Quelles sont les indications de l ablation dans la Fibrillation auriculaire?

Size: px
Start display at page:

Download "Quelles sont les indications de l ablation dans la Fibrillation auriculaire?"

Transcription

1 Quelles sont les indications de l ablation dans la Fibrillation auriculaire? Maurice Jo7rand 6 juin 2015 Maurice Jottrand

2 Incidence de la FA estimation popul USA en FA prévalence de la FA % >90 groupes d'âge

3 Une affection à très large spectre! D. de M. 43 ans Sportif (250 km vélo / sem) FA parox. Palpitations extrêmement désagréables (5 visites aux urgences en 2 ans) Aucune anomalie cardiaque sousjacente V.G. 73 ans Apothicaire retraité HTA avec HVG S/P AMI FE 35% Diabète II FA «asymptomatique» rapide découverte à examen pré-op PTH

4 Historique des concepts physiopathologiques de la FA Nishida K. et al. JACC 2014; 64:

5

6 Traitement chirurgical de la FA The Cox-Maze III procedure has excellent long-term results. In our series at Washington University, of 198 consecutive patients undergoing the procedure, 97% of all patients at a mean follow-up of 5.4 years were in sinus rhythm Voeller R Ki, Schuessler R Bi, Damiano R Ji J r. Surgical Treatment of Atrial Fibrillation. Cohn Lh, ed. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2008:

7 Septal and left-atrial linear ablation for AF 44 p (M 38, F 6) 54 ± 7 y daily parox AF / permanent AF(4) 4.7 ± 1 ineffecsve AAD HCM 4, ICM 3, DCM 2, other ± 1.3 sessions (total 120) procedure 615 ± 345 min fluoroscopy 171 ± 94 min Rf 104 ± 56 min follow- up 19 ± 7 months Succes sans AA Succes avec AA N= foci >=1 ligne bloc Echecs ComplicaSons Pericardial effusion 5 ( 3 drained) Pulmonary embolism 1 Inferior myocardial infarcson 1 LPV thrombosis 1 TIA 1 Jaïs Am J Cardiol 1999; 84: 139R-146R

8 La veine pulmonaire : déclencheur de la FA? Jaïs P Circulation 1997

9 Left inferior pulmonary vein ectopic activity Haïssaguerre NEJM 1998;339:659-66

10 Onset of AF from foci in a RIPV and a LSPV Haïssaguerre NEJM 1998;339:659-66

11

12 Effect of successful RF ablation in the PV Haïssaguerre NEJM 1998;339:659-66

13 Pulmonary vein stenosis after catheter ablation of AF Robins Circulation 1998; 98:

14 Cathéter «lasso»

15

16

17 Atrial Remodeling and Atrial Fibrillation S. Nattel, B. Burstein, and D. Dobrev Circ Arrhythmia Electrophysiol. 2008;1:62-73

18 Atrial Remodeling and Atrial Fibrillation S. Nattel, B. Burstein, and D. Dobrev Circ Arrhythmia Electrophysiol. 2008;1:62-73

19 Atrial Remodeling and Atrial Fibrillation S. Nattel, B. Burstein, and D. Dobrev Circ Arrhythmia Electrophysiol. 2008;1:62-73

20

21

22 A, Annualized single- and multiple- procedure arrhythmia-free success were calculated (subtable number of studies at each year after ablation). Long-term Outcomes of Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta-analysis Anand N. Ganesan et al. J Am Heart Assoc 2013;2:e004549

23 Ablation versus antiarrhythmic therapy: randomized trials

24 Indications and contraindications for catheter ablation of AF

25 Merci pour votre a7enson. 25

26 AF Catheter Ablation to Maintain Sinus Rhythm Class I 1.AF catheter ablason is useful for symptomasc paroxysmal AF refractory or intolerant to at least 1 class I or III ansarrhythmic medicason when a rhythm- control strategy is desired ( ). (Level of Evidence: A) 2.Before considerason of AF catheter ablason, assessment of the procedural risks and outcomes relevant to the individual pasent is recommended. (Level of Evidence: C) 2014 AHA/ACC/HRS Guideline for the Management of Pa=ents With Atrial Fibrilla=on

27 AF Catheter Ablation to Maintain Sinus Rhythm Class IIa 1.AF catheter ablason is reasonable for some pasents with symptomasc persistent AF refractory or intolerant to at least 1 class I or III ansarrhythmic medicason (157, ). (Level of Evidence: A) 2.In pasents with recurrent symptomasc paroxysmal AF, catheter ablason is a reasonable inisal rhythm- control strategy before therapeusc trials of ansarrhythmic drug therapy, aier weighing the risks and outcomes of drug and ablason therapy ( ). (Level of Evidence: B) 2014 AHA/ACC/HRS Guideline for the Management of Pa=ents With Atrial Fibrilla=on

28 AF Catheter Ablation to Maintain Sinus Rhythm Class IIb 1.AF catheter ablason may be considered for symptomasc long- standing (>12 months) persistent AF refractory or intolerant to at least 1 class I or III ansarrhythmic medicason when a rhythm- control strategy is desired (154,167). (Level of Evidence: B) 2.AF catheter ablason may be considered before inisason of ansarrhythmic drug therapy with a class I or III ansarrhythmic medicason for symptomasc persistent AF when a rhythm- control strategy is desired. (Level of Evidence: C) 2014 AHA/ACC/HRS Guideline for the Management of Pa=ents With Atrial Fibrilla=on

