Atrial Fibrillation Ablation: Reaching the Mainstream

Fisher, John D.; Spinelli, Michael; Mookherjee, Disha; Krumerman, Andrew; Palma, Eugen C.

doi:10.1111/j.1540-8159.2006.00388.x

Cited by 62 publications

(36 citation statements)

References 181 publications

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“…Patients were enrolled in the study if they met the following criteria: (1) previous ablation procedure that consisted of PV encircling plus PV disconnection performed for drug-refractory recurrent persistent AF; (2) intraprocedural end point of voltage abatement inside the lesions, PV disconnection, and exit-block pacing inside the lesions, attained in all PVs during the ablation procedure; and (3) stable SR without the use of antiarrhythmic drugs (AADs), documented on seriate ECG-Holter recordings and transtelephonic monitoring during a minimum follow-up of 2.5 years after the ablation procedure. Patients in AF at the time of the initial procedure were excluded from the study.…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…1,2 Since 1994, different approaches have been tested in patients with similar characteristics, but the intraprocedural target is still not well standardized. 2 Both pulmonary vein (PV) encircling with 3 and without 4 PV disconnection have been reported with analogous results by different authors. Moreover, several data exist about conduction recovery in patients treated with RF ablation who underwent a repeat ablation procedure.…”

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confidence: 99%

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Radiofrequency Ablation of Atrial Fibrillation

et al. 2008

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Background-Several approaches have been developed for radiofrequency catheter ablation of atrial fibrillation, but the correct intraprocedural end point is still under debate, and few data exist about the destiny of ablation lesions over time. The aim of the present study was to evaluate the long-term maintenance of intraprocedural end points of ablation procedures. Methods and Results-Inclusion criteria were (1) a previous ablation procedure of pulmonary vein (PV) encircling performed for drug-refractory persistent atrial fibrillation; (2) a "complete" intraprocedural end point, which consisted of voltage abatement inside the lesions, PV disconnection, and exit-block pacing from inside the lesions, attained in all PVs; and (3) stable sinus rhythm documented during a minimum follow-up of 2.5 years after the procedure. Twenty volunteers were selected (12 males, mean age 59Ϯ7 years) and underwent a repeat electrophysiological study. After a follow-up of 36.4Ϯ4.7 months, complete voltage abatement was maintained around 32 PVs (40.0%), PV disconnection persisted in 12 (37.5%) of the previously isolated PVs, and exit block was present in 39 PVs (48.7%). Ten patients who underwent a redo ablation procedure because of recurrences of atrial fibrillation were used as the control group. Differences in intraprocedural end-point maintenance between the 2 groups were not statistically significant. Conclusions-Common intraprocedural end points such as voltage abatement, PV disconnection, and exit block persist only in a limited number of patients, even when the outcome is favorable during follow-up. Further investigation will be required to determine whether such data will have implications for ablation strategies.

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Section: Inclusion Criteriamentioning

confidence: 99%

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confidence: 99%

Radiofrequency Ablation of Atrial Fibrillation

et al. 2008

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“…2), hat zur Entwicklung von Katheterablationstechniken zur Verhinderung von Vorhofflimmern geführt. Diese Techniken befinden sich im Stadium der fortgeschrittenen klinischen Entwicklung [22]. Dabei werden über einen transseptalen Zugang mittels Hochfrequenzenergie elektrisch isolierende Narben um die Pulmonalvenen und weitere kritische Strukturen im linken Vorhof gezogen (.…”

Section: Katheterablation Zur Verhinderung Von Vorhofflimmernunclassified

Therapie von Vorhofflimmern

Kirchhof

Breithardt

2007

Internist

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Atrial fibrillation is a common and in most patients recurrent arrhythmia. Atrial fibrillation can increase mortality and causes at times severe symptoms in affected patients. Timely initiation of sustained oral anticoagulation is indicated in patients with atrial fibrillation at risk for stroke to prevent thromboembolic complications. Patients at risk for stroke can be identified by clinical characteristics using validated score systems, e.g., the CHADS(2) score or the Framingham score. Drugs that slow AV nodal conduction can improve symptoms associated with high ventricular rate. Cardioversion can acutely terminate atrial fibrillation in almost all patients, but many patients suffer from recurrent atrial fibrillation. The prevention of arrhythmia recurrences ("rhythm control therapy") is indicated in patients with severe arrhythmia-related symptoms. Antiarrhythmic drugs can approximately double the maintenance rate of sinus rhythm. Other drugs that were not primarily developed as antiarrhythmic agents, e.g., ACE inhibitors, sartans, and possibly statins, can further improve maintenance of sinus rhythm in selected patient groups. Catheter-based isolation of the pulmonary veins is a recently developed intervention that can cure some forms of atrial fibrillation. It is likely that a multimodal therapeutic approach will in the future allow rhythm control therapy to become more effective.

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“…The link between the pulmonary veins and initiation of atrial fibrillation has led to changes in management of this common arrhythmia [1,2]. Non-pharmacologic treatment alternatives using catheter ablation are now widely utilized [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Ablation procedures depend on imaging to depict the anatomy of the PVAJ.…”

Section: Introductionmentioning

confidence: 99%