Epicardial Ablation Complications.

The percutaneous epicardial approach has become an adjunctive tool for electrophysiologists to treat disparate cardiac arrhythmias, including accessory pathways, atrial tachycardia, and particularly ventricular tachycardia. This novel technique prompted a strong impulse to perform epicardial access as an alternative strategy for pacing and defibrillation, left atrial appendage exclusion, heart failure with preserved ejection fraction, and genetically engineered tissue delivery. However, because of the incremental risk of major complications compared with stand-alone endocardial ablation, it is still practiced in a limited number of highly experienced centers across the world.

Toward a Uniform Ablation Protocol for Paroxysmal, Persistent, and Permanent Atrial Fibrillation.

Atrial fibrillation catheter ablation has emerged as the most effective strategy to restore and maintain sinus rhythm. The cornerstone of atrial fibrillation ablation is elimination of triggers from the pulmonary veins by pulmonary vein isolation. Nevertheless, some patients may experience atrial tachyarrhythmia recurrences even with permanent pulmonary vein antral isolation.

Thromboembolic events and need for anticoagulation therapy following left atrial appendage occlusion in patients with electrical isolation of the appendage.

Introduction: Electrical isolation of the left atrial appendage (LAA) is an important adjunctive ablation strategy in patients with nonparoxysmal atrial fibrillation (AF). Patients who have impaired LAA contractility following isolation may require long-term oral anticoagulant (OAC) therapy irrespective of their CHADS -VASc score. Percutaneous LAA occlusion (LAAO) is a potential alternative to life-long OAC therapy.

Prevalence of right atrial non-pulmonary vein triggers in atrial fibrillation patients treated with thyroid hormone replacement therapy.

Background: Thyroid hormone (TH) is known to enhance arrhythmogenicity, and high-normal thyroid function is related with an increased recurrence of atrial fibrillation (AF) after catheter ablation. However, the impact of thyroid hormone replacement (THR) on AF ablation is not well known.

Methods: This study evaluated 1163 consecutive paroxysmal AF patients [160 (14%) on THR and 1003 (86%) without THR] undergoing their first catheter ablation.

Association of pretreatment with angiotensin-converting enzyme inhibitors with improvement in ablation outcome in atrial fibrillation patients with low left ventricular ejection fraction.

Background: Angiotensin-converting enzyme inhibitors (ACEIs) reduce the incidence of atrial fibrillation (AF).

Objective: The purpose of this study was to assess the impact of upstream ACEI therapy on postablation AF recurrence and hospitalization in patients with low left ventricular ejection fraction (LVEF).

Methods: Three hundred forty-five consecutive patients undergoing first AF ablation with low LVEF (≤45%) were classified into group 1 (ACEI+, n = 187 [54%], of whom 44 patients [23.

Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrial fibrillation patients with or without pre-existent migraine: results from a prospective study.

Background: We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history.

Methods And Results: Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires.

Effect of periprocedural amiodarone on procedure outcome in patients with longstanding persistent atrial fibrillation undergoing extended pulmonary vein antrum isolation: results from a randomized study (SPECULATE).

Background: The impact of amiodarone on ablation outcome in longstanding persistent atrial fibrillation (LSPAF) patients is not known yet.

Objective: The purpose of this study was to assess the effect of amiodarone on procedural-outcomes in LSPAF patients undergoing catheter ablation.

Methods: We enrolled 112 LSPAF patients on amiodarone and scheduled to undergo atrial fibrillation (AF) ablation.

Outcomes of atrioesophageal fistula following catheter ablation of atrial fibrillation treated with surgical repair versus esophageal stenting.

Introduction: Atrioesophageal fistula (AEF) is a rare but devastating complication of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Surgical repair and esophageal stents are available treatment options for AEF. We report outcomes of these 2 management strategies.

Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes.

Introduction: Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence.

Methods And Results: We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF).

Catheter ablation of asymptomatic longstanding persistent atrial fibrillation: impact on quality of life, exercise performance, arrhythmia perception, and arrhythmia-free survival.

