Catheter ablation for paroxysmal and persistent atrial fibrillation

Chen, Huai Sheng; Wen, Jun; Wu, Sheng Nan; Liu, Jianping

doi:10.1002/14651858.cd007101.pub2

Cited by 27 publications

(21 citation statements)

References 83 publications

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“…1,2 With this has come the requirement to simplify and shorten the procedure to meet the exponential increase in patient demand as demographic trends predict an epidemic of this condition. The advent of fluoroscopically guided ‘one-shot’ ablation technologies, e.g.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

et al. 2014

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AimsThe current challenge in atrial fibrillation (AF) treatment is to develop effective, efficient, and safe ablation strategies. This randomized controlled trial assesses the medium-term efficacy of duty-cycled radiofrequency ablation via the circular pulmonary vein ablation catheter (PVAC) vs. conventional electro-anatomically guided wide-area circumferential ablation (WACA).Methods and resultsOne hundred and eighty-eight patients (mean age 62 ± 12 years, 116 M : 72 F) with paroxysmal AF were prospectively randomized to PVAC or WACA strategies and sequentially followed for 12 months. The primary endpoint was freedom from symptomatic or documented >30 s AF off medications for 7 days at 12 months post-procedure. One hundred and eighty-three patients completed 12 m follow-up. Ninety-four patients underwent PVAC PV isolation with 372 of 376 pulmonary veins (PVs) successfully isolated and all PVs isolated in 92 WACA patients. Three WACA and no PVAC patients developed tamponade. Fifty-six percent of WACA and 60% of PVAC patients were free of AF at 12 months post-procedure (P = ns) with a significant attrition rate from 77 to 78%, respectively, at 6 months. The mean procedure (140 ± 43 vs. 167 ± 42 min, P<0.0001), fluoroscopy (35 ± 16 vs. 42 ± 20 min, P<0.05) times were significantly shorter for PVAC than for WACA. Two patients developed strokes within 72 h of the procedure in the PVAC group, one possibly related directly to PVAC ablation in a high-risk patient and none in the WACA group (P = ns). Two of the 47 patients in the PVAC group who underwent repeat ablation had sub-clinical mild PV stenoses of 25–50% and 1 WACA patient developed delayed severe PV stenosis requiring venoplasty.ConclusionThe pulmonary vein ablation catheter is equivalent in efficacy to WACA with reduced procedural and fluoroscopy times. However, there is a risk of thrombo-embolic and pulmonary stenosis complications which needs to be addressed and prospectively monitored.ClinicalTrials.gov IdentifierNCT00678340.

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Section: Introductionmentioning

confidence: 99%

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

et al. 2014

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“…When catheter ablation is used in combination with antiarrhythmic drug therapy, the success rate of achieving normal sinus rhythm was 71% [95% confidence interval (CI), 65-77%], which is superior to antiarrhythmic drug therapy alone at 57% (95% CI, 50-64%) (88). Catheter ablation also produces an AF recurrence rate of 20%, which is superior to the 75% found in those taking antiarrhythmic drug therapy alone (89). A recent systematic review comparing catheter vs. surgical ablation for AF demonstrates higher freedom from AF with surgical ablation (90) though complications, including tamponade and pacemaker implantation rates were higher in those that underwent surgical ablation.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation: review of current treatment strategies

Xu¹,

Luc²,

Phan³

2016

J. Thorac. Dis.

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Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia in modern clinical practice, with an estimated prevalence of 1.5-2%. The prevalence of AF is expected to double in the next decades, progressing with age and increasingly becoming a global medical challenge. The first-line treatment for AF is often medical treatment with either rate control or anti-arrhythmic agents for rhythm control, in addition to anti-coagulants such as warfarin for stroke prevention in patient at risk. Catheter ablation has emerged as an alternative for AF treatment, which involves myocardial tissue lesions to disrupt the underlying triggers and substrates for AF. Surgical approaches have also been developed for treatment of AF, particularly for patients requiring concomitant cardiac surgery or those refractory to medical and catheter ablation treatments. Since the introduction of the Cox-Maze III, this procedure has evolved into several modern variations, including the use of alternative energy sources (Cox-Maze IV) such as radiofrequency, cryo-energy and microwave, as well as minimally invasive thoracoscopic epicardial approaches. Another recently introduced technique is the hybrid ablation approach, where in a single setting both epicardial thoracoscopic ablation lesions and endocardial catheter ablation lesions are performed by the cardiothoracic surgeon and cardiologist. There remains controversy surrounding the optimal approach for AF ablation, energy sources, and lesion sets employed. The goal of this article is review the history, classifications, pathophysiology and current treatment options for AF.

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“…Several studies have also shown that the success rate is much higher when catheter ablation is used in combination with antiarrhythmic drug therapy, as compared to using antiarrhythmic drug therapy alone [50]. Furthermore, the recurrence rate with catheter ablation was far lower as compared to antiarrhythmic drug therapy alone [51,52]. Overall, radiofrequency catheter ablation is a treatment method that has been shown to enhance the patient’s quality of life and also improves ventricle function in a large portion of patients [53,54].…”

Section: Management and Treatmentmentioning

confidence: 99%

Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

Shah

Luu

Calestino

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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The term ‘flutter’ and ‘fibrillation’ were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.

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Catheter ablation for paroxysmal and persistent atrial fibrillation

Abstract: There is limited evidence to suggest that CA may be a better treatment option compared to medical therapies in the management of persistent AF. This review was also unable to recommend the best CA method.

Cited by 27 publications

References 83 publications

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

Safety and efficacy of multipolar pulmonary vein ablation catheter vs. irrigated radiofrequency ablation for paroxysmal atrial fibrillation: a randomized multicentre trial

Atrial fibrillation: review of current treatment strategies

Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

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