29 AF Catheter Ablation to Maintain Sinus Rhythm Class III: Harm 1.AF catheter ablason should not be performed in pasents who cannot be treated with anscoagulant therapy during and aier the procedure. (Level of Evidence: C) 2.AF catheter ablason to restore sinus rhythm should not be performed with the sole intent of obviasng the need for anscoagulason. (Level of Evidence: C) 2014 AHA/ACC/HRS Guideline for the Management of Pa=ents With Atrial Fibrilla=on

30 AF Catheter Ablation to Maintain Sinus Rhythm 2014 AHA/ACC/HRS Guideline for the Management of Pa=ents With Atrial Fibrilla=on

Indicatie voor ablatie bij voorkamerfibrillatie. Andrea Sarkozy Cardiologie Universitair Ziekenhuis Antwerpen

Indicatie voor ablatie bij voorkamerfibrillatie. Andrea Sarkozy Cardiologie Universitair Ziekenhuis Antwerpen Indicatie voor ablatie bij voorkamerfibrillatie Andrea Sarkozy Cardiologie Universitair Ziekenhuis Antwerpen Definition and Classification of AF - Practical aspects Classification of AF Paroxysmal, persistent,

More information

ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital

ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ. ΥΠΕΡ. Michalis Efremidis MD Second Department of Cardiology Evangelismos General Hospital Rate control versus Rhythm control for Atrial Fibrillation AFFIRM N Engl J Med 2002;347:1825-33

More information

Fibrillation Atriale Paroxystique : ablation, résultats, complications

Fibrillation Atriale Paroxystique : ablation, résultats, complications Fibrillation Atriale Paroxystique : ablation, résultats, complications DIU Rythmologie Paris, le 27/01/16 sboveda@clinique-pasteur.com 1 A disease with bad consequences RR de patients en FA comparé avec

More information

AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT

AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT AF :RHYTHM CONTROL BY DR-MOHAMMED SALAH ASSISSTANT LECTURER CARDIOLOGY DEPARTMENT 5-2014 Atrial Fibrillation therapeutic Approach Rhythm Control Thromboembolism Prevention: Recommendations Direct-Current

More information

Stand alone maze: when and how?

Stand alone maze: when and how? Stand alone maze: when and how? Dong Seop Jeong Department of Thoracic and Cardiovascular Surgery, HVSI Samsung Medical Center Type of atrial fibrillation First diagnose AF Paroxysmal AF: self-terminating

More information

Catheter ablation of AF Where do we stand, where do we go?

Catheter ablation of AF Where do we stand, where do we go? Catheter ablation of AF Where do we stand, where do we go? Sébastien Knecht MD, PhD Hôpital cardiologique du Haut L Evêque, Bordeaux Declaration of conflict of interest ABLATION STRATEGIES Duration proc:

More information

Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro

Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro Progression of atrial fibrillation: can we prevent it? Early catheter ablation will stop progression of atrial fibrillation pro Jerónimo Farré MD, Madrid, ES AF: the kingdom of wishful thinking In AF we

More information

Combined catheter ablation and left atrial appendage closure as a. treatment of atrial fibrillation

Combined catheter ablation and left atrial appendage closure as a. treatment of atrial fibrillation Combined catheter ablation and left atrial appendage closure as a hybrid procedure for the treatment of atrial fibrillation Giulio Molon, MD FACC, FESC, Fellow ANMCO Card Dept, S.Cuore hospital Negrar

More information

In Whom and When Should Atrial Fibrillation Ablation be Considered?

In Whom and When Should Atrial Fibrillation Ablation be Considered? In Whom and When Should Atrial Fibrillation Ablation be Considered? Christian de Chillou, MD, PhD Department of Cardiology University Hospital Nancy, France ESC 2010 Stockholm, August 30. 2010 2 In Whom?

More information

Atrial Fibrillation Ablation: in Whom and How

Atrial Fibrillation Ablation: in Whom and How Update on Consensus Statement on Management of Atrial Fibrillation: EHRA 2012 Atrial Fibrillation Ablation: in Whom and How Update of HRS/EHRA AF/ECAS Ablation Document 2012 Anne M Gillis MD FHRS Professor

More information

Debate-STAR AF 2 study. PVI is not enough

Debate-STAR AF 2 study. PVI is not enough Debate-STAR AF 2 study PVI is not enough Debate about STAR AF 2 trial STAR AF trial Substrate and Trigger Ablation for Reduction of Atrial Fibrillation EHJ 2010 STAR-AF 2 trial One Size Fits All? PVI is

More information

Διαδερμική Θεραπεία Κολπικής Μαρμαρυγής: Αποτελέσματα και Δεδομένα στην Ελλάδα

Διαδερμική Θεραπεία Κολπικής Μαρμαρυγής: Αποτελέσματα και Δεδομένα στην Ελλάδα Διαδερμική Θεραπεία Κολπικής Μαρμαρυγής: Αποτελέσματα και Δεδομένα στην Ελλάδα Eleftherios M. Kallergis MD, PhD, FESC Cardiology Department Heraklion University Hospital ΠΑΝΕΛΛΗΝΙΑ ΣΕΜΙΝΑΡΙΑ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ

More information

Catheter Ablation of Atrial Fibrillation in Patients with Prosthetic Mitral Valve

Catheter Ablation of Atrial Fibrillation in Patients with Prosthetic Mitral Valve Catheter Ablation of Atrial Fibrillation in Patients with Prosthetic Mitral Valve Luigi Di Biase, MD, PhD, FHRS Senior Researcher Texas Cardiac Arrhythmia Institute at St. David s Medical Center, Austin,

More information

The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On?

