Catheter Ablation to Maintain Sinus Rhythm

Calkins, Hugh

doi:10.1161/circulationaha.111.019943

Cited by 51 publications

(33 citation statements)

References 62 publications

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“…1 Trigger elimination by pulmonary vein (PV) isolation represents the cornerstone of ablation strategies. Further modification of AF maintaining atrial substrate seems necessary in at least some patients.…”

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confidence: 99%

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Rolf

Kircher

Arya

et al. 2014

Circ: Arrhythmia and Electrophysiology

460

511

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Background-Reduced electrogram amplitude has been shown to correlate with diseased myocardium. We describe a novel individualized approach for catheter ablation of atrial fibrillation (AF) based on low-voltage areas (LVAs) in the left atrium (LA). We sought to assess (1) the incidence of LVAs in patients undergoing AF catheter ablation, (2) the distribution of LVAs within the LA, and (3) the effect of an individualized ablation strategy on long-term rhythm outcomes. Methods and Results-In 178 patients with paroxysmal or persistent AF, LA voltage maps were created during sinus rhythm after circumferential pulmonary vein isolation. Subsequent substrate modification was confined to the presence of LVA (<0.5 mV) and inducible regular atrial tachycardias. LVAs were identified in 35% and 10% of patients with persistent and paroxysmal AF, respectively. The LA roof and the anterior, septal, and posterior wall LA were most often affected. The 12-month atrial tachycardias/AF-free survival was 62% for patients without LVAs and 70% for patients with LVAs and tailored substrate modification (P=0.3). Success rate in a comparison group of 26 LVA patients without further substrate modification was 27%. Conclusions-LVAs can be found at preferred sites in 10% of patients with paroxysmal AF and in 35% of patients with persistent AF. This is the first clinical report describing a consistent voltage-based approach for substrate modification in addition to circumferential pulmonary vein isolation irrespective of AF type. Application of this limited individualized approach may have the potential to compensate for the impaired 12-month outcome of patients with endocardial structural defects. (Circ Arrhythm Electrophysiol. 2014;7:825-833.)

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confidence: 99%

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Rolf

Kircher

Arya

et al. 2014

Circ: Arrhythmia and Electrophysiology

460

511

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“…11,12 However, success of ablation also depends on adequate catheter contact, power, and duration of energy application. 9,10,12,30 Several indirect parameters have been used to estimate the applied contact force, although none has shown reliability. To date, temperature has been regarded as the most effective indicator of lesion and contact.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8] AF ablation focused on triggers in the pulmonary veins (PVs), 3,4 but subsequently the importance of non-PV triggers became relevant, especially in the setting of nonparoxysmal AF. [8][9][10] Mapping and ablation can be performed either manually or robotically, using fluoroscopy, intracardiac echocardiography (ICE), and electroanatomic mapping. 11,12 Recurrence at follow-up remains the main limitation.…”

Section: Introductionmentioning

confidence: 99%

Visual, tactile, and contact force feedback: Which one is more important for catheter ablation? Results from an in vitro experimental study

et al. 2014

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“…4, 5 Catheter ablation of AF is an important therapeutic modality for patients with AF. [4][5][6][7] The aim of catheter ablation for AF is to eliminate the triggers or substrate that initiate and maintain the disorder, to maintain sinus rhythm. 8 Findings from several multicenter prospective clinical trials, 9-11 systematic reviews, and metaanalyses 4,12-15 have consistently shown that catheter ablation is more effective than anti-arrhythmic drug (AAD) therapy for maintenance of sinus rhythm.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Ipsilateral Circumferential Radiofrequency Ablation of Atrial Fibrillation With Irrigated Tip Catheter

Wójcik

Erkapic

Berkowitsch

et al. 2013

Circ J

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2280WÓJCIK M et al. We present a very long-term outcome and its predictors in a cohort of patients after single ipsilateral circumferential antrum pulmonary vein isolation (PVI) with irrigated tip catheter using uniform approach without 3-D mapping system at a single center. Methods Patient CharacteristicsTo determine long-term outcome, we retrospectively followed a cohort of 356 patients who had PVI performed at Kerckhoff trial fibrillation (AF) is the most common sustained clinical arrhythmia 1 associated with significant morbidity and impaired quality of life. 2,3 Medical therapy is of limited efficacy. 4,5 Catheter ablation of AF is an important therapeutic modality for patients with AF. 4-7The aim of catheter ablation for AF is to eliminate the triggers or substrate that initiate and maintain the disorder, to maintain sinus rhythm. 8 Findings from several multicenter prospective clinical trials, 9-11 systematic reviews, and metaanalyses 4,12-15 have consistently shown that catheter ablation is more effective than anti-arrhythmic drug (AAD) therapy for maintenance of sinus rhythm. 6 Furthermore, successful catheter ablation of AF was associated with improved symptoms and quality of life. 16, 17 The published data suggest that, although sinus rhythm is better preserved after ablation procedures than with AAD, late recurrences are not uncommon. 18 Despite the fact that the re-

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Catheter Ablation to Maintain Sinus Rhythm

Cited by 51 publications

References 62 publications

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Tailored Atrial Substrate Modification Based on Low-Voltage Areas in Catheter Ablation of Atrial Fibrillation

Visual, tactile, and contact force feedback: Which one is more important for catheter ablation? Results from an in vitro experimental study

Ipsilateral Circumferential Radiofrequency Ablation of Atrial Fibrillation With Irrigated Tip Catheter

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