AF ABLATION Concepts and Techniques
|
|
- Catherine Paul
- 5 years ago
- Views:
Transcription
1 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
2
3 HIGHLIGHTS The main indications for AF ablation: failure of drug therapy inability to tolerate drug therapy quality of life AF ablation objective: to create scar tissue in rings around the ostia of the pulmonary veins in the left atrium to electrically isolate TRIGGERS of fibrillation and areas that sustain AF
4 HIGHLIGHTS Results of the ablation are superior to those of drug therapy Success rates of ablation are generally higher for those with paroxysmal atrial fibrillation than for those with persistent atrial fibrillation (overall >70%) More patients with atrial fibrillation are asking their physicians about catheter-based radiofrequency ablation as a treatment option
5 AF ABLATION:WHAT IT S NOT AFIB is NOT the same determining the clinical context of a patient s AF is key to creating viable therapeutic strategy Pulmonary Vein Isolation is not a cure but valuable in managing AF burden Patients must understand that ablation therapy will NOT eliminate the need to take anticoagulant drugs
6 AFIB BURDEN 2-3 million Americans have AF 70% of AF patients are between the ages of 65 and 85 The number of Americans with atrial fibrillation is expected to double by 2050
7 AFIB INCREASED MORTALITY Framingham Heart Study, AF was associated with a 1.5- to 1.9-fold mortality risk after adjustment for the preexisting cardiovascular conditions with which AF was related. The decreased survival seen in men and women and across a wide range of ages
8 The Need For A True AF Solution AF Population is Expected to Increase Substantially Projected U.S. AF Population (millions) Miyasaka Y, et al. Secular trends in incidence of atrial fibrillation in Olmsted county, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114:
9 RHYTHM VS RATE Several randomized clinical trials (most importantly AFFIRM) found that attempting to restore and maintain sinus rhythm with anti-arrhythmic drugs has no significant survival benefit compared with a strategy of controlling the heart rate only Recent studies, including an AFFIRM investigator analysis, suggest that rhythm control may have a survival benefit over rate control if sinus rhythm achieved without the adverse effects of antiarrhythmic drugs
10 RHYTHM VS RATE Is the benefit of sinus rhythm eliminated by the toxicity of anti-arrhythmic therapy?
11 What are the Symptoms of AF? 60-90% of AF Patients are Symptomatic
12 LONE AF
13 STRUCTURAL HD & AF
14 Treatment for Paroxysmal, Lone AF is in View Paroxysmal, Lone AF AF Population 12% are Paroxysmal 1 12% have Lone AF 2 1 Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Arch Intern Med 1994;154: Fuster and Rydén et al. ACC/AHA/ESC Practice Guidelines. JACC Vol. 38, No. 4, October, 2001.
15 However, New Techniques are Needed to Address Persistent & Permanent AF Paroxysmal, Lone AF Paroxysmal w SHD or Enlarged LA Persistent AF Longstanding/ Permanent AF AF Population 88% are Persistent or Permanent 1 88% have Structural Heart Disease 2 85% 60 yrs old 2 1 Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Arch Intern Med 1994;154: Fuster and Rydén et al. ACC/AHA/ESC Practice Guidelines. JACC Vol. 38, No. 4, October, 2001.
16 Lone AF May Be Benign; AF with LA Size or SHD is NOT Increased LA size is highly predictive of AF, stroke, and mortality 1 Lone AF population progressed into two distinct groups: 1 Pts with normal LA size experienced a benign clinical course. Pts with enlarged atria experienced adverse events. No LA Size = No Complications LA Size = Complications 1 Osranek M. Left atrial volume predicts cardiovascular events in patients originally diagnosed with lone atrial fibrillation: three-decade follow-up. European Heart Journal (2005) 26,
17 Left Atrial Size is a Predictor of AF Incidence Increase in Left Atrial Size Leads to AF As LA Size increases, 30% of patients develop AF in 10 years If LA Size does not increase, 10% of patients develop AF in 10 years Ommen SR, et al. Usefulness of serial echocardiographic parameters for predicting the subsequent occurrence of atrial fibrillation. Am J Card. Vol 87. June 1, 2001.
