AIMS: Electro-anatomical mapping may be critical to identify atrial fibrillation (AF) subjects who require substrate modification beyond pulmonary vein isolation (PVI). The objective was to determine correlations between pre-ablation mapping characteristics and 12-month outcomes after a single PVI-only catheter ablation of AF. METHODS AND RESULTS: This study enrolled paroxysmal AF (PAF), early persistent AF (PsAF; 7 days-3 months), and non-early PsAF (>3-12 months) subjects undergoing de novo PVI-only radiofrequency catheter ablation. Sinus rhythm (SR) and AF voltage maps were created with the Advisor HD GridTM Mapping Catheter, Sensor EnabledTM for each subject, and the presence of low-voltage area (LVA) (low-voltage cutoffs: 0.1-1.5 mV) was investigated. Follow-up visits were at 3, 6, and 12 months, with a 24-h Holter monitor at 12 months. A Cox proportional hazards model identified associations between mapping data and 12-month recurrence after a single PVI procedure. The study enrolled 300 subjects (113 PAF, 86 early PsAF, and 101 non-early PsAF) at 18 centres. At 12 months, 75.5% of subjects were free from AF/atrial flutter (AFL)/atrial tachycardia (AT) recurrence. Univariate analysis found that arrhythmia recurrence did not correlate with AF diagnosis, but LVA was significantly correlated. Low-voltage area (<0.5 mV) >28% of the left atrium in SR [hazard ratio (HR): 4.82, 95% confidence interval (CI): 2.08-11.18; P = 0.0003] and >72% in AF (HR: 5.66, 95% CI: 2.34-13.69; P = 0.0001) was associated with a higher risk of AF/AFL/AT recurrence at 12 months. CONCLUSION: Larger extension of LVA was associated with an increased risk of arrhythmia recurrence. These subjects may benefit from substrate modification beyond PVI.
- MeSH
- Time Factors MeSH
- Electrophysiologic Techniques, Cardiac MeSH
- Atrial Fibrillation * diagnosis surgery MeSH
- Atrial Flutter * diagnosis surgery etiology MeSH
- Catheter Ablation * adverse effects methods MeSH
- Humans MeSH
- Recurrence MeSH
- Heart Rate MeSH
- Heart Atria MeSH
- Pulmonary Veins * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
AIMS: Interventional cardiology procedures may expose patients and staff to considerable radiation doses. We aimed to assess whether exposure to ionizing radiation during catheter ablation of supraventricular tachycardia (SVT) can be completely avoided. METHODS AND RESULTS: In this prospective randomized study, patients with SVT (atrioventricular re-entrant tachycardia n = 94, typical atrial flutter n = 29) were randomly assigned in a 1:1 ratio to catheter ablation with conventional fluoroscopic guidance (CF group) or with the EnSite Precision mapping system [zerofluoro (ZF) group]. Acute procedural parameters, increased stochastic risk of cancer incidence and 6-month follow-up data were assessed. Between May 2019 and August 2020, 123 patients were enrolled. Clinical parameters were comparable. Median procedural time was 60.0 and 58.0 min, median fluoroscopy time and estimated median effective dose were 240 s vs. 0 and 0.38 mSv vs. 0 and arrhythmia recurrence was 5% and 7.9% in the CF and ZF groups, respectively. The acute success rate was 98.4% in both groups. No procedure-related complications were reported. At an average age of 55.5 years and median radiation exposure of 0.38 mSv, the estimate of increased incidence was approximately 1 in 14 084. The estimated mortality rate was 1 per 17 857 exposed persons. CONCLUSIONS: The procedural safety and efficacy of the zero-fluoroscopic approach are similar to those of conventional fluoroscopy-based ablation for atrioventricular nodal re-entrant tachycardia and atrial flutter. Under the assumption of low radiation dose, the excessive lifetime risk of malignancy in the CF group due to electrophysiology procedure is reasonably small, whilst totally reduced in zero fluoroscopy procedures.
