Catheter Ablation for Persistent Atrial Fibrillation

Roten, Laurent; Derval, Nicolas; Jaı̈s, Pierre

doi:10.1161/circep.112.974873

Cited by 20 publications

(14 citation statements)

References 89 publications

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“…Focal triggers may also still act in combination with re-entrant activity to maintain AF (40). This is supported by the finding that multiple persistent AF patients had 2 to 4 foci in each atrium from which the wave fronts emanated (40,47).…”

Section: Pathophysiologymentioning

confidence: 85%

“…While less common, rapid ectopic activity can also arise from the muscular sleeves of the superior vena cava, coronary sinus or ligament of Marshall (37)(38)(39). The exact mechanisms behind AF initiation due to rapid firing have not been fully elucidated but it may potentially involve enhanced automaticity, micro-reentry, or triggered activity (40). The focal rapid firing activity in the atria seems to be the cause of paroxysmal AF, and is the rationale behind pulmonary vein isolation as a treatment option.…”

Section: Pathophysiologymentioning

confidence: 99%

“…While triggers for persistent AF are commonly also located in the pulmonary veins, exclusive pulmonary vein isolation in persistent AF has a low success rate (41,42). Thus other triggers may be involved in longstanding AF although they are still not well elucidated (40).…”

Section: Pathophysiologymentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Pathophysiologymentioning

confidence: 85%

Section: Pathophysiologymentioning

confidence: 99%

See 1 more Smart Citation

Atrial fibrillation: review of current treatment strategies

Xu¹,

Luc²,

Phan³

2016

J. Thorac. Dis.

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“…Besides, the exact mechanism behind AFIB initiation have not been fully elucidated but it is believed that it involves enhanced automaticity or micro-entry [25]. Studies have further shown that the disease progression from Paroxysmal to Persistent AFIB is due to structural and electrical changes within the atrium [26].…”

Section: Pathophysiologymentioning

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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“…PeAF is frequently caused by different coexistent electrophysiological mechanisms of induction [2]. This complex origin frequently requires the use of a combination of ablation techniques to achieve acceptable results.…”

Section: Introductionmentioning

confidence: 99%

Staged transthoracic approach to persistent atrial fibrillation (TOP-AF): study protocol for a randomized trial

Pragliola

Mastroroberto

Gaudino

et al. 2014

Trials

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BackgroundPersistent atrial fibrillation frequently shows multiple different electrophysiological mechanisms of induction. This heterogeneity causes a low success rate of single procedures of ablation and a high incidence of recurrence. Surgical ablation through bilateral thoracotomy demonstrates better results after a single procedure. Prospective observational studies in inhomogeneous populations without control groups report a remarkable 90% of success with hybrid or staged procedures of surgical ablation coupled with catheter ablation. In this trial, we will examine the hypothesis that a staged approach involving initial minimally invasive surgical ablation of persistent atrial fibrillation, followed by a second percutaneous procedure in case of recurrence, has a higher success rate than repeated percutaneous procedures.Methods/DesignThis is a controlled (2:1) randomized trial comparing use of a percutaneous catheter with minimally invasive transthoracic surgical ablation of persistent atrial fibrillation. The inclusion and exclusion criteria, definitions, and treatment protocols are those reported by the 2012 Expert Consensus Statement on catheter and surgical ablation of atrial fibrillation. Patients will be randomized to either percutaneous catheter (n = 100) or surgical (n = 50) ablation as the first procedure. After 3 months, they are re-evaluated, according to the same guidelines, and receive a second procedure if necessary. Crossover will be allowed and data analyzed on an “intention-to-treat” basis. Primary outcomes are the incidence of sinus rhythm at 6 and 12 months and the proportions of patients requiring a second procedure.DiscussionThe use of a staged strategy combining surgical and percutaneous approaches might be more favorable in treatment of persistent atrial fibrillation than the controversial single percutaneous ablation.Trial registrationISRCTN08035058 Reg 06.20.2013

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Catheter Ablation for Persistent Atrial Fibrillation

Cited by 20 publications

References 89 publications

Atrial fibrillation: review of current treatment strategies

Atrial fibrillation: review of current treatment strategies

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

Staged transthoracic approach to persistent atrial fibrillation (TOP-AF): study protocol for a randomized trial

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