18 Relationship between AF w/ SHD & Heart Failure AF with SHD Must be Treated to Break the Cycle Atrial Fibrillation LV Dysfunction Left Atrial Size Progression of Structural Heart Disease Heart Failure Atrial Dysfunction Ommen SR, et al. Usefulness of serial echocardiographic parameters for predicting the subsequent occurrence of atrial fibrillation. Am J Card. Vol 87. June 1, 2001.
19 Atrial Fibrillation Caused by Atrial Remodeling Underlying Factors: Electrical, Contractile & Structural Electrical Remodeling AF Begets AF Atrial Fibrillation SHD Structural Remodeling Fibrosis Myolysis Glycogen Accumulation Cell Enlargement Cell Death SHD Contractile Remodeling
20 AF TRIGGER SITES Haissaguerre M et al. N Engl J Med 1998;339:
21 Physiologic basis for AF ablation: ~80-90% of APDs triggering AF originate from pulmonary veins Four ECG leads Firing without exit to atrium Firing with exit to atrium Circular Mapping Catheter in RSPV Firing with exit to atrium triggering atrial fibrillation Ablation Catheter in LSPV Circular Mapping Catheter in RSPV Ablation Catheter in LSPV Coronary Sinus Catheter Right Atrial Catheter Right Atrial Catheter Coronary Sinus Catheter
22 AF IS NOT THE SAME
23 Structure and mechanism of AF
24
25 Common Lesions Performed in AF Ablation A. Circumferential ablation around left and right PV antra B. and C. Additional linear lesion sets for the roof, mitral isthmus, carinae, SVC, and cavotricuspid isthmus D. Targeting fractionated electrograms and/or ganglionic plexi LSPV LIPV LSPV LIPV SVC A. B. RSPV LSPV RIPV LIPV IVC SVC C. D. RSPV LSPV RIPV LIPV IVC SVC RSPV RIPV IVC SVC RSPV RIPV IVC PV = pulmonary vein; SVC = superior vena cava; LSPV = left superior pulmonary vein; RSPV = right superior pulmonary artery; LIPV = left inferior pulmonary vein; RIPV = right inferior pulmonary vein; IVC = inferior vena cava. Calkins H, et al. Heart Rhythm. 2007;4(6):
26
27 ABLATION ENERGY SOURCES RF- Radiofrequency Cryoablation Microwave Ultrasound- Hi frequency Laser
28
29
30
31 A Convergent Procedure Lesion Pattern Illustration of generic lesion set. Physician medical practice to modify as required. Epicardial Lesion Endocardial Lesion
32 N-Contact Device
33 Convergence of EPs & Surgeons Multidisciplinary Collaboration for a Single Procedure Surgeons Able to See Anatomy Visualize Lesion Connections Access Epicardial Substrates Create Linear Lesions Total Multidisciplinary Treatment Electrophysiologists Eliminate Surgeon Need for Chest Incisions Eliminate Need to Dissect Pericardial Reflections Able to Map Epicardial Lesions Confirm Conduction Block & PVI Confirm Inability to Induce Arrhythmias
34 Components of the Convergent Procedure Combining Strengths of EPs & Surgeons Together
35 Paracardioscopic Access Transdiaphragmatic Approach to Posterior Atria
36 Accessing Posterior Left Atrium Creating Lesions with Direct Visualization
37 Access Anterior LPV & Ligament of Marshall
38 Access Anterior RPV & Right Atrium
39 Percutaneous Endocardial Ablation Access Percutaneous Access Breakthrough Pericardial Reflections
40 Endocardial Ablation Catheter and Lesion Locations Mapping Identifies Reflections Ablating Reflections Ablating Reflections Ablating Reflections
41 Ensures Isolation of the Posterior LA & PVs Activation Map Pre Lesion Creation Activation Map Post Lesion Creation
42 Post Epicardial Ablation Voltage Map Isolated RSPV Isolated RSPV & LIPV Isolated LIPV
43 Post Convergent Procedure Isolation of Posterior LA
44 Convergent Procedure Access No Chest Incisions, No Rib Spreading, No Lung Deflation, No Anterior Pericardial Incisions, No Dissections Access for Bilateral Thoracotomy Clamping Hybrid Procedure* Closed Chest Convergent Procedure Abdominal Access *Source: Medtronic, Inc. Minimally Invasive Vertical Approach for the Surgical Treatment of Lone Atrial Fibrillation.
