Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Hindricks, Gerhard; Shamloo, Alireza Sepehri; Lenarczyk, Radosław; Kalarus, Zbigniew; Arya, Arash; Kircher, Simon; Darma, Angeliki; Dagres, Nikolaos

doi:10.5603/kp.a2018.0216

Cited by 18 publications

(11 citation statements)

References 81 publications

(91 reference statements)

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“…Atrial fibrillation (AF) has been recognised as the most prevalent sustained arrhythmia in medical practice [1]. Its prevalence rate also varies in different age and gender groups, with more than 3.7% cases in the age group of 60-70 years old, and more than 10% in individuals aged over 80 years [2].…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions

Shamloo

Dagres

Müssigbrodt

et al. 2020

Heart, Lung and Circulation

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Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions

Shamloo

Dagres

Müssigbrodt

et al. 2020

Heart, Lung and Circulation

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“…The longitudinal change in the HRV parameters during the first year after CPVI depicted a characteristic square root pattern, consisting of significant early parasympathetic success may optimize the selection of appropriate rhythm monitoring strategy, AADs use, and anticoagulant treatment following CA. 16 Study limitations Intermittent rhythm monitoring strategy with a 24-hour Holter recording probably underestimated the AF recurrence rate after CPVI. 2 In all patients, AADs were routinely prescribed during the blanking period, which possibly affected the HRV parameters after CA.…”

Section: Resultsmentioning

confidence: 99%

A square root pattern of changes in heart rate variability during the first year after circumferential pulmonary vein isolation for paroxysmal atrial fibrillation and their relation with long‑term arrhythmia recurrence

et al. 2020

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BACKGROUND An incidental lesion of the parasympathetic ganglia during circumferential pulmonary vein isolation (CPVI) may affect heart rate variability (HRV). AIMS We studied the pattern of changes in HRV parameters and the relationship between the 1-year HRV change following CPVI and the recurrence of atrial fibrillation (AF). METHODS A total of 100 consecutive patients undergoing CPVI for paroxysmal AF were enrolled (mean [SD] age, 56 [11.2] years; 61 men). We measured HRV on the day before and after CPVI, and then at 1 month as well as 3, 6, and 12 months after CPVI using 24-hour Holter monitoring. RESULTS During the median follow -up of 33 months, 38 patients experienced the late recurrence of AF (LRAF). Compared with the pre -CPVI values, HRV was significantly attenuated on day 1 after CPVI in all patients. However, at 3 to 6 months after CPVI, all HRV parameters remained significantly decreased in LRAF -free patients but not in those with LRAF. The multivariate Cox analysis showed that early AF recurrence within the blanking period (hazard ratio [HR], 4.87; 95% CI, 2.44-9.69; P <0.001) and a change in the standard deviation of normal -to -normal intervals (SDNN) observed 3 months after ablation (HR, 0.99; 95% CI, 0.98-1; P = 0.01) were associated with LRAF. The cumulative LRAF freedom after CPVI was greater in patients with an SDNN reduction of more than 25 ms reported 3 months after ablation than in those with a reduction of 25 ms or lower (log -rank P = 0.004). CONCLUSIONS Sustained parasympathetic denervation during 12 months after CPVI was a marker of successful CPVI, whereas a 3-month post -CPVI SDNN reduction of 25 ms or lower predicted LRAF. KEY WORDSablation for atrial fibrillation, atrial fibrillation recurrence, heart rate variability, Holter monitoring, pulmonary vein isolation O R I G I N A L A R T I C L EA square root pattern of changes in heart rate variability during the first year after circumferential pulmonary vein isolation for paroxysmal atrial fibrillation and their relation with long -term arrhythmia recurrence

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“…This suggests that performing the USGVA has a very good safety profile, which is of importance considering the constantly increasing number of CA. 7,8 Vascular complications are usually nonfatal. However, if these occur, they are associated with bleeding, the need for transfusions, surgical interventions, prolonged hospital stay, and increased morbidity; they may also increase mortality.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‑guided venous access facilitated by the Valsalva maneuver during invasive electrophysiological procedures

Futyma¹,

Ciąpała²,

Sander³

et al. 2020

Kardiol Pol

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BACKGROUND Data on the feasibility of an ultrasound-guided venous access (USGVA) for catheter ablation (CA) and electrophysiological studies (EPS) in large cohorts are scarce. The impact of the Valsalva maneuver (VM), which can increase the diameter of the femoral vein (FV), on the USGVA is unknown. AIMS The study aimed to determine the impact of the VM on FV diameters during establishing the USGVA and overall safety and effectiveness profile of the USGVA in a large cohort. METHODS Consecutive patients undergoing CA and / or EPS with the USGVA were included, and those with anatomical landmark-guided VA were recruited as controls. In a subgroup of USGVA patients, a VM-facilitated FV puncture was performed. The measurements obtained before and during the VM were used to calculate the estimated access area (EAA) of the FV. RESULTS A total of 1564 ultrasound-guided FV accesses in 876 patients and 172 FV accesses in 105 patients in the anatomical-VA group were performed. We observed no major complications associated with the USGVA. Minor adverse events related with VA were less common in the USGVA group than in controls (1.5% vs 6.7%, respectively; P = 0.001), resulting in a 4-fold decrease in VA-related complications. In 204 consecutive patients who underwent the VM-facilitated USGVA, the FV diameters increased during VM in both vertical (mean [SD], 10.1 [3] mm vs 14.4 [3.2] mm; P <0.001) and horizontal axes (10.6 [2.9] mm vs 14.5 [3.2] mm; P <0.001). This led to the mean (SD) increase in EAA of 38%: from 0.8 (0.2) cm 2 at baseline to 1.1 (0.2) cm 2 during VM (P <0.001). CONCLUSIONS The USGVA for EPS and / or CA is feasible. Complication rates for the USGVA are low and result in minor events. The Valsalva maneuver is a simple way to remarkably increase the femoral vein EAA and it can be helpful in performing the USGVA in difficult cases.

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Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Cited by 18 publications

References 81 publications

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions

Atrial Fibrillation and Cognitive Impairment: New Insights and Future Directions

A square root pattern of changes in heart rate variability during the first year after circumferential pulmonary vein isolation for paroxysmal atrial fibrillation and their relation with long‑term arrhythmia recurrence

Ultrasound‑guided venous access facilitated by the Valsalva maneuver during invasive electrophysiological procedures

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