The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? The EP Perspective: Should We Do Hybrid Ablation, and Who Should We Do It On? L. Pison, MD PhD FESC AATS Surgical Treatment of Arrhythmias and Rhythm Disorders November 17-18, 2017 Miami Beach, FL, USA

More information

Atrial Fibrillation Ablation Recent Clinical Trials That Changed (or not) My Practice

Atrial Fibrillation Ablation Recent Clinical Trials That Changed (or not) My Practice Atrial Fibrillation Ablation Recent Clinical Trials That Changed (or not) My Practice Walid Saliba, MD, FHRS Director, Atrial Fibrillation Center Director EP laboratory Heart and Vascular Institute Cleveland

More information

Surgical Ablation of Atrial Fibrillation. Gregory D. Rushing, MD. Assistant Professor, Division of Cardiac Surgery

Surgical Ablation of Atrial Fibrillation. Gregory D. Rushing, MD. Assistant Professor, Division of Cardiac Surgery Surgical Ablation of Atrial Fibrillation Gregory D. Rushing, MD Assistant Professor, Division of Cardiac Surgery Midwestern Conference on Optimizing Electrophysiology Patient Care and Procedural Success

More information

Catheter Ablation for Persistent Atrial Fibrillation

Catheter Ablation for Persistent Atrial Fibrillation Catheter Ablation for Persistent Atrial Fibrillation Saeed Oraii MD, Cardiologist Interventional Electrophysiologist Tehran Arrhythmia Clinic April 2016 Atrial Fibrillation First reported by Sir William

More information

2004 3 32 3 Chin J Cardiol, March 2004, Vol. 32 No. 3 211 4 ( ) 4 (HRA) (CS), 10 (Lasso ),, 4 (3 ) (1 ), 118,3,1, 417, ; ; The electrophysiological characteristics and ablation treatment of patients with

More information

Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes

Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes Catheter Ablation for Atrial Fibrillation: Patient Selection and Outcomes Francis Marchlinski, MD Richard T and Angela Clark President s Distinguished Professor Director Cardiac Electrophysiolgy University

More information

Atrial fibrillation: Who should be referred for ablation therapy for atrial fibrillation?. September 12 th, 2015

Atrial fibrillation: Who should be referred for ablation therapy for atrial fibrillation?. September 12 th, 2015 Atrial fibrillation: Who should be referred for ablation therapy for atrial fibrillation?. September 12 th, 2015 MMMMMMM MMMMMMM MMMMMMM Sohail Hassan MD FACC, FHRS Director, Cardiac Electrophysiology

More information

Catheter ablation in AF patients with heart failure. What is possible?

Catheter ablation in AF patients with heart failure. What is possible? Catheter ablation in AF patients with heart failure What is possible? Sébastien Knecht, MD PhD Hôpital cardiologique du Haut L Evêque, Bordeaux HEART FAILURE AND AF Ehrlich. JCE 2002 (13): 399-405, Wang

More information

Surgical AF Ablation : Lesion Sets and Energy Sources. What are the data? Steven F Bolling, MD Cardiac Surgery University of Michigan

Surgical AF Ablation : Lesion Sets and Energy Sources. What are the data? Steven F Bolling, MD Cardiac Surgery University of Michigan Surgical AF Ablation : Lesion Sets and Energy Sources What are the data? Steven F Bolling, MD Cardiac Surgery University of Michigan Disclosures Consultant/Advisory Board: Abbott, Edwards Lifesciences

More information

Catheter ablation is not a class I indication after failed antiarrhythmic drugs

Catheter ablation is not a class I indication after failed antiarrhythmic drugs Catheter ablation is not a class I indication after failed antiarrhythmic drugs Martin Jan Schalij Department of Cardiology Leiden University Medical Center Disclosure: Research grants from: Boston Scientific

More information

Atrial Fibrillation 2009

Atrial Fibrillation 2009 Atrial Fibrillation 2009 Michael Glikson, MD Director of Pacing & Electrophysiology Leviev Heart Center Sheba medical Center Sheba Medical Center Tel Hashomer The Leviev Heart Center Rhythm vs rate control

More information

AF Ablation in Patients with Heart Failure

AF Ablation in Patients with Heart Failure AF Ablation in Patients with Heart Failure Christian de Chillou, MD, PhD Department of Cardiology University Hospital Nancy, France 28ème Journée Internationale du Centre Cardio-Thoracique de Monaco Monaco,

More information

Interventional solutions for atrial fibrillation in patients with heart failure

Interventional solutions for atrial fibrillation in patients with heart failure Interventional solutions for atrial fibrillation in patients with heart failure Advances in Cardiovascular Arrhythmias Great Innovations in Cardiology Matteo Anselmino, MD PhD Division of Cardiology Department

More information

Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation

Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation Ablation Should Not Be Used as Primary Therapy for Treatment of Patients with Atrial Fibrillation 25 October 2008 Update in Electrocardiography and Arrhythmias Zian H. Tseng, M.D., M.A.S. Assistant Professor

More information

AF ABLATION Concepts and Techniques

AF ABLATION Concepts and Techniques AF ABLATION Concepts and Techniques Antony F Chu, M.D. Director of Complex Ablation Arrhythmia Services Section Division of Cardiology at the Rhode Island and Miriam Hospital HIGHLIGHTS The main indications

More information

Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method. Konstantinos P.

Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method. Konstantinos P. Ioannina 2015 Catheter ablation of atrial fibrillation: Indications and tools for improvement of the success rate of the method Konstantinos P. Letsas, MD, FESC SECOND DEPARTMENT OF CARDIOLOGY LABORATORY

More information

Trattamento interventistico

Trattamento interventistico Fibrillazione Atriale Trattamento interventistico Milano 5/10/18 Prof. Fiorenzo Gaita University of Turin Mechanisms of AF Trigger Atrial premature contractions (P/T) AF Substrate Anatomical: Critical

More information

Who Gets Atrial Fibrilla9on..?

Who Gets Atrial Fibrilla9on..? Birmingham October 20 th 2013 AFA Pa9ents Day Symptoma9c Atrial Fibrilla9on What therapies are available? GENERAL BACKGROUND Andrew Grace Papworth Hospital and University of Cambridge Consultant: Medtronic

More information

Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland

Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland Dipen Shah Cardiology Service, University Hospitals, Geneva Switzerland Disclosures Research Grants: Biosense Webster, St. Jude, Bard, Endosense, Biotronik Speakers Honoraria: Biosense Webster, Endosense,

More information

PRIMARY RESULTS OF RF CATHETER ABLATION FOR AF IN VIETNAM HEART INSTITUTE. PHAM QUOC KHANH, MD, PhD. et al Vietnam Heart Institute

PRIMARY RESULTS OF RF CATHETER ABLATION FOR AF IN VIETNAM HEART INSTITUTE. PHAM QUOC KHANH, MD, PhD. et al Vietnam Heart Institute PRIMARY RESULTS OF RF CATHETER ABLATION FOR AF IN VIETNAM HEART INSTITUTE PHAM QUOC KHANH, MD, PhD. et al Vietnam Heart Institute Background - Forms of Atrial Fibrillation - Clinical type of AF: + paroxysmal

More information

A Cryo Anatomical Procedure to Everyone? Saverio Iacopino, FACC, FESC

A Cryo Anatomical Procedure to Everyone? Saverio Iacopino, FACC, FESC A Cryo Anatomical Procedure to Everyone? Saverio Iacopino, FACC, FESC AF Clinical/Referral Challenge Asymptomatic 40% 3 Rx Effective 30% Failed Rx Ablation Atrial fibrillation (AF) is the most common Candidate

More information

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation

Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Long-Term Outcome and Risks of Catheter Ablation for Atrial Fibrillation Carlo Pappone, MD, PhD, FACC EP Director, Villa Maria Hospital Group How many times AF can increase mortality DO MORTALITY REALLY

More information

Atrial Fibrillation Ablation in Patients with Heart Failure

Atrial Fibrillation Ablation in Patients with Heart Failure Atrial Fibrillation Ablation in Patients with Heart Failure Eleftherios M. Kallergis, MD, PhD, FESC Cardiology Department, Heraklion University Hospital Since auricular fibrillation so often complicates

More information

Linear Ablation Should Not Be a Standard Part of Ablation in Persistent AF. Disclosures. LA Ablation vs. Segmental Ostial Ablation With PVI for PAF

Linear Ablation Should Not Be a Standard Part of Ablation in Persistent AF. Disclosures. LA Ablation vs. Segmental Ostial Ablation With PVI for PAF Linear Ablation Should Not Be a Standard Part of Ablation in Persistent AF The CA Heart Rhythm Symposium September 7, 2012 Gregory K. Feld, MD Professor of Medicine Director, Cardiac EP Program University

More information

Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond

Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond Catheter Ablation for Treatment of Atrial Fibrillation 2010 and Beyond John M. Miller, MD Professor of Medicine Indiana University School of Medicine Director, Clinical Cardiac Electrophysiology Krannert

More information

AF ablation Penn experience. Optimal approach to the ablation of PAF: Importance of identifying triggers 9/25/2009

AF ablation Penn experience. Optimal approach to the ablation of PAF: Importance of identifying triggers 9/25/2009 Optimal approach to the ablation of PAF: Importance of identifying triggers David J. Callans, MD University of Pennsylvania School of Medicine AF ablation Penn experience Antral (circumferential) PV ablation

More information

Innovations in AF Management

Innovations in AF Management Innovations in AF Management Barry Boilson MD PhD FRCPI boilson.barry@mayo.edu Disclosures Relevant None financial relationship(s) with industry None Off Label Usage None Overview Mechanisms of AF AF as

More information

Catheter Ablation of Atrial Fibrillation

Catheter Ablation of Atrial Fibrillation Cardiology Update 2011 Catheter Ablation of Atrial Fibrillation Laurent Haegeli University Hospital Zurich February 16, 2011 Willem Einthoven and Sir Thomas Lewis The first ECG in 1903 Willem Einthoven

More information

What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation?

What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation? What s New in the Guidelines for Surgical Ablation for Atrial Fibrillation? Vinay Badhwar, MD Gordon F. Murray Professor and Chairman Department of Cardiovascular & Thoracic Surgery West Virginia University

More information

Outcomes of AF Ablation

Outcomes of AF Ablation 2017 춘계심혈관통합학술대회 AF Summit: Atrial Fibrillation Apr.21(Fri) 14:40-16:10 Rm.300B 15:00-15:10 Outcomes of AF Ablation Gi-Byoung Nam MD Asan Medical Center, UUCM 2017 Annual Spring Scientific Conference of

More information

Κατάλυση παροξυσμικής κολπικής μαρμαρυγής Ποια τεχνολογία και σε ποιους ασθενείς; Χάρης Κοσσυβάκης Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ.