45 Convergent Procedure Access Less Invasive Access, Smaller Incisions, Less Trauma Bilateral Thoracotomy Clamping Hybrid Procedure Chest Incisions After 3 Months Closed Chest Convergent Procedure Abdominal Access Site After 3 Months Bilateral Thoracotomy Chest Incisions Closed Chest Convergent Access
46 Procedure Mapping Comprehensive Biatrial Pattern with Post PVI Clamping Procedure No Posterior Lesions Posterior Lesions Post Convergent Procedure Isolated Posterior Activity Throughout Posterior Left Atrium Posterior Left Atrium is Isolated Kron J, et al. Management of recurrent atrial arrhythmias after minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation. Heart Rhythm. 2010;7:
47 Protocol If in AF, cardiovert and look for ERAF Start isoproterenol 3, 6, 12, 20 mcg/min with titration every 3 minutes to look for APDs triggering AF Burst pace from LA (distal CS) from 250 to 180 msec If no triggers, then induce AF with rapid burst pacing with and without low dose ISO (2-3 mcg/min) and cardiovert again Perform PVI (proximal/antral isolation) with entrance AND exit block as endpoint Target any non-pv triggers that cause AF
48 Acute Endpoints for PAF Ablation - Recommendations PV isolation with entrance and exit block Persistent PV isolation confirmed at 20 + minutes In response to provocative maneuvers (Iso to 20mcg/Afib induction and CV with Iso) No PV reconnection and no PV APDs Target all Non PV triggers causing Afib SVC isolation only if AF trigger ( 3 %) Flutter line only if clinically observed flutter (9 %) 1% late CT Isthmus dependent flutter If make lines make sure there is block
49
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 informationHybrid 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 informationAF 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 informationStand 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 information2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation
Summary of Expert Consensus Statement for CLINICIANS 2017 HRS/EHRA/ECAS/APHRS/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation This is a summary of the Heart
More informationAtrial 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 informationThe 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 informationCatheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD
Catheter Ablation of Atrial Fibrillation Strategy and Outcome Predictors Shih-Ann Chen MD Taipei Veterans General Hospital, Taiwan Outline of AF Ablation 1. Strategy for Catheter Ablation of AF 2. Substrate
More informationAblation 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 informationCatheter 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 informationPRIMARY 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 informationAF :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 informationMapping techniques in AFib. Helmut Pürerfellner, MD Public Hospital Elisabethinen Academic Teaching Hospital Linz, Austria
Mapping techniques in AFib Helmut Pürerfellner, MD Public Hospital Elisabethinen Academic Teaching Hospital Linz, Austria critical zone Microreeentrant circuits LOM PV foci Sueda Ann Thorac Surg 1997 Haissaguerre
More informationAtrial Fibrillation: Classification and Electrophysiology. Saverio Iacopino, MD, FACC, FESC
Atrial Fibrillation: Classification and Electrophysiology Saverio Iacopino, MD, FACC, FESC Sinus Rythm Afib (first episode) AFib Paroxistic AFib Spontaneous conversion Permanent AFib Recurrence Sinus Rythm
More informationCatheter 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 informationDebate-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 informationCATHETER 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 informationCatheter 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 informationAF 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 informationShould 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 informationCatheter 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 informationAtrial 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 informationABLATION TECHNIQUES FOR ATRIAL FIBRILLATION
ABLATION TECHNIQUES FOR ATRIAL FIBRILLATION Demosthenes G. Katritsis, MD, PhD(Lon), FRCP Athens Euroclinic Ablation for AF Cox JL, et al. Surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg.
