undertaking a structured fellowship at Blackpool Victoria Hospital, a low-volume centre. MATERIALS AND METHODS: A retrospective analysis of outcomes for all consecutive minimally invasive cardiac surgery procedures performed via a right mini-thoracotomy at our institution between 2007 and 2017 was undertaken. Clinical outcomes included death, conversion to sternotomy, stroke, renal failure and other organ support. Cardiopulmonary bypass, aortic cross-clamp times and learning cumulative sum sequential probability method curves were also assessed to determine how safely the procedure was adopted. RESULTS: A total of 316 patients were operated on for mitral, tricuspid, atrial fibrillation, septal defects or other conditions. The mean logistic European System for Cardiac Operative Risk Evaluation score was 7.0 (± 8.5). Conversion to sternotomy occurred in 12 patients (3.8%) and in-hospital mortality was 7 (2.2%). None of the converted patients died. The learning curves showed an accelerated process of adoption, similar to reference figures from a high-volume German centre. DISCUSSION: It is possible for low-volume cardiac surgical centres to undertake minimally invasive surgical programmes with good outcomes and short learning curves. Despite technical complexities, with a team approach, the learning curve can be navigated safely.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/cirurgia , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/cirurgia , Ponte Cardiopulmonar , Feminino , Defeitos dos Septos Cardíacos/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Hospitais com Baixo Volume de Atendimentos/organização & administração , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Duração da Cirurgia , Estudos Retrospectivos , Esternotomia , Toracotomia/métodos , Adulto Jovem
17.
Herzschrittmacherther Elektrophysiol ; 32(2): 236-243, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33999265

RESUMO

BACKGROUND: Catheter ablation for atrial fibrillation (AF) has become an effective treatment to control symptoms. The second generation cryoballoon (CB) was designed for more efficient and homogenous freeze. Radiofrequency (RF) ablation catheters using three-dimensional electroanatomical mapping with the use of contact-force radiofrequency (CF RF) technology has achieved good results in several studies. OBJECTIVES: To compare the efficacy and safety of second-generation CB ablation in contrast to CF RF ablation in the ablation of paroxysmal AF. METHODS: A total of 81 consecutive patients suffering from paroxysmal AF underwent pulmonary vein isolation (PVI) either by the second generation cryoballoon (n = 44) or a contact force-sensing RF catheter (n = 37). The study was conducted at Ain Shams University Hospitals and Royal Brompton & Harefield NHS trust. Baseline data, procedural data and patient follow up-at 3, 6 and 12 months-were collected and analysed. RESULTS: The mean age was 53.8 ± 15 years in the CB group and 62.4 ± 12 years in the RF group, females representing 40.9% and 48.6% respectively. The baseline characteristics were comparable, but the CB group had less left atrial diameter and more left ventricular ejection fraction. The CB procedure was shorter (94.4 ± 39.3 vs. 140.8 ± 44.3 min, p < 0.0001), with longer fluoroscopy time (30 vs. 15.1 min, p = 0.047). Procedural complications were comparable between the two groups (CB 4.6%, CF RF 2.7%, p = 0.411). After 1 year, the recurrence rate in the CB group was similar to RF (27.3% vs. 27% respectively, p = 0.980). CONCLUSION: Second-generation CB ablation of paroxysmal AF has similar efficacy and safety to contact force-sensing RF catheters, with shorter procedure times and more fluoroscopy.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Veias Pulmonares , Adulto , Idoso , Fibrilação Atrial/cirurgia , Cateteres , Feminino , Humanos , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Recidiva , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
18.
Herzschrittmacherther Elektrophysiol ; 32(2): 274-284, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34009451

RESUMO

Due to good results, increasing standardization and lack of equivalent alternatives, catheter ablation has been established as an increasingly common procedure in clinical routine. This article describes common and necessary puncture techniques in catheter ablation (puncture of the groin vessels, transseptal puncture, pericardial puncture) and represents a practical instruction for the catheter laboratory. This article is part of a series of manuscripts presenting topics of interventional electrophysiology in the course of electrophysiology training.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Eletrofisiologia Cardíaca , Técnicas Eletrofisiológicas Cardíacas , Humanos , Punções
19.
Herzschrittmacherther Elektrophysiol ; 32(2): 244-249, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33977306

RESUMO

BACKGROUND: Three-dimensional mapping systems and the use of ultra-low dose radiation protocols have supported minimization of radiation dose during left atrial ablation procedures. By using optimal shielding, scattered radiation reaching the operator can be further reduced. This prospective study was designed to determine the remaining operator radiation exposure during left atrial catheter ablations using real-time dosimetry. METHODS: Radiation dose was recorded using real-time digital dosimetry badges outside the lead apron during 201 consecutive left atrial fibrillation ablation procedures. All procedures were performed using the same X­ray system (Siemens Healthineers Artis dBc; Siemens Healthcare AG, Erlangen, Germany) programmed with ultra-low dose radiation settings including a low frame rate (two frames per second), maximum copper filtration, and an optimized detector dose. To reduce scattered radiation to the operators, table-suspended lead curtains, ceiling-suspended leaded plastic shields, and radiation-absorbing shields on the patient were positioned in an overlapping configuration. RESULTS: The 201 procedures included 139 (69%) pulmonary vein isolations (PVI) (20 cryoballoon ablations, 119 radiofrequency ablations, with 35 cases receiving additional ablation of the cavotricuspid isthmus) and 62 (31%) PVI plus further left atrial substrate ablation. Mean radiation dose measured as dose area product for all procedures was 128.09 ± 187.87 cGy ∙ cm2 with a mean fluoroscopy duration of 9.4 ± 8.7 min. Real-time dosimetry showed very low average operator doses of 0.52 ± 0.10 µSv. A subanalysis of 51 (25%) procedures showed that the radiation burden for the operator was highest during pulmonary vein angiography. CONCLUSION: The use of ultra-low dose radiation protocols in combination with optimized shielding results in extremely low scattered radiation reaching the operator.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Veias Pulmonares , Fibrilação Atrial/cirurgia , Fluoroscopia , Alemanha , Humanos , Estudos Prospectivos , Veias Pulmonares/cirurgia
20.
J Int Med Res ; 49(5): 3000605211010103, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33942630

RESUMO

OBJECTIVE: Atrial fibrillation (AF) and sinus node dysfunction (SND) have common underlying pathophysiological mechanisms. As an index of SND, corrected sinus node recovery time (CSNRT) may also reflect atrial function. The aim of the present study was to determine whether CSNRT predicts AF recurrence in patients undergoing AF ablation. METHODS: Consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent radiofrequency catheter ablation between January 2017 and December 2018 were enrolled. Clinical data, CSNRT, and other electrophysiology indices were collected and analysed between patients with or without AF recurrence. RESULTS: A total of 159 patients with PAF who underwent the same radiofrequency catheter ablation procedure were enrolled, including 25 patients with SND. During the one-year follow-up period, 22 patients experienced AF recurrence. Patients with recurrence had a significantly longer CSNRT and a larger left atrial volume index (LAVI) than patients without AF recurrence. SND (CSNRT > 550 ms) and a larger LAVI were independently associated with AF recurrence after ablation. A statistically significant CSNRT cut-off value of 550 ms predicted AF recurrence with 73% sensitivity and 85% specificity. CONCLUSION: CSNRT and LAVI are independent predictors of PAF recurrence following ablation.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Humanos , Recidiva , Síndrome do Nó Sinusal , Nó Sinoatrial , Resultado do Tratamento
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