Κατάλυση παροξυσμικής κολπικής μαρμαρυγής Ποια τεχνολογία και σε ποιους ασθενείς; Χάρης Κοσσυβάκης Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. Κατάλυση παροξυσμικής κολπικής μαρμαρυγής Ποια τεχνολογία και σε ποιους ασθενείς; Χάρης Κοσσυβάκης Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. ΓΕΝΝΗΜΑΤΑΣ» Rhythm control antiarrhythmic drugs vs catheter ablation Summary

More information

Evidence for Longitudinal and Transverse Fiber Conduction in Human Pulmonary Veins

Evidence for Longitudinal and Transverse Fiber Conduction in Human Pulmonary Veins Evidence for Longitudinal and Transverse Fiber Conduction in Human Pulmonary Veins Relevance for Catheter Ablation Javier E. Sanchez, MD; Vance J. Plumb, MD; Andrew E. Epstein, MD; G. Neal Kay, MD Background

More information

Παροξυσμική Κολπική μαρμαρυγή σε νέο άτομο 40 ετών

Παροξυσμική Κολπική μαρμαρυγή σε νέο άτομο 40 ετών Παροξυσμική Κολπική μαρμαρυγή σε νέο άτομο 40 ετών Ιωάννης Σκιαδάς MD, FESC, EHRA Accredited in Cardiac Pacing Καρδιολογικό Τμήμα Ιπποκράτειο ΓΝΑ Prevalence, percent AF Prevalence: Age and Gender Prevalence

More information

Treatment of Atrial Fibrillation in Heart Failure

Treatment of Atrial Fibrillation in Heart Failure Stockholm, September 1st 2010 Treatment of Atrial Fibrillation in Heart Failure Rhythm control: Which drugs? Stefan H. Hohnloser J.W. Goethe University Frankfurt, Germany Presenter disclosure information:

More information

Atrial Fibrillation Procedures Data Summary. Participant STS Period Ending 12/31/2016

Atrial Fibrillation Procedures Data Summary. Participant STS Period Ending 12/31/2016 Period Ending 12/31/2016 Number of Cases Preoperative Predominant Atrial Arrhythmia Type Paroxysmal Atrial Fibrillation... - - Persistent Atrial Fibrillation... - - Longstanding Persistent Atrial Fibrillation...

More information

480 April 2004 PACE, Vol. 27

480 April 2004 PACE, Vol. 27 Incremental Value of Isolating the Right Inferior Pulmonary Vein During Pulmonary Vein Isolation Procedures in Patients With Paroxysmal Atrial Fibrillation HAKAN ORAL, AMAN CHUGH, CHRISTOPH SCHARF, BURR

More information

AF Today: W. For the majority of patients with atrial. are the Options? Chris Case

AF Today: W. For the majority of patients with atrial. are the Options? Chris Case AF Today: W hat are the Options? Management strategies for patients with atrial fibrillation should depend on the individual patient. Treatment with medications seems adequate for most patients with atrial

More information

Raphael Rosso MD, Yuval Levi Med. Eng., Sami Viskin MD Tel Aviv Sourasky Medical Center

Raphael Rosso MD, Yuval Levi Med. Eng., Sami Viskin MD Tel Aviv Sourasky Medical Center Radiofrequency Ablation of Atrial Fibrillation: Comparison of Success Rate of Circular Ablation vs Point-by-Point Ablation with Contact Force Assessment in Paroxysmal and Persistent Atrial Fibrillation

More information

20% 10/9/2018. Fluoroless Ablation relinquishing an old habit. Prevalence of Atrial Fibrillation. Atrial Fibrillation is a Progressive Disease

20% 10/9/2018. Fluoroless Ablation relinquishing an old habit. Prevalence of Atrial Fibrillation. Atrial Fibrillation is a Progressive Disease Fluoroless Ablation relinquishing an old habit Robert Percell, MD, FACC Cardiac Electrophysiologist, Bryan Heart Institute Lincoln, NE Prevalence of Atrial Fibrillation 3.1 Million + 1 Million by 2020

More information

AF Ablation in 2015 Why, Who, What and How? Steve Wilton ACC Rockies, Banff March 10, 2015

AF Ablation in 2015 Why, Who, What and How? Steve Wilton ACC Rockies, Banff March 10, 2015 AF Ablation in 2015 Why, Who, What and How? Steve Wilton ACC Rockies, Banff March 10, 2015 Disclosures Research grant: St. Jude medical Speaking: Boehringer-Ingelheim Consulting: Arca Biopharma Learning

More information

Role of LAA isolation in AF cure

Role of LAA isolation in AF cure MAM 2017, Zurich Role of LAA isolation in AF cure Sakis Themistoclakis, MD Director, Unit of Electrophysiology and Cardiac Pacing Department of Cardiothoracic & Vascular Medicine Ospedale dell Angelo,

More information

Current Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine

Current Guideline for AF Treatment. Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Current Guideline for AF Treatment Young Keun On, MD, PhD, FHRS Samsung Medical Center Sungkyunkwan University School of Medicine Case 1 59 year-old lady Sudden palpitation and breathlessness for 12 hours

More information

Rebuttal. Jerónimo Farré MD 2010

Rebuttal. Jerónimo Farré MD 2010 Rebuttal 1.We do not know what are the types of AF in which ablation is worthless or most effective 2.Waiting implies to consider the ablation at an older age and when the duration of the history of AF

More information

Fibrillazione atriale e scompenso: come interrompere il circolo vizioso.

Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Alessandria, September 23 th 2017 Fibrillazione atriale e scompenso: come interrompere il circolo vizioso. Professor Fiorenzo Gaita Chief of the Cardiovascular Department Città della Salute e della Scienza

More information

Ablation of persistent AF Is it different than paroxysmal?