More informationMechanisms of atrial fibrillation terminations in humans: insights from non-invasive cardiac mapping
VENICE ARRHYTHMIAS, 16-18 OCTOBER, 2015 Mechanisms of atrial fibrillation terminations in humans: insights from non-invasive cardiac mapping E. Fetisova, A. Tsyganov, M. Chaykovskaya, V. Kalinin, M. Yakovleva
More informationLinear 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 informationSurgical Ablation: Which Lesion Set for Which Patient?
Surgical Ablation: Which Lesion Set for Which Patient? Patrick M. McCarthy MD, FACC Director of the Bluhm Cardiovascular Institute Chief of Cardiac Surgery Division Heller-Sacks Professor of Surgery in
More informationAF 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 informationCatheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping -
Catheter ablation of atrial macro re-entrant Tachycardia - How to use 3D entrainment mapping - M. Esato, Y. Chun, G. Hindricks Kyoto Ijinkai Takeda Hosptial, Department of Arrhythmia, Japan Kyoto Koseikai
More informationWhat s new in my specialty?
What s new in my specialty? Jon Melman, MD Heart Rhythm Specialists McKay-Dee Hospital some would say some would say my specialty 1 some would say my specialty First pacemaker 1958 some would say my specialty
More informationHybrid approaches in atrial fibrillation ablation: why, where and who?
Review Article Hybrid approaches in atrial fibrillation ablation: why, where and who? Kevin Driver, J. Michael Mangrum University of Virginia, Charlottesville, VA, USA Correspondence to: Kevin Driver,
More information20% 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 informationCatheter 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 informationElectrical 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 informationAtrial 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 informationSurgical 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 informationAtrial 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 informationTHE AFIB REPORT. Your Premier Information Resource for Lone Atrial Fibrillation! NUMBER 115 DECEMBER 2011/JANUARY th YEAR
THE AFIB REPORT Your Premier Information Resource for Lone Atrial Fibrillation! NUMBER 115 DECEMBER 2011/JANUARY 2012 11 th YEAR Welcome to our 7 th ablation/maze survey. Previous surveys dealt mainly
More informationAblation 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 informationA New Approach for Catheter Ablation of Atrial Fibrillation: Mapping of the Electrophysiologic Substrate
Journal of the American College of Cardiology Vol. 43, No. 11, 2004 2004 by the American College of Cardiology Foundation ISSN 0735-1097/04/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2003.12.054
More informationA 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 informationIndividualised strategy approach to AF ablation
Individualised strategy approach to AF ablation Dr Tim Betts MD MBChB FRCP Consultant Cardiologist & Electrophysiologist Oxford Heart Centre, John Radcliffe Hospital Oxford University Hospitals NHS Foundation
More informationΔιαδερμική 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 informationIntegration of CT and fluoroscopy images in the ablative treatment of atrial fibrillation
Clinical applications Integration of CT and fluoroscopy images in the ablative treatment of atrial fibrillation C. Kriatselis M. Tang M. Roser J-H. erds-li E. leck Department of Internal Medicine/Cardiology,
More informationThe problem with concomitant atrial fibrillation in non-mitral valve surgery
Safeguards and Pitfalls The problem with concomitant atrial fibrillation in non-mitral valve surgery Mark La Meir 1,2, Sandro Gelsomino 2, Bart Nonneman 3 1 Department of Cardiothoracic Surgery, University
More informationHybrid Surgical Ablation in South America: Lesson Learned. Joao R. Breda
Hybrid Surgical Ablation in South America: Lesson Learned Joao R. Breda DISCLOSURES NONE 2 How to treat Atrial Fibrillation (AF) Understanding of pathophysiology mechanisms Ablation approach Choice of
More informationCatheter 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 informationCardiovascular Surgery and Electrophysiology: Where are the opportunities for a Combined Interdisciplinary approach in Atrial Fibrillation?