- MeSH
- Tachycardia, Atrioventricular Nodal Reentry * diagnostic imaging surgery MeSH
- Fluoroscopy methods MeSH
- Atrial Flutter * diagnostic imaging surgery MeSH
- Catheter Ablation * adverse effects methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Atrioventricular Node MeSH
- Prospective Studies MeSH
- Arrhythmias, Cardiac surgery MeSH
- Tachycardia, Supraventricular * diagnostic imaging surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Keywords
- Hybridní terapie fibrilace síní, Konkomitantní chirurgická ablace fibrilace síní,
- MeSH
- Ablation Techniques methods trends utilization MeSH
- Electrophysiologic Techniques, Cardiac methods utilization MeSH
- Atrial Fibrillation * surgery therapy MeSH
- Atrial Flutter diagnosis surgery therapy MeSH
- Cardiac Care Facilities MeSH
- Cardiac Surgical Procedures * methods trends utilization MeSH
- Comorbidity MeSH
- Humans MeSH
- Interdisciplinary Communication MeSH
- Minimally Invasive Surgical Procedures methods trends utilization MeSH
- Registries MeSH
- Practice Guidelines as Topic MeSH
- Statistics as Topic MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Katetrizační řešení poruch srdečního rytmu patří v současné arytmologii mezi rutinní způsoby léčby. Kavální fi ltr (IVC fi ltr) zavedený do lumen dolní duté žíly představuje mechanickou překážku, která může katetrizaci komplikovat či zcela znemožnit. V literatuře není mnoho sdělení týkajících se této problematiky a chybějí údaje o ablačním řešení komplexních levosíňových arytmií s nutností transseptální punkce v přítomnosti IVC fi ltru. Naše kasuistika reprezentuje úspěšnou komplexní elektrofyziologickou intervenci v levé i pravé srdeční síni transfemorálním přístupem u pacienta s IVC fi ltrem.
Catheter ablation is currently a routine clinical method for the treatment of heart rhythm disorders. The presence of a fi lter in the lumen of the inferior vena cava represents a mechanical obstruction that may complicate or contraindicate the procedure. Still, there is not enough information available on this topic and there is no research data on the catheter ablation of complex left atrial arrhythmias with a transseptal puncture in the presence of an inferior vena cava fi lter. Our case report represents a successful complex electrophysiology intervention in both the left and right atria with femoral venous access in a patient with an inferior vena cava fi lter.
- MeSH
- Atrial Flutter diagnosis etiology surgery MeSH
- Catheter Ablation * history methods MeSH
- Vena Cava Filters MeSH
- Humans MeSH
- Aged MeSH
- Arrhythmias, Cardiac diagnosis etiology drug therapy surgery MeSH
- Thromboembolism prevention & control therapy MeSH
- Risk Adjustment MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Anti-Arrhythmia Agents pharmacology therapeutic use MeSH
- Defibrillators, Implantable utilization MeSH
- Atrial Fibrillation * etiology surgery complications MeSH
- Atrial Flutter epidemiology etiology surgery MeSH
- Catheter Ablation methods MeSH
- Tachycardia, Ventricular etiology complications physiopathology MeSH
- Humans MeSH
- Heart Failure * etiology complications physiopathology MeSH
- Thromboembolism prevention & control MeSH
- Check Tag
- Humans MeSH
- MeSH
- Adult MeSH
- Echocardiography methods instrumentation utilization MeSH
- Atrial Flutter surgery therapy MeSH
- Fontan Procedure methods adverse effects utilization MeSH
- Cardiovascular Surgical Procedures methods adverse effects MeSH
- Catheter Ablation methods statistics & numerical data utilization MeSH
- Humans MeSH
- Heart Diseases surgery therapy MeSH
- Postoperative Complications etiology classification therapy MeSH
- Risk Factors MeSH
- Arrhythmias, Cardiac surgery therapy MeSH
- Tachycardia surgery therapy MeSH
- Transposition of Great Vessels surgery therapy MeSH
- Congenital, Hereditary, and Neonatal Diseases and Abnormalities surgery therapy MeSH
- Treatment Outcome MeSH
- Imaging, Three-Dimensional methods utilization MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
The supraventricular arrhythmias include a wide spectrum of disorders including, in descending order of frequency, atrial fibrillation, atrial flutter, atrioventricular nodal reentry, Wolff-Parkinson-White syndrome, and atrial tachycardia. While not life-threatening in most cases, they may cause important symptoms, such as palpitations, chest discomfort, breathlessness, anxiety, and syncope, which significantly impair quality of life. Medical therapy has variable efficacy, and most patients are not rendered free of symptoms. Research over the past several decades has revealed fundamental mechanisms involved in the initiation and maintenance of all of these arrhythmias. Knowledge of mechanisms has in turn led to highly effective surgical and catheter-based treatments. Atrial fibrillation remains a therapeutic challenge but is also yielding to investigation and therapeutic efforts. The supraventricular arrhythmias and their treatment are described in this report.