Ablation of persistent AF Is it different than paroxysmal? Ablation of persistent AF Is it different than paroxysmal? Steven J. Kalbfleisch, MD Medical Director Electrophysiology Laboratory Ohio State University Wexner Medical Center Ross Heart Hospital Columbus,

More information

3/25/2017. Program Outline. Classification of Atrial Fibrillation

3/25/2017. Program Outline. Classification of Atrial Fibrillation Alternate Strategies to Antiarrhythmic Therapy: The Role of Ablation Jennifer El Aile, MS, AGPCNP-BC Electrophysiology Nurse Practitioner Clinical Lecturer at the University of Michigan Program Outline

More information

Trial design and selection criteria

Trial design and selection criteria Background Cox-MAZE open chest, cardiac surgery was a very successful invasive procedure for treatment of AF 1, but highly invasive Since the landmark trial by Haissaguerre et al. 2, PV isolation by catheter

More information

עדכונים באלקטרופיזיולוגיה Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev

עדכונים באלקטרופיזיולוגיה Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev עדכונים באלקטרופיזיולוגיה 2014 Electrophysiology Unit Soroka University Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev 1 מבנה הצגת היחידה פעילות ביחידה סקירה על הטיפול באלקטרופיזיולוגיה

More information

The pulmonary veins have been demonstrated to often

The pulmonary veins have been demonstrated to often Pulmonary Vein Isolation for Paroxysmal and Persistent Atrial Fibrillation Hakan Oral, MD; Bradley P. Knight, MD; Hiroshi Tada, MD; Mehmet Özaydın, MD; Aman Chugh, MD; Sohail Hassan, MD; Christoph Scharf,

More information

Ablazione della fibrillazione atriale: dubbi presenti e prospettive future

Ablazione della fibrillazione atriale: dubbi presenti e prospettive future Ablazione della fibrillazione atriale: dubbi presenti e prospettive future Carlo Pappone, MD, PhD, FACC Cardiac Pacing & Electrophysiology Department, Director Villa Maria Group, Italy Atrial Fibrillation

More information

Μηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα

Μηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα Μηνύματα από τις σπουδαιότερες μελέτες στην ηλεκτροφυσιολογία το διάστημα 2015-2016 Δημήτριος M. Κωνσταντίνου Ειδικός Καρδιολόγος, MD, MSc, PhD, CCDS Πανεπιστημιακός Υπότροφος Dr. Konstantinou has received

More information

Atrial Fibrillation Christopher L. Fellows, MD, FACC, FHRS Virginia Mason Medical Center Seattle, Wa.

Atrial Fibrillation Christopher L. Fellows, MD, FACC, FHRS Virginia Mason Medical Center Seattle, Wa. Atrial Fibrillation 2017 Christopher L. Fellows, MD, FACC, FHRS Virginia Mason Medical Center Seattle, Wa. Hering HE. Das Elektrocardiogramm des Irregularis perpetuus. Deutsches Archiv fur Klinische Medizin.

More information

Atrial Fibrillation: Interventional Approaches

Atrial Fibrillation: Interventional Approaches Atrial Fibrillation: Interventional Approaches Tyler Taigen, MD Eric Espinal, MD Discussion Outline Review current treatment of atrial fibrillation Pathophysiology Risk assessment and treatment to reduce

More information

Atrial Fibrillation: Catheter Ablation with New Technologies, Improving Quality of Life and Outcomes in Various Disease States

Atrial Fibrillation: Catheter Ablation with New Technologies, Improving Quality of Life and Outcomes in Various Disease States Atrial Fibrillation: Catheter Ablation with New Technologies, Improving Quality of Life and Outcomes in Various Disease States Srinivas R. Dukkipati, MD Co-Director, Cardiac Arrhythmia Service The Mount

More information

Pulmonary Vein Isolation for AF RF or Cryo? Dr. Yuen Ho Chuen Princess Margaret Hospital

Pulmonary Vein Isolation for AF RF or Cryo? Dr. Yuen Ho Chuen Princess Margaret Hospital Pulmonary Vein Isolation for AF RF or Cryo? Dr. Yuen Ho Chuen Princess Margaret Hospital PV as a Source of Ectopic Activity Haissaguerre, et al. NEJM 1998 RF Ablation Gold standard Point by point ablation

More information

Atrial Fibrillation Ablation in Patients with Heart Failure

Atrial Fibrillation Ablation in Patients with Heart Failure Atrial Fibrillation Ablation in Patients with Heart Failure Eleftherios M. Kallergis, MD, PhD, FESC Cardiology Department, Heraklion University Hospital Since auricular fibrillation so often complicates

More information

Long-Term Atrial Fibrillation Progression: What We Know in 2014

Long-Term Atrial Fibrillation Progression: What We Know in 2014 Long-Term Atrial Fibrillation Progression: What We Know in 2014 Advances in Cardiac Arrhythmias and Great Innovations in Cardiology XXVI Giornate Cardiologiche Torinesi Turin, 23-25 October 2014 Davide

More information

Scompenso cardiaco e F A : ruolo della ablazione transcatetere. Prof. Fiorenzo Gaita

Scompenso cardiaco e F A : ruolo della ablazione transcatetere. Prof. Fiorenzo Gaita Scompenso cardiaco e F A : ruolo della ablazione transcatetere Prof. Fiorenzo Gaita Patients with atrial fibrillation (%) Prevalence of AF in HF Trials 60 50 30% NYHA III-IV NYHA IV 40 NYHA II-III 30 20