Cardiovascular Surgery and Electrophysiology: Where are the opportunities for a Combined Interdisciplinary approach in Atrial Fibrillation? Felix Yang, MD, FACC, FHRS, CCDS Associate Director, Cardiac
More informationAtrial Fibrillation and Sleep Apnea. Farhat S. Khairallah, MD, FHRS, FACC
Atrial Fibrillation and Sleep Apnea Farhat S. Khairallah, MD, FHRS, FACC The art of medicine consists in amusing the patient while nature cures the disease. Voltaire Classification of AF Paroxysmal AF
More informationCLINICAL OUTCOME OF AF ABLATION Who Benefits from Catheter Ablation?? Dr Gamal Shaban MD FESC Fellow of EHRA ECR AFA AFIB ALLIANCE NHI
CLINICAL OUTCOME OF AF ABLATION Who Benefits from Catheter Ablation?? Dr Gamal Shaban MD FESC Fellow of EHRA ECR AFA AFIB ALLIANCE NHI RHYTHM IS THE SOUL OF LIFE AF the last remaining challenge Considerable
More informationComplications During Cardiovascular Interventions: Management and Prevention
Complications During Cardiovascular Interventions: Management and Prevention Helmut Pürerfellner, MD Public Hospital Elisabethinen Academic Teaching Hospital Linz, Austria Atrial Tachycardia/Atypical left
More informationESSA HEART AND VASCULAR INSTITUTE APR/MAY/JUNE 2009 CLINICAL LETTER
CLINICAL LETTER Exciting things are happening at the ESSA Heart and Vascular Institute and the Pocono Medical Center! We are all proud of the stellar team of professionals who are working very hard to
More informationRecent observations have focused attention on the PVs as a source of ectopic activity i determining i AF
Atrial Fibrillation in 2010 Panos Vardas Professor of Cardiology President of EHRA Atrial Fibrillation Pathophysiology of AF Triggers Recent observations have focused attention on the PVs as a source of
More informationPeri-Mitral Atrial Flutter with Partial Conduction Block between Left Atrium and Coronary Sinus
Accepted Manuscript Peri-Mitral Atrial Flutter with Partial Conduction Block between Left Atrium and Coronary Sinus Ryota Isogai, MD, Seiichiro Matsuo, MD, Ryohsuke Narui, MD, Shingo Seki, MD;, Michihiro
More informationCatheter 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 informationCatheter 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 informationElectrogram-Guided Ablation
GRBQ381-3653G-C11[184-197].qxd 12/20/2007 07:45 PM Page 184 Aptara(PPG Quark) 11 Electrogram-Guided Ablation Evan Lockwood Koonlawee Nademanee In 1994, Swartz et al. (1) ushered in an era of incredible
More informationΚατάλυση 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 informationThe HISTORIC-AF TRIAL
European Prospective Multicenter Study of Hybrid Thoracoscopic and Transcatheter Ablation of Persistent Atrial Fibrillation: The HISTORIC-AF TRIAL Claudio Muneretto 1, Gianluigi Bisleri 1, Gianluca Polvani
More informationPVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York
PVI and What Else for Persistent AF Lessons Learned from STAR AF 2 CCCEP 2015 October 31, New York Atul Verma, MD FRCPC FHRS Director, Arrhythmia Services Southlake Regional Health Centre Faculty of Medicine
More informationHow to Distinguish Focal Atrial Tachycardia from Small Circuits and Reentry
How to Distinguish Focal Atrial Tachycardia from Small Circuits and Reentry Pierre Jaïs; Bordeaux, France IHU LIRYC ANR-10-IAHU-04 Equipex MUSIC imaging platform ANR-11-EQPX-0030 Eutraf HEALTH-F2-2010-261057
More information1995 Our First AF Ablation. Atrial Tachycardias During and After Atrial Fibrillation Ablation. Left Atrial Flutter. 13 Hours Later 9/25/2009
1995 Our First AF Ablation Atrial Tachycardias During and After Atrial Fibrillation Ablation G. Neal Kay MD University of Alabama at Birmingham Right Anterior Oblique Left Anterior Oblique Left Atrial
More informationProgression 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 informationAtrial 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 information2015 Atrial Fibrillation Therapy Meds, Shock, or Ablate? D. Scott Kirby MD, FACC Cardiac Electrophysiologist
2015 Atrial Fibrillation Therapy Meds, Shock, or Ablate? D. Scott Kirby MD, FACC Cardiac Electrophysiologist Todays Objectives Atrial Fibrillation evaluation and treatment from an EP perspective Multimodal