- MeSH
- Tachycardia, Atrioventricular Nodal Reentry surgery MeSH
- Atrial Fibrillation surgery MeSH
- Atrial Flutter surgery MeSH
- Catheter Ablation MeSH
- Humans MeSH
- Aged MeSH
- Arrhythmias, Cardiac surgery physiopathology MeSH
- Tachycardia, Supraventricular surgery MeSH
- Wolff-Parkinson-White Syndrome surgery MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
INTRODUCTION: Conduction recurrence during radiofrequency (RF) ablation of cavotricuspid isthmus for typical atrial flutter is common. Understanding the temporal pattern of recurrences could help to predict a durable bidirectional block (BDB) and optimize the procedure. METHODS AND RESULTS: We analyzed atrial flutter ablations in 108 consecutive patients (85 males, age 63 +/- 11 years). RF energy was delivered through 8-mm tip or 4-mm cooled-tip catheter. On average, 18 +/- 11 pulses were necessary to achieve BDB. The time to recurrence of conduction after RF cessation was recorded. Early and late conduction recurrences were defined as < or =10 minutes and >10 minutes, respectively. Patients were observed for > or =30 minutes after bidirectional cavotricuspid isthmus (CTI) block was achieved. Conduction did not recur in 46 patients. In 8 cases, no block was achieved. A total of 167 conduction recurrences were recorded in the remaining 54 cases (1-10 per case). Of these, in 53 patients, recurrences were classified as early (98%) and 14 patients had late recurrences (8%). Thirteen patients had both early and late recurrences (24%). All but one late recurrence were preceded by at least one early recurrence. Absence of early recurrence had negative predictive value of 98%, while any early recurrence had positive predictive value of 26% for subsequent late conduction recovery. CONCLUSION: Incidence of isthmus conduction recurrence rapidly decayed during the waiting period. Absence of conduction recurrence within 10 minutes after first successful RF delivery was highly predictive of persistent BDB.
Patients who suffer from recurrent thromboembolic events often receive an inferior vena cava (IVC) filter. There are few data available regarding treatment of this patient population with catheterization interventions, especially catheter ablation. We report a case of cavotricuspid isthmus catheter ablation across an IVC filter.
- MeSH
- Atrial Flutter surgery MeSH
- Cardiovascular Surgical Procedures methods MeSH
- Vena Cava Filters MeSH
- Humans MeSH
- Heart Conduction System surgery MeSH
- Aged MeSH
- Tricuspid Valve surgery MeSH
- Vena Cava, Inferior surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Refrigeration MeSH
- Adult MeSH
- Atrial Fibrillation diagnosis MeSH
- Atrial Flutter diagnosis drug therapy surgery MeSH
- Catheter Ablation methods MeSH
- Humans MeSH
- Recurrence MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