More information

Atrial Fibrillation: Guidelines through clinical cases and 2010 updates

Atrial Fibrillation: Guidelines through clinical cases and 2010 updates Atrial Fibrillation: Guidelines through clinical cases and 2010 updates Samy Claude ELAYI Cardiac Clinical Pacing and Electrophysiology World incidence 720, 000 new cases / year World prevalence 5.5 million

More information

Long-Term ECG Monitoring Using an ILR. Evgeny Pokushalov, MD, PhD

Long-Term ECG Monitoring Using an ILR. Evgeny Pokushalov, MD, PhD Long-Term ECG Monitoring Using an ILR Evgeny Pokushalov, MD, PhD Long- Term ECG Monitoring Using an ILR Evgeny Pokushalov, MD, PhD, FESC State Research Ins;tute of Circula;on Pathology, Novosibirsk, Russia

More information

Should hybrid ablation be the standard of care instead of transcatheter ablation techniques?

Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Should hybrid ablation be the standard of care instead of transcatheter ablation techniques? Christian Shults, MD Assistant Professor, Georgetown University School of Medicine Cardiac Surgeon, Medstar

More information

Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm

Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm Mechanism of Immediate Recurrences of Atrial Fibrillation After Restoration of Sinus Rhythm AMAN CHUGH, MEHMET OZAYDIN, CHRISTOPH SCHARF, STEVE W.K. LAI, BURR HALL, PETER CHEUNG, FRANK PELOSI, JR, BRADLEY

More information

Electrophysiology 101: What Do Surgeons Need to Know. Richard B Schuessler PhD

Electrophysiology 101: What Do Surgeons Need to Know. Richard B Schuessler PhD Electrophysiology 101: What Do Surgeons Need to Know Richard B Schuessler PhD Disclosures Research Grant from Atricure, Inc. Arrhythmias Where The Surgical Approach Has Been Used WPW AVNRT Automatic Ectopic

More information

ABLATION OF CHRONIC AF

ABLATION OF CHRONIC AF ABLATION OF CHRONIC AF A PISAPIA ST JOSEPH HOSPITAL MARSEILLE MEET 2008 Atrial Fibrillation The most common significant heart rhythm disturbance Incidence increases with age and the development of structural

More information

Surgical Ablation for Lone AF: What have we learned after 30 years?

Surgical Ablation for Lone AF: What have we learned after 30 years? Surgical Ablation for Lone AF: What have we learned after 30 years? Ralph J. Damiano, Jr., MD Evarts A. Graham Professor of Surgery Chief of Cardiothoracic Surgery Vice Chairman, Department of Surgery

More information

5/5/2010. World incidence 720, 000 new cases / year. World prevalence 5.55 million AF prevalence increasing with aging of population

5/5/2010. World incidence 720, 000 new cases / year. World prevalence 5.55 million AF prevalence increasing with aging of population Atrial Fibrillation: Guidelines through clinical cases and 2010 updates Samy Claude ELAYI Cardiac Clinical Pacing and Electrophysiology UK World incidence 720, 000 new cases / year World prevalence 5.55

More information

Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring

Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring Catheter Ablation of Atrial Fibrillation: State of the Art Post-ablation Management: Drug therapy, Anticoagulation and long-term Monitoring Dipen Shah Service de Cardiologie Hospital Cantonal de Genève

More information

Incidence and Disease Burden. Role of Catheter ablation Outcomes Data

Incidence and Disease Burden. Role of Catheter ablation Outcomes Data Management of Atrial Fibrillation Nitish Badhwar, MD, FACC University of California, San Francisco Risk Appraisal Forum April 23, 2010 Incidence and Disease Burden Drug therapy Role of Catheter ablation

More information

Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation

Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation Minimally Invasive Stand Alone Cox-Maze Procedure For Patients With Non-Paroxysmal Atrial Fibrillation Niv Ad, MD Chief, Cardiac Surgery Inova Heart and Vascular Institute Disclosures Niv Ad: Medtronic

More information

Specific Linear Left Atrial Lesions in Atrial Fibrillation Intraoperative Radiofrequency Ablation Using Minimally Invasive Surgical Techniques

Specific Linear Left Atrial Lesions in Atrial Fibrillation Intraoperative Radiofrequency Ablation Using Minimally Invasive Surgical Techniques Journal of the American College of Cardiology Vol. 40, No. 3, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)01993-9

More information

CATHETER ABLATION FOR ATRIAL FIBRILLATION WHEN and HOW

CATHETER ABLATION FOR ATRIAL FIBRILLATION WHEN and HOW CATHETER ABLATION FOR ATRIAL FIBRILLATION WHEN and HOW Carlo Pappone, MD, PhD, FACC San Raffaele University Hospital, Milan, Italy ATRIAL FIBRILLATION FOR CLINICIANS FIRST DETECTED PAROXYSMAL PERMANENT

More information

Contemporary Strategies for Catheter Ablation of Atrial Fibrillation

Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Contemporary Strategies for Catheter Ablation of Atrial Fibrillation Suneet Mittal, MD Director, Electrophysiology Medical Director, Snyder Center for Atrial Fibrillation The Arrhythmia Institute at The

More information

La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO

La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO La terapia non anticoagulante nel paziente con FA secondo le Linee Guida F. CONROTTO Rhythm or rate control strategy? N Engl J Med 2002;347:1834 40 Rate Control versus Electrical Cardioversion for Persistent

More information

Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure. Spectrum of Atrial Fibrillation

Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure. Spectrum of Atrial Fibrillation Hybrid Ablation of AF in the Operating Room: Is There a Need? MAZE III Procedure Paul J. Wang, MD Amin Al-Ahmad, MD Gan Dunnington, MD Stanford University Cox J, et al. Ann Thorac Surg. 1993;55:578-580.