More informationContemporary 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 informationLong 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 informationAtrial 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 informationCombined 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 informationA MULTIDISCIPLINARY APPROACH TO ATRIAL FIBRILLATION: OUR EXPERIENCE WITH THE CONVERGENT PROCEDURE
A MULTIDISCIPLINARY APPROACH TO ATRIAL FIBRILLATION: OUR EXPERIENCE WITH THE CONVERGENT PROCEDURE Joe Aoun, MD Ioannis Koulouridis, MD, MSc Aleem Mughal, MD Maxwell Eyram Afari, MD Caroline Zahm, MD John
More informationCatheter Ablation of Supraventricular Arrhythmias: State of the Art
124 NASPE 25TH ANNIVERSARY SERIES Catheter Ablation of Supraventricular Arrhythmias: State of the Art FRED MORADY, M.D. From the Division of Cardiology, Department of Medicine, University of Michigan,
More informationעדכונים 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 information2004 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 informationINTRODUCTION. Key Words:
Original Article Acta Cardiol Sin 2015;31:317 324 doi: 10.6515/ACS20141218A EPS and Arrhythmia The Electrical Characteristics and Clinical Significance of the Effect of Adenosine on Dissociated Activity
More informationFibrillation 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 informationKey words: Paroxysmal atrial fibrillation, Pulmonary vein isolation, Cardiac autonomic nerve denervation, Catheter ablation
Combined Effect of Pulmonary Vein Isolation and Ablation of Cardiac Autonomic Nerves for Atrial Fibrillation Kimie OHKUBO, 1 MD, Ichiro WATANABE, 1 MD, Yasuo OKUMURA, 1 MD, Sonoko ASHINO, 1 MD, Masayoshi
More informationSEVEN YEARS OF CRYO-BALLOON CATHETER ABLATION
SEVEN YEARS OF CRYO-BALLOON CATHETER ABLATION. FOLLOW-UP ANALYSIS, RESULTS, RECURRENCES, COMPLICATIONS AND SIDE EFFECTS IN PATIENTS TREATED FOR PAROXYSMAL ATRIAL FIBRILLATION, WITH A PROSPECTIVE PROTOCOL
More informationComparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Executive Summary
Number 15 Effective Health Care Comparative Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation Executive Summary Background The Agency for Healthcare Research and Quality commissioned
More informationHow to improve procedural outcome of cryoballoon ablation in persistent AF Experience from Redo procedures
How to improve procedural outcome of cryoballoon ablation in persistent AF Experience from Redo procedures Kyoung-Ryul Julian Chun Cardioangiologisches Centrum Bethanien (CCB) Markus Krankenhaus, Med.
More informationMinimal access ablation of atrial fibrillation (AF) has undergone
Total Thorascopic Ablation of Atrial Fibrillation Using the Dallas Lesion Set, Partial Autonomic Denervation, and Left Atrial Appendectomy James R. Edgerton, MD Minimal access ablation of atrial fibrillation
More informationAblation Update and Case Studies. Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group
Ablation Update and Case Studies Lawrence Nair, MD, FACC Director of Electrophysiology Presbyterian Heart Group Disclosures No financial relationships to disclose Objectives At the conclusion of this activity,
More informationPulmonary vein isolation (PVI) is
Case Report Hellenic J Cardiol 2012; 53: 163-167 The Use of the Multi-Electrode Duty-Cycled Radiofrequency Ablation Catheter PVAC for the Ablation of a Left Atrial Tachycardia Dionyssios Leftheriotis 1,
More informationThe Who, What, Why, and How-To Guide for Circumferential Pulmonary Vein Ablation
1226 TECHNIQUES AND TECHNOLOGY Editor: Hugh Calkins, M.D. The Who, What, Why, and How-To Guide for Circumferential Pulmonary Vein Ablation CARLO PAPPONE, M.D., PH.D., and VINCENZO SANTINELLI, M.D. From
More informationStoria 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 informationSurgical thermoablation of atrial fibrillation: Epicardial
Surgical thermoablation of atrial fibrillation: Epicardial Nicolas Bonnet Centre Cardiologique du Nord CCN Saint Denis FRANCE Place of Surgery in AF treatment Historical Models and concepts Treatments
More informationAblation of long-standing AF. Is it wise to pursue it?
