Catheter Ablation as First-Line Therapy for Atrial Fibrillation: Ready for Prime-Time?

Carrizo, Aldo; Morillo, Carlos A.

doi:10.1007/s11886-016-0747-4

Cited by 5 publications

(2 citation statements)

References 41 publications

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“…1 However, growing evidence has shown lower rates of AF recurrence and AF burden in patients with paroxysmal AF that were submitted to ablation as a first-line therapy option. 2 In addition to that, progression from paroxysmal AF to persistent AF appears to be delayed by early catheter ablation of AF. 2 Therefore, catheter ablation has been increasingly considered as a first-line therapy option, which makes it more important to use screening factors to closely follow patients with higher risk of AF recurrence and post-procedural complications.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Stiffness: A Predictor of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation - A Systematic Review and Meta-Analysis

Correia¹,

Barbetta²,

Silva³

et al. 2019

Arquivos Brasileiros De Cardiologia

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Background Radiofrequency catheter ablation (RFCA) is a standard procedure for patients with atrial fibrillation (AF) not responsive to previous treatments, that has been increasingly considered as a first-line therapy. In this context, perioperative screening for risk factors has become important. A previous study showed that a high left atrial (LA) pressure is associated with AF recurrence after ablation, which may be secondary to a stiff left atrium. Objective To investigate, through a systematic review and meta-analysis, if LA stiffness could be a predictor of AF recurrence after RFCA, and to discuss its clinical use. Methods The meta-analysis followed the MOOSE recommendations. The search was performed in MEDLINE and Cochrane Central Register of Controlled Trials databases, until March 2018. Two authors performed screening, data extraction and quality assessment of the studies. Results All studies were graded with good quality. A funnel plot was constructed, which did not show any publication bias. Four prospective observational studies were included in the systematic review and 3 of them in the meta-analysis. Statistical significance was defined at p value < 0.05. LA stiffness was a strong independent predictor of AF recurrence after RFCA (HR = 3.55, 95% CI 1.75-4.73, p = 0.0002). Conclusion A non-invasive assessment of LA stiffness prior to ablation can be used as a potential screening factor to select or to closely follow patients with higher risks of AF recurrence and development of the stiff LA syndrome.

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Section: Introductionmentioning

confidence: 99%

Left Atrial Stiffness: A Predictor of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation - A Systematic Review and Meta-Analysis

Correia¹,

Barbetta²,

Silva³

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…It has been shown that fibrotic tissue correlates with regions of low voltage ( Jadidi et al, 2013 ; Rodríguez-Mañero et al, 2018 ; Caixal et al, 2020 ). Beyond pulmonary vein isolation, these low voltage regions are commonly targeted by ablation ( Nielsen et al, 2014 ; Carrizo and Morillo, 2016 ; Schade et al, 2020 ). A drawback of the low voltage guided approach is that it ignores the rate-dependent nature, i.e., restitution information, of both amplitude and CV.…”

Section: Introductionmentioning

confidence: 99%

CVAR-Seg: An Automated Signal Segmentation Pipeline for Conduction Velocity and Amplitude Restitution

et al. 2021

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BackgroundRate-varying S1S2 stimulation protocols can be used for restitution studies to characterize atrial substrate, ionic remodeling, and atrial fibrillation risk. Clinical restitution studies with numerous patients create large amounts of these data. Thus, an automated pipeline to evaluate clinically acquired S1S2 stimulation protocol data necessitates consistent, robust, reproducible, and precise evaluation of local activation times, electrogram amplitude, and conduction velocity. Here, we present the CVAR-Seg pipeline, developed focusing on three challenges: (i) No previous knowledge of the stimulation parameters is available, thus, arbitrary protocols are supported. (ii) The pipeline remains robust under different noise conditions. (iii) The pipeline supports segmentation of atrial activities in close temporal proximity to the stimulation artifact, which is challenging due to larger amplitude and slope of the stimulus compared to the atrial activity.Methods and ResultsThe S1 basic cycle length was estimated by time interval detection. Stimulation time windows were segmented by detecting synchronous peaks in different channels surpassing an amplitude threshold and identifying time intervals between detected stimuli. Elimination of the stimulation artifact by a matched filter allowed detection of local activation times in temporal proximity. A non-linear signal energy operator was used to segment periods of atrial activity. Geodesic and Euclidean inter electrode distances allowed approximation of conduction velocity. The automatic segmentation performance of the CVAR-Seg pipeline was evaluated on 37 synthetic datasets with decreasing signal-to-noise ratios. Noise was modeled by reconstructing the frequency spectrum of clinical noise. The pipeline retained a median local activation time error below a single sample (1 ms) for signal-to-noise ratios as low as 0 dB representing a high clinical noise level. As a proof of concept, the pipeline was tested on a CARTO case of a paroxysmal atrial fibrillation patient and yielded plausible restitution curves for conduction speed and amplitude.ConclusionThe proposed openly available CVAR-Seg pipeline promises fast, fully automated, robust, and accurate evaluations of atrial signals even with low signal-to-noise ratios. This is achieved by solving the proximity problem of stimulation and atrial activity to enable standardized evaluation without introducing human bias for large data sets.

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Atrial Fibrillation

Issa

Miller

Zipes

2019

Clinical Arrhythmology and Electrophysiology

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Catheter Ablation as First-Line Therapy for Atrial Fibrillation: Ready for Prime-Time?

Cited by 5 publications

References 41 publications

Left Atrial Stiffness: A Predictor of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation - A Systematic Review and Meta-Analysis

Left Atrial Stiffness: A Predictor of Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation - A Systematic Review and Meta-Analysis

CVAR-Seg: An Automated Signal Segmentation Pipeline for Conduction Velocity and Amplitude Restitution

Atrial Fibrillation

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