Atrial Mapping and Radiofrequency Catheter Ablation in Patients With Idiopathic Atrial Fibrillation (original) (raw)
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International journal of applied & basic medical research
Cardiac electrophysiologic study and radiofrequency ablation (RFA) have become an established mode of treatment for patients with refractory arrhythmias. These procedures are carried out regularly at the cardiac catheterization laboratory of Madras Medical Mission India. The purpose of this study was to evaluate our experience with cardiac electrophysiologic studies (EPS) and RFA catheter of atrial fibrillation (AF). This was a retrospective study carried out in the Cardiac Electrophysiology Department of the Institute of Cardiovascular Diseases, Madras Medical Mission, India. All cases diagnosed to have AF following cardiac EPS between January 2010 and April 2014 was selected for the study. The records, which were obtained from the Cardiac Electrophysiology Clinical Research Office of Madras Medical Mission, were reviewed. Forty-nine cases were chosen for analysis, using SPSS statistical software version 15. There were 49 patients, 23 males and 26 females. The mean age was 57.53 ye...
1994
Atriofascicular Ablation During Fibrillation. Introduction: A male patient with an atriofascicular pathway underwent catheter ablation of the atriofascicular pathway during atrial fibrillation. Methods and Results: The patient had preexcited atrial fihrillation both clinically and repeatedly during electrophysiologic study. A preexcited tachycardia with a 1:1 AV relationship and regular RR intervals was also induced. Catheter ablation of the atriofascicular pathway could only be performed during persistent atrial fibrillation, based on mapping of tbe pathway's insertion into the right hundle branch. Following successful ablation and cardioversion to sinus rhythm, a regular QRS tachycardia (atrioventricular (AV] nodal reentry) having the same rate, atrial activation sequence, and His-atrial time as the regular preexcited tachycardia noted preablation was initiated. An AV nodal slow pathway modification eliminated this tachycardia. Neither atrial fihrillation nor AV nodal reentry has recurred on follow-up. Conclusion: This is the first report of atriofascicular mapping and ablation performed exclusively during atrial fibrillation and illustrates the utility of mapping the pathway's ventricular insertion. Other unusual features ("bystander" pathway activation during AV nodal reentry, possible role of the pathway in genesis of atrial fibrillation) are discussed.
Journal of Cardiovascular Medicine, 2008
Background The optimal approach and long-term results of radiofrequency catheter ablation of atrial fibrillation (AF) are still unknown. We report our experience with respect to an ablation protocol diversified on a patient's AF pathophysiology with long-term follow-up. Methods Seventy-two patients with paroxysmal/persistent drug-resistant AF were selected. Patients with apparently normal hearts (group 1, n U 20) underwent electrophysiological disconnection of pulmonary veins (PVs) presenting a clear PV potential, whereas those with even initial cardiopathy (group 2, n U 52), underwent PV encircling. Results Sinus rhythm was maintained at 6 months in 85% of group 1 and 71% of group 2 patients. After 42 months of follow-up, including 15.2% redo procedures, 85% of group 1 and 77% of group 2 patients were in sinus rhythm, including patients with anti-arrhythmic drugs (AADs). The long-term success rate without AADs was 75% and 46% for each group, respectively. Age and the 6-month success of the procedure were predictive of sinus rhythm maintenance during follow-up. Conclusions An ablation protocol diversified on AF pathophysiology assured, at 3 years of follow-up, sinus rhythm maintenance in 85% of patients with a normal heart and in 77% of those with even initial cardiopathy. The 6-month result of the ablation procedure remained stable over time.
Atrial Fibrillation Ablation by Use of Electroanatomical Mapping: Efficacy and Recurrence Factors
Arquivos Brasileiros de Cardiologia, 2013
Background: Radiofrequency catheter ablation guided by electroanatomical mapping is currently an important therapeutic option for the treatment of atrial fibrillation. The complexity of the procedure, the several techniques used and the diversity of the patients hinder the reproduction of the results and the indication for the procedure. Objective: To evaluate the efficacy and factors associated with recurrence of atrial fibrillation. Methods: Prospective cohort study with consecutive patients submitted to atrial fibrillation ablation treatment guided by electroanatomical mapping. The inclusion criteria were as follows: minimum age of 18 years; presence of paroxysmal, persistent or long-standing persistent AF; AF recording on an electrocardiogram, exercise testing or Holter monitoring (duration longer than 15 minutes); presence of symptoms associated with AF episodes; AF refractoriness to, at least, two antiarrhythmic drugs, one of which being amiodarone, or impossibility to use antiarrhythmic drugs. Results: The study included 95 patients (age 55 ± 12 years, 84% men, mean CHADS2 = 0.8) who underwent 102 procedures with a median follow-up of 13.4 months. The recurrence-free rate after the procedure was 75.5% after 12 months. Atrial fibrillation recurred as follows: 26.9% of patients with paroxysmal and persistent atrial fibrillation; 45.8% of patients with long-standing persistent atrial fibrillation (p = 0.04). Of the analyzed variables, the increased size of the left atrium has proven to be an independent predictor of atrial fibrillation recurrence after the procedure (HR = 2.58; 95% CI: 1.26-4.89). Complications occurred in 4.9% of the procedures. Conclusion: Atrial fibrillation ablation guided by electroanatomical mapping has shown good efficacy. The increase in left atrium size was associated with atrial fibrillation recurrence.