Ablation of long-standing AF. Is it wise to pursue it? Carlo Pappone, MD and Vincenzo Santinelli, MD From: Department of Arrhythmology,GVM Care and Research, Cotignola, Ravenna, ITALY Address for correspondence:
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationEvidence 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 informationBalloon and Mesh Catheter Ablation of Pulmonary Veins
Balloon and Mesh Catheter Ablation of Pulmonary Veins ISHNE 2009 Atul Verma, MD FRCPC Cardiology/Electrophysiology Heart Rhythm Program, Division of Cardiology Southlake Regional Health Centre Newmarket,
More informationTHE AFIB REPORT. Your Premier Information Resource for Lone Atrial Fibrillation! NUMBER 76 FEBRUARY th YEAR
THE AFIB REPORT Your Premier Information Resource for Lone Atrial Fibrillation! NUMBER 76 FEBRUARY 2008 8 th YEAR In this first issue of our 8 th year of publication we complete the evaluation of responses
More informationΚΑΤΑΛΥΣΗ 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 informationIndicatie 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 informationWhat is an O.R. Report? BY STEVE S. RYAN, PhD
BY STEVE S. RYAN, PhD Steve is a former A-Fib patient, publisher of the non-profit patient education website, Atrial Fibrillation: Resources for Patients, (A- Fib.com), author of the award-winning book,
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationTreating Atrial Fibrillation. Richard Schilling. St Bartholomew's Hospital, Queen Mary s University of London
Treating Atrial Fibrillation Richard Schilling St Bartholomew's Hospital, Queen Mary s University of London AF burden Framingham Lifetime risk of developing AF = 25% Mortality: SMR =1.9 1.5 NHS audit 1%
More informationCardiology Department, Ain Shams University, Cairo, Egypt.
Early Pulmonary Vein Conduction Recovery After Catheter Ablation Of Atrial Fibrillation Ayman Mortada 1, Saeed Khaled 1, Samir Wafa 1, Hayam Eldamanhoury 1, Ahmed Nabil 1 1 Cardiology Department, Ain Shams
More informationAtrial fibrillation (AF), the most sustained cardiac arrhythmia
Difference Between Dormant Conduction Sites Revealed by Adenosine Triphosphate Provocation and Unipolar Pace-Capture Sites Along the Ablation Line After Pulmonary Vein Isolation Rikitake Kogawa, 1 MD,
More informationWhat is Minimally Invasive Surgical Ablation?
What is Minimally Invasive Surgical Ablation? ( and who might be suitable for it?) HRC October 2011 Mr. Jonathan Hyde Consultant Cardiac Surgeon Royal Sussex County Hospital, Brighton Introduction Atrial
More informationCatheter ablation of the pulmonary veins (PVs) is. Anatomic Relationship of the Esophagus and Left Atrium*
Anatomic Relationship of the Esophagus and Left Atrium* Implication for Catheter Ablation of Atrial Fibrillation Hsuan-Ming Tsao, MD; Mei-Han Wu, MD; Satoshi Higa, MD; Kun-Tai Lee, MD; Ching-Tai Tai, MD;
More informationSalt Lake Regional Medical Center, Cardiology. Terron Arbon, Stacy Tukuafu, Dean Porcelli, Paul Allred
Salt Lake Regional Medical Center, Cardiology Terron Arbon, Stacy Tukuafu, Dean Porcelli, Paul Allred Superior Vena Cava (SVC) Inferior Vena Cava (IVC) Right Atrium (RA) Atrial Appendage Crista Terminalis
More informationBiatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD
Biatrial Maze or PVI to Ablate Afib? Marc Gillinov, MD Disclosures Consultant/Speaker AtriCure Medtronic CryoLife Edwards Abbott Research Funding Abbott Equity Interest Clear Catheter Cleveland Clinic
More information