Background: Impact of catheter ablation on exercise performance, quality of life (QoL) and symptom perception in asymptomatic longstanding persistent AF (LSP-AF) patients has not been reported yet.

Methods And Results: Sixty-one consecutive patients (mean age 62 ±13 years, 71% males) with asymptomatic LSP-AF undergoing first catheter ablation were enrolled. Extended pulmonary vein antrum isolation plus ablation of complex fractionated atrial electrograms and nonpulmonary vein triggers was performed in all.

Biomarkers of myocardial injury with different energy sources for atrial fibrillation catheter ablation.

Background: Our study aims to compare acute myocardial injury biomarker rise after atrial fibrillation ablation performed with different technologies.

Methods And Results: One hundred and ten patients were treated with pulmonary vein isolation with 4 different technologies: open-irrigated tip radiofrequency (RF) catheter in35 patients (Group A), cryoballoon in 35 patients (Group B), visually guided laser balloon in 20 patients (Group C), open-irrigated tip RF catheter with contact-force-sensing technology in 20 patients (Group D). Post-procedure samples of cardiac troponin I (cTnI) and creatinine kinase-MB (CK-MB) were collected at 19 ± 3 h and 43 ± 3 h after ablation.

Impact of Metabolic Syndrome on Ablation-Outcome in Patients with Atrial Fibrillation: A Systematic Review.

Metabolic syndrome (MS), a pro-inflammatory state with hypertension, diabetes, dyslipidemia and obesity is presumed to be a close associate of atrial fibrillation (AF). However, the exact mechanism by which MS facilitates perpetuation of AF is yet to be fully understood. Moreover, the impact of the components of MS as well as MS as a group, on ablation-outcome in AF is not clearly elucidated until now.

Impact of metabolic syndrome on procedural outcomes in patients with atrial fibrillation undergoing catheter ablation.

Objectives: The aim of this study was to investigate impact of metabolic syndrome (MS) on outcomes of catheter ablation in patients with atrial fibrillation (AF) in terms of recurrence and quality of life (QoL).

Background: MS, a proinflammatory state with hypertension, diabetes, dyslipidemia, and obesity, is presumed to be a close associate of AF.

Methods: In this prospective study, 1,496 consecutive patients with AF undergoing first ablation (29% with paroxysmal AF, 26% with persistent AF, and 45% with long-standing persistent AF) were classified into those with MS (group 1; n = 485) and those without MS (group 2; n = 1,011).

Influence of body mass index on quality of life in atrial fibrillation patients undergoing catheter ablation.

Background: Obesity increases the risk of atrial fibrillation (AF), and AF seriously impairs the quality of life (QoL). However, it is not known whether body mass index (BMI) has any direct influence on QoL in AF.

Objective: To study the association between baseline BMI and QoL improvement in patients with AF following catheter ablation.

Baseline B-type natriuretic peptide: a gender-specific predictor of procedure-outcome in atrial fibrillation patients undergoing catheter ablation.

Background: Close association between atrial fibrillation (AF) and brain natriuretic peptide (BNP) has been demonstrated by several studies. Important gender differences exist in AF patients including a higher plasma BNP level in women. Therefore, it is imperative to evaluate the relationship between AF and BNP separately in men and women.

Prevention of phrenic nerve injury during epicardial ablation: comparison of methods for separating the phrenic nerve from the epicardial surface.

Background: The proximity of the phrenic nerve (PN) to cardiac tissue relevant to arrhythmias may increase the risk of PN injury. Strategies for preventing PN injury in the pericardial space are limited.

Objective: The purpose of this study was to compare methods for separating the PN from the epicardial surface in order to prevent PN injury.

Catheter ablation of atrial fibrillation.

Atrial fibrillation is a common arrhythmia associated with significant morbidity, including angina, heart failure, and stroke. Medical therapy remains suboptimal, with significant side effects and toxicities, and a high recurrence rate. Catheter ablation or modification of the atrioventricular node with pacemaker implantation provides rate-control but exposes patients to the hazards associated with implantable devices and does nothing to reduce the risk for stroke.