Journal of the American College of Cardiology, 2004
We sought to test the hypothesis that complex fractionated electrograms (CFAEs) recorded during atrial fibrillation (AF) could be used as target sites for catheter ablation of AF. BACKGROUND Mapping of AF in humans has shown that areas of CFAEs correlate with areas of slowed conduction and pivot points of reentrant wavelets. We hypothesized that such areas of CFAEs could be identified in patients with AF and might serve as target sites for catheter ablation to maintain sinus rhythm.
Circulation-arrhythmia and Electrophysiology, 2009
Atrial fibrillation (AF) is the most common arrhythmia experienced in clinical practice (approx. 1% predominance in the adult population). Unfortunately, longterm efficacy of antiarrhythmic drug therapy is disappointing and could cause serious side effects. Radiofrequency (RF) catheter ablation has emerged as an important therapeutic option for drug refractory patients. However, the development in ablation strategies remains complex with often lengthy procedures. This study investigates whether a novel multielectrode catheter, delivering duty-cycled bipolar/unipolar RF energy, is feasible and safe. Therefore, 81 consecutive patients with paroxysmal or persistent AF has been analyzed. Pulmonary vein isolation with the pulmonary vein ablation catheter was safe with short fluoroscopy/procedural time and good clinical efficacy at 6 months (stable sinus rhythm in 78% of patients).
Atrial fibrillation ablation guided with electroanatomical mapping system: A one year follow up
Medical Journal of Indonesia, 2010
Tujuan AF merupakan aritmia yang paling banyak ditemukan dalam praktek klinis dan berkaitan dengan peningkatan risiko stroke jangka panjang, gagal jantung dan segala sebab kematian. Ablasi kateter pada AF merupakan modalitas yang relatif baru untuk konversi AF ke irama sinus. Studi ini bertujuan untuk mengetahui efektifitas ablasi kateter pada tipe AF campuran. Metode 30 pasien (umur 52 ± 8 tahun) yang terdiri dari 19 paroksismal and 11 AF kronik dilakukan ablasi kateter radiofrekuensi dipandu oleh sistem pemetaan elektroanatomikal CARTO™. Digunakan pendekatan ablasi bertahap dengan isolasi vena pulmonalis (IVP) sebagai intinya. Tambahan ablasi berupa garis atap, garis mitral isthmus, complex fractionated atrial electrogram (CFAE), garis septal dan sinus koronarius dilakukan secara bertahap bila diperlukan. Pengamatan terhadap rekurensi AF dilakukan selama 1 tahun. Hasil IVP sirkumferensial berhasil dilakukan pada semua pasien kecuali 1 orang. Rata-rata masa pengamatan 11,5 bulan. Lebih dari 80% pasien masih dalam irama sinus pada akhir masa pengamatan dengan 62% di antaranya bebas dari obat anti-aritmia. Tidak terjadi komplikasi mayor pada serial pasien dalam studi ini. Kesimpulan Ablasi radiofrekuensi kateter yang dipandu oleh sistem pemetaan electroanatomikal efektif dan aman pada tipe AF campuran.
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2002
The aims of this study were to compare the efficacy of a 2- versus a 3 RF lesions ablation procedure in the RA in patients with paroxysmal AF, and to map right atrial activation during AF. RF catheter-mediated ablation lines mimicking the Maze operation have been proposed as a novel curative approach for AF. The relationship between this type of ablation and right atrial mapping has not been extensively studied. Twenty-four patients with recurrent, drug-refractory, paroxysmal AF underwent an extensive mapping of the RA before attempting linear lesion RF ablation. Patients were divided into two groups: 15 patients received two linear lesions (Group 1), 9 patients three linear lesions (Group 2). One-month success rate AF did not recur in 40% of Group 1 patients (6/15) and in 66% (6/9) of Group 2 patients. 27% of patients in Group 1 and 11% of patients in Group 2 had recurrences controlled by drugs. No benefit in 33% of Group 1 patients and 22% of Group 2. Long-term follow-up In the ab...