More information

RADAR-AF Trial. A Randomized Multicenter Comparison of Radiofrequency Catheter Ablation of Drivers vs. Circumferential Pulmonary Vein

RADAR-AF Trial. A Randomized Multicenter Comparison of Radiofrequency Catheter Ablation of Drivers vs. Circumferential Pulmonary Vein RADAR-AF Trial A Randomized Multicenter Comparison of Radiofrequency Catheter Ablation of Drivers vs. Circumferential Pulmonary Vein Isolation in Patients with Atrial FibRillation Felipe Atienza, MD, PhD,

More information

Electrical isolation of the pulmonary veins (PVs) to treat

Electrical isolation of the pulmonary veins (PVs) to treat Mechanisms of Organized Left Atrial Tachycardias Occurring After Pulmonary Vein Isolation Edward P. Gerstenfeld, MD; David J. Callans, MD; Sanjay Dixit, MD; Andrea M. Russo, MD; Hemal Nayak, MD; David

More information

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology

Atrial Fibrillation: Rate vs. Rhythm. Michael Curley, MD Cardiac Electrophysiology Atrial Fibrillation: Rate vs. Rhythm Michael Curley, MD Cardiac Electrophysiology I have no relevant financial disclosures pertaining to this topic. A Fib Epidemiology #1 Most common heart rhythm disturbance

More information

UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate

UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate KPAF trial The Kansai Plus Atrial Fibrillation (KPAF) trial is a 2x2 factorial randomized controlled trial, composed of the UNDER-ATP and EAST-AF trials. Efficacy of adenosine triphosphate guided ablation

More information

Atrial Fibrillation: Electrophysiological Mechanisms and the Results of Interventional Therapy

Atrial Fibrillation: Electrophysiological Mechanisms and the Results of Interventional Therapy Vol. 8, No. 3, September 2003 185 Atrial Fibrillation: Electrophysiological Mechanisms and the Results of Interventional Therapy A.SH. REVISHVILI Bakoulev Research Centre for Cardiovascular Surgery, Russian

More information

Storia dell ablazione della fibrillazione atriale: da dove siamo partiti, dove siamo, dove andremo. Prof. Fiorenzo Gaita

Storia dell ablazione della fibrillazione atriale: da dove siamo partiti, dove siamo, dove andremo. Prof. Fiorenzo Gaita Storia dell ablazione della fibrillazione atriale: da dove siamo partiti, dove siamo, dove andremo Prof. Fiorenzo Gaita Knowledge Idea Serendipity Technology (right tools) Serendipity - discovery of a

More information

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh

Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Dr Chris Lang Consultant Cardiologist and Electrophysiologist Royal Infirmary of Edinburgh Arrhythmias and Heart Failure Ventricular Supraventricular VT/VF Primary prevention

More information

Long Standing Persistent AF ; CPVI is enough for it

Long Standing Persistent AF ; CPVI is enough for it Long Standing Persistent AF ; CPVI is enough for it Kee-Joon Choi, MD University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea Boston AF Symposium 2012 In a patient undergoing AF ablation

More information

Samuel Asirvatham, MD & Enrique Melgarejo Rojas, MD Saturday, June 24, :40 to 3:25 p.m.

Samuel Asirvatham, MD & Enrique Melgarejo Rojas, MD Saturday, June 24, :40 to 3:25 p.m. Arrhythmias and Clinical EP Atrial Fibrillation: Contemporary Management Strategies Samuel Asirvatham, MD & Enrique Melgarejo Rojas, MD Saturday, June 24, 2017 2:40 to 3:25 p.m. AF Ablation and The Impact

More information

Jesus M. Paylos, C. Ferrero, L. Azcona, A. Morales, M. A. Vargas, L. Lacal, V. Gomez Tello.

Jesus M. Paylos, C. Ferrero, L. Azcona, A. Morales, M. A. Vargas, L. Lacal, V. Gomez Tello. CRYO-BALLOON CATHETER ABLATION EFFICACY RESTORING AND MAINTAINING SINUS-RHYTHM IN PATIENTS TREATED FOR PERSISTENT LONG STANDING ATRIAL FIBRILLATION AFTER ACUTE COMPLETE ELECTRICAL ISOLATION OF THE PULMONARY

More information

Catheter Ablation: Atrial fibrillation (AF) is the most common. Another Option for AF FAQ. Who performs ablation for treatment of AF?

Catheter Ablation: Atrial fibrillation (AF) is the most common. Another Option for AF FAQ. Who performs ablation for treatment of AF? : Another Option for AF Atrial fibrillation (AF) is a highly common cardiac arrhythmia and a major risk factor for stroke. In this article, Dr. Khan and Dr. Skanes detail how catheter ablation significantly

More information

ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION

ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION ATRIAL FIBRILLATION: REVISITING CONTROVERSIES IN AN ERA OF INNOVATION Frederick Schaller, DO, MACOI,FACP Adjunct Clinical Professor Touro University Nevada DISCLOSURES I have no financial relationships

More information

Is cardioversion old hat? What is new in interventional treatment of AF symptoms?

Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Is cardioversion old hat? What is new in interventional treatment of AF symptoms? Joseph de Bono Consultant Electrophysiologist University Hospitals Birmingham Atrial Fibrillation (AF) Affects 2% of the

More information