Caution over use of catheter ablation for atrial fibrillation

Brabandt, Hans Van; Neyt, Mattias; Devos, Carl

doi:10.1136/bmj.f5277

Cited by 11 publications

(11 citation statements)

References 35 publications

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“…This will add to the existing evidence base as data on very long‐term follow‐up is currently sparse. Brabandt and colleagues noted that further research into long‐term outcomes is required. The routine use of PROMs by all ablation centers could help fill this evidence gap and facilitate improved quality of care across centers.…”

Section: Discussionmentioning

confidence: 99%

Quality of life benefits from arrhythmia ablation: A longitudinal study using the C‐CAP questionnaire and EQ5D

Evans

Withers

Lencioni

et al. 2019

Pacing Clinical Electrophis

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AimsTo investigate long‐term efficacy of cardiac ablation for symptomatic arrhythmia by gathering generic and arrhythmia‐related quality of life data using patient‐reported outcome measures before and after ablation.MethodsConsecutive patients undergoing cardiac ablation procedures at three sites in the United Kingdom were enrolled (n = 561). Data were collected at baseline, at 8–16 weeks, and 12 months after the ablation with responses from 390 patients received at all three time points. Nonparametric tests were used to identify any changes in patient outcomes due to nonnormal data.ResultsThere were significant improvements in symptom severity, impact on life scores, EQ‐5D‐5L indices, and visual analogue score (VAS) scores at pre‐ versus 3 months and at preablation versus 1 year. Impact on life score showed additional improvement at 1 year versus 3 months, while improvements in symptom severity, EQ‐5D‐5L indices, and VAS scores continued to be maintained between 3 months and 1 year.ConclusionCardiac ablation provides patients with arrhythmias relief from symptoms, and results in an improvement in quality of life. Improvements observed at 3 months are maintained at 1 year follow‐up.

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Section: Discussionmentioning

confidence: 99%

Quality of life benefits from arrhythmia ablation: A longitudinal study using the C‐CAP questionnaire and EQ5D

Evans

Withers

Lencioni

et al. 2019

Pacing Clinical Electrophis

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“…Mitral annuloplasty 2,4 and transseptal arrhythmia ablation 5,6 are examples of such special situations.…”

Section: Discussionmentioning

confidence: 99%

Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

Spotnitz

Yeager

Cabreriza

et al. 2015

Innovations�(Phila)

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Objective Right parasternal mediastinotomy with right atriotomy has been used clinically for pacemaker insertion. A similar approach might facilitate access to the coronary sinus for biventricular pacing and other manipulations when more conventional approaches are not feasible. The primary barrier to this is lack of appropriate introducers and techniques. Methods Anatomically derived introducers were developed in 2 anesthetized domestic pigs using data from computerized axial thoracic tomography. Each digitized tomogram defined a unique introducer shape and was constructed using 3-dimensional (3D) modeling software and printing. Each parent pig then underwent surgery demonstrating coronary sinus lead insertion, using its custom-configured introducer. Next, with institutional review board approval, 65 patients were identified who had undergone conventional endocardial coronary sinus lead insertion followed by thoracic scanning. These tomograms were used to design appropriately curved introducers for human anatomy. Results Fifty-one introducer paths were defined following anatomic pathways and avoiding bends inconsistent with materials used for commercial peel-away introducers. Each path was defined by a bend and distance toward the coronary sinus ostium and a hook and twist out of plane to align with the local orientation of the coronary sinus. The average dimensions were the following: distance, 67 mm; bend angle, 47 degrees; hook angle, 39 degrees; and twist angle, 20 degrees. A prototype cannula was tested for fit in a fresh frozen postmortem human specimen. Conclusions Parasternal mediastinotomy access to the coronary sinus for cardiac resynchronization, mitral annuloplasty, and instrumentation is feasible. Human computerized tomographic scans can be used to define curvatures and dimensions for marketed introducers.

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“…Buoyed by the success of ablation for ‘simple’ supraventricular and ventricular arrhythmias, ablation is increasingly used for AF 5 and is superior to pharmacological therapy for patients with early (paroxysmal) 6, 7 to advanced (persistent) AF 8 . Nevertheless, fibrillation is a complex disease and the overall success of ablation remains lower 9 for AF than for other arrhythmias 6, 7, 10-13 – despite remarkable successes in individual patients. This has fueled a vibrant culture of intense patient-focused translational research that has characterized the field since its earliest days 14-16 .…”

Section: Introductionmentioning

confidence: 99%

Ablation of atrial fibrillation

Wright

Narayan

2015

Trends in Cardiovascular Medicine

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Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multi center trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.

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Caution over use of catheter ablation for atrial fibrillation

Cited by 11 publications

References 35 publications

Quality of life benefits from arrhythmia ablation: A longitudinal study using the C‐CAP questionnaire and EQ5D

Quality of life benefits from arrhythmia ablation: A longitudinal study using the C‐CAP questionnaire and EQ5D

Introducer Development for Coronary Sinus Access from Parasternal Mediastinotomy

Ablation of atrial